Pharmacotherapy Review Course, Pract Exam, and Core Therapeutic Modules Package (No Recert Credit) (Cert # L189167)

PLEASE NOTE: The Review Course Modules will become available to access on February 6, 2019.  All other modules, as well as the practice exam, are available upon purchase.

ACPE Numbers: Various – see listing below
Release Date: 11/14/2018
Expiration Date: 11/12/2019
Activity Type: Application-based
CE Credits: 32 hours (ACPE only)
Activity Fee: $420 (ASHP member); $620 (non-member)

Accreditation for Pharmacists

ASHP is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Target Audience

These activities are intended for pharmacists who are seeking to update their knowledge and skills commensurate with a board certification examination in the areas listed below.

Activity Overview

This online course provides a robust preparatory curriculum for the pharmacy professional preparing for the Board of Pharmacy Specialties (BPS) Pharmacotherapy Specialty Certification Examination. Designed based on the domains, tasks, and knowledge statements developed by the BPS for the certification examination, this course will help you prepare for the exam by identifying areas needed for in‐depth review of pharmacotherapy issues by:

  • Reviewing pertinent clinical topics and practice skills
  • Providing exam practice questions
  • Listing valuable references for further study

This course is NOT intended for those obtaining recertification credit. To earn recertification credit, please see courses here http://elearning.ashp.org/catalog/ptherapy-recert

These activities are part of the ASHP professional development program.  

Review Course
This course consists of 11 activities (see table below) and provides up to 16 hours of continuing pharmacy education credit. The Review Course includes case-based presentations for application to real-life scenarios, a practice exam along with correct answers, and links to the reference sources, and domains, tasks, and knowledge statements. To help you further prepare, this package includes a compilation of practice questions in the same format and rigor to help you prepare for the BPS Specialty Examination.  

Learning Module

ACPE Number

Credit Hours

ACPE Expiration

Pharmacotherapy Review and Recertification Course: Cardiovascular Disease: Primary Prevention Case

0204-0000-18-983-H01-P

1.5

11/30/21

Pharmacotherapy Review and Recertification Course: Cardiovascular Disease: Secondary Prevention Case #1

0204-0000-18-984-H01-P

1.5

Pharmacotherapy Review and Recertification Course: Cardiovascular Disease: Secondary Prevention Case #2

0204-0000-18-985-H01-P

1.5

Pharmacotherapy Review and Recertification Course: Regulatory and Quality Issues

0204-0000-18-986-H03-P

1

Research Design, Methodology, Statistical Analysis, and Application

0204-0000-18-606-H04-P

2

Pharmacotherapy Specialty Review and Recertification Course: Complex Breast Cancer Case

0204-0000-18-988-H01-P

1.5

Pharmacotherapy Review and Recertification Course: Complex Nursing Home Case

0204-0000-18-989-H01-P

1.5

Pharmacotherapy Specialty Review and Recertification Course: Medication Safety

0204-0000-18-990-H05-P

1

Pharmacotherapy Specialty Review and Recertification Course: Complex HIV Case

0204-0000-18-991-H02-P

1.5

Pharmacotherapy Review and Recertification Course: Complex Pediatric Asthma Case

0204-0000-18-992-H01-P

1.5

Pharmacotherapy Specialty Review and Recertification Course: Complex Pneumonia Case

0204-0000-18-993-H01-P

1.5

 

Learning Objectives

At the end of the presentations, the pharmacist should be able to: 

Cardiovascular Disease: Primary Prevention Case
ACPE # 0204-0000-18-983-H01-P

  • Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including hypertension, dyslipidemia, chronic kidney disease, diabetes, and obesity.
  • State the Center for Disease Control and Prevention Advisory Committee on Immunization Practices recommendations for adult immunizations.
  • Determine how to advise a patient on point-of-care testing to measure response to drug therapy.
  • Discuss national benchmarking standards and implications to patient care. 

Cardiovascular Disease: Secondary Prevention Case #1
ACPE # 0204-0000-18-984-H01-P

  • Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including, acute decompensated heart failure/electrolyte disturbances, ACS, and GERD.
  • Develop a plan to address continuity of care issues.
  • Formulate a plan for smoking cessation.
  • Determine how to manage drug – drug and drug-induced disease interactions in a patient with ischemic heart disease.
  • Discuss quality of life in this population.
  • Discuss national benchmarking standards and implications to patient care. 

