A test-prepper's most significant decision in the final three weeks before the PANCE is whether they feel ready. They should consider the following factors and make a serious decision. There is no shame in saying, “I need another three weeks.” I find that even preppers who have jobs waiting for them “after PANCE” have little trouble admitting, “I’m not ready yet.” Generally, I think employers would much rather have employees with first-time pass rates.

But how to tell for certain? Here is a list of trouble signs. If one or more of these are the case, the prepper is likely unprepared.

• The prepper is experiencing a major life stressor that interferes with productive study. I urge preppers to be clear-headed about what is happening in their lives. If anything else is causing grief, unusual stress, or anxiety, do not tackle the PANCE simultaneously. This includes things like weddings, sick family members, a move, or another disruptive adjustment.

• Prepper has not yet studied the blueprint topics assigned by clerkship

• Prepper has a high Risk status low PACKRAT II< 140 / EOC < 1450,

• Prepper receives a faculty recommendation to wait to take PANCE.

Remember, rescheduling or cancelling an exam date during the exam timeframe (as indicated on your NCCPA exam acknowledgment) must be done through Pearson VUE at least one (1) business day before the scheduled exam date, or the student will lose their entire exam fee and will have to reapply and pay for the exam again. However, up until that one (1) business day before, preppers need to carefully consider their readiness. I reiterate, it is far better to postpone than to fail.

The Swiss Cheese Model

Some may disagree, but I’ve been at this for a long time, and I believe the last three weeks before the PANCE are definitely not the time to introduce new materials, resources, or subjects. Students in trouble may think that every medical detail is vital and fail to master anything in-depth.

I tell my preppers the key is to master the “must-know” information. After two years of PA school, they should have a sense of what the “must-know” information is; the PANCE tests important medical knowledge, not the tricky or obscure. Focus on consolidating the information learned over the past two years and reinforcing key concepts to maximize PANCE scores.

Preppers should focus on what they know has given them trouble during prep. Look at repeatedly missed questions or less successful categories and ask, “Why does this problem keep popping up? What have I never fully grasped?” Dig in and bolster those weaker topics.

I call this the “Swiss Cheese” model. How many of those holes can be filled in the last couple of weeks that will maximize a PANCE score?

Push test-taking skills

I encourage preppers to push the boundaries of their test-taking skills, especially in the final week before the PANCE. Here’s how:

• Try spending less than a minute on each question.

• Increase speed on answering shorter stem questions to allow for more time to examine longer, data-heavy stems.

• Try to complete a block of 300 questions in less than four hours total.

• Take one or more practice exams in an unfamiliar and somewhat uncomfortable place, like the library (we can’t take the PANCE in the comfort of home!)

Practice mental fatigue

Especially in these last practice tests, preppers should push themselves to the point of mental fatigue.

They face a six-hour ordeal: 15 minutes of tutorial, 45 minutes of permitted breaks, and five hours of intensive testing. The PANCE is not the time to discover the real fallout of mental fatigue. Preppers should learn how fatigue feels and what mistakes it can prompt. Mental fatigue is a serious problem in the last section: a tired mind will play tricks on the test-taker, making them second-guess their answers, lose focus, and slow down.

There are five sections of that test, and the test-takers are permitted 45 minutes of breaks. I’ve heard too many stories of students ignoring their fatigue and pushing straight through the last section without allowing themselves to take a break.

I’ve heard distressing stories of people failing to get to the final 20 or more test questions because they were mentally exhausted. That 45 minutes of breaktime should be used strategically to stretch, eat something, drink some water, and just breathe. It’s incredible how much good this can do. Generally, I say never to do more than two test segments in a row without a break. Knowing before the test how to recognize and combat mental fatigue is critical.

The last three days

What I suggest for preppers, in the last three days, is contrary to what most people want to do: study themselves into exhaustion. But this is the time to taper off study: only a couple hours of intermittent question review on three or two days out. But on the day before the test, don’t study! Preppers should look at it this way: they have taxed their minds to the limit for weeks. The smartest thing to do now is to trust that they know that material well and give their brains a rest. As much as possible, preppers should spend the day before the PANCE, resting, relaxing, and doing something they enjoy.

Next time: The Truth about the PANCE

Next week’s blog will be the final one in this series. At the conclusion, I’ll clear up a “myth” about the PANCE and then give my final advice to test-takers, which I hope is just as valuable for those of you who work with these students daily.