How a Study Schedule Helped Me Rock My Rotation Exam

November 19, 2018
I am a second-year PA student at Mercyhurst University in Erie, PA, 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, I was unsure of how to prepare for the first rotation exam, and I felt very nervous. General surgery is a challenging topic to begin with, and I had no idea what the rotation exam would be like. My approach paid off, and I finished the exam feeling well prepared. I decided to stick with the same approach to study for my pediatrics exam and felt just as prepared. By studying for the exam, I was also preparing myself to perform well on the rotations.

Create a study schedule

I am fortunate that my program provided a lot of required readings, practice exams, and assignments to help set me up for success on my rotation exam. 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 End of Rotation Exam (EOR™) blueprints listed on the organization’s website and made a reading schedule for each rotation. I scheduled my readings to finish one week prior to taking the exam. This gave me one week to review the material, focus on the topics that needed extra attention, and study before taking the exam.

I designed my schedule to include 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 spent the Sunday prior to each rotation reviewing the relevant pharmacology and steps for procedures that I may be asked to perform since I would need this information daily.

General surgery can come with a pretty grueling and demanding schedule, so the first week was 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, but I quickly got into the swing of things. My typical day was 6:00 am–5:00 pm in the hospital, after which I relaxed, ate dinner, and ran after getting home each night. After that, I followed with an average of two hours of reading, depending on which topics I had assigned myself for the day.

Brush up on relevant topics

After finishing my reading, I spent time reading up on the cases I would be scrubbing in for the next day so I could be prepared. 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 rotation 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.

Utilize charts

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 are well-child visits, especially in the middle of the summer. The main component of these visits includes asking pertinent developmental milestone questions 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 need to study them again for the 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 do the majority of my studying in a quiet room at home, which seems to work well. I’m glad that I created a study plan prior to starting my rotations because, with the busy schedules and fast pace of rotations, it’s helped me 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, such as 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 rotation 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 with my last-minute studying in the two to three days leading up to the 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 rotation exam.

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™. During week four of each core rotation, our program makes the corresponding exam available to us for completion prior to arriving for the 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 rotation 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 rotation exam is to not allow yourself to get burned out. It can be easy to become absorbed in reference materials, textbooks, and class notes, 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 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.

Hands-on learning

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.

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 highly recommend reviewing any CTs, MRIs, X-rays, or blood work that is 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 or CMP 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 rotation 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 rotation 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 rotation 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!

Learn more about Rosh Review’s Physician Assistant Qbanks.

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.

Rosh Review, LLC is not sponsored or endorsed by, or affiliated with, the Physician Assistant Education Association (PAEA) or the End of Rotation™ Exam (EOR). All trademarks are the property of their respective owners.

You may also be interested in these blogs:
How to Rock Your Clinical Rotations and End of Your Rotation Exams
The Exam Writer’s Strategy That Test Takers Don’t Know About (But Should)
Pummel the PANCE blog series

By Danielle Kindron, PA-S

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