Cardiovascular Disease: Secondary Prevention Case #2
ACPE # 0204-0000-18-985-H01-P

  • Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including heart failure, atrial fibrillation, and thyroid disorders.
  • Discuss safety issues and health literacy in this population.
  • Discuss national benchmarking standards and implications to patient care. 

Regulatory and Quality Issues
ACPE # 0204-0000-18-986-H03-P

  • Discuss national regulations and local (but universally adopted) practices related to quality metrics.
  • Discuss national regulations and local (but universally adopted) practices related to agencies that oversee quality (governmental and nongovernmental).
  • Discuss national regulations and local (but universally adopted) practices related to major public health initiatives (e.g., REMS programs, Healthy People 2020, Core Measures).
  • Discuss national regulations and local (but universally adopted) practices related to prescribing and monitoring specific drugs (e.g., methadone, isotretinoin, REMS programs).
  • Discuss national regulations and local (but universally adopted) practices related to federal regulations related to patient’s rights and protections (e.g., privacy, child/adult protective services, advance directives, living will, power of attorney, do not resuscitate). 

Research Design, Methodology, Statistical Analysis, and Application
ACPE # 0204-0000-18-606-H04-P

  • Analyze biomedical literature with regard to study methodology, statistical analysis, and significance.
  • Explain the use of evidence-based treatment guidelines and protocols.
  • Interpret the biomedical literature and its application to clinical practice.
  • Identify appropriate sources of information to use in addressing questions that arise in one’s practice or from patients and other healthcare professionals.
  • Explain how to provide education regarding the principles and practices of evidence-based medicine to current and future health care professionals. 

Complex Breast Cancer Case
ACPE # 0204-0000-18-988-H01-P

  • Select the appropriate treatment and monitoring for a complex patient case with multiple conditions, including breast cancer, febrile neutropenia and pulmonary embolism.
  • Compare and contrast current breast cancer screening recommendations.
  • Develop a plan to manage pain and nausea/vomiting in a patient with cancer.
  • Discuss safety issues in this population.
  • Discuss adherence issues with oral chemotherapy regimens. 

Complex Nursing Home Case
ACPE # 0204-0000-18-989-H01-P

  • Select the appropriate treatment for a complex patient-case with multiple conditions, including stroke, depression/anxiety, dementia, chronic COPD management, osteoarthritis, osteoporosis, and pain.
  • Discuss complimentary/alternative medicine and safety issues in this population.
  • Discuss quality improvement initiatives and regulations in the nursing home setting. 

Medication Safety
ACPE # 0204-0000-18-990-H05-P

  • Discuss national regulations and local (but universally adopted) practices related to adverse drug reaction reporting.
  • Discuss national regulations and local (but universally adopted) practices related to medication safety.
  • Discuss national regulations and local (but universally adopted) practices related to formulary management.
  • Discuss national regulations and local (but universally adopted) practices related to drug development and approval processes.
  • Discuss national regulations and local (but universally adopted) practices related to ethical issues, such as appropriate interactions with industry, conflict of interest disclosures. 

Complex HIV Case
ACPE # 0204-0000-18-991-H02-P

  • Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including dyslipidemia, and hepatitis B.
  • Identify and manage common drug interactions experienced by HIV-treated patients.
  • Identify and manage common adverse drug reactions experienced by HIV-treated patients.
  • Determine appropriate medication choices for the treatment and prevention of common opportunistic infections.
  • Discuss quality of life issues in terms of medication therapy for HIV-infected patients.
  • Identify and recommend appropriate resource organizations/groups to assist a specific patient. 

Complex Pediatric Asthma Case
ACPE # 0204-0000-18-992-H01-P

  • Select the optimal treatment and monitoring for a complex patient case with acute asthma exacerbation, acute otitis media and seasonal allergies.
  • Determine methods for counseling a patient and/or caregiver regarding asthma self-management plan.
  • Formulate a plan for childhood vaccinations in a child who has been delayed in receiving them.
  • Discuss complimentary/alternative medicine and cultural issues in this population. 

