10 reasons people fail the Exam

1: Insufficient core data knowledge.

There are a few principals which pertain to the base information you need to note pass these exams. The first and most important is to make sure you have a well-balanced approach before you take your exam. Your goal is to be Jack of all trades but master of none, meaning that you do not want to spend too much time on one certain subject or organ system and not have a broad-based fund of knowledge to pull from at the time of the test. Your goal is to understand at least 80% of 80% of the subjects on the NCCPA blueprint. It is important to use a review program or product that allows you to not only determine which organ systems and/or subjects you are weak in, but also allows you to quickly choose those which you need to study and focus on. The other key point in regards to the core data for your exam is understanding the role in which zebras play specifically as it pertains to this exam. Those subjects which may be zebras, or very rare in clinical practice, have a different value when it comes to the PANCE or PANRE. While there are certain subjects which are rare to see clinically and are also rare to see on the test, there are many subjects which clinically are very seldom seen yet have a much higher incidence on the exam. Differentiating which zebras are truly zebras in all settings versus those which are zebras in the exam is very important.

2: Insufficient knowledge of key associations.

We use associations daily in medicine to help us come to a diagnosis or appropriate diagnostic pathway. These associations are extremely important to our understanding of a certain disease state specifically and how it relates to our other differential diagnoses. This is also true in differentiating between the correct answer on your exam and the four distractors. Key associations are very important in our assessment of the stem of the question in which points are important in our pathway to get to the correct answer. Examples of such associations may be “moon face” and its relationship to a Cushinoid syndrome, or a simple fact such as hyperuricemia occurring with the use of hydrochlorothiazide. You must master as many of these associations as you possibly can prior to taking your exam.

3: Poor understanding of question format.

Understanding the format that is used in the process of writing the questions for the PANCE or PANRE is also vital to your success. Contrary to popular belief the questions on our exam are not randomly generated nor are they created to trick us. They are instead created with a very specific set of rules on how they are to be written in the structure in which the answers and distractors must have. Understanding both the parts of the question and how these relate will greatly assist you as you take your test.

4: Bad timing.

Whether you take a PANCE or PANRE, you will take either 5 (PANCE) or 4 (PANRE) 60 question exams which you must complete in 60 minutes. This means you have one minute per question. Although it may seem like a minor issue, failing to practice your timing prior to taking your exam can be disastrous. I’ve counseled many people who have failed unfortunately due to their lack of preparation. You need to use some type of a program with computer-based questions in which you may train yourself to take multiple questions at one sitting. You will have to take either 240 questions or 300 questions. It is suggested that you are able to sit in one sitting and do 500 questions on a computer-based program prior to taking your exam. This will well prepare you for test day and make sure that you are not fatigued during your exam itself. In addition you must be very aware of how long one minute is to make sure that you do not spend too long on anyone question. Running out of time prior to finishing your exam will leave many questions unanswered and do poorly for your score. If you spend a minute on a question and you are unsure of the answer, you should guess mark the question, and return to that question only if you have time at the end of your exam.

5: insufficient time to study.

If you wait until close to your exam date to start to study for your test, you will likely do poorly. You are responsible for “all of medicine”. This is a large amount of information, and trying to put it in your brain in a short period of time will likely not work. When we are short on time and under a lot of stress we not only do not have enough physical time to get all the information in, but we also retain poorly. Trying to consume all of the information you need to know to pass your exam is much like eating elephant. You should eat that elephant one piece at a time over a prolonged period of time. In general, I recommend the following time tables: Students should study throughout their entire clinical year. For experienced Physician assistants who work in a general medicine fields such as family medicine, internal medicine, emergency medicine or urgent care, three months should be sufficient. If you are a Physician assistant working in a specialized field, 3 to 6 months should be good. For those who have been out of practice for more than one year, 9 to 12 months it is suggested.

6: Bad test day.

