Studying for the NARM - Page 3

[price]

feb 08 exam

Hi, am new to this message thing!! Fell across this and felt I wanted to join in. RE TAKING the exam soon. Was really shocked to have not gotten last time. Told I missed it by 3 points, on their scoring system...dam!! so expensive!! Felt confident when i left last time. Having read comments hear I wonder if I jumped in with the high tech answer???

The annoying thing is, really cant remember questions they asked, but they were not really medical. Anyone else re taking soon???

[momileigh]

OK, I have a serious question here.

My mother, an RN w/ two masters degrees and a lot of testing experience (but of course not NARM), keeps emphasizing, "They just want to know that you are going to be SAFE. So if there is ever a choice to call 911 or go to the hospital, if there's any chance that's the answer, go with that."

I have heard practically this exact advice from a CNM (they don't take the NARM) and one CPM/LM (who of course took the NARM).

Do those of you with a feel for the NARM test think this is an accurate attitude? To be as conservative and safe as possible, even if it means making possibly unnecessary transports? Going back to the breech example, perhaps transfer IS the way to go, assuming you're a new midwife who has never done a breech, if they're looking for ultimate safety. Are there a lot of questions where you have to make the call between transfer and using questionable midwifery skills (like, off the top of my head, fundal pressure?)??

[jenmidwife2b]

I am really enjoying this thread as I plan on taking the NARM next year. I too wish that there was an actual study guide out there somewhere. I'm enrolled in an online school and have done a lot of the coursework there. I've read Frye's stuff cover to cover, and am in a wonderful apprenticeship now with an experienced midwife but I still find myself worried about taking the NARM next year and wasting money that I dont have. I took two years of a local midwifery school and the CPM who ran it said the same thing as momileigh just posted, that when in doubt, check off "transport!", so I'm a little confused by the other poster who talked about the breech question also.

[sevenkids]

You're being tested on your knowledge of basic skills. If you have the knowledge of skills necessary to handle different situations, that is what makes you safe.
Remember, the test is not asking questions on any state-specific laws and rules, (the exam is a written test on midwifery theory, your practical skills are what you have actually done, documented by your preceptor) the answer will apply to the LM in Florida who suddenly finds herself with a surprise breech at 9 cm, and the CPM in Oregon where it is perfectly legal to attend a breech, and they're going to apply to the Boston midwife with a back-up hospital 4 minutes away, and the Montana midwife practicing where the closest hospital is 4 hours away. Obviously, if you attemp to transport her to a hospital 4 hours away, at 9 cms, you're going to risk a car birth on the side of the road, which is decidedly LESS safe than continuing with the birth at home. There may be a question where transporting a breech IS the correct answer (everyone gets a different version of the test), perhaps if Mom is 4 cms and you discover a little foot in her vagina, for example. They don't want to know if you can pick up a phone and call 911. They want to know you have the knowledge of the skills necessary to manage a breech (or shoulder dystocia, or PPH....) at home if you need to (even if in real life you DO call 911 and transport).

Now, if a question asks you if you discover a placenta previa in early labour....., the answer will of course be transport. That is not considered safe in any situation, or in any state, no matter your skill level. But generally, the answer will not be transport, the answer will be what is appropriate management.

I hope I'm being helpful and not making you more stressed out. I personally found the NARM to be rather easy. I finished both portions in less than an hour each and passed with a 98%. (I swear, I'm not trying to show off) I understood that the exam was testing my knowledge of midwifery theory, not my knowledge of my state laws, not what I would actually do in a real life situtation, with my skill level and my state laws to consider, but what is considered a working knowledge of good management skills.

[momileigh]

I absolutely appreciate hearing that the NARM is easy and it is possible to get a 98%. I am really trying to believe you. (Not that I think you're lying, just that a little part of me is objecting that you must be a superhuman prodigy.)

"I understood that the exam was testing my knowledge of midwifery theory, not my knowledge of my state laws, not what I would actually do in a real life situtation, with my skill level and my state laws to consider, but what is considered a working knowledge of good management skills."

I am going to memorize that.

[momileigh]

Well, I took it.

I would NEVER call that test easy. And I studied a lot of the wrong things. And if I had to take it again, I would be at a loss as to what exactly to study. I don't have a sense of whether I passed or not. I did fill out 5 comment forms. (I had to keep getting up to ask for more.)

