How To Increase Your PANCE or PANRE Score By 100 Points

“If at first the idea is not absurd, then there is no hope for it”

-Albert Einstein
This article is going to show two very easy ways to help increase your PANCE or PANRE score by 100 points. I’ve written about this topic before but there is new information I want to share. While there is no magic pill or wand to achieve this, these two techniques are the most useful, easy to implement, and only require a little of your time. This means anyone can take advantage of them. The first tactic is to use a system over a couple of months to identify what you don’t know. Sounds easy, right? The key is to go through a curriculum and identify what you don’t know—not what you are weak at, but what you don’t know. The second strategy is to take advantage of human error. Tests are written by humans, of course, and humans make errors. This article will show you 5 very easy techniques to narrow down an answer choice to either the correct answer or to a 50/50 probability, even without knowing anything about the topic. By combining these two strategies, you’ll be able to increase your PANCE or PANRE score by 100 points, which could be the difference between passing or failing. Let’s get started.

Unknown unknowns 

As you begin to study for your exam, there are areas you know well and are comfortable with. Maybe you have a special interest in orthopedics and feel confident with any question that might be asked on interpreting the X-ray of a child with slipped capital femoral epiphysis (SCFE). Because you are confident in orthopedics, you spend less time reviewing it. Let’s call this your known knowns. There is very little utility in spending too much time on your known knowns in preparing for your exam.

During medical training, I realized my understanding of liver disease was poor. Hepatic encephalopathy was just a term to me. I did not understand how or why it occurred and I had a poor grasp on managing the condition. Liver disease was a known unknown. Because I recognized this specific deficiency, I was able to target my learning to diseases of the liver.

Once I started to focus my learning, I came across many concepts and ideas that I knew nothing about…never even heard about some of them. These were the unknown unknowns, a concept created by psychologists Joseph Luft and Harrington Ingham. It is part of their “Johari window,” a tool that helps users identify blind spots about themselves and others.

Known unknowns are things you’re aware that you don’t know—you can recognize that you don’t understand them. Unknown unknowns, however, are unexpected because you don’t know they exist.

The way to supercharge your In-Training or Certification exam score is to identify your unknown unknowns. It takes a little effort, but it is rather easy. All you need are two things:

notebook-and-time

The system works like this:

Step 1: You answer a question from a question bank. If you get the answer wrong, read the explanation. Then write down in your notebook the part of the explanation that describes why the correct answer is correct. This process helps to identify your unknown unknowns. Subsequently, if there is any other information that you did not know or somewhat knew, record it as well in your notebook under the same topic.

You must do this for every question you get incorrect. I also encourage it for questions you may answer correctly but discovered new information in the explanation that you previously did not know.

Step 2: Start each study session by reviewing your notebook that contains the key knowledge that was previously unknown or weakly known by you. As you do more questions, you are going to get questions wrong on topics already recorded in your notebook. For example, if you answer a question incorrectly on which age group most commonly gets de Quervain tendinopathy, you’ll record in your notebook something like “de Quervain tendinopathy: Epidemiology includes women between 30–50 yrs old and postpartum.” Two weeks later, if you can’t name the diagnostic test characterized by thumb flexion and ulnar deviation of the wrist, you should go back through your notebook to find your first entry on de Quervain tendinopathy and add the Finkelstein test as the way to diagnose the condition. While we are on the topic, here is a cheat sheet for de Quervain tendinopathy.

After a month or two of recording your incorrect answer explanations, you will have a filled notebook of your unknown unknowns and maybe many of your known unknowns. If you do this on a consistent basis and get through 1,000 to 2,000 question bank questions for a 300-question standardized exam, you’ll have identified most of your blind spots that questions can be asked about. You end up converting your unknown unknowns to known knowns

Here is a page taken out of my notebook from 2004!

notebook

This is a Mead Composition notebook. All 100 pages (front and back) are filled with explanations from question bank questions I answered incorrectly.

I use the same system and process to prepare for all standardized exams. And even used it to learn how to read EKGs better than a cardiologist.

Study Schedule

By the end of residency, after taking four In-Training exams, my bookshelf looked like this

bookshelf

With the PANCE/PANRE and end of rotation exams (EORs) around the corner, now is the perfect time to begin this system. It leaves time for adjustment and plenty of time to accumulate your unknown unknowns. Earlier in this post, I mentioned that to supercharge your standardized exam score you’ll need two things: a notebook and time. The notebook you can buy anytime. However, time disappears.

Identifying you unknown unknowns is how you can prepare to the lead up to your exams. But what can you do to improve your score simply by showing up to your exam? How can you use the errors made by question writers to boost your score?


