Ashish Goyal, M.D.

Author Archives: Ashish Goyal, M.D.

Ultimate Guide to the MOCA-Peds Assessment

The MOCA-Peds Assessment is an alternative to the American Board of Pediatrics’ traditional 4-hour pediatric MOC exam. Standing for “Maintenance of Certification Assessment – Pediatrics,” MOCA-Peds is an option that many practicing pediatricians find preferable to the standard Maintenance of Certification exam. There are advantages and disadvantages to each, but we believe that the advantages outweigh the disadvantages. PBR can prepare you to take the MOCA-Peds test in an easy and painless way by providing you with guidance on how to navigate the MOCA-Peds experience and by giving you one-page summaries of the exact topics you will be tested on.

But first of all, what is the MOCA-Peds, and why is it preferable to the MOC?

What’s the Difference Between the MOC Exam and the MOCA-Peds Assessment?

MOC Exam

The Maintenance of Certification Exam is a 4-hour examination offered by the American Board of Pediatrics to board-certified pediatricians once every five years to help maintain board certification. It is a standardized, proctored test that lasts for five hours and is similar to the Initial Certification board exam for pediatrics. It can be on any topic related to pediatrics.

If you’re good at standardized tests and have been at low risk for failing (meaning you usually pass these types of tests with flying colors) then it might be a good option for you. The benefits are that it’s only once every five years, so you don’t have to worry about it the rest of the time. Because of this alone, we estimate that approximately 10-20% of pediatricians prefer to take the MOC Exam.

A related reason why some pediatricians might prefer the MOC exam has to do with subspecialties. For subspecialists who decide to maintain their subspeciality board certification and their general pediatric board certification, it’s preferable to only focus on their specialty most of the time and then shift their attention to general pediatrics only once every five years as they prepare for the MOC exam. 

MOCA-Peds Assessment

The MOCA-Peds exams are much shorter and the time commitment can be tailored to suit your needs. These mini-exams have many advantages over the MOC exam. In the MOCA-Peds exams you:

  • Answer 20 questions per quarter, every quarter, for four years. If you pass within your first 3 years, you get the fourth and fifth years off.
  • Answer one question at a time and get an instant result (answer and explanation).
  • Have five minutes per question.
  • Take the test at home, in the office, or any place with internet access without a proctor.
  • Take the test as an open-book, open-computer exam with the freedom to access the MOCA-PBR Study Guide & Test Companion, UpToDate, Peds in Review, or any other online resource.
  • Can fail up to four quarters in the five-year cycle and still maintain your certification.
  • Study only a limited number of topics to prepare for the exams. Instead of studying everything in the world of pediatrics, you only have to study the 40 Learning Objectives and 4 Featured Readings laid out at the beginning of each year by the American Board of Pediatrics (ABP). The 80 questions per year come from those topics and a new MOCA-PBR Study Guide & Test Companion is created every year to cover the new Learning Objectives and Featured Readings.

What are Learning Objectives and Featured Readings?

The American Board of Pediatrics provides 40 Learning Objectives which are somewhat vague. But, even 40 vague topics are much better than having to study every little thing that might show up on a pediatric board exam. The Learning Objectives and Featured ReadingsLearning Objectives are typically released on the ABP website one to two months prior to the new year. Some recent examples of MOCA-Peds Learning Objectives include:

  • Counsel parents regarding circumcision
  • Differentiate between normal and abnormal variations in head growth and manage appropriately
  • Evaluate and manage a child with an inguinal mass

The Featured Readings are articles published in medical journals. Some examples of recent featured Readings include:

  • Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics. 2019.
  • Acute Treatment of Migraine in Children and Adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019.

What Happens if You Fail the MOC or Fail the MOCA-Peds?

If you fail the MOC, it is a complete fail and you have to take the entire exam again. The exam is administered four times per year. 

If you fail a MOCA-Peds quarterly assessment, nothing happens at that time. You only have to pass twelve quarterly assessments within the first four years of your five-year cycle to maintain certification. If you do not pass at least twelve quarters by the end of your fourth year, then you must pass the proctored MOC exam by the end of the five-year cycle.

MOCA-Peds is built into your recurring ABP dues. You must pay extra to take the MOC exam. Failure to meet your recertification requirements will result in additional fees and can result in the loss of your job (many hospitals and clinics will only employ board-certified pediatricians).

