Welcome to episode 79 of the Audio PANCE and PANRE PA Board Review Podcast.
In this episode 35-year PA veteran and PANCE/PANRE board review expert Joe Gilboy PA-C shares his top tips on how to best prepare for the Physician Assistant National Certification Exam
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Welcome, PA, world. My name is Joe Gilboy, PA-C. I work with Stephen Pasquini with the smarty PANCE website.
Today’s podcast is going to be on how to prepare for the PANCE, which is a very big subject and a very important subject to a lot of you guys out there. So come on guys, let’s get this game roll, and let’s learn how to prepare for the PANCE.
Hello, PA podcast world. My name is Joe Gilbert. I’ve been a PA for about 35 years, with all my time being in the emergency room.
I’m a graduate of the Duke University PA program from 1984. I started helping students prepare for the PANCE and PANRE starting in 1990. So, as you can imagine, I’ve had a lot of students come through my hands. The answer is greater than 10,000. I’ve taught in several schools here in California I teach at several schools in Nevada. I also help in Tennessee. I help in Ohio, I help in Georgia, so I am around in a lot of different places, but for today, let’s get you ready to take the PANCE. So I know a lot of ways to get students prepared. So, let’s start.
So, today’s podcast is actually going to be on how to prepare for the PANCE. So before we get going into the very specifics, let’s look at so just come some basic guidelines as a student as you’re getting ready to take the PANCE. So, the first thing that we need to actually do is study! I now I know this sounds a little oxymoronic, but you’d be surprised how many students I’ve met along the way, do really well in PA school, you know, they do well in their grades they do well in their End of Rotation Exams, they feel like they don’t need to study. This couldn’t be farther from the truth.
So usually what I tell most students to do is start preparing for this exam literally about a year before it comes. What you don’t understand and what’s coming is that when you get towards the end of your PA school, you’re going to be so burned out is just amazing how burned out you’ll be, and you’ll see that especially when you go out on rotations and come back for maybe your callback week, or maybe End of Rotation Exam or some kind of maybe specific lecture, and I can guarantee you on that first day back, when you’ve been gone on rotations, it’s like pulling teeth, you’re like, oh, I’m back in this room, again, that I’ve spent so much of my life, I don’t want to be here. And it’s like, your mind’s just not ready for it. So, what I tell my students to do, instead of trying to cram this all in at the end, play it out.
So basically, about a year before, start getting ready for this. So what I tell most people to do study. Now, one of the questions that commonly comes up is how much do I study? And at most, most people, I tell them, if you can get up to like maybe two hours or three hours a day, that’s great. Max is four. So you’ll see there’s a lot of studies out there that will show that if you take a human being and actually get them studying for more than about three hours, three and a half hours they do not retain and then things get a little frustrating. So two to three hours if you can, no more than four. And of course, you know, always give yourself a day off.
The other thing about studying is the worst place to study. Yeah, where are you going to study guys home? And so what you have to understand is that when you’re studying, you actually need stimulus free. So your cell phone is off. Now I know this is a big one for most of you young millennials out there; you’re going “what, I have to turn it off?” That’s right. Don’t worry; the world will keep revolving with the cell phone off. But one of the things they’ve done there’s a lot of studies out there showing that when a cell phone is on, literally 15% of your brain is waiting for that thing to go off. I need that 15% of the brain getting ready for the PANCE, and at the end of the day, guys, there’s no cell message or text messages that’s that important. They can always call 911. So again, just make sure your cell phone is off. This is a big thing to really keep in the back your head.
The other thing sometimes people like to work together and groups. Groups are great. Study groups work well; just the key thing to a study group is that as you’re in the group, you have to teach the other student, maybe about a subject. And you see when you’re a teacher, you have to know a subject twice, once for your own knowledge, but second to be able to present it that knowledge to another person. So study groups do work.
The other thing I tell people to do is print out the PANCE blueprint. It’s pretty extensive and pretty large if you’ve ever seen it, it’s a very large extensive blueprint. And what I tell people to do, so go the NCCPA website, print out the blueprint.