The Anatomy of a Question

First, let’s understand the anatomy of a question.

Anatomy of a Question

A question is made up of the stem and the lead in. The stem is where you find all the details of the question such as the clinical presentation, past medical history, and laboratory results.  But, the critical part of the question is the lead in. The question writer uses the lead in to find out what you know or don’t know about the topic in the stem. But it is also the place where question writers make errors. By applying basic grammatical analysis, you will be able to identify the correct answer or at least narrow down the answer choices without knowing anything about the topic.

Here is an example of using grammatical cues.

Grammatical cues

Here is another technique that focuses on logical cues.

Logical cues

Let’s now focus on answer choices to identify a few more areas we can gain an edge.

The Anatomy of Answer Choices
The Anatomy of Answer Choices

Once you understand the goal of the question writer to create answer choices that are supposed to discriminate knowledge, it is easier to exploit technical flaws and improve the odds of getting a question correct.

Absolute Terms
Long Correct Answer
Word repeats

Whether you are taking your end of rotation exam, PANCE, or PANRE, there is so much at stake. Taking the time to identify your unknown unknowns will not only help you prepare for and excel on your exam, you’ll expand your core knowledge. Then, on test day, use the simple techniques to identify common flaws in questions which will increase your chances of getting a question correct.

Give these methods a try and let me know how it goes. Moreover, I’d love to hear about techniques you use that I did not write about.

And if you are looking for a PANCE Qbank or PANRE Qbank…you know where to find one.

Best,
Adam Rosh, MD



Comments (12)
  1. Cecilia Cannon
    March 5, 2017

    Really enjoyed and appreciated the free Review you gave to us loyal AAPA members. Test is in 18 days; am anticipating an easy “Pass.” Thanks!

    Reply
    • Adam Rosh
      March 6, 2017

      Dear Cecilia,
      We are privileged to be able to help.
      Best,
      Adam

      Reply
  2. Felix
    March 5, 2017

    This is very insightful. Thanks

    Reply
    • Adam Rosh
      March 6, 2017

      Dear Felix,
      Thank you. I hope you can benefit from it.
      Best,
      Adam

      Reply
  3. Nicole
    March 9, 2017

    I’ve actually been using the notebook trick- but I found it hard to maintain because once I had filled out pages of topics, I couldn’t quickly locate the topic when I wanted to add in a small detail. It almost became more of a hassle to flip through my notes and remember where my page on a certain topic was. How did you get around this with multiple notebooks? In theory it’s good, but almost too time consuming.

    Reply
    • Adam Rosh
      March 9, 2017

      Great questions Nicole. The key is not to write too much at first for each topic. Keep it to the most important. Try and return to review the notebook almost daily and you should become more familiar with locating the content. Another idea is to number the pages in top right – this provides another “marker” to remember content by. You can also create a color code system (e.g. by system) on the side of each page. These are some ideas. If you are spending more than a minute looking for a page, I’d recommend one of these additional techniques.

      Reply
  4. Diane Bairas
    April 13, 2017

    I just took my boards 2 weeks ago and passed. Used the Rutgers course and the review book, and studied for 3 months, daily. I took notes in a similar way, but had 17 headings in my notebook, one for each organ system. When I got a question wrong, I flipped to that section, made my notes, and studied them daily or while waiting in a line, etc. Also printed out flash cards – very helpful.

    Reply
    • Adam Rosh
      April 13, 2017

      Congratulations Diane and thank you for sharing your experience.

      Reply
  5. Luke
    January 13, 2018

    I feel like this practice has greatly helped me in the past month or two, but I’m curious at what point you cut yourself off from reviewing prior study sessions. 45 minutes? an hour? Based on your total notebook count, you might be reading for HOURS before you begin new questions.

    What was your timeline per study session while using this method?

    Thanks!

    Reply
    • Adam Rosh
      January 13, 2018

      Great question Luke. There should be a time that you become familiar with much of the content in the notebook that all you need is a glance. But you are correct in that the notebook review can take 30-60 minutes. It should not go more than that. Also, you do not have to do the full notebook; sometimes just start with the middle to the end.

      Reply
  6. Remonia
    March 2, 2018

    Thanks, just started this method for PANRE review, used similar method with index/flash card when studying for my PANCE exam to pass. Keeping those I missed in a separate stack. I enjoy your website especially the new board review questions. Thanks for your help.

    Reply
    • Adam Rosh
      March 2, 2018

      Thanks for your feedback Remonia.
      Best,
      Adam

      Reply

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