Complex Pneumonia Case
ACPE # 0204-0000-18-993-H01-P

  • Select the appropriate treatment and monitoring for a complex patient-case with multiple conditions, including pneumonia, acute renal insufficiency, sepsis, COPD and dehydration.
  • Interpret clinical data, including lab, physical examination and vital signs.
  • Determine and prioritize pneumonia-related treatment goals.
  • Determine approaches to manage drug allergies and select next best drug therapy when primary drugs are precluded.
  • Discuss approaches to limiting antimicrobial over use by stewarding antibiotic usage appropriately.
  • Discuss safety issues in patients receiving treatment for pneumonia.

Core Therapeutic Modules

The Core Therapeutic Modules Review Package consists of 14 activities in which faculty review clinical topics and practice skills using a case-based approach. The activities are designed to assist the learner in identifying knowledge gaps in preparation for a pharmacy specialty board examination. In addition to a recorded presentation, each activity includes links to resources for further self-study and a practice test developed in the same format and rigor as the specialty exam.

Learning Module

ACPE Number

Credit Hours

ACPE Expiration Date

Statistics, Evidence-Based Medicine, and Clinical Trial Design

0204-0000-18-934-H04-P

2

05/16/21

Cardiac Arrhythmias and Advanced Cardiac Life Support

0204-0000-16-919-H01-P

1

06/02/19

Pharmacotherapy Considerations in the Management of Shock

0204-0000-17-931-H01-P

1

05/30/20

Nutrition, Fluid, and Electrolytes

0204-0000-18-600-H01-P

1

06/06/21

Select Topics in Infectious Diseases

0204-0000-16-962-H01-P

2

06/02/19

Select Topics in Men's Health

0204-0000-17-932-H01-P

1

05/30/20

Select Topics in Women's Health

0204-0000-18-921-H01-P

1

05/22/21

Select Topics in Neurologic Disorders

0204-0000-18-602-H01-P

1

06/06/21

Select Topics in Psychiatric Disorders

0204-0000-18-603-H01-P

1

08/06/21

Select Topics in Gastrointestinal Diseases

0204-0000-18-922-H01-P

1

05/22/21

Select Topics in Rheumatology

0204-0000-18-604-H01-P

1

08/06/21

Diabetes

0204-0000-17-933-H01-P

1

05/30/20

Heart Failure

0204-0000-18-923-H01-P

1

05/23/21

Selected Topics in Renal Disease

0204-0000-18-998-H01-P

1

11/14/21

 


Learning Objectives
 

After participating in these CPE activities, learners should be able to: 

Statistics, Evidence-Based Medicine, and Clinical Trial Design
ACPE #0204-0000-18-934-H04-P

  • Determine quality and appropriateness of a study by examining study design, statistical analysis, sources of bias, quality of conclusions, and interpretation of graphs.
  • Determine clinical and statistical significance of a study outcome.
  • Determine whether the study applies to a specified patient population. 

Cardiac Arrhythmias and Advanced Cardiac Life Support
ACPE # 0204-0000-16-919-H01-P

  • Interpret signs, symptoms and diagnostic tests for cardiac arrhythmias.
  • Identify drug-related problems, including drug interactions and adverse effects, associated with pharmacotherapy of cardiac arrhythmias.
  • Identify and prevent drug-induced cardiac arrhythmias.
  • Determine the most appropriate therapy and monitoring for cardiac arrhythmias based on patient-specific information and the most current guidelines.
  • Utilize advanced cardiac life support (ACLS) guided therapies. 

Pharmacotherapy Considerations in the Management of Shock
ACPE # 0204-0000-17-931-H01-P

  • Interpret diagnostic and/or laboratory tests, vital signs, and clinical presentation in order to differentiate types of shock (hypovolemic, distributive, cardiogenic).
  • Compare and contrast the pharmacologic agents utilized in shock.
  • Determine the most appropriate therapy and monitoring based on patient-specific information and the most current guidelines for the treatment of shock. 