Then what you do, it’s like, let’s say you get to your cardiovascular and let’s say it says mitral stenosis. So, what I tell my students to do is actually physically write down the word mitral stenosis, and then just jog down some quick notes about things that you memorize in school, and you’re like, I think I remember opening snap. I think I remember rheumatic fever. I think I remember somebody Jones, Jone’s criteria. Jones something, I remember and then stop. And then at that moment, what you do is you start reading up on other things about the Jones criteria. So, in other words, you write more notes to help you out and stuff like that. And this is one of the things that I tell a lot of students to do. Because believe it or not, when you write something down, you know, it’s twice, once for thought, second for motor. For example, just to show you how your brain works, and I know you did this in PA school, you wrote down a note, maybe like, on your one note on your computer, or maybe you wrote it down on a handout that you’re given. You took the test. There you were on the test going. What was it again? I wrote about Jone’s criteria? God, I can’t remember this question. I know I wrote it down somewhere, but I can’t remember. And as soon as the test is over, you walk outside, and you know exactly where it is on your notes. It is in the upper right-hand corner of circle than pink. Welcome to your Brain, you wrote it down once for thought and then second for motor. So when we do this, we actually locking it. I’m not saying that we need to write a dissertation on mitral stenosis, what I’m really saying to you is that just write down some quick notes and try to make this more kind of like thought friendly, like, hey, this is what I remember. And this is what makes sense. And then you read up on the Jones criteria like That’s right. Fevers, minor, even though I want to make it major and things like that. So that tends to work out really well with my students.
The other thing that we’re going to do, and I’ll try to help you guys out, is with the ambiguous questions. Who got into a test, you’re taking the test? And you were choosing between A and B. And you were like, I think it’s A I think it’s B thing? It’s A I think it’s B. And so, there was this ambiguous question, and you couldn’t figure out which was the right answer. So you felt like you’re in this what I call ambiguous 50/50 game. So when we play the ambiguous 50/50 game, there are a couple things you need to do. Just a little test-taking technique that works all the time. One, keep it simple. The simple answer is usually the correct answer one more time; the simple answer is usually the correct answer.
If one answer outweighs the other, even if it’s to a 51/49 edge. In other words, 51% of the time is right here. 49% of the time, it’s right there. What do I take? The 51! So, it only takes 1% to push me over. So one more time. Keep it simple. And the one that weighs just a little bit more than the other? That’s your answer.
Every now and then, what you’ll see is that student’s kind of miss like a little, like a little piece of the word up in the question. In other words, most likely, at least likely first line, second line. So again, as we go through test questions, we have to be really alert about all the various words they use. And remember at the end of the question is what I call the hook. So sometimes what students will do is they’ll read the last line of the question, so we’ll just say, you know, there’s a question, and it says, What’s the most likely treatment. So as you go to the question, you realize this is what it’s asking for is a treatment. So the whole time you read the question like, so what’s going to be the treatment for this patient? Maybe it’s a CHF, pneumonia, whatever it may be. So again, another test-taking technique that kind of works pretty well. Yeah, try saying that five times fast.
The other thing that I tell students to do, and hopefully this, this handout will also be up there on the smarty PANCE website on how to prepare the seven major points, which is what we’re going over is to control your x-factors. This is huge. Guys. If I had to put my 30 years of teaching students into a paragraph, oh, this is it. So when I say control your x-factors, what I’m saying to you is this is that as you get ready to take this PANCE, don’t change your emotional or social wellbeing at all. Now granted, you can’t prevent certain things from coming like a death in the family and illness, things like that. But don’t create chaos is what I always tell my students because PA school is chaotic enough; the last thing you need to do is create more chaos. So don’t try to change your relationships during PA school, just play them out. Don’t try to change your surroundings, don’t buy anything big. I mean, come on, guys, every single one of you guys is in debt. So, going out and buying a Tesla is not the smartest thing to do before the PANCE because now you’re kind of worried about how am I going to pay for this Tesla. And I always tell people, this is you know, in other words, don’t add stress to your life. This is what I’m really trying to get at. Try to make this as stress-free as possible.