You can see why it is so important that you do well on the ABP MOCA-Peds assessments or the MOC exam.

How Do You Prepare For MOCA-Peds?

The good news with the MOCA-Peds is that the ABP gives you the 40 Learning Objectives and Learning Objectives4 Featured Readings in advance. This gives you a great place to start your studies. Therefore, your options when taking the MOCA-Peds exam are:

  1. Wing it! Use Google, UpToDate, Peds in Review, and other online resources to hopefully find the answers within the five-minute window that is allowed per question. This is not recommended since it can result in anxiety and failure. 
  2. Find resources on your own that allow you to prepare for the topics and subtopics related to the 40 Learning Objectives and Featured ReadingsFeatured Readings. This is doable but requires a lot of work and research on your part–and most of all, a lot of time.
  3. Get the MOCA-PBR Study Guide & Test Companion in an online format and/or hardcopy format. Every year, we do the hard work for you. When the ABP publishes the Learning Objectives and Featured ReadingsLearning ObjectivesFeatured Readings, we do a deep dive into those topics and create concise study guides to capture the common, and uncommon, information that may be covered on the exam. Use Study Guide and Test Companion as your open-book and open-computer tool. Even if you’re not tech-savvy, our online resource makes it easy to search, efficiently answer questions and PASS your MOCA-Peds exams.


Are you ready to take on MOCA-Peds?

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How to Prepare For the Pediatric Boards

Getting to the pediatric boards is a major step in your career, but passing isn’t a walk in the park. You’ve worked your way through test after test, through medical school and residency, and now comes the time to take your boards–are you going to lose it all now?

Pediatrics Board Review is here to make sure that you don’t. We’ve helped thousands of pediatricians get through the initial certification exam, including those who have failed it many times before. PBR offers focused, easy-to-use resources that will get you across that finish line. Don’t believe us? We back it up with a Money-Back First-Time Pass Guarantee. And of the thousands who have utilized our resources, less than 0.5% of pediatricians have had to ask for their money back.

We’ve helped them, and we can help you.

The Three Pillars of Passing the Pediatric Boards

Passing the pediatric boards isn’t easy. We know that; we’ve taken them ourselves. We’re not just a testing company: we’re board-certified pediatricians who know what it’s like to go through these exams and we have the knowledge base and continuing education to help you pass.

There are three must-have ingredients for passing the pediatric board exams. They are content, technique, and commitment. Each one is important in its own way, and you won’t get far into the exam if you’re lacking in any of these three areas. Let’s look at them each in turn.


Content refers to the development of your fund of pediatric knowledge as you prepare for the pediatric boards. You may think that this is a time when you need to gather all the resources possible, read countless books, and spend agonizing hours flipping from one cross-reference to another. But the truth is, more is not better when it comes to taking this board exam. Turning to other textbooks and medical journals and notes can be a recipe for disaster. What you need is a single source that is comprehensive, focused on board-relevant information, and allows for repetition in order to guarantee reinforcement of the concepts.

Using the PBR Core Study Guide and Q& A Book, in both online and hardcopy formats, as well as audio and video courses and virtual atlas (the PBR All-Access Pass), will get you on the pathway to success faster than turning to every resource under the sun. The reason is congruence. Looking at every available text will result in the cardinal sin of “information overload.” In fact, we recommend that after you get the PBR study guides you don’t consult outside information at all. Resist the urge. Having a single signpost pointing you in the right direction will give you better information than trying to listen to a hundred voices.[1] [2]

“Content is king.” So, getting the right content in hand is the single biggest thing you can do to change your FAILED pediatric board experience into a PASS.


Technique refers to how you process board-style questions and how you take the exam. Exams are different from clinical work, different from laboratory work, different from hands-on skills. Taking a standardized test is a challenge all its own and it requires a certain set of skills. Some people are born great test-takers. Others may be brilliant clinical physicians but struggle to tackle the format and code-breaking that is a standardized pediatric board exam.

The thing is, there are “rules to the board game.” Medical board questions cannot be viewed as miniature patients. They have to be viewed as silent puzzles with rules that can help you solve the puzzles, oftentimes even without the supporting clinical knowledge in place. This has to do with understanding the various styles of pediatric board exam questions, how to navigate those different styles of questions, and how to process the answer choices in a way that leaves only the answer that the test makers want.