Nutrition, Fluid, and Electrolytes
ACPE # 0204-0000-18-600-H01-P

  • List appropriate indications for enteral and parenteral nutrition.
  • Determine if nutrition needs are being met.
  • Interpret lab tests.
  • Identify drug-related electrolyte and nutrient interactions.
  • Determine the most appropriate therapy and monitoring based on patient-specific information and the most current guidelines. 

Select Topics in Infectious Diseases
ACPE # 0204-0000-16-962-H01-P

  • Determine the most appropriate empiric therapy and monitoring based on patient-specific information and the most current guidelines for the following conditions:
    • Syphilis, gonorrhea, chlamydia, herpes
    • Uncomplicated and complicated urinary tract infections
    • Urinary tract infection in pregnancy
    • Otitis media, sinusitis, pharyngitis
    • Endocarditis
    • Meningitis
    • C. difficile
    • MRSA skin infections 

Select Topics in Men's Health
ACPE # 0204-0000-17-932-H01-P

  • Identify the role of prostate cancer screening and discuss available options for those requiring treatment.
  • Determine the most appropriate treatment and monitoring based on patient-specific information and the most current guidelines for patients with benign prostatic hyperplasia, erectile dysfunction and testosterone deficiency.
  • Provide an overview of screening and treatment of osteoporosis in men.
  • Discuss current recommendations for prevention of HIV transmission in high risk patient populations. 

Select Topics in Women's Health
ACPE # 0204-0000-18-921-H01-P

  • Identify how drug response differs based on sex.
  • Recommend health screenings based on patient-specific information for osteoporosis, breast cancer, endometrial cancer, and cervical cancer.
  • Determine the most appropriate treatment and monitoring based on patient-specific information and the most current guidelines for osteoporosis and menopausal symptoms.
  • Determine which contraceptive options are appropriate based on patient-specific information, including emergency contraception.
  • Recommend safe and effective therapies to use during pregnancy and lactation. 

Select Topics in Neurologic Disorders
ACPE # 0204-0000-18-602-H01-P

  • For patients with seizure disorders, Parkinson’s disease, migraine and sleep disorders:
    • Identify the risks and benefits of drug therapy, considering medication and patient specific risk factors
    • Discuss the most appropriate treatment and monitoring based on patient-specific information and most current guidelines
    • Identify available information to determine drug-related problems and response to therapy
    • Identify appropriate modifications of patient-specific treatment plans based on follow-up assessment 

Select Topics in Psychiatric Disorders
ACPE # 0204-0000-18-603-H01-P

  • For patients with bipolar disorder, schizophrenia, anxiety disorder, and post-traumatic stress disorder:
    • Identify basic diagnostic factors, clinical presentation, and target symptoms of selected psychiatric disorders.
    • Determine the most appropriate treatment and monitoring based on patient-specific information and the most current guidelines.
    • Assess available information to identify drug-related problems and response to therapy.
    • Recommend appropriate modifications of patient-specific treatment plans based on follow up assessment. 

Select Topics in Gastrointestinal Diseases
ACPE # 0204-0000-18-922-H01-P

  • For patients with nausea, vomiting, inflammatory bowel disease, gastroesophageal reflux disease or peptic ulcer disease:
    • Determine the most appropriate treatment and monitoring regimen based on drug-specific variables, patient-specific factors, and clinical practice guidelines.
    • Assess available information to identify drug-related problems and response to drug therapy.
    • Identify appropriate modifications to optimize patient-specific treatment plans based on follow-up assessment. 

Select Topics in Rheumatology
ACPE # 0204-0000-18-604-H01-P

  • For patients with rheumatoid arthritis, osteoarthritis, gout:
    • Determine the most appropriate treatment based on patient-specific information and the most current literature.
    • Assess available information to identify drug-related problems and response to therapy.
    • Identify appropriate modifications of patient-specific treatment plans based on follow-up assessment. 

Diabetes
ACPE # 0204-0000-17-933-H01-P

  • Interpret diagnostic and/or laboratory tests in patients with Diabetes.
  • Determine the most appropriate treatment based patient-specific information and the most current guidelines for patients with diabetes.
  • Identify appropriate modifications of patient-specific treatment plans based on follow up assessment in patients with diabetes. 

