The boards is the most feared exam. After all, in order to become certified, this is a necessary obstacle.
If you’re a practicing clinician, then it’s equally important to keep practicing.
Most of you are also in debt which means you can’t afford not to pass.
You need to get into clinical practice, so that you can pay off your loans and finally start living the dream you’ve worked so hard to achieve.
Your life can finally start after this exam.
Whether you're looking to pass the boards for the first time, or recertifying, studying for your exam is an overwhelming task.
Many students and clinicians get caught up in the nuances of medicine. So, when it comes time to take the exam, they end up seeing nothing they studied for...
Unfortunately, we've seen this happen all too often.
Students end up spending all this time learning specific things that statistacally are unlikely to be on their next exam.
That is the exact reason we created our "High Yield Immerson Strategy", to ensure you have a solid foundation when it comes time to pass your boards.
Let's put this another way.
If you’re a PA studying for the PANCE, then I’m sure you’ve taken a look at the blueprint.
But, if not let me do a quick breakdown.
You’ll see there are 542 topics you’re expected to know..but your exam is only 300 questions.
This means they can’t even ask 1 question for every topic listed on the blueprint.
The numbers will vary based on your exam...but the concept is the same.
Based on this statistic alone, you are undoubtedly studying things that just don’t matter.
You’re studying things that aren’t high yield and studying things that won’t be on the exam.
And, I’m not just referring to disease topics...I’m also referring to the naunces found within each disease process. There are things that will simply be beyond your scope…
The problem? As a student, everything seems important!
We get countless of emails from students who are unsure how far they need to dig.
Remember, you need to pass the exam first.
So, what should you focus on?
High yield pearls, triads, classic presentations
Charcot’s triad, Virchow’s triad, Christmas tree pattern, Koplick spots.
Ahh yes, we all remember these from our lectures and textbooks.
Classic presentations are extremely important to know—that includes epidemiology (e.g. age, gender) as well as characteristic signs and symptoms.
Triads or common descriptors help organize the material nicely to ease learning.
The exam must give you something pertinent to make the diagnosis.
The only way to do this is to give you associations, classic presentations, and triads.
This is where exams differ from the real world.
Learn these, because it would be unfair to test you on unusual presentations and/or on uncommon scenarios.
Let’s go over an example:
A 22 year old male presents to your primary care office with a rash noted on the penis. He denies pain, pruritis, discharge, or dysuria. He also states he is sexually active with multiple sex partners. On examination you notice an ulcer.
What is the treatment of choice?
This is describing a classic presentation of syphilis.
But, this question is not only asking you to come up with the most likely diagnosis, but is also asking you to know the stage of syphilis this patient has, and finally the first line treatment.
Penicillin G is the treatment of choice for all stages of syphilis.
Doxycycline, ceftriaxone, and amoxicillin are considered second line therapies for early syphilis.
On exams, syphilis always presents with a painless genital ulcer.
But, guess what? In clinical practice, the ulcer can be painful.
Again, here lies the difference between exams and real life; you will never see syphilis present this way on your exam… because it would be unfair.
But, should you learn every presentation when you’re goal is to pass the boards?
Unless you’ve learned the high yield presentations for the hundreds of diseases bound to be on the exam.
Exams are easy
In real life, anything can be anything.
Guidelines aren’t always clear.
Things are subjective and everything varies based on a case by case basis.
But, on your exam, everything is clear cut.
There is only one correct answer.
Students and clinicians often have a difficult time choosing the best treatment plan.
Because they are learning from multiple resources, which means it's often difficult to decipher what to do.
But, I have good news: exams are easy, because there will always be one best answer.
There might be a few answer choices which seem correct, but not in the specific scenario you're being presented.
If you see two "correct" answers...
...then look for a contraindication and/or an exception to the rule.
There will always be one.
Let's go through an example:
A 5 year old male is coming into the ED complaining of fever and abdominal pain. As you examine the patient further, you notice a rash over the palms, soles, and abdomen. The patient also recalls being bit by a tick a few days prior. What is the treatment of choice for this patient?
The most common wrong answer is amoxicillin.
This is because students mistake this for lyme disease and/or because they think doxycycline is contraindicated in children.
But, the correct answer here is in fact doxycycline.
The correct diagnosis is rocky mountain spotted fever and doxycycline is the only treatment for this disease (with the exception of chloramphenicol which has it's restrictions).
The benefit of doxycycline (saving the patients life) far outweighs the risk (tooth discoloration) which is why it's the correct answer.
This is why you have to know contraindications and the exceptions to the contraindications when taking your exam.
But, does this mean you need to know them all?
Nope, just the high yield contraindications and exceptions.