One Patient's Positive Perspectives

Lupus Adventures Studying...

Lupus patients with central nervous system involvement and short-term memory problems face special challenges as they study new information and try to learn new bodies of knowledge.  Studying for complex written tests may require some different approaches than would typically used by most students cramming for their high school or college final exams.  Being over 50 makes the learning even more challenging.  Studying for and failing my first attempt at a professional certification exam humbled me a little (maybe a lot) and caused me to adjust my learning methods.  My certification journey started several years ago, and my adventure is still continuing.

A specific learning goal and a two-part challenge

After taking required professional training classes and studying intently for over a three-year period, I sent in my résumé, educational history, application and fee requesting eligibility to sit for the exam.  The first hurdle was passed and I was approved!  I continued to study for months before the exam.  I struggled with the difficulties of lupus central nervous system involvement, and short-term memory challenges.  However, I was determined that with enough study it was possible to learn enough to pass the exam.

A few months later, I traveled across country at my employer’s cost to a national professional conference for my first attempt at the difficult exam.  I reviewed flash cards on the 5-hour flight, took a cab to my hotel, and checked in early.  After dinner, I snuggled into my bed, reviewed my six-inch stack of flash cards one more time, and went to sleep looking out my 27th floor window at the glittering lights of the Boston harbor below.

Early wake up call

The morning wake-up call came early!  I awoke ready to battle my lupus-clouded brain with an arsenal of morning medications, coffee, yoga and a light breakfast.  At 8:00 a.m. I arrived at the formal exam room, and put my purse on the floor beside me.  I sat down at one of 16 well-spaced tables, looking forward with anticipation at the a proctor.   The linen table-cloth was bare except for several pencils, a scratch pad, an exam packet and an answer sheet.  Me and my still foggy lupus-challenged brain were ready to give it my best.  I scanned the rest of the room, and no one else was smiling either.

It was a grueling, mentally taxing 4-hour exam, tougher than any I have ever taken, bar none!  I paced myself, took brief mental breaks, and answered each question thoughtfully to the best of my ability.  Many questions were things I understood very well and knew how to answer without much deliberation.   Others required educated guesses, deciding which was wisest, most-advised or most-likely option between reasonable choices.  Many professional scenario situation questions that were toughest for me were those not covered by my own professional experiences.  In these most challenging topics, I had “book learning” knowledge only.

I was guardedly hopeful afterward, thinking it was probably 50/50 whether I passed or failed.  I was certain I had given it my best effort, but knew I had not mastered everything covered in the exam.  I told everyone back at work that “it is possible that I might have passed, but then again, it is possible that I failed.  It could go either way, but I gave it my best.”

A few weeks later

A few weeks later, I opened a confidential letter containing my scores.  There it was in writing.  Failure!  This was humbling but not altogether surprising.  I knew before taking the exam that it was statistically more likely that I could fail at my first attempt, than pass.  Approximately 50% fail their first attempt, so I could logically accept the truth of my failure without total loss of self-esteem.  Still, the lack of success had some sting in it!

It was going to be hard to go to work the next day and tell my bosses that I had failed.   Explaining the difficulty of the exam and pass/fail rates beforehand helped my pride now, even if just a little.  They both understood how much I learned while studying for the exam, much of which had been directly applied to my work as I learned it.  But now, we all would have to accept that I still did not know enough to pass the test.

Many other people who have failed this exam are so discouraged that they do not give it another try.  It was clear from my scores that I had failed one of the five major sections of the exam, and therefore failed the exam.  I had not done badly on the other four sections.  The good side of failure?  It told just me what information to concentrate on before my next attempt.  I felt affirmed by my good scores in the other three major exam sections.  Now, there now was no doubt about what I did and did not know well enough!

Looking ahead, I knew that continued study for my next attempt at this complex exam would be a doubly challenging up-hill climb.

Education means learning, learning is key to remembering

First, CNS lupus involvement impairs my short-term memory

Some of the symptoms of CNS lupus that most challenge my learning abilities are occasional mental confusion, overwhelming fatigue, and short-term memory problems.  For me, learning poses a complex challenge that at times involves all three.

Experts suggest that cognitive dysfunction in lupus may be due to circulating chemicals called cytokines, and changes in the blood flow to different parts of the brain caused by inflammation or blood clots.  Some aspects of CNS lupus mental impairment have been attributed to lupus lesions in brain tissue, as antibodies attack brain tissue, triggering early cell death. http://www.lupusinternational.com/Resources/brochures_09.aspx

All my life I have told people I would make a terrible witness!  Remembering exact details or quoting conversations exactly has always challenged me.  When I learned that lupus was a cause of some of my short-term memory challenges, it explained my difficulty recalling small details, events or exact words from conversations.  Some recent examples…

  • I can remembered ideas and arguments I wrote in an email, but could not remember if finished or sent the email out.
  • I remembered some complex issues discussed with someone else, but forgot whether it happened as email, on the telephone or during a face-to-face meeting.
  • I vividly remembered everyone who was at a recent meeting, the room we met in, the attitude and facial expression of everyone in the room, the places each person sat in around the conference table, and the major concerns that were discussed and negotiated.  However, the final decisions and action items were forgotten.  Thankfully, I remembered that I had 3 pages of notes, and in my mind could “see” the spot on page 3 where I had written the action items in the margin, so I knew where to go to find my take-away responsibilities.  But could I remember them without finding my notes?  Not a chance!