Heart Failure
ACPE # 0204-0000-18-923-H01-P

  • Interpret diagnostic findings and/or laboratory test results, vital signs, clinical presentation.
  • Determine the most appropriate treatment based on patient-specific information and the most current treatment guidelines.
  • Identify appropriate modifications of patient-specific treatment plans based on follow-up assessment. 

Selected Topics in Renal Disease
ACPE # 0204-0000-18-998-H01

  • For patients with acute kidney injury or chronic kidney disease determine the most appropriate treatment and monitoring based on drug characteristics, patient-specific factors, and current clinical practice guidelines.
  • Manage drug dosing and drug-related complications in patients receiving renal replacement therapy.
  • Identify appropriate modifications to the treatment plans based on follow-up assessment to optimize outcomes.

Faculty/Content Matter Experts 

Christopher Betz, Pharm.D., BCPS, FKSHP, FASHP*
Professor
Sullivan University College of Pharmacy
Cardiovascular Clinical Pharmacy Specialist
Jewish Hospital Rudd Heart & Lung Center - KentuckyOne Health
Louisville, Kentucky 

Snehal H. Bhatt, Pharm.D., BCPS AQ-Cardiology, FASHP, AACC*
Associate Professor of Pharmacy Practice
MCPHS University
Clinical Pharmacist
Beth Israel Deaconess Medical Center
Boston, Massachusetts 

Larry W. Buie, Pharm.D., BCOP, FASHP
Clinical Specialist – Leukemia
Memorial Sloan Kettering Cancer Center
New York, New York 

Sarah Clark, PharmD, BCPS
Clinical Pharmacist, Neurosciences
Instructor of Pharmacy,
Mayo College of Medicine
Rochester, Minnesotta  

Jennifer N. Clements, Pharm.D., BCACP, BCPS, CDE, FCCP,
Associate Professor of Pharmacy Practice
Coordinator of Postgraduate Education
Presbyterian College School of Pharmacy
Clinton, South Carolina 

Kalin M. Clifford, Pharm.D., BCPS, BCGP
Assistant Professor – Geriatrics & Pediatrics Division
Texas Tech University HSC School of Pharmacy
Clinical Pharmacy Specialist/Advanced Practice Pharmacist – Geriatrics
Dallas, Texas 

Ilya M. Danelich, Pharm.D., BCPS
Cardiology Clinical Pharmacist
Advanced Heart Failure & Cardiac Transplant
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania 

Heather Draper, Pharm.D., BCPS
Clinical Specialist, Emergency Medicine
Mercy Health Saint Mary’s
Grand Rapids, Michigan 

Jessica Farrell, Pharm.D.
Clinical Pharmacist/Associate Professor
Albany College of Pharmacy and Health Sciences
The Center for Rheumatology
Albany, New York 

Stuart T. Haines, Pharm.D., BCACP, BCPS, BC-ADM, FASHP
Professor and Director, Pharmacy Professional Development
University of Mississippi School of Pharmacy
Jackson, Mississippi 

Suzanne C. Harris, Pharm.D., BCPP, CPP
University of North Carolina
UNC Eshelman School of Pharmacy and UNC Medical Center
Chapel Hill, North Carolina 

Meredith D. Keisler, Pharm.D., BCOP, CPP
Clinical Pharmacist Practitioner
Outpatient Oncology Palliative Care Service
University of North Carolina Health Care
Chapel Hill, North Carolina 

Patricia C. Kienle, R.Ph., M.P.A., FASHP
Director, Accreditation and Medication Safety
Cardinal Health Innovative Delivery Solutions
Wilkes-Barre, Pennsylvania 

Katelin M. Lisenby, Pharm.D., BCPS
Assistant Clinical Professor of Pharmacy Practice
Auburn University Harrison School of Pharmacy
Tuscaloosa, Alabama 

Joel C. Marrs, Pharm.D., ASH-CHC, BCACP, BCPS-AQ-Cardiology, CLS, FAHA, FASHP, FCCP, FNLA
Associate Professor
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Aurora, Colorado
Clinical Pharmacy Specialist
Denver Health Medical Center
Denver, Colorado 