The last thing, the number seven-point that I’m always trying to make to my students, practice your questions in tutor mode. This is big. This is huge. And if all this thing in the podcast I hope remember is this point, you see guys; our brain is much more like a dog than you know. In other words, we need to be corrected in real-time. For example, there’s this world called neuroplasticity, just type it in enjoy the ride, guys. Okay, and it pretty much goes like this. you fire it, I wire it. That’s how your brain works. If you fire it, I’ll wire it. But if it’s fired the wrong way, you need to wire it the correct way, in real-time. For example, when your dog pees on the bed, what do you do? You scold him at that moment, but you don’t scold him three hours later. He’s like, going, what do you hit me for? I’m over here chewing my bone, and in other words, you have to correct them in real-time. As humans, we’re the same way.
We need to be corrected in real-time. And so, there’s a lot of studies that have come out here in the world of neuroplasticity and how our brain works like this. So, I kept telling my students to keep it in Tudor mode. Let’s say you get the question wrong. We’re back to mitral stenosis, and for whatever reason, you forget the left lateral decubitus position is the best way to listen to the murmur. So what you do is you stop at that moment. You read up on it, you correct yourself in real-time, and then you go back to the question again. So again, it’s correcting yourself in real-time. This is huge. You have no idea how big this is. But it’s always in Tudor mode
The other thing to do high-quality questions, one more time, high-quality questions. One of the biggest mistakes students will make they’ll tell you like, yeah, I’m doing 150 questions today. Wrong. What you’re doing is you’re probably going through these questions so fast, you’re probably developing a lot of bad habits.
So I tell students to do is 20-25 a day, Max, no, Max, but I want you to do them in a high-quality fashion. I want you to pick apart every single word on that question. I want you to go beyond the question. So they’re asking the question, you know, aortic stenosis. Like I got this. I know the left ventricular hypertrophy, I know It’s a split S2 to I want you to go past the answer. In other words, you got the answer. And you went through it nice and slow. You peeled it apart. It was ambiguous, and you chose 51 verses 49. Practice these good habits because come the day the test, these good habits will rear up and they will help you. Because one of the things I see all the time with my high-risk students, the ones that fail, it’s always the same story. They’re always telling me that they are doing anywhere between the one to 200 questions a day, and I’m like I need you to do 25 high-quality questions a day. In other words, practice good test habits. So when you get to the day of the test, this will help you out the most.
So now, our next topic we’re going to talk about is what are the best textbooks to get ready for the PANCE. About five years ago, I went out and actually bought all the PANCE and PANRE review booklets. I’m a big fan. If I’m going to talk the talk, I’m going to walk the walk, and what I did is it went out to and took a look at all these booklets that you guys are being introduced to. And what I did is I came up with the list of the booklets that I thought was best. Let me frame this statement quite clearly. There is no great book one more time; there is no great book; you will be piecemealing this. They’re all good. Nobody’s great. Each one is good, but each one has its flaws. So there are a lot of good ones out there, but nobody’s Great. So what were the better booklets that I saw out there when I was kind of doing my little research on how to get ready for the PANCE? First, one I came by is the AAPA book. That’s a Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants that you see. It’s good. It’s not great. Some of the information is pretty good, but as you read through it, it’s really hard to find the nugget. Go ahead, look up meningitis, and osteomyelitis. You’ll be spending minutes trying to find out what your most common cause, which IV anabolic do I use? Things like that. So it’s good. It’s not great. Then there’s the Physician Assistant Board Review: Certification and Recertification by James Van Rhee, which is also a good book, but it’s not great. The Davis PA Exam Review book is good. There’s a Kaplan medical PANCE review book that’s good. Lange has gotten really good. So Lange, if you go back in time, 10 years ago, Lange was definitely not the best book that out there. But they got new editors, and they’ve done much, much better and I can only tell you the book is very good and this is the one that’s the Lange Q&A Physician Assistant Examination, Seventh Edition by Rachel Carlson and Albert Simon. It’s gotten very, very good. So highly recommend that one as well.
