Tips on how to pass the PANCE

Hello!  I just recently took the Physician Assistant National Certification Exam (PANCE), and I'm so thankful to say that I passed!  Friends have asked for tips and what books are best to prepare for the  PANCE.  Honestly, I'm not sure if I'm the best person to ask but I can share the resources some of my classmates and I used to prepare for it and information about the PANCE that will hopefully help you too!

The Exam:

• The exam has a total of 300 questions.  
• There are 5 sections of 60 questions.  
• You get 60 mins to complete each section
• You get an optional break in between each section, but the addition of those breaks cannot be more than 45 minutes.  
• Each question has 5 multiple choice answers. They're not easy choices.  Many times I'd narrow it down to 2-3 answers and had to make my best educated guess.
• Questions are usually short paragraphs of 3-4 sentences.  They aren't very specific either.  For example, they rarely provide key words such as "projectile vomiting" or "worst headache of her life."  You know, all of those good key words we learned to recognize during PA school :P 
• There are a lot of tertiary questions on the exam.  For example, a tertiary question would ask, "12yo presents with shortness of breath and wheezing after exercise.  What medication do you most likely need to caution use of?"  So, you not only have to know that the most likely diagnosis is asthma, but you also have to know that they cannot take aspirin or any non selective beta blockers.  
• My exam had a bunch of pharmacology on it, so I'd recommend reviewing your medications and contraindications to each of those medications.  
• Here is a breakdown of the PANCE by organ system (taken from the NCCPA website):

Organ System % of Exam Content Cardiovascular 16 Dermatologic 5 EENT(Eyes, Ears, Nose and Throat) 9 Endocrine 6 Gastrointestinal/Nutritional 10 Genitourinary 6 Hematologic 3 Infectious Diseases 3 Musculoskeletal 10 Neurologic System 6 Psychiatry/Behavioral 6 Pulmonary 12 Reproductive 8 Total: 100% Tasks % of Exam Content History Taking & Performing Physical Examinations 16 Using Laboratory & Diagnostic Studies 14 Formulating Most Likely Diagnosis 18 Health Maintenance 10 Clinical Intervention 14 Pharmaceutical Therapeutics 18 Applying Basic Science Concepts 10 Total: 100%

• Cardiovascular and pulmonary systems were definitely a huge portion of my exam.  It seemed like every patient I encountered had shortness of breath, chest pain or both!

Resources:

Here are the books and online resources I used:

Van Rhee PA Board Review	I find this one to be the most organized and concise. If you were to purchase one book, I'd recommend this one.  It's my favorite out of all of them. At the end of the book, there are appendices that layout things clearly such as Poisoning Antidotes.  If I had not looked at this before taking the PANCE, I would have missed that question on the exam on what to give a patient with opiate overdose: Naloxone.
A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants	2nd favorite. This book is great during clinical rotations and has up to date treatments and diagnostic tools.  I've pretty much butchered this book with tags, highlights, pen marks everywhere, drawings, coffee stains, abuse.  I think the more you abuse a book, the more you know it inside and out.  I read this book throughout clinical year and again after graduation.  It has great online practice questions.
Exam Master Packrats	Exam Master was the best study tool for me.  I started these questions AFTER I went through all of the PA review books, though, because I knew they were hard.  The Exam Master practice questions are long and very challenging. Many of my classmates and I were scoring 45% on each section!  This was a real downer.  That's why I recommend doing a mixture of easy and hard practice questions.  Although they were tough, they gave scenarios and asked questions that are similar to the ones on the PANCE.  Additionally, what's even more great is that each question provided explanations for why each answer was either right or wrong.  It was my favorite study tool for the PANCE.  Packrats are practice questions that were given by our program. They are very similar to the PANCE.  Surprisingly, I didn't use them during my preparation, and I kind of regret that.  But, I did fine with the Exam Master questions, so if you only have access to one or the other, you should be fine.
Physician Assistant Review 3rd edition Aka “Pat Auth” book	I believe this book was recommended by our school.  I didn't think the book was as good as the comprehesive review one, but it still provided some pretty good online practice questions.
PANCE Kaplan	I mainly used the online practice questions.  I didn't really use the actual book.
Davis’ PA Exam Review	Many classmates and 2 preceptors recommended this book.  “The questions in the book and on the CD were very similar to the ones on the PANCE. It’s full of questions, and friends basically did them until they could know the answer to the questions after reading the first and second sentence.”  Unfortunately, I didn't have enough time to go through this book, but from what I hear, it's a great resource.
Lange Q&A Physician Assistant Examination	Many of my classmates who did well on the exam recommended this book, but I didn’t get my hands on it in time.

