5 Tips for PANCE Test Day


    Several weeks before the exam, list on an index card several of your greatest personal strengths and attributes, such as, “I’m an intelligent person who reacts well under pressure,” or, “I know I’m going to be a great physician assistant.” Keep this card handy so that whenever negative thoughts intrude while you are studying or practicing with questions, you can pull the card out, read the statements, and reflect on their truth. Luxuriate in the calm, positive feelings you associate with each of these statements. Fairly soon, you won’t even need the card because you will know all the statements by heart and will be able to mentally review them as an antidote to negative thoughts and self-doubt.


    Keep a master tally sheet nearby each time you sit down to study. Make a mark each time you find yourself engaging in negative thinking, daydreaming, or otherwise mentally escaping from the study situation. For many, the very act of counting the frequency of mind-wandering or lapses in concentration actually reduces the frequency of these behaviors, and they find that their daily tallies decrease over time. This is a mild form of behavior modification that you can apply to your own study behavior.


    Months (or at least a few weeks) before the exam, spend some quiet time thinking back over your life experiences to select one event in which you were the “hero” of the situation. Perhaps you walked in on a serious fight between two friends and were able to bring about a peaceful resolution. Perhaps you administered CPR successfully to someone or orchestrated a successful fund-raising event for a charitable cause during college. Whatever life event you select, it must be a situation in which your abilities and actions solved a problem or redeemed a bad situation. Spend at least 10 minutes each day in a quiet place reliving this event, trying to bring back the memory in as much detail as possible. What time of year/day was it? What were you wearing? What was the setting like? As you practice this, it will take less and less time for you to retrieve the memory in graphic detail. The purpose of this exercise is to allow you to mentally revisit the event quickly, because stored with this remembered event are all of the associated psychological feelings of being in control, a successful problem solver, confident, and, in general, winning over adversity. When anxious feelings arise during the exam and you take a brief time-out to retrieve this memory, these positive emotions serve to counteract the negative emotions associated with the test-taking process.


    Pacing problems will be far less likely if you work through lots of sample tests during your preparation. With practice, you will sense the right pace and will be able to walk in on test day confident in the knowledge that you can handle it. The test setting will feel less strange—and the more familiar it feels, the less anxious you will feel. During the actual test, use the same pacing plan that you used in practice testing in the final week or two. Before you begin, determine the items that correspond with 1/4, 1/2, and 3/4 points. When you take the test and reach a time-marker item, check your time. For example, in a 60-item test, you might write numbers 16, 31, and 46 on the marker board. When you reach Question 16, you should have used roughly a quarter of the total time; by Question 31 half of the time; and so on. Worrying about running out of time contributes to anxiety and often leads to time-wasting behaviors, such as checking the clock every couple of minutes—a nervous habit that continually interrupts your thought process and often results in the need to re-read once you return to the question. If you do run short of time toward the end of a session, use question “triage,” that is, scan the remaining items to find the ones that are easiest and mark the answers to these first. Return to the remaining items and mark some answer for all of them. Remember that giving no answer is an automatic error, so never leave items blank. The item-review option allows you to easily check to see what you have done with all items in the section, so always use this feature before exiting the test session.


    If you feel anxiety during the exam that is interfering with your ability to concentrate on the questions, take a brief mental “time-out.” Shut your eyes, lean back, and slowly rotate your neck and roll your shoulders to relax them. Take several slow, cleansing, deep breaths and exhale each breath slowly. This time-out helps break the cycle of anxiety and will usually help you focus with a greater sense of calm and improved concentration.

Signs of Anxiety That May Require Professional Help

If you experience significant anxiety symptoms, such as muscle twitching, chronic insomnia, nausea, hyperventilation episodes, or chest tightness when you think about taking exams or while taking them, then self-help tactics may not be enough. If you experience several of these symptoms and they are severe, seek professional help from either a psychiatrist or a cognitive psychologist who is experienced in helping people overcome situational anxiety. Therapies may include anti-anxiety medications, behavioral retraining, or a variety of other interventions. Do not delay making an appointment—each of these treatment modalities requires time to become effective.


Managing Time During the Exam

Don’t skip around frantically searching for easier items. Doing this can result in missing items and will leave you feeling out of control in the test situation—something you definitely want to avoid. Also, because you won’t easily be able to estimate how many items you have left to answer at any given point, skipping around makes following any pacing plan very difficult.

Decision Rule One

Use decision rules to make the most of your testing time. Everyone needs at least two decision rules. Rule One is used when you are able to narrow the possible answers to two options. At this point, self-honesty is paramount. If you have already used recall and any strategies appropriate to such a question, it’s time to choose and move on. Rule One prevents you from ineffectually reading and re-reading the item. Mark the upper of the final two choices and move to the next question. The second half of Rule One says that the next time you are faced with the same “final two choices” dilemma, you should mark the lower of the final two choices and then move on. This is actually a time-management rule, designed to prevent you from obsessing between those two options.

Test Day Tip

Throughout the exam, change an answer only if you realize that you initially misread the question or because new and specific recall occurs that now allows you to answer the question correctly.

Decision Rule Two

The second time-management rule pertains to questions about material that you’ve never come across before. You are unlikely to encounter many of these “clueless” items. Most test takers report that on standardized examinations, they encounter only a handful of items that they truly have no idea how to answer. If you encounter a question dealing with totally unknown content, then have a favorite letter between A and E in mind, mark the choice that corresponds to the favorite letter, and move on. There is little to be gained from re-reading the item multiple times.

Test Day Tip

Remember to answer all questions on the PANCE. Every blank item counts as an error, so you might as well take a guess.

Concentration, Anxiety Prevention, and Pacing Routine Checklist

  • Have you created self-affirming index cards?
  • Have you identified, monitored, and changed your mind-wandering behaviors?
  • Have you mastered memory that provokes self-confidence during anxious moments?
  • Have you implemented the practice of marking time junctures during exams?
  • Have you found quick relaxation routine (e.g., deep breaths, shoulder rolling) that works for you during high-stress moments?
  • Have you established and mastered “decision rules” to save time in answering questions that you don’t know?