But at least I can now add my own original sample question for those looking forward to taking it:

A woman is anemic. Which of these foods would you recommend?

A. Chard, strawberries, peas, ice cream, and rose hips
B. Goldenseal, motherwort, hot dogs, cream cheese, and moxibustion
C. Lettuce, beans, pixie stix, meatloaf, and cranberries
D. Hops, chicken soup, peanut butter, orange juice, and celery

I'm really not exaggerating. (Maybe a tiiiiiiiiiny bit.)

[MamaRabbit]

On first guess..... C. But then, A sounds good too. Well I do love the taste of OJ so mabe D????

[Inner_Serenity]

Choice A keeps jumping out for me....

Tia

[momileigh]

I just want to mix all the choices together for a big delicious salad.

[Peppamint]

Originally Posted by momileigh

I just want to mix all the choices together for a big delicious salad.

:

[Maggi315]

So, have we come to any conclusions on what is the best way to study? Like varney's workbook? Or the skills manual? I know I have several months to go, but since I like to study and get organized, I would like to have some sort of plan.

also, lots of people mention herbs, should I be concentrating more on herbs? And supplements/vitamins?

I am hoping as a LC, I have that part covered. So I won't be studying that too much.

[nashvillemidwife]

You shouldn't focus on herbs and supplements. It was only a couple questions about a very broad topic. It just peeves me that there were any questions about herbs at all.

[jenmidwife2b]

Originally Posted by nashvillemidwife

You shouldn't focus on herbs and supplements. It was only a couple questions about a very broad topic. It just peeves me that there were any questions about herbs at all.

May I ask why that peeves you?

[momileigh]

I think that *some* herbal things ought to be part of midwifery. For example, if you're somewhere where you can't get pitocin, wouldn't it be nice to at least be aware that there are some herbs that can help staunch a hemorrhage? But overall, they are different specialties, midwifery and herbalism. I wouldn't expect a midwifery exam to cover chiropractic or acupuncture either.

[mwherbs]

so many women/moms have questions about herbs and supplements - and they do ask or are given advice all the time, shouldn't we know some of the answers? . Best to know the field - In a recent Midwife Handbook written by Constance Sinclair CNM she does a very decent job of presenting several alternative therapies as well as conventional ones.

When we take the NNR class and test we have to know about drugs we will never touch or administer.

[nashvillemidwife]

So many moms also have questions about Rhogam and GBS that CPMs can't seem to answer. Why is that?

Where would one draw the line on how much midwives should know about herbs? Which ones are high in vitamin C? Which ones to treat toxemia? What's the best way to administer them? How should you store them? What are the phytochemical properties and how do they work? Herbalism is a separate but complimentary discipline. Yes, it's good for midwives to know about it, but to have to show proficiency in that knowledge in order to become a CPM? I don't think so. Why don't we have to show proficiency in IVs? Sutures? Aren't those things good to know about too?

(I've never had to take the NRP sections on intubation and drugs. It's not required of providers who aren't qualified to do so.)

[momileigh]

I took NRP w/ Karen Strange and we didn't learn the intubation or drugs either.

[mwherbs]

Nahsvillemidwife- the test may very well change, since how they arrive at the test questions has to do with job/work surveys as well as having existing midwives write the test questions and comb though/edit the questions- it must be to some degree what has been useful information. I know that new test questions were being compiled when we had Ida come talk a while back.
GBS and Rh info probably will be on a newer test, don't you think? I think Rh would be easier to discuss because not much has changed over the years about it but GBS protocols and standards have changed fairly recently-
So for a very long time some knowledge of herbs has been of use to practicing midwives, enough so that they have written the test questions to reflect that import... no you don't have to be an herbalist, but as alternative providers our clients are more likely than the mainstream to be utilizing other alternative means - also we still have 1/2 the states with no recognized legal status for midwives, alternative treatments like herbs are more readily accessible and more frequently utilized- so in those states where CPM are writing the test questions that is a necessary core knowledge -

on the resuscitation classes- all but the intubation section- no I don't practice the intubation but the LM that teaches as well as the other local teachers all have had us do the drug sections- really not that hard, knowing what epinephrine looks like/when it is used and dosages as well as the use of narcan--- and really if we were resuscitating a baby and an actual paramedic showed up with the stuff in tow we may very well be the ones assisting drug delivery and really in the field we are the "experts" yes the emts and paramedics have doctor backing but who but us see babies and moms all the time? anyhow off the point there is a ton of info I have learned over the years and have to accountable for one way or another- even if I never use it.