We’ve noticed that the test-taking technique is especially difficult for non-U.S. trained pediatricians (aka International Medical Graduates). They may have the content nailed, but if they don’t know the technique of answering questions, they’ll get eaten up on the test. This is often because standardized tests in this country are different from the types of exams used in their home countries: some had essay questions and others had oral exams. This is an entirely different world.

A good example of this is the time of test questions: you’re only expected to spend 75 seconds per question. What do you do when time gets running into two or three minutes and you’re still not done? Do you pass the question by or keep at it? You might waste a lot of time on a single question and blow five questions at the end of the test–that you knew the answer to–because you were out of time. (This is a particular issue when it comes to international students, who may be used to different test formats: some tests penalize you more for leaving a question blank whereas some penalize you more for entering a wrong answer. Learning the right way to answer the right test is essential.)

Time management is only one of the many test taking strategies we teach you in the technique section of our PBR Test Taking Strategies and Coaching course. [3]


Commitment is a huge reason why pediatricians fail the board exams. It takes a lot of effort and time to prepare yourself for the test, and if you’re an intelligent physician who is confident in your abilities but doesn't take the time to devote to studying, you will fail. We recommend that low-risk, first-time test takers should have a minimum of 300 dedicated study hours. For moderate and high-risk test-takers, at least 500 hours should be set aside.

PBR dives deep into what is required to develop the study habits that you’ll need to get to where you want to be. This is done in our Live Test-Taking Strategies & Deep Study Course. The lectures around PBR’s concept of “Deep Study” are so impactful in multiple areas of life, that they are often described as life-changing. They won’t be easy; but with the study skills gained through PBR, this may free up time for you to spend with your family and doing things for yourself. The key is to have high-quality study time or deep study, you won’t have to waste time spinning your wheels later on. Make the time that you’re spending in front of the books more impactful and important, so you can spend time on other things as well.

We offer three 90-day personalized schedules, which are customized to you, your personal schedule, and your learning style, and those personalized schedules come free with the package.

You can do it. We can help you.[4]

High Risk vs Low Risk for Failing Your Pediatric Boards

Are you at high risk or low risk for failing your pediatric boards? That’s something you’d want to know, right? Even though absolutely everyone needs to study and get ready for the exams, if you’re at high risk then you know that you have to put in that extra effort, and do so in the right way, to pass. We can help you get there, and we can even help you identify whether you’re a high risk or low risk.

What Makes Someone High Risk?

A physician, or resident, who is “high risk” would be anyone who:

  •       Struggled to pass (or failed) ANY board exam
  •       Classifies themselves as having difficulty with standardized board exams
  •       Is an International Medical Graduate
  •       Was told they are “at-risk” of failing the boards based on In-Training Exam scores
  •       Comes from an “at-risk” residency program with a pass rate of less than 90% – click here to see where your residency program stands
  •       Has taken a year off from studying for the exam
  •       Scored less than a 222 on the USMLE Step 1

What Makes Someone Low Risk?

A physician, or resident, who is “low risk” would be anyone who:

  •       Has never failed any medical board exams
  •       Typically scores near, or above, the national average
  •       Self-identifies as someone who is a good test-taker and generally does well on standardized board exams
  •       Graduated from a US medical school
  •       Was never “at-risk” of failing the boards based on residency In-Training Exam scores
  •       Comes from a residency program with a pass rate of greater than 90% (click here and check your residency's pass rate)
  •       Will take the boards in the same calendar year as their graduation from residency
  •       Scored at least a 222 on the USMLE Step 1

Use Our Risk Calculator To Find Out Where You Are

Are the Study Plans Different if You Are High Risk Versus Low Risk?

For low-risk pediatricians, we recommend that you definitely set aside at least 300 hours of prep time. At a minimum, we recommend the All-Access Pass, which includes 100% of our Initial Certification exam educational resources. It primarily focuses on providing you with concise, board-relevant content presented to you in a multimodal manner.