Tips for the Day of:

• Try to visit the testing center the day before or much earlier than your testing time just so you know the area and won't get lost the day of.  You don't get your money back if you're late, and last I heard, money don't grow on trees.
• Also, get there at least 30 mins before your actual testing time.  I got there a whole hour and 15 mins earlier because I was just so nervous lol!  I ended up chillin' in the car with my Mom at 6:30am.  She gave me lots of encouragement and eased my anxiety.  They'll usually let you in 30 mins before your testing time.  Mine was at 8am in Atlanta (Dunwoody), and they started to let us in at 7:15am. But I'm sure every testing center is different.
• Bring lots of snacks and water. I brought a sandwich, some fruit and a bottle of water.  At each break, I pretty much forced myself to eat something even though I was so nervous I didn't have an appetite to eat.  I guess it's better to be filled than emptied and growling.
• Try to go to the bathroom at every break even if you don't have to.  Not good if you gotta go but you're on question #10 out of 60.  

What helped me the most:

• I had bad anxiety one week before the exam. I'd get palpitations and had to get up and stretch or do 100 jumping jacks.  What helped me out with the anxiety was going to the track afterwards with a friend and taking a brisk walk for about 45 mins.  I also discovered relaxing in a whirlpool for 15 mins in the evening made a world of difference and calmed me down instantly.  I also couldn't sleep at night, so I'd take my notes and study them to sleep.  Studying usually gets me to sleep very easily so I was knocked out in 15 mins or less. :P
• Every day, I'd go to the public library from 9am until they closed which was about 8pm. I'd pack a lunch and get a small private room to study, and I did this for about 2.5 weeks straight.  
• Having a support system. I was really grouchy during those 2.5 weeks. It was probably a good thing my husband was an ocean away from me at the time, otherwise, I'd make a fuss over stupid little things.  My mom was incredibly supportive and encouraging throughout the whole preparation for the exam.  My dad was too by telling me, "it's okay if you don't pass the first time.  You'll know how the test goes and will be prepared 2nd time around."  This put me a little more at ease after I realized that he was true and it wouldn't be the end of the world if I didn't pass.
• Practice tests.  Take a mixture of both easy ones and hard ones so you don't get bogged down with all the ones you missed with the hard tests.  
• Make notes or flashcards of the questions you got wrong.  Quiz yourself constantly.
• During my last semester as a PA student, I served as a TA for Anatomy.  This helped me out tremendously as there were about four questions on my PANCE that dealt with anatomy so review your anatomy!  For example, know the bones in the wrist and their location, review over radiographs, CTs and MRIs, know the different types of fractures like colles, the 5 types of salter harris fractures, and so on.  
• Surprisingly, a lot of questions on the exam weren't from lectures or text books.  They were from the experiences I gained in the clinical setting.  For example, prior to my dermatology clinical rotation, I didn't know anything about moles, lesions, or anything skin. I knew textbook material only.  But after starting the rotation, I discovered that a lot of it has to be felt with your own touch.  Soon into the rotation, I was able to fully understand textbook's descriptions of lesions.  This experience at this Dermatology clinic gained me 100% for derm on the exam.

What I recommend most:

• Allow yourself enough time to study. I did 2.5 weeks, and I wish I had more time.  I didn't feel prepared prior to the exam; however, somehow I still managed to pass the exam.
• Create a game plan.  Layout all the things you want to accomplish during the amount of time you have and create a day by day schedule.
• Try to go over all of the study books, take each of the exams, practice those Exam Master questions and do those packrats.  
• Make flashcards or notes and quiz yourself all the time, even on the John.
• Get plenty of rest each night because you're going to need it every day.  It's mentally exhausting!
• If you're still a student, take advantage of your clinical rotations and don't be so eager to go home.  Staying at the practice might give you opportunities to learn something that may be on the PANCE or more importantly of course, for someone's life.
• A classmate of mine made great charts and divided them up into systems like musculoskeletal, OB-GYN, Infectious Disease, etc.  She provided columns that described the symptoms, clinical picture, diagnostic test needed to be ordered and treatment options for each disease.  I reviewed over all of her charts, and it helped me out a lot.  If you are a student still, I'd recommend starting these charts early on.  They will help you during didactic, clinical and board review times.
• Sign up to take the PANCE on a Monday.  The NCCPA site will tell you it takes them 2 weeks for exam results to get in, but if you take it on Monday, you'll get results by Thursday.  Unfortunately, I took mine on a Tuesday, and didn't get results until a week and two days later which seemed like torture for me.

If anyone else has tips they liked to share as well, please leave share in the comment section!  Thank you and good luck to everyone!