It became clear from my exam failure that I needed a more effective learning strategy!  I read about a lupus study in 2009  that showed “learning ability was impaired in patients with SLE with a poor and inefficient learning strategy, as reflected by an impaired learning curve, repeated omissions and impaired retrieval.” http://ard.bmj.com/content/68/6/812.abstract.

That medical journal could have been describing my mind!  I concluded I needed a better learning strategy that would compensate for the short half-life of my memories.

Second, it is most difficult to remember what is not understood

Second, the most difficult information to remember is professional knowledge outside the scope of my own job and work experience.  Over the years I have gained solid on-the-job mastery of a majority of knowledge areas covered by the exam.  However, the knowledge I do not use presents my greatest learning and memory challenge!

Studying Many Subjects

In preparing for this exam, I am studying some pretty complex intellectual information that crosses over several disciplines and bodies of professional knowledge and skill.  This stuff I am learning is really tough and in-depth.  Some of the big topic areas include business law, financial and investment portfolio management, human resources management, organizational theory, operations management and technology management.

Each of these topics alone was complex enough, but the financial analysis area was my undoing on the exam.  I didn’t understand this well enough to make good judgment calls between choices and best courses of action in many of the test questions.  This kind of analysis depends upon having a thorough knowledge and understanding of concepts, and ability to discern the best of several seemingly feasible choices.

Unlike me, the “humble public servant,” many of my professional counterparts working in private business have more hands-on experience with the two financial subjects areas I failed.  These subjects related to things I never do in my government position, because they are handled by our accounting, finance and treasury divisions.  There are several hundred certified members of our professional organization worldwide, but to my knowledge, no other government employee has ever passed the certification exam.  However, I hope to be the first.

If I understand something thoroughly, I can better remember it.  Finding ways to understand the challenging areas of financial and investment knowledge might improve my recall of the information.  Remembering terms without deeply understanding what they mean is almost impossible.  This is why cramming just never works for me.  I have to study so that I really own the information, and must grapple with it until it makes sense to me.  Transforming words into ideas that I understand improves my ability to remember!

Writing and review as a memory tool

Taking Notes

So, I write the key information down to accommodate my lack of reliable short-term recall.  Then, I review and briefly mull over my notes on several occasions over several subsequent days to plant the new information deeper, into my long-term memory accurately.  In business, after an important discussion, I write a digital note into the file about the gist of the conversation with my conclusions and observations.  In business, using notes as memory joggers during later conversations is just fine, but notes like those cannot come along to my exam!

I have always known that cramming for exams doesn’t work for me, and that its easy to forget what has not been planted into my long-term memory by comprehension.  Even in high school and college, I figured out very early that I had to study subjects for total comprehension, and that relying on short-term recall would mean certain academic failure.  It worked better to study something for several different times over several days, and not spend one long cramming session to try to memorize information.

Memories blow away, knowledge has roots

Like seeds of thought blown away by the wind of the next complex idea or wearying experience, information crammed into short-term memory is long-term unreliable if it never crosses over into my long-term memory.

Coping with disappointment of failure while celebrating personal victory

To cope with my disappointment, I had to recognize my personal victory.  I had come reasonably close to passing the exam, all except for two major subject areas that I failed by about 20%.  But, it helped me to think about how much my job skills had improved over the past couple of years from new professional knowledge I had gained from my study.

Failure couldn’t take away the stuff that had “stuck” in my understanding and long-term memory, that was already being applied in my daily work.  Pass or Fail, I had still learned so much just trying!

My favorite methods for planting information deep into my long-term memory

  • Learn with a goal of total comprehension, go beyond short-term memory, learn until it “makes sense” and until the “ah hah” moment happens
  • Using multiple parts of brain to cross-connect information between types of multiple senses
  • Type up hand-written notes.  Then add thought comments and questions to interact a second time with the material.  Do this 1.5 days after the first session with the material
  • Using spatial memory and full-page cheat sheets – burn key words into your memory looking at them
  • Stick with tough ideas long enough
  • Go over flash cards while spinning on my bike in the fluid trainer
  • Discuss the ideas from my notes out loud to myself, as if I were giving a business presentation or classroom training session on the topics
  • Explain what I have just studied to a poor, unsuspecting victim – my husband, my assistant at work, or even one of my bosses.
  • Make up ditty’s, and acronyms for the hardest details
  • Join a study group – this has encouraged me and is much less lonely than solo study

So, I will be trying again! I mustered up the courage to give it another go.   I bought an airline ticket, registered to re-take the exam, and in mid September will fly to a neighboring state to give it another shot!

With God’s help and lots of hard work behind me, maybe, just maybe, I will pass it this time!

 

[Errata:  Statistical correction to percentage of first time failures in the certification exam, based upon recent improvements in exam pass/fail rates. 1/12/2012 LA]

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Comments on: "Lupus adventures studying for a professional exam" (1)

  1. I am so glad you have touched on this topic- I have been experiencing the “pleasures” of CNS lupus- memory loss, confusion, and just pure brain fog. It has been a tough process to adjust and cope with these changes- especially in the work setting. I am scheduled to go through a lumbar puncture (spinal tap) this Friday– have you gone through this? Has anyone? I am a bit nervous and would like to know what to expect… Thanks again for your posts!

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