How to prepare for the NAVLE from someone who writes it

Most veterinarians decide on their vocation before they are 10 years old. As a result, those preparing for the North American Veterinary Licensing Examination (NAVLE) have been studying for most of their lives. Still, trepidation and anxiety naturally accompany this looming milestone exam. And why shouldn’t it? We have all studied for exams, for which the questions turned out differently than anticipated. Some exams are just unfair. Believe it or not, the NAVLE will be one of the fairest exams you’ll take.

My journey to NAVLE

In 2017, I survived the preventive medicine board exams, which consisted of 10 exams, each taking 12 hours and lasting 2 days. Minimum scores in each exam are also required. Apparently, I thrived rather than survived by being in the top 3% to 5% of international scores. As a result, the American College of Veterinary Preventive Medicine (ACVPM) reached out to me to ask whether I would help write future NAVLE exams.

I told ACVPM that I never took the NAVLE. No, I didn’t cheat the system, I’m just old as dirt. When I attended UC Davis in the 1990s, and before 2000, veterinarians wanting to practice in North America had to pass the National Board Examination (NBE) and the Clinical Competency Test (CCT). These worked well enough but did not have the same standards of fairness. A fair examination determining the application skills of medicine helps provide several benefits: ensuring baseline standards, protecting the public, and providing successful examinees with the confidence they are ready to practice.

The earlier CCT utilized Dick Tracy technology with invisible ink on our paper booklet exam. It was like a boring and stress-filled Choose Your Own Adventure book. Pick an answer, highlight it, and try reading the smudged, light-grey text underneath it to reveal whether you should or can move to the next question. Unfortunately, the NBE had questions that could be answered on topic recognition or test savviness. If you passed the NBE and CCT, you could practice in North America.

In 1998, the NBE Committee for Veterinary Medicine signed with the National Board of Medical Examiners (NBME) to redefine the boards. Since 1915, the NBME has worked to ensure standards for human doctors, the United States Medical Licensing Examination. Each examination aims to ensure the “average” medical doctor baseline. Thus, every practicing veterinarian, in theory, could take the NAVLE cold and pass.

How does this apply to you?

Although the NBE and CCT allowed many veterinarians to practice prior to when the tests were last used in April 2000, the NAVLE, developed by the NBME, represents one of the fairest but also one of the most expensive tests in existence. The NAVLE costs more than $1 million to produce. When the NBME explained that each question cost $3000 and that I was tasked with 3 questions per year, I asked whether I could write 50. I was told that I could if I understood my contribution was pro bono, so I told them 3 was reasonable.

Enter the dreaded 60 of 360 questions that do not count toward your score. Every question has been written by a specialist but is designed to be answered by a first-year veterinarian with no specialty training. If you answer a question on an ovarian hysterectomy, then the item was constructed by a board-certified surgeon and reviewed by an educational expert at the NBME. The items are often reviewed by other specialists within the same discipline.

Even with this expertise behind each item, the fancy term for the question, the NBME knows that unforeseen characteristics may impact the item. Metrics are run for several exams to ensure that the new 60 are worth being asked. If a new surgery question is run, metrics help establish fairness. The exact metrics are held by the NBME, and these examples are for demonstration purposes only:

• How often was this item answered correctly?
• For top-scoring examinees, how often was this item answered correctly?
• For top-scoring examinees within surgical questions, how often was this surgery item answered correctly?
• When answered incorrectly, was the spread equal across the distractors (incorrect answers)?
• For low-scoring examinees, how often was this item answered correctly and incorrectly?

Finally, items will have the same format and will be written in the same voice. The anatomy of an item includes stem, lead-in, options, internal coding, and references. The stem will be a small paragraph that sets up the clinical setting. The lead-in is a clearly written question and should be short and concise.

One frustration is that every option should be correct, but only 1 should be “most correct.” Let’s assume that A is correct. A will be a common and likely answer to the question asked, B and C are possible but unlikely, and D and E would be considered extremely rare and unusual.

Exam tips

Prepare ahead

Example of study flash cards (Image courtesy of Lee)

If there is background anxiety about this exam, then now is the time to start preparing. Any resource that helps you prepare is a great idea. With that said, just remember that the questions in these apps are often not presented in the same format as the NAVLE. Writing a case-based item in the NAVLE voice with 4 to 5 answers, for which all are correct but only 1 is clearly the best answer, and passing the muster of metrics is not easy. Still, from what I have seen, these resources work well. Personally, I use handwritten 3x5 cards and hand-drawn pictures.

Study sheet example

Check your 6

This military term reminds us to know our weaknesses. One reason that I use color coding in my flash cards is to ensure that I am not deprioritizing test aspects that I’m weak on. The breakdown on species is maintained on a strict percentage, along with topics such as professional behavior, communication, practice, health maintenance, problem management, data gathering, and interpretation.

For my preventive medicine boards, I noted that flash cards in toxicology, administration, and food safety were lacking. Thus, I increased time and effort there. Still, I despise all things pharmacology and toxicology. Thanks to the boards, I’m at least baseline competent in these areas. In short, don’t focus on what you love. There will be time for this on the other side.

Study horses, not zebras

Often, fourth-year students are reminded to watch for zebras. When looking at differentials, there are common and likely causes of a disease, a horse, and a rare etiology, a zebra. Knowing the zebras helps separate the exception from the rest but isn’t required to establish a best requirement.

Thus, it is easy to remember that Yersinia pestis, the cause of plague, may be causing a feline abscess, but it is not the most common etiology. Unless the question specifically is leaning you toward the bubonic plague, don’t choose it.

Don’t overthink, and breathe

You’ve been preparing for this since you were a child. Between 2018 and 2024, the national passing percentage ranged from 86% to 95%.¹ Your college has done well by you, and you have done well by yourself. You have done well for yourself.

Be kind to yourself and remember that board exams are like intellectual Olympics. They are a challenge to your body, mind, and soul. Get sleep, exercise, and proper nutrition.

In conclusion

Finally, remember that, like the Olympics, you may have an off day. If you fail, the eligibility to sit for this remains an honor. Everyone has a bad day, and, unlike the Olympics, you won’t have to wait 4 years to establish your worthiness in the small, dedicated group of professionals who work to maximize the health and well-being of animals throughout North America.

There are no trick questions on the NAVLE, so follow your instincts. You got this!

Reference

1. AVMA accreditation status and NAVLE pass rates. Virginia-Maryland College of Veterinary Medicine. Accessed April 29, 2025. https://dvm.vetmed.vt.edu/about-dvm-program/navle-pass-rates.html