SPEX: SPECIALPURPOSE EXAMINATION
OUTLINE
Mark Davis MD SPEX TUTOR AND MENTOR
Special
Purpose Examination, commonly called SPEX, is a test unlike any you have taken
before. Created by the minds at the Federation of State Medical Boards it
attempts to test a physician on a wide range of subjects. Federation officials
claim in their literature that every physician, regardless of specialty, should
have knowledge of the subject matters contained within the structure of the
SPEX. Their claim further notes that participants in this exam who stayed
current with general medical literature should not find the questions on this
test “totally unfamiliar.” Reading the Federation’s literature many candidates
for the SPEX, who took this exam, would
contest the Federation’s description that common medical knowledge is
sufficient to obtain a passing grade. The high rate of failure speaks for
itself.
Medical
Boards send their SPEX candidates into this exam literally blind. They provide
no guidelines, literature or other information to enable a potential examinee
to know what they will be confronting.
Most candidates I have come in contact with were given a phone number of
a faceless bureaucrat at the Federation of State Medical Boards to call. The
voice on the other end is more interested in collecting the enormous exam fee
than guiding the examinee on how to study for this very broad based test. It is
to the benefit of this Federation for you to fail because they can collect
additional test fees. Obtaining an edge up on the questions and subject matters
of this exam is extremely important. Why? Because it can make the difference
between passing or failing. It will only take a few questions marked the wrong
way to fail this extensive exam. Hence SPEX tutoring came into being. As a tutor I come into contact with many who
have moved through this exam. Their feedback is enormously helpful for future
test takers. Reviewing books on the market, many of them antiquated for this
test, have not been very helpful to the multitude of examinees who could not
make it through this exam the first time. Physicians taking this exam two,
three and even four times are not uncommon. Since there are no legitimate live
courses available the tutor, Mark Davis MD, can provide help to overcome the
hurdles of a test designed to fail. The content of this e-book provides a
glimpse how a tutor can be of great assistance to a potential examinee.
Given by computer over a
one day period this test is a challenge to fully complete in the allotted time.
There is a total of 336 questions divided into 7 segments each containing 48
clinical presentations. Each segment is given 64 minutes to complete. This
provides 1.3 minutes per question. Many of these presentations are a full page
long with paragraphs that contain 8-10 sentences or more not including the
multiple answers to evaluate. Being well versed in the content of this exam and
its layout is extremely important. The Federation of State Boards’ description
of this exam is illusive at best. Listed subject matters on their website
concerning this exam are incomplete. Therefore tutors, such as this author, are
indispensable to help a potential examinee through the maze of literature
necessary to succeed.
Versatility in many
subject areas is a must to conquer this expansive exam. There is an array of
radiographs one must be able to assess quickly. These x-rays do not always have
the clarity one would expect on an exam yet you are expected to know the answer
to the problem presented. When x-rays are displayed the written clinical
presentation may not always be clear exactly what the author of the question is
looking for. There have been a number of x-rays which have been repeated over
the years and a tutor can clue you in to those he or she has come across. Certain
types of fractures, dislocations and injuries show up more often than others.
In the pulmonary category there is a focus on certain disease states. Both
pediatric and adult equivalents must be known by the test taker as well.
Reported that EKGs are not
of the best quality is also a fact. The clinical presentation may request a
treatment based on your diagnostic capability therefore analyzing the
cardiogram appropriately is a must. SPEX designers may have purposely
introduced artifact into their EKGs to confuse the test taker into thinking
they are viewing a rhythm other than it really is. Certain patterns have shown
up more frequently in recent years which your tutor would be able to reveal to
you.
Though clinical genetics
is a class we took in our medical school days it is ever present on current
SPEX tests. The Federation’s foray into genetics encompasses inheritance,
chromosomal anomalies and phenotypic expression. The test participant should be
aware of both pediatric and adult presentations of genetic anomalies.
Emphasized most recently is the percent of genetic expression for specific
diseases. Your tutor can enlighten you on which diseases were most frequently
represented on the test.
Orthopedics is showing up
more frequently on current exams. Many of the presentations are purposely
misleading which diminishes the amount of time you have for evaluation. Fractures, dislocations and tumors in both the
pediatric and adult age ranges have been displayed. Knowing which have shown up
more frequently could save you much time. Many of these presentations are not
common bone diseases therefore a tutor who has communicated with prior
examinees is someone you should seek out.
Vaccines have been
included in recent exams. An odd presentation of a very common disease showed
up more than once in the most recent circuit of exams. The wording was straight
forward yet those who studied for this exam overlooked this disease. It is not
enough to know vaccine schedules. One must understand when to apply them in emergency
settings and or not use them as a specific case is referenced. A tutor could be
instrumental here.