Krystal Moorman, Pharm.D., BCPS
Clinical Assistant Professor, Pharmacotherapy
University of Utah College of Pharmacy
Clinical Pharmacist
University of Utah Hospitals and Clinics
Salt Lake City, Utah 

Erin Nystrom, Pharm.D., BCNSP
Clinical Specialist, Nutrition Support
Assistant Professor of Pharmacy, College of Medicine
Mayo Clinic, Rochester, Minnesota 

N. Jim Rhodes, Pharm.D., MSc, BCPS
Assistant Professor of Pharmacy Practice
Department of Pharmacy Practice
Midwestern University, Chicago College of Pharmacy
Infectious Diseases Pharmacist
Department of Pharmacy
Northwestern Memorial Hospital
Chicago, Illinois 

Marc H. Scheetz, Pharm.D., M.Sc., FCCP, BCPS (AQ-ID)
Professor of Pharmacy Practice and Pharmacology
Director of Pharmacometrics Center for Excellence
Midwestern University, Downers Grove, Illinois
Chicago College of Pharmacy and Osteopathic Medicine
Infectious Diseases Pharmacist, Northwestern Medicine
Chicago, Illinois 

Douglas Slain, Pharm.D., BCPS, FCCP, FASHP*
Professor
Infectious Diseases Clinical Specialist
West Virginia University
Morgantown, West Virginia 

Kyana D. Stewart, Pharm.D., M.S., BCPS
Clinical Pharmacy Specialist
Pediatric & Adult Infectious Diseases
Ochsner Medical Center, New Orleans
New Orleans, Louisiana 

Paul M. Szumita, Pharm.D., BCCCP, BCPS, FCCM
Clinical Pharmacy Practice Manager
Program Director Critical Care Pharmacy Residency Program
Brigham & Women’s Hospital
Boston, Massachusetts 

Laura H. Waite, Pharm.D., BCPS, BC-ADM, CLS
Vice Chair and Associate Professor of Clinical Pharmacy
Philadelphia College of Pharmacy
University of the Sciences
Adult Internal Medicine Clinical Pharmacy Specialist
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania 

* Content Matter Experts 

Reviewers

Susan R. Dombrowski, M.S., R.Ph.
Kristi Hofer, Pharm.D.
Tony R. Martin, Pharm.D., M.B.A.
Anna M. Wodlinger Jackson, Pharm.D., BCPS 

Disclosures

In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support and the Accreditation Council for Pharmacy Education’s Standards for Commercial Support, ASHP requires that all individuals involved in the development of activity content disclose their relevant financial relationships. A person has a relevant financial relationship if the individual of his or her spouse/partner has a financial relationship (e.g. employee, consultant, research grant recipient, speakers bureau, or stockholder) in any amount occurring the in the last 12 months with a commercial interest whose products or series may be discussed in the educational activity content over which the individual has control. The existence of these relationships is provided for the information of participants and should not be assumed to have an adverse impact on the content. 

All faculty and planners for ASHP education activities are qualified and selected by ASHP and required to disclose any relevant financial relationships with commercial interests. ASHP identifies and resolves conflicts of interest prior to an individual’s participation in development of content for an educational activity. Anyone who refuses to disclose relevant financial relationships must be disqualified from any involvement with a continuing pharmacy education activity. 

  •          Snehal Bhatt: Advisory Board, Portola Pharmaceuticals; Speaker’s Bureau, Janssen Pharmaceuticals, Inc.
  •          Patricia Kienle: Employee, Cardinal Health; Committee Volunteer, USP; Consultant, Critical Point.
  •          Mark Scheetz: Grant Recipient, Merck; Consultant, Bayer.
  •          All planners, presenters, and reviewers of this session report no financial relationships relevant to this activity. 

Methods and CE Requirements

Activities can be completed in any order. Each activity consists of audio, video, and/or PDFs, and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity. 

Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity. 

System Technical Requirements

Courses and learning activities are delivered via your Web browser and Acrobat PDF. For all activities, you should have a basic comfort level using a computer and navigating web sites. 

View the minimum technical and system requirements for learning activities. 

Development

These activities were developed by ASHP. 

To maintain its strict, independent standards for certification, BPS does NOT endorse or provide review information, preparatory courses, or study guides for Board Certification Examinations.