Read my post:
So let’s stop right here right now. I can guarantee you, if you’re listening to this podcast, you have this booklet. Make no mistake. It’s a great book, but it’s a reference book, not a study book. One more time, PANCE Prep Pearls. Wonderful reference book, not a good study book. If you don’t believe me, I know you already did this. What did you do? And I’m not begrudging anybody out there in the podcast world, but as students would you do? Okay, so let’s just say you had a GI test on a Monday, and you had a pulmonary test on Wednesday, and you had an ENT test on Friday. What do you do? You pulled out your PANCE Prep Pearls. You looked at the subjects or the objectives you had to do and you just brutally memorize the stuff, did you not you brutally memorize all the stuff at the pulmonary exam, the ENT exam, so you really memorized it off the reference book. Then what happened? I don’t know. By Friday afternoon, I could walk up to you and say, Hey, what is the first-line treatment of choice for pneumonia? Like I have no idea. I don’t even know where I parked. So in other words, you memorized it. It’s in it’s out. So again, it’s a great reference book, but not a good study book. If I had to paint, the student who is going to fail the boards. How would I paint on this one? I know I have your attention now. So who are my high-risk students? Oh, let me tell you what they all have in common. One. They live off a PANCE Prep Pearls. No, that’s the only book they have. They live off a Rosh review. That’s the only database and questions they use, period. And then what ends up happening to them because they had all the stuff memorized. They get a concept question. Some type of concept question shows up, and oh my god, they’re flat-footed. They have no idea which way to go. Because you see if it doesn’t show up as a trigger word of something they memorize and PANCE Prep Pearls. They’re done. And we’ll get to talk about Rosh in a second here about why I think Rosh is good, but again, it’s not great. So again, PANCE Prep Pearls is a wonderful, wonderful reference book. I think it’s great. It’s wonderful. I think Dwayne Williams did a wonderful job on this. But to use it specifically to study for the PANCE. Oh no, not at all. You’re going to get yourself lost.
When it comes to the website question. There are some database questions out there that are pretty good, and again, I went out there bought them all and there are some good ones some of them can get pretty pricey there’s no doubt about they can get pretty expensive.
So the first one I came across was PA Easy. I like PA Easy; it is quite good on the databank questions with the Lange references was really good, and again, you can put it in tutor mode. And again, I really enjoyed that a lot.
Kaplan is good, alright, so let’s stop right here. I love Kaplan Don’t get me wrong, but Kaplan, you know, I will say with Kaplan, take it with a grain of salt. Do you ever see some of those questions on Kaplan? They are hard so if you score above 60% or Kaplan, you’re doing great. And I know as students that suddenly you take some you know, cardiovascular exam, you score 62% and you swear that you’re going to you know, not pass the PANCE. That’s not true. Kaplan is a very, very difficult exam bank, but again, just take it with a grain of salt and just understand that some of these questions can be very tough.