But, the most common bundle for test takers of the Initial Certification exam is the No Brainer Bundle. It includes resources to support all 3 of the key pillars needed to pass the pediatric boards:

  •       All-Access Pass
  •       Full Online Test-Taking Strategies Course
  •       Three 90-Day Personalized Study Schedules created by Team PBR

The No Brainer is the best pediatric study package on the market, and it costs less than the price of a traditional video board review course.


Are you ready to take on the pediatric board exams?


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Test-Taking Strategies for Medical Board Exams


Test-taking strategy is often overlooked when you are preparing for your board exams, yet it can be the difference between passing or failing. Since there is no question that physicians are extremely bright, why is it that even great physicians often fail their board exams?

Answer: A good clinician is not the same thing as a good test-taker.

When I failed the boards the first time, I was confused. I felt like I had a good handle on the material, but I quickly realized that how you treat a board style question is very different than how you should treat a patient. But it was too late. I had the “standard” top to bottom approach to answering board-style questions, and I ultimately failed the board exam.

I simply did not know how to approach the questions on the test effectively.

And this isn’t uncommon.

However, during my 2nd attempt at the pediatric board exam, I had a strong focus on pacing and a strategic approach to questions. That led to me not only passing my boards, but I increased my score by 160 points! I scored above the national average, and after failing the previous year, the American Board of Pediatrics asked me to write questions for them.

The skill set needed to be a master clinician is completely different than the skill set needed to be a master test-taker and win this “board-game”. Developing this strategy requires training and education like any other skill that you have had to practice. But with practice, you can have dramatic increases in your score like this member of our test-taking strategy course.

Learn Test-Taking Strategies for Medical Board Exams


While having a strong knowledge base is important to pass the pediatrics boards, it will mean nothing if you are unable to apply what you know to the test.

If you consider yourself to be a test-taker with average (or below average) scores on standardized tests, then learning test-taking strategies can QUICKLY give you an advantage to increase your score, and pass the boards.

Plus, unlike studying for a single chapter that may be applicable to 5% of your exam, test-taking skills can be leveraged throughout 100% of this exam (and every future board exam that you ever take).

Study a ton, remember none. Sound familiar?

If you've previously done well on standardized exams, just follow the PBR “Roadmap to Success” and you will do great.

BUT, if you:

  • Struggle with standardized tests,
  • Get test anxiety,
  • Find yourself running out of time on exams,
  • Were told that you were “at-risk” of failing the boards based on IN-Training Exam scores,
  • Have taken a year off from studying for the exam, or
  • Scored less than a 222 on the USMLE Step 1

… then improving your test-taking technique is just as, if not MORE, important for you to study than the actual material.

Below you’ll find some of my top strategies I teach our PBR students to sharpen their test-taking skills before the board exam.


  1. NEVER process a question in a top to bottom manner. Processing the information in a different order will give you much more control and clarity over the question
  2. Do not try to predict the question or answer. When you try to guess what will be asked, or what the answer will be, you waste time and energy as you think through hundreds of possibilities.
  3. Start by reading the question being asked of you, and then reading the vignette. This narrows your focus and gives you tremendous insight into what information from the vignette will be crucial to extract in order to answer the question correctly.
  4. Find your answer through the process of elimination. It’s easier, less stressful and more appropriate to eliminate weaker answer choices rather than choosing the first answer that seems to be correct.
  5. Skip “data blocks” and come back to them if needed. Most vignette-style questions can be answered by just using the text, so try that before reviewing tables of data, x-rays or images.

Click Here And Continue Reading…

Why AAP Prep Questions are NOT the Best Study Questions



A question I’m often asked is “Ashish, what makes your pediatric study guide better than prep questions?” Whether they are talking about general board prep questions or the American Academy of Pediatrics PREP® questions, my answer is always the same (read on).Shhhh it's a secret!


The AAP PREP questions are NOT written by the American BOARD of Pediatrics (ABP). They are written by the American ACADEMY of Pediatrics (AAP). The names of these organizations are so similar (American ______ Pediatrics), that MANY pediatricians believe that they are one and the same.


Yet, the AAP's annual question series has somehow become the “go-to” Q&A resources for the pediatric boards.

Many pediatricians tend to use AAP PREP questions exclusively as their source of study for the boards. I'm baffled by this. While PREP is a great resource for anyone who is a board-certified pediatrician looking for Continuing Medical Education (CME), or for any non-board certified pediatrician trying to simulate an ABP practice session, these questions should NOT be used as a primary study resource while studying for the ABP initial certification exam.