[midwifebethany]

I was looking for study helps and located these flashcards and this study guide (I'm not 100% sure this is for the NARM). Does anyone have experience, either positive or negative, with these tools? I'm feeling rather at a loss for what exactly to study.

Thanks!

[momileigh]

Hi Bethany,

I bought those flash cards and posted the following review:

OK, so I got the NARM flash cards. Here are my reactions:

1. Quality of the cards: meh. They come 6 up on cardstock and you have to tear them apart yourself. Not in any way laminated or anything, would be easy to stain/tear/lose. Some of the pages weren't perforated and I had to cut them. Some of the words printed on the cards are faded out, but not so bad you can't tell what it says.

2. Material: Seems pretty exhaustive, and seems to come straight out of H&H. Sometimes the accuracy is not 100%. For example, "define rectocele," and the answer is "a swelling on the vulva near the rectum." Well... not exactly! That's an approximation of what you might SEE on exam but it isn't what a rectocele actually IS. (Right? I'm pretty sure seeing as I have a rectocele myself, and it is totally invisible from the outside.) There are occasional typos I have noticed.

3. Study value: My idea of a flashcard is that there is a question on one side, and a definite correct answer on the other side. These are not like that. Each flashcard says something like, "Discuss the importance of..." Or "Explain the use of..." on the front, and there is a whole long paragraph on the back. So it isn't what I imagined (ie, "What drug is used to treat syphillis?" Other side: "Penicillin G") where you can quickly go through. You sit there considering the question and discussing it for a while, trying to hit as many points as possible, and then flip the card and read the paragraph to see what points you hit and anything you may have missed. It is going to take FOREVER to get through the whole deck.

So, am I happy with them? Yes and no. I'm using them to study now, and when a topic comes up I feel I'm weak on, I jot it down to read from Frye later. I'm separating out the cards that I feel are easy stuff (a lot of the social things, like about domestic violence or single motherhood, that I'm just not worried about) from the more complicated topics (how do you diagnose and treat shock, etc.).

My plan is to use them, and after I take the test I'll have a much better idea if they were very useful or not! Meanwhile, I wouldn't classify them as a "must-have," but if you've got an extra $50 kicking around, it won't hurt.

**Update:**

OK, so I went through the entire deck. It DID take forever. I finished 2 days before the NARM. I honestly think they wasted my time more than anything else. I returned them for a refund. So, I ended up out about $10 for shipping both ways.

The more I went through them, the more I realized that half of the info was waaaay too medical, the other half was too fluffy. Some of the cards were straight (I mean STRAIGHT) out of H&H. Others included terms I was in no way familiar with... Probably 10 or more of the cards said, "Describe ROS of the ________" (the blank would say head, eyes, nose, etc.). My classmates and I are all, "WTF is ROS?" I googled it and figured out it meant, literally, "Rule out systems" but I still don't understand what it means, and all of those cards were nitpicky medical stuff. (On my version of the NARM there were almost no nitpicky medical questions.)

The study guide I did not get, but as it is by the same company, I believe it will be equally unhelpful. Believe me, I wish it wasn't so! I wanted badly for there to be NARM prep materials that would help.

Here is what I credit my passing the NARM: Heart & Hands. I basically memorized it. Every protocol I knew step-by-step. I skipped nothing. I wrote my own comprehensive review of that book. I read it cover to cover twice, some sections more, plus the note-taking. Basically, I made it my Bible and became very, very religious for a couple months.

If I had had more time to study for the NARM (I only had about 6 weeks to focus on it) I probably would have studied my Frye Vols. 1 and 2 as much as H&H. There are some great tips on this thread for studying using the NARM outline as a study guide.

I felt overall the NARM was testing me on how "midwifey" I was. (That, and whether I could keep clients safe.) The more you immerse yourself in the books, the better picture you'll have. The flashcards do not do this.