by Kristian Savic
I am a second year PA student at Mercyhurst University in Erie, Pennsylvania and started the exciting journey through clinical rotations this past June. First up for me was General Surgery, followed by Pediatrics, and now an elective rotation in Emergency Medicine. I will admit, for the first End of Rotation™ Exam (EOR™), I was unsure of how to prepare, and I felt very nervous going into the exam; General Surgery is a challenging topic to begin with, and I had no idea what the EOR™ examination would be like. I am happy to say that I feel as if my approach paid off for me, and I finished the exam feeling that I was well prepared. I decided to stick with the same approach to study for my Pediatrics exam and felt just as prepared. I would also like to add that by studying for the EOR™, I was also preparing myself to perform well on the rotations.
Creating a study schedule
I am fortunate that my program provided me with a lot of required readings, practice exams, and assignments to help set me up for success on my EOR™ exams. Prior to the start of my clinical year, I combined the reading list created by my program (devised from the NCCPA PANCE blueprint) with the PAEA EOR™ exam blueprints listed on the organization’s website and utilized these to make myself a reading schedule for each rotation. I created my schedule so that I would finish my readings one week prior to taking the EOR™ exam, allowing myself that week to review the material I had read, focus on the topics that needed extra attention, and get as much studying in as I could before taking the exam.
My typical schedule involved a 6:00 am–5:00 pm work day in the hospital, after which I allowed myself some time for relaxing, dinner, and a run after I got home each night. After that, I would follow with an average of two hours of reading, depending on which topics I had assigned myself for the day.
My schedule was designed so that I was reading about the most common things I would encounter on rotation first. For Surgery, there were mostly GI-related topics such as acute appendicitis, inguinal hernias, gallbladder disease, and diverticulitis. For Pediatrics, I focused on well-child examinations, developmental milestones, and vaccination schedules before diving into the infectious diseases and ENT pathologies such as otitis media, strep throat, and hand foot and mouth disease. Additionally, I would spend the Sunday prior to each rotation reviewing the relevant pharmacology and steps involved in certain procedures that I may be asked to perform while on rotation since I could be certain I would need this information on a daily basis.
General Surgery can come with a pretty grueling and demanding schedule, so the first week was a bit of a challenge. It was my first week on rotations and I was working 60 hours per week while trying to balance the schedule I created for myself, but I quickly got into the swing of things. My typical schedule involved a 6:00 am–5:00 pm work day in the hospital, after which I allowed myself some time for relaxing, dinner, and a run after I got home each night. After that, I would follow with an average of two hours of reading, depending on which topics I had assigned myself for the day. After finishing my reading for surgery, I would spend some time reading up on the cases I would be scrubbing in for the next day so that I could be prepared for them. The Surgical Recall book was helpful for this, as it is a textbook full of rapid recall questions that surgeons will likely ask during an operation. Although the majority of the EOR™ exam was filled with clinical vignettes, there were a few rapid recall type questions sprinkled in that this textbook was helpful for.
Switching from General Surgery to Pediatrics was quite a change of pace, but I was thankful for the lighter schedule because the pediatric population is vastly different from adults, and I had much less experience working with kids in the healthcare setting. For this rotation, I had time each morning and during my lunch breaks to complete most of my reading list which gave me extra time to study in the evening—a time I used to both get ahead on the reading list and refresh on things I had seen on rotation that day or things I had read about earlier in the day. One tactic that I found particularly useful for Pediatrics was having charts on developmental milestones, developmental red flags, primitive reflexes, and routine childhood vaccinations handy to review between patients. The majority of pediatric office visits, especially in the middle of the summer, are well-child visits and the main component of these visits includes asking pertinent developmental milestone questions in the history as well as evaluating these or primitive reflexes on physical examination.
My approach for this was to review the age-appropriate components of each chart prior to seeing a patient for a well-child visit, based on that day’s schedule. Before long, I found that I no longer needed the charts for some of the age groups I was seeing frequently, and by the end of the rotation, I had learned these so well that I didn’t feel the need to study them again for the EOR™ exam. My preceptor usually expected me to know which vaccinations a child would be receiving before entering the patient’s room—another topic I felt confident about at the completion of my rotation.
Books, books… and more books!
I have done the majority of my studying in a quiet room at home, which seems to work well for me. I’m glad that I had created a study plan for myself prior to starting my rotations because, with the busy schedules and fast pace of rotations, it has helped me to stay honest with myself, manage my time wisely, and feel as if I am accomplishing a lot on a daily basis. As far as reading materials, I have been utilizing the Current textbook series with the textbook corresponding to the specific rotation I am on. These textbooks worked well for me, as they are an easy read and highlight the important aspects of each disease; clinical features, epidemiology, pathophysiology, diagnosis, treatment, and prognosis. Another textbook that I found useful to review prior to the start of rotations was Bates’ Guide to Physical Examination and History Taking, a book that we used often during the didactic year. This helped me refresh on important physical exam techniques and findings, for example, McBurney’s point in appendicitis and Murphy’s sign for cholecystitis. Reviewing these not only helped me on rotation but also helped me correlate specific physical exam findings listed in clinical scenarios to the appropriate disease process on the EOR™ exam.