Here is a note I received from a PBR alum, now a Board Certified Pediatrician, who made one of the most dangerous test-taking mistakes the year that she failed her pediatric boards:

Hello Ashish, Last year I failed my boards. I spent countless hours studying using prep questions but didn't have one good source to use to really learn from and I thought using questions would be my key to success. Unfortunately, I was wrong. I was so lost and frustrated after I received that FAIL, and I thought there is no way that I was going to pass. I had spent hours and months studying… What more could I have done?!? I googled ‘failed pediatric boards' and PBR came up. It was an answer to prayer. It was exactly what I needed. I was blown away by the help that PBR gave me. From the PBR book itself to the videos, audio and online portals – I am so incredibly thankful. I think PBR should be adopted by residency programs nationwide as it would be a great resource to have to study for in-training exams and to use alongside rotations. Just my two cents!! If there is something that I could do to help you and the PBR membership, please let me know!
Dr. Stephanie Moses, Board Certified Pediatrician

Learn from Stephanie’s experience; it takes more than questions to pass the pediatric board exam. There are three pillars I like to refer to when it comes to successfully passing the boards:

  1. CONTENT: How well you know the material.
  2. TECHNIQUE: How to quickly and effectively process board-style questions.
  3. COMMITMENT: How disciplined you are to the process.

You can read more about these pillars in my article covering the 3 must-have ingredients to passing the pediatric boards.

In order to succeed on the boards, you have to separate your board prep time into two buckets. Your CONTENT TIME (the time to develop your knowledge base) and your TECHNIQUE TIME (the time to develop your test-taking strategy).


Failed But Then Finally Passed With PBR TTS and Coaching

Again, the AAP has put together a GREAT resource. I actually think it stands above all others in the marketplace for simulating the board exam experience. It's also wonderful for pediatric continuing medical education (CME). However,  it should NEVER be used as a standalone resource for board study. I simply cannot imagine that the AAP would ever cover all of pediatrics as a comprehensive board review in a set of 200-300 questions.


Dr. Stephanie Moses is now a board-certified pediatrician practicing emergency medicine. But, that wasn't always the case. In the video below, she talks about the advice that she received and how she focused on PREP the first time that she took the boards. Her second experience was very different. What she says is amazing. Watch the video below now, and be sure to watch until the end.


In short, you should do at least 5 practice questions per day in addition to your studying materials. These should be from PREP as well as from other Q banks. This way, you are able to get a taste of various question flavors and have a broad understanding of how questions can be written for the boards. Read my article called “How Many AAP Prep Questions Should I Do?“and learn more about why I recommend this.


Here are a few additional key points about using the AAP's questions, as well as any other pediatric board prep questions:

  • If you insist on using questions to study, pick a company who creates study materials for the boards as well. This will (hopefully) ensure that the questions actually correlate with the content you need to know for the boards. This way, the answers/explanations tie in seamlessly with the core content necessary to pass the boards. However, finding this magical batch of questions that will give you everything you need to know for the boards typically does not exist. That’s why it's IMPERATIVE to study from a well-written and easy-to-understand study guide and to use questions for the practice of your test-taking TECHNIQUE.
  • The boards are not always current! PREP does a great job of staying current, but the ABP questions you'll see on the boards are not always that up to date. So BE CAREFUL.
  • PREP answers/explanations often go into excellent detail to explain all possible viewpoints. When you're studying for the boards, EFFICIENCY IS KEY so SKIM the answers. If you answered the question correctly, pat yourself on the back and MOVE ON! If you answered the question incorrectly, focus only on the answer that you chose and also on the answer that was the correct answer. Figure out where you went wrong. Was it a TECHNIQUE problem, or was it purely a CONTENT problem? If you felt like you had a good handle on the subject matter but still answered the question incorrectly, it was definitely a TECHNIQUE problem and you must figure out how to strengthen your test-taking strategies.

PREP is a great tool when used correctly

So, to answer the question posed in the title of this article, “Ashish, what makes your pediatric study guide better than prep questions?”, it’s near impossible to find ANY board prep questions that would do a good job of serving as a stand-alone STUDY resource.

