CME4Life Synapse 
These are my top ten bits of advice and test-taking strategies for passing your boards. These are based on my experiences helping lots of people prepare for the PANCE and PANRE, as well as working with test writers. Of course, I also took my own boards.
1. Don’t Skip Any Questions
You’re going to get 60 questions during 60-minute blocks. I don’t recommend skipping a question that seems a little bit overbearing and then coming back to it. Time can catch up with you. Every single question, I want you to leave an answer.
What if you don’t know the answer? There are going to be a lot of questions you viscerally know the answer to. But there will also be a lot of questions you read and just don’t know how to answers. I’m going to challenge you to put the question into one of two subcategories: Hail Mary questions and coin toss questions.
Hail Mary Questions
If a question is a Hail Mary question, it means you read it and you have absolutely no idea what the answer is. It’s like you’re on the 50-yard line and you just throw the ball up at the end zone with three seconds left. It’s like it’s written in a different language.
With these questions, I want you to drop an answer down and move on and never look back. It’s done. Don’t come back to it.
There are questions on the boards that you’re probably not going to know the answer to. The NCCPA includes them to test concepts outside of what you’re supposed to know. At the end of the day, these questions are thrown out; they mean absolutely nothing.
If you’re nervous about this test and you get one of these throwaway questions, or maybe even a few in a row, it can feel like a punch in the face. I want you to throw an answer down and move on. It’s like a hockey goal. You got scored on and there’s nothing you can do about it now.
Coin Toss Questions
On a coin toss question, you can eliminate all but two of the answers. I recommend you answer these questions and then flag it, so you can come back to it at the end if you have time. Never come back to your Hail Mary questions, but take a second look at your coin toss questions if you can.
When you come back and change your answer on a coin toss question, do you more often change it to the wrong answer or the right answer? You change it to the right answer more often than the wrong answer.
I’m not saying you should always change your answer. Just give the question a fresh look. Maybe another question jogged your memory.
2. Go With Your Gut
My obsession, my passion is helping people prepare for their boards and be better clinicians. I studied learning techniques, so everything I do has meaning. I’m not giving you a tacky mnemonic because I think it’s cute. I’m giving it to you because it works. You’re learning so many things that you might not consciously pick up on all of it. But when you see that information in a test question, your gut is going to say, “Wait a second, I want to pick this one, but something is drawing me to this one.”
I love my gut and I’m saying you should go with yours. You have so much stored – you can’t even imagine. If your gut tells you an answer, my advice is to go with that one. Is it a perfect strategy? No, but it is my advice. When you take your pretests, practice trusting your gut. You won’t get every question right, but you’ll get more right than wrong.
3. Consider the Question Writer’s Perspective
It’s easy to write a test question. It’s hard to write plausible distractors, or answers that could fool you. Instructors love the similars because they can write a plausible distractor with Crohn’s when ulcerative colitis is the answer. It could almost be both, you’re just looking for which one has fistulas.
If you read an answer you’ve never heard of before, it’s not the answer. The question writer is making something up.
4. Take the Passive Path
If there is a very passive answer, take it. Look at all the possible answers (made up of the one correct answer and three or four distractors) and pick the most conservative one. Then look at that most conservative choice and ask yourself if it’s the right answer. Most likely, it is. For example, what is the first thing you do with erectile dysfunction? Put them on testosterone? Is it Viagra? No, it’s couples counseling. That’s the passive path.
However, this doesn’t apply if the sequelae of the disease are catastrophic. There are two cases I want to bring to your attention. In these cases, you need to be more aggressive. GERD isn’t GERD until you allow cardiac. You should not go passive on GERD. GERD is really cardiac ischemia until proven otherwise. If you have a patient hallucinating, we don’t send them to counseling. They need to be put on an antipsychotic.
5. Use the Bestowa Technique
This is my term for the best way to bestow information from a test question. Let me tell you where this came from. You have the NCCPA and the AAPA. The NCCPA writes the PANCE and PANRE. The PAEA (Physician Assistant Education Association), which is part of the AAPA, writes your PACKRAT. Who is on the PACKRAT committee? The same kind of people that write the PANCE: academics. In general, the PACKRAT writers are younger, but they’re trying to mimic the PANCE and PANRE writers.
One of those writers once suggested I teach a specific technique to my board review courses. He suggested that when you have a long base question, something like five lines, you should read the last line of the question, then the distractors and then the base question. He thought it really helped test takers focus their thinking.
At first, I didn’t think this was as credible as some of the other PANCE and PANRE test-taking strategies I was teaching. Then, something happened to make me change my mind.
I was working one on one with a student who had a lot of knowledge but had a hard time thinking through questions. I asked her to think through a question out loud and it was like she was cognitively trying to herd cats. So finally, I asked her to go through a question with the technique my test writing friend told me about:
- Read the last line of the question.
- Read the distractors, then tell me what you know about them.
- Read your base question.
All of a sudden, she started nailing it. Obviously, that made me really believe in this way of using a test question to help you find the right answer. I called it the Bestowa Technique. Let me say that to use this technique, you need to practice it because you are conditioned test takers.
6. Do What You’ve Always Done
You don’t change your socks in the middle of the World Series, so don’t drink a Red Bull before your PANCE or PANRE if you never drink Red Bull.
7. Set a Disciplined Study Plan
What got you here may not be enough for you to succeed on your boards. The stakes are high and this is arguably going to be the heaviest test you’ve ever taken. It’s an endurance event.
I once heard a speaker who said one hour of uninterrupted time is the same as 2.6 hours of time with minor interruptions. Let me give you a metaphor. When you’re doing CPR, it takes 20 compressions just to get profusion pressure. Then it works. It’s the same when you’re studying. It takes something like 16 or 17 minutes to get your brain ready to really study. That focus dissolves with every distraction, so every distraction costs you at least 16 minutes.
I can study for about 45 minutes at a time without getting squirrely. My advice is to know your squirrely time and stop to take a little break before you hit it. Stretch out, do some jumping jacks, listen to a song, watch a video. Whatever it is, take five minutes and give yourself a break.
8. Take a Pretest
Take a pretest, and then after you get your results, work on the topics you struggled with. Just pick one or two topics where you were weakest and really study them. When you feel like you’ve mastered the topic, take another pretest. This will not only help you really learn the areas where you’ve historically struggled, but it will give you confidence moving forward.
9. Use the Four Questions of Mastery
When you’re studying specific diseases, I want you to ask yourself if you know the
- Pathophysiology
- Presentation
- Diagnosis
- Treatment
When you know those four things, you own the disease. Studying with these questions of mastery allows you to study smarter. Make sure you include demographics within your answers to those four questions.
10. Know Key Triads
I used to think it was important to know all the triads, but I’m shying away from that recommendation. Instead, I think you should really know about a dozen key triads, including Beck’s triad, Virchow’s triad, Charcot’s triad and Samter’s triad.