With the week I left myself for more focused studying, I went back to the information I had highlighted in my reading from the Current textbook and combined it with my class notes from the didactic year. PANCE Prep Pearls, a favorite among many PA students, was particularly helpful to me with my last minute studying in the two to three days leading up to the EOR™ exam. It provides a brief synopsis of the keywords, physical exam findings, diagnostic studies, and treatment for each disease and has helpful tricks for remembering certain characteristics of a disease. It even had a “pediatric blueprint” chapter at the end, which was a great crash course the night before my pediatric EOR™ exam.
Other great features on Rosh Review are the explanations and clinical pearls section provided with each question, including handy mnemonics and pictures. After completing any practice exam on Rosh Review, I go back to the “review exam” feature and take notes from each question, especially those that I got wrong.
Learning tools… which one works for you?
In addition to completing the reading list, I completed practice questions to keep myself used to test taking. I did this by utilizing the Rosh Review and PanceMaster question banks. Rosh Review also has rotation-specific examinations available to purchase that are the same length and format as the PAEA EOR™ examinations. During week four of each core rotation, our program makes the corresponding exam available to us for completion prior to arriving for the EOR™ exam. This was a great way to simulate the length, format, and question types for each specific rotation. I tried my best to simulate an actual exam scenario by taking these exams in a quiet place without any of my textbooks or distractions nearby, keeping myself at a pace of one minute per question. This allowed me to get an idea of which topics I knew well and which topics needed some attention before my EOR™ exam. Other great features on Rosh Review are the explanations and clinical pearls section provided with each question, including handy mnemonics and pictures. After completing any practice exam on Rosh Review, I go back to the “review exam” feature and take notes from each question, especially those that I got wrong.
In my opinion, another important aspect of succeeding at the EOR™ exam is to not allow yourself to get burned out. It can be easy to become absorbed in reference materials, textbooks, class notes, etc. but it is just as important to step back and take a break from studying to take care of yourself. After all, taking an exam while fatigued or burnt out does no good. For me, this meant going for a run or going on a walk with my dogs in between work and studying. That way I could decompress from the day and clear my mind before diving into some reading for the night.
Lastly, the beauty of rotations is that you get the opportunity to see, diagnose, and treat many of the diseases you spent all of the didactic year studying so hard to remember, and you get to learn from providers with years of experience. Some of the things that took me hours of studying to memorize during didactic year are now ingrained in my memory from seeing them first-hand on rotations. Once you see the signs and symptoms of a disease in real life, you can easily correlate those on a test later on. Use rotations as an opportunity to ask questions, observe other providers’ approaches to history taking and physical examination, and gather words of wisdom from the providers around you. Some of the best pieces of advice or clinical pearls I have learned on rotations have come from nurses, PAs, or physicians with years and years of experience in their respective careers.
Use rotations as an opportunity to ask questions, observe other providers’ approaches to history taking and physical examination, and gather words of wisdom from the providers around you.
Rotations have been especially helpful with learning how to read certain diagnostic imaging modalities and interpret laboratory results. If you have access to online medical records while on rotations, I would highly recommend reviewing any CTs, MRIs, X-rays, or blood work that are ordered (without reading the radiology/lab report first) and ask questions. I did this often on my General Surgery rotation, and it helped connect the pathophysiology of a disease with the clinical manifestations and imaging or laboratory findings. Reading about certain “buzzword” imaging findings in a textbook is nothing like seeing it first-hand. Additionally, understanding how an elevated or decreased number on a CBC, CMP, etc. ties into a patient’s presentation is much more solidifying than trying to memorize a list of numbers. I also kept a small notebook in the pocket of my white coat where I would write down unique things I learned, lab findings, and treatment plans for things I had seen on rotations.
Studying for the EOR™ exams is different for everyone, and some techniques will work better for some students than others. There are a ton of question banks, review books, and websites geared to help with studying for the PANCE and EOR™ exams, so sorting through all of them to find what works best for you can be a bit of a challenge. Overall, I recommend creating a schedule to adhere to and combining reading with practice questions of some sort. Though I have only taken two EOR™ exams, I plan to stick with the routine I have created for myself and I hope that by sharing my approach to studying I can help other students succeed as well!
By Danielle Kindron is a PA-S2 at Mercyhurst University in Erie Pennsylvania
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Rock Your Rotation Exam Series shares the experiences, insights, and perspectives of PA students preparing for their Rotation Exams. The goal of the series is to provide you with actionable information and key takeaways to help you not only prepare for, but to excel on your Rotation Exams.
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Rock your Rotation Exam series includes profiles of PA students who excelled on their Rotation exams and would like to share their experiences.