If you’re listening to this podcast, I’d say about 80% of you guys use Rosh Review. Rosh is good, but it’s not great. Let me explain to you why. Who out there in podcast world took a question on Rosh Review, you swore you got it, right? You’re like I know this, this is what I learned in school. And then you went to Rosh Review, and they said no. And then if you look to the right, there is this thing called peer comparison, and you’re gonna find out that wait a second 70% that people got the question wrong. So as a teacher, just let you know that peer comparison over there. So when you do peer comparison, one of the things you should do if you’re a good teacher, your test question should sit around 70/30. This is really what’s called the discretion of a question in the education world. In other words, if a question is presented correctly, 70% of your class should get it right, 30% should get it wrong. That’s pretty much the ballpark. That’s the sweet spot anything hire is obviously good, but anything lower, ends up being a context problem. So when you get below 70%, getting it right. This is context. This isn’t a knowledge base issue with the students. This is a context of the question and otherwise, the question is worded poorly or incorrectly? Who on Rosh, if you have seen peer comparisons below 70/30? Yeah, you’re all shaking your head. Aren’t you going? Yeah, I’ve seen it all the time, Joe. Exactly. That’s my whole point. The other problem with Rosh, some of those questions aren’t even on the blueprint. That’s right. Look it up. You’ll see some of these questions going, who’s this disease? And it’s not even on your blueprint? So again, it’s like, I always tell people stick to the blueprint. This is what you’re going to be held accountable for. You’re not going to be held accountable for some, you know, chemo drug from breast cancer and some crazy side effects. But knowing the breast guidelines and what kind of cell type breast cancer is. Yes, that will be there. But not this other craziness that sometimes you’ll see on Rosh. So again, Rosh, it’s good. It’s not great. Of course, I’m going to push out my personal bias, Smarty PANCE. I think it’s a great website.
It’s just a treasure trove of information that takes a while to get through, but it’s a treasure trove of information. Wonderful website. And it follows the blueprint. So what I tell people to do is open up your smarty PANCE. There’s your blueprint, right, so let’s just say we’re back to aortic stenosis or mitral stenosis. So there it is, on the smarty PANCE blueprint there it is, you’re like, Okay, I gotta know, mitral stenosis. You open it up there’s an opening snap. Maybe you use another reference to study, and maybe you use the Merck manual? Maybe you’re using Lang, but in other words, you’re using other references to pull this all together? I keep trying to tell you guys; this is piecemeal, nobody’s great. Everybody’s good. So now, with all the information that you have, what would I recommend? Oh, this is what I would tell people to do.
One, start studying a year before, keep the stress out of your life. What I’d start doing is start studying. Yes, I would buy smarty PANCE ASAP use the blueprint; there’s my blueprint. This is the information I will be held accountable for, then I’m I looked at other references about maybe a or cynicism or look at PANCE pro tips. Maybe here’s some stuff that I forgot that and maybe I’ll read up on Merck manual or maybe I’ll read up on Lang and I’m going to do my questions how tutor mode? Because what do I need to correct myself in real-time? And that’s exactly what you need to do. So again, tutor mode, correct myself from real-time have all these references, my cell phone is off. I got no stress in my life. And I’m starting to go at it. That’s how you do it guys. That’s the secret sauce. That’s how it goes about. You see, where people go wrong, is they start not studying till the very end, they start memorizing things. They start doing things in test mode, not tutor mode. They’re doing 100 questions a day, not high-quality questions. But if we could just do high-quality questions, start them out a year before, it’s in tutor mode. I got smarty PANCE up and on one side, I’m looking at my blueprint. I got her other resources. Maybe I’m going to spend the afternoon on aortic stenosis. That’s all I’m doing. Sounds good to me. And then the next day, maybe another murmur and start trying to make sense of it all. Not memorize, because you see guys, just as my last little parting comment to you see, guys, the reason the board scores have dropped, and they have nationwide, and for some of these schools, they have dropped like a rock.
What happened? Well, what they did is a couple of things. One, they took away the buzzwords. So all these little buzzwords that you were used to writing, you know, you know, frothy green discharge, you know, purulent those kinds of things, right? They’re all gone. And now what they did is they made some of these questions, kind of concept questions. Do you know the concept of this issue and that is what I’m really trying to get at and see if you see something and you’ve got a big broad look at it? Now you understand the concept. You didn’t memorize it off PANCE Prep Pearls. You kept to the blueprint. You didn’t go way off base on some crazy Rosh Review that had nothing to do with the blueprint. And you stuck to it. You stick to that and I guarantee you you’re going to do great guys. So in the end of the day, high-quality questions, tutor mode, stick to the blueprint. Keep the stress out of my life. You do that guys, nine times out of 10 you’re going to end up in a very very good area guys. You really will.
So I hope this helps you guys out there in the podcast world. It was really great talking to everybody and I will be talking to you guys real soon. Take care.
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