There are thousands of
variations of cardiac disease. Yet the Federation of State Boards appears to
want their physicians to know certain disease states. Knowing Cardiology is not
sufficient. Odd presentations of symptomatology are examined on SPEX. Also tested is the examinees ability to
elicit certain symptoms to arrive at a diagnosis. Physical diagnosis is tested
in a number of ways. When to test and when to withhold testing of a patient is
paramount. Which cardiac drug to select when a patient presentation is given is
of utmost importance to know. As a tutor for SPEX those who have taken this
exam several times reported back the recurring themes the Federation of State
Boards has utilized in cardiology.
A wide range of pulmonary
presentations have confronted recent examinees. The examiners have introduced
an international flavor to the test. Diseases normally not seen frequently in
the United States have challenged test takers. Remember you have approximately
1.3 minutes to evaluate an x-ray, graph or chart. In addition you must read and
evaluate the clinical presentation before moving onto the 4-5 answers to
select. Preparation is key. With few exceptions the flash cards offered for
study of SPEX and other books sold were not very helpful in this section as
reported to me. Variants of common pulmonary disease states both in the
pediatric and adult categories were also amongst the offerings. Several deceptive presentations of lung
cancer and uncommon bacterial/viral diseases made their mark on examinees.
Knowing where to emphasize your studies in this medical subject is paramount.
Psychiatry had a wide
presence on recent exams. A series of symptoms describing a patient’s
personality was frequently seen. The examinee was required either to make the
correct diagnosis or chose the medication for that diagnosis. Some of these
presentations were a full page in length.
One clever presentation gave a description of an infection which
required a psychiatric diagnosis. There are several methods to cut down the
time for evaluation of these types of questions.
Check with your tutor for
the best approach. Parsing your time is one of the keys to passing SPEX.
Numerous questions in
gastroenterology, both in the pediatric age group and adults have been given on
recent exams. These questions frequently but not always have x-rays along with
their extensive description of diseases. Knowing which age groups these
diseases appear more frequently would substantially cut down the time in
finding the answer. Remember many of these clinical presentations appear the
same except for a few distinguishing characteristics. Questions related to the liver and the various
toxic encounters it incurs should not be overlooked. A large number of errors are made in this
area of the anatomy. Your tutor can cue you in on what has been seen most
recently.
A wide ranging knowledge
of infectious disease is a must to move into the passing grade zone. This
subject overlaps with every other category of disease on the exam. Odd
presentations of common diseases have been seen. Both domestic and foreign vermin
are presented to challenge the examinee. In some questions a specific symptom
or set of symptoms may be given and you have to know the disease presented in
order to answer which treatment modality is needed. This is called a second
level question. This type of question is seen frequently. A patient presents to
a physician with several symptoms of severe neurological disease. On first
glance at the question the examinee may not consider this is an infectious
disease problem, yet it is. The Federation test writers do an excellent job
with infectious disease questions literally
misleading the test candidate by adding vacuous information to the introductory
paragraph of a given question. Your
challenge is to get beyond the confusing verbiage to quickly delineate the
answer. Tutors are helpful here because
they can clarify the fine differences in questions to get to an answer sooner.
There are numerous
questions on Oncology and Hematology. Many of the books on the market have
physicians studying various slide presentations of cells or other extraneous
lab data. If that makes the examinee comfortable then by all means study this
material. Recent tests did not have microscopic slides for these specific subjects.
Questions are definitely recycled. Additionally
a clinical setting may be given requesting the examinee to answer several
questions based on its contents. This type of presentation was given throughout
the test. On the Oncology side pulmonary, bone and skin cancers have been frequently
seen. These questions either ask the
diagnosis and or the most common treatment mode. Few may request the cause of the cancer which
may not be as obvious as one would think. A vast array of hematology questions
have been seen from bio-chemical deficiencies to blood born cancers. Your tutor
can be very helpful here directing the examinee to emphasize certain areas of
study.
Neurology and Neurosurgery
questions are part of the repertoire of presentations. Symptomatology is
similar for many of these diseases. Therefore questions can be quite confusing.
With limited time available the examinee must get into the “meat” of the
question quickly. Knowing the physical findings specific for compressing
lesions and or vascular anomalies would be very helpful to the test candidate.
Within these fields your ophthalmological knowledge will also be tested.
Knowing the layout of specific nerve roots could help answer some of these
complex questions. Your tutor can enlighten you on some of the more broad based
approaches examinees should take to get beyond these types of questions.
Nephrology is represented
by many key questions from urinary crystals to cancers. Vascular anomalies have
been presented in creative ways to throw the examinees’ thinking for the proverbial
loop. A multi-prong study approach should help the test candidate through these
difficult questions. Let your tutor guide you to the best approach in this
subject.
Special Purpose
Examination (SPEX) has shown itself to be incredibly difficult. Failing this
exam two, three and even four times has occurred frequently by test candidates.
The cost in time and money can be cut down substantially for examinees by
proper preparation and study for this exam. A tutor who has a wide ranging
knowledge of this exam and who has come in contact with a multitude test
candidates is well suited to help the potential examinee. Please contact Mark Davis MD at platomd@gmail.com to inquire concerning fees and study times available.
Mark Davis MD
SPEX Tutor and Mentor