Yes, you will undoubtedly learn some information about pediatrics by going through board prep questions. But your primary goal should be to use prep questions for PRACTICE and refinement of your test-taking TECHNIQUE rather than a STUDY resource.


Set time aside to specifically grow your knowledge base and work on your test-taking technique. If you aren’t sure how to create such a schedule, I have two articles with step-by-step directions on how to set up your study schedule. Regardless of how much time you have left before the boards, these articles are great resources!

If you consider yourself to be a great test-taker, or if you are taking the boards for the first time, follow this schedule.

If you have failed the boards before (welcome to the club!), or if you are not a great test-taker, then follow this study schedule.

For those who are wanting to take that next step to pass the boards, the go-to resource is Pediatrics Board Review. As a PBR member, you’ll have access to high-yield board review questions and our test-taking strategy resources!

So, what are you waiting for? PBR offers, online, hardcopy, audio, and video resources. Click here now and find the PBR resource that’s right for you!

Pediatric Study Guide, Pediatric Question Book, iPad

2020 Pediatric Board Review Sneak Peek

Your 2020 Pediatric Board Review PREVIEW (and Discounted PREORDER Code) Is Here!

Published in 10/2019

Pediatric Study Guides, Laptop, SmartphoneUnlike other board review courses, the PBR's Core Study Guide gets corrected and updated EVERY year. Many of the corrections and clarifications of the are made available to the PBR community (below) prior to the pediatric initial certification exam. This allows members to have a more secure pediatric board review experience, and more secure board exam experience. This is one of the many reasons why members recognize PBR as the best pediatric board review course in the industry.

For non-members who are trying to figure out how they will approach the board exam, or for anyone preparing for the MOC (or for MOCA-Peds), this is a great opportunity to essentially have a sneak peak into the 2020 edition.

In this article, you will:

  • Get a preview of the most EFFICIENT 2020 pediatric board review course available
  • Get a great review of several excellent and high-yield topics
  • Get a FREE MP3 Audio Chapter from PBR
  • Get 50 FREE High-Yield Images from PBR
  • Get a FREE Test-Taking Strategies Video Training Session
  • Get the opportunity to PREORDER the 2020 edition books for 50% off of the value of the Ultimate Bundle Pack or 85% OFF of the LIFETIME package called “PBR FOR LIFE!” Please note that the PBR FOR LIFE package is NOT typically available through the PBR catalog, so this is a SPECIAL opportunity!


Every year I like to go through all PBR error submission and send corrections to PBR members before the initial certification exam. It’s an EXTREMELY time consuming task (takes weeks), but it’s worth it.

Although the information in this guide SHOULD NOT make or break your test-experience if you have followed, THE PBR EFFICIENCY BLUEPRINT, several test-takers have previously said that these corrections and clarifications have helped them correctly answer questions that came up on the exam.

Click Here And Continue Reading…

Creating Memorable Pediatric Mnemonics

Pediatric Mnemonics that Stick

Overwhelmed by informationCreating pediatric mnemonics can be a lifesaver for the boards. Did you know that most memory champions in the world do NOT have a photographic memory? They actually TRAIN their brains to remember lists, names and other random facts. So trust me when I say that you can too!

As doctors, most of us were in the top 10% of our class until we hit medical school, but that doesn't mean it’s easy for us to retain the vast amounts of knowledge necessary to pass the pediatric boards. I remember the overwhelming feeling of being crushed by all of the information I was being bombarded with during my studies.

It wasn't until I learned how to create pediatric mnemonics and memory aids that I was finally able to feel comfortable with the idea of housing all of that information in my brain. The mnemonics I created were essential in helping me retain information and pass the USMLE Step exams as well as the pediatric initial certification exam.

So, unless you’ve got a photographic memory, I’d highly recommend spending some time learning memory techniques.

The [PBR] mnemonics were stellar, if not a little goofy , but that just added to their utility. I will likely remember some the mnemonics for the rest of my life, especially the autosomal dominant diseases. – Dr. Kristen Macleod” – Read Kristen's full testimonial by clicking HERE.


Use ROY G BIV as an example of how to start thinking about creating pediatric mnemonicsIn a nutshell, mnemonics are memory aid devices that can help you to remember difficult to absorb information.

Does the name ROY G BIV sound familiar? Click Here And Continue Reading…

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