Passed the PANCE as a bottom 10%
No hate to the existing PANCE advice columns, but here are some things that I think are important but were not emphasized in columns I read:
Main points: (1) passive UWORLD questions get you nowhere, (2) etiology and physical exam were the most tested concepts, (3) the NCCPA practice exams (A, B, C) are the closest style of practice questions out there, (4) you have to practice staying calm when you have zero f-in clue what they’re getting at in a question, or that test will eat you alive. (5) I think three weeks of studying is the sweet spot; 4 feels exhausting and 5+ truly has significantly diminishing returns.
Ranked resources (for me): UWORLD ready decks (by far), UWORLD medical library, UWORLD question explanations, Cram the PANCE videos/podcasts, PANCE Prep Pearls, Katy Blair Conner videos, Blueprint outline, ROSH, SmartyPance (not a recommendation)
There is no perfect resource for this exam...but, I do believe there is a near-perfect strategy, as well as a perfect way to waste time:
(the time waster) passive UWORLD questions absolutely do not prepare you. UWORLD explanations, DO! (Aka, just doing the questions and quickly reading the explanation) Personally, I think it’s bad advice to just read the explanations of the questions you got wrong. It will surprise you how many questions you get right without really understanding (or having forgotten) the nuances of the physiology. Ultimately, this is the device of each question on the PANCE. They indirectly test your APPLICATION of knowledge of NUANCES of the physiologies. A simplified (!!) example: why are women more nauseous in the first trimester? The increasing hCG. How does this apply to hyperemesis gravidarum? Their hCG continues to climb even after the first trimester at an astronomical level, without the plateau or a normal pregnancy. Why are sickle cell trait patients less susceptible to malaria? Etc.
(the near perfect way) You need to know the nuance and reason behind every single symptom. When you are studying, you need to focus on why every patient experiences the symptoms that they do, not just ‘x’ diagnosis presents with ‘x’ symptoms. It’s hard at first, but as you start to understand them, you can apply them to other diagnoses. This is the way the PANCE tests you. You need to be able to explain and comprehend every physical exam sign AND etiology. You will surely have less than 10% of all your questions just asking for the diagnosis. About 70% of my questions required either (1) knowledge of minor physical exam signs (AKA SEEMINGLY UNIMPORTANT) or (2) second and third line etiologies (especially related co-morbidities). Cram the PANCE is a perfect podcast to get your feet wet of the level in which you need to understand the physiology. I also think he explains them very well and in an entertaining-enough way. PANCE Prep Pearls is a great resource, however, I found this more helpful after I had already done my initial review through all the diagnosis, because it does leave a good bit out. It also does not explain much, it just lists. Why is this important? Relevance, relevance, relevance. You need to know why every single aspect of a diagnosis is related to that diagnosis. If it feels like you’re reading someone else’s notes, it’s because you are. This is good for quick familiarization, but ultimately this will not assist you in understanding the physiology. I still think it is a great tool for comparing diagnoses and familiarization with medications, I just would make sure you don’t regard it as all-exhaustive. Katy Blair Conner videos: loved her videos, but be careful with the treatments as her stuff is a little older at this point. I found a lot of her references for treatments or first line approaches were not the same as listed in UWORLD or PPP. However, her videos are still a GREAT resource and excellent example of patient presentation, just be cognizant of the changes in nuances of treatments and the changes in the PANCE outline since she’s produced those videos. She’s got some stellar stuff. Her first videos are also free which is a very kind way to allow you to test her method of teaching and see if it vibes with your learning style without the full commit right away.
At the end of the day, some of the best advice I got about picking resources from the overwhelming pile is to just pick whatever keeps you focused. If you can’t stay focused for anything when you’re just reading a book, then that’s not the resource for you. You need to find a video or a worksheet. Personally, I focused so much better when I have a worksheet to go along with what I’m reading. I ultimately made a couple hundred copies of a shell that included diagnosis, signs and symptoms, etiologies (do NOT sleep on this one), and treatments and would pick the top five most similar presenting conditions and have them on the same sheet for comparisons.
Best practice test for assessment of knowledge in space and time: Katy Blair Conner’s mini-PANCE. I wouldn’t necessarily relate your PANCE score as it seems more recently myself and my friends got about ~50+ points lower than her predicted; but I would relate it to a true analysis of your best and worst subjects, as well as overall preparedness. If you fail her mini exam, I would strongly reconsider moving your test date to allow for more study time. I would also reevaluate your approach. Best (BEST) test to replicate the emotional trigger on your “shock factor” and anger during the PANCE— NCCPA’s practice exams. The results are all over the place for people so please PLEASE don’t use it to discourage OR encourage you as “ready.” However, this is a perfect way to test your ability to remain calm when you feel that you get a nonsense question.
One of the most under-discussed pieces of advice for the exam is how to stay calm. You are going to read these questions and feel exasperated and annoyed or angry as to why they are asking you that question when you feel that it’s not really testing your knowledge. Looking back on some of the specific questions, they were kind of ingenious. You have to trust the process. They are INDIRECTLY testing your deductive reasoning, your knowledge, your inductive reasoning, your familiarization of common etiologies relating to a specific race, gender or community, as well as your ability to remain calm and see past nonsensical details. It is far too easy to remember and memorize an association between a diagnosis and a treatment, without really understanding the pathophysiology.
STOP TRYING TO LOOK FOR A COMPARISON ON HERE. I would post my scores but I feel like I'm feeding a toxic idea that you aren't good enough on your own. How ANYONE else did in didactic canNOT be used as a reliable source for yourself. You are either (a) trying to beat yourself up for doing so poorly that you need external validation that someone else who did poorly succeeded, so therefore you can or (b) you are stuck in a menty-b spiral and need (again) external validation to return to baseline. Either way -- you need to revisit your affirmations, girly pop. You are enough on your own! Be careful with comparison. Everyone’s results are all over the place with these practice exams… at the end of the day if you HAVE TO, hold KBC’s results as the highest regard. I make sure to get at least a 400 on this before attempting the PANCE.
I graduated in the bottom 5% of my class and was a firefighter prior to PA school. I say that because I was always comparing myself and trying to gauge my preparedness against others' because I felt like it was written in the cards that I wouldn't be a first time go. Truthfully, SO MUCH of that test is luck....luck that you just so happened to look at that question one week ago, luck that you got that one question early on in the exam when you were fresh, luck that you happened to review that topic right before you came in the door.... so recalibrate and stop the low-key aggressive searching for some sort of validation that you will pass. (That person was me and I wasted so much time doing that and I wish I didn’t.)
You will pass. If it takes 2 or 3 tries, whatever, you WILL pass. It will suck and feel terrible, but you eventually WILL PASS.
If you fail, I promise no one in your class will think less of you. There are so many factors that go into test day, likely everyone you know will simply feel brokenhearted that your weekend to relax is postponed by another couple months… be a kind homie.
CLOSING: Test day… show up 30 mins early. Have a playlist with some hype songs and go for a walk. I recommend doing 10-15 warm up questions to get you ready so you can just jump on in when it’s go time. I did the first two sections back to back and then took breaks for the other three. Once you submit, give it up, dude. There’s nothing you can do so don’t waste anxiety about your score. Future you has handled everything well so far and future you will handle that, too. Trust them and just relax. No need to suffer twice if that’s what it comes to. There has never been a situation in my life where I was eventually disappointed by my result, but still grateful that I spent the week prior anxious and mentally bullying myself about the outcome. It never made the shitty outcome less shitty.