Even if you do everything perfectly to prepare for your exam, if on test day you are tired, stressed and or hungry, you still may fail. It is strongly suggested that you do not study 48 hours before your test, but instead relax and engage in an activity that you find enjoyable. Make sure you get good sleep the night before the test and eat a good breakfast. A snack such as an apple or other low glycemic index, slow burning carb just before the test also will help to sustain energy and focus.

7: Poor recall prep for subjects which are difficult to remember (Poor “White board” prep).

Everyone has certain subjects that they don’t remember well. Identifying these subjects in finding a way to easily remember them can greatly increase your chances of passing your exam. We call these “White board” topics in reference to use man dry erase board which you will be given when you first it down to take your exam. You may write anything you want on this board. It is recommended that you compile a list of the subjects which are important yet you are having a difficulty remembering in addition to short written reminders that you can easily remember. But properly preparing yourself, you can quickly write down what you need before you start. If you get to a question with the subjects, you have your traders on the board and need not to get anxious as the answer will be there waiting. Some “White board” examples are “MRTAPS” these are the 4 main adult systolic heart murmurs (MRT = MR and TR) (APS= AS and PS). This is just one example, there are many such tools available.

8: Poor familiarity with generic and lesser known medications in a class.

This is specifically true with those who have a lot of clinical experience as most of us tend to use trade names quite often our practice. The PANCE and PANRE now only use generic names so familiarizing yourself with these names in key to success. As important, it is the recognition of those medications which of lesser known in a class. For example, if you are very well versed in thiazide diuretics but get a question about chlorthalidone and don’t know that chlorthalidone is a thiazide diuretic, you will do poorly. The PANCE and PANRE routinely ask questions about the lesser known drug in a class. Another example would be a question using bumetanide instead of furosemide (much more commonly known) for a loop diuretic question. Understanding specific indications as they apply to medications in regards to the FDA approved usage is also very important. This is another example where our clinical practice may causes trouble on the exam. For example, many practitioners use metoprolol for congestive heart failure regardless of the ejection fraction of the patient. However, carvedilol still remains the only FDA approved beta blocker for use in heart failure in patients with an ejection fraction less than 35%.

9: Assumptions.

Test item writers only include information that is pertinent to their test question. Is important to remember that the test question is not an actual patient and oftentimes the writer is creating the scenario specifically as it relates to the answer. This means that despite what clinically may occur in our experience the question is what the question is. For example, if they were questioned in the patient with severe peripheral vascular disease, lower extremity ulcers, and stage renal disease and bronzing of his skin, we could easily assume he has diabetes. However if the question does not mention diabetes then for this question he does not have diabetes. These type of clinical assumptions were often viewed as a stray and can often lead us to a wrong answer. Remember the writer has put the information you need in the question and that is the only information you should use to get your answer.

10: Not reading the entire question or missing key words in the question itself.

We often will jump at an answer after only reading part of the question. This is particularly dangerous with the PANCE and PANRE. Very often the initial set up in the question is a first step which will lead you to the answer. Skipping over key terms such as ”initial” or “first” can make a big difference in which answer is the best choice. Often times you will be asked to determine a subtle difference in which all the potential answers occur with a specific disease state, but only one corresponds with the key words in the question. For example: a question which starts – A 28 year old female presents with a free T4 of 3.2 and a TSH of 0.1. If you were to stop here and look to the answers, you would know she has hyperthyroidism. The answers are A: PTU B: Tapazole C: endocrinology consult D: beta blocker E: Thyroidectomy. You may want to jump at PTU, or thyroidectomy or the consult, you don’t have all the information you need. Now read the rest of the question: She has a heart rate of 143 and a B/P of 210/110. Which of the following treatments in the most appropriate initial therapy? Having read the entire question, you know that beat blocker is the correct answer and that the word “initial” was key to this question.

Take some time to make sure these common pitfalls don’t affect you. Best of luck in your practice and on your exam.

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