Common PANCE Errors

In order to score well on the PANCE, you must analyze your errors. Do this routinely throughout your preparation process. Most people look at two things after they take a test: their overall performance and which items they answered incorrectly. Looking at just these two aspects wastes a lot of potentially valuable information.

Overall performance tells you how you did on a mixture of items covering various aspects of the material. If your practice test covered an entire subject, first compare this score with your initial score on the subject profile testing you used to determine strengths and weaknesses.

Second, take time to sort out where you made your mistakes. Did errors load up on a particular type of question, such as items involving calculations or use of graphs and data sets? If so, you may have discovered a type of material that you tend to understudy or avoid. Continue looking for patterns among the items that you missed.

Test Day Tip

Negatively phrased items (e.g., “What is the least likely diagnosis?”) commonly cause confusion.

Test Anxiety

If many of your errors occurred on items early in the exam, this may reflect the fact that difficult content happened to be asked early in the test. Or, more likely, it may be an indicator of test anxiety, which is often felt most strongly during the early stages of taking an exam.

Pacing/Fatigue Setbacks

If many errors occurred on the final pages of the exam and you answered the items in numerical order, then pacing or mental fatigue may be a problem for you. How much sleep did you get the night before the exam? Did you run short of time near the end of the exam, causing you to rush through answering the final items? Was the most difficult material covered mainly in the final portion of the exam?


Reading mistakes are common during exams. People feel nervous, rushed, or simply tired toward the end and may easily misread a word or key phrase. They may even answer the question that they expected to be asked, rather than one actually asked. How can you tell if an error was due to a reading mistake? Read the item and note the correct answer, as well as the answer you selected. If your choice makes no sense, given what was asked, then it is highly likely that you misread the question at the time.

Test Day Tip

Beware of misreading. Only a few letters in a prefix or suffix can change the entire meaning of a question (e.g., hyper versus hypo).

Anger Management

Were there any items on the exam that, at the time, made you very upset or frustrated? Students often describe such questions as tricky or picky, if not downright unfair. Test takers frequently make silly mistakes on items following the ones that made them upset. Their strong emotions interfered with their concentration on subsequent items.


When a test question asks about information from an unexpected direction, performance on the item tends to decrease. For example, a physiology question might ask what effect living at high elevation might have on variables of the respiratory system. If, while studying, the test taker reviewed notes that presented such unusual conditions (e.g., high altitude, deep sea diving) followed by a discussion of the effects such environments have on the lung, then the item would not cause much trouble. However, if the test writer instead created a description of a patient with pulmonary function test results, chief complaint, and results of history and physical exam, then asked what might account for the patient’s respiratory findings, then simply changing the task of the item from “state cause→ ask about effects” to “describe effects→ ask about cause” may affect the test taker’s performance.

Another problem test takers sometimes struggle with during exams is determining what the item writer is actually asking when the question involves a series of steps. For example, if a certain mechanism proceeds A → B → C → D → E, a test question might ask what causes E but list answer choices that include both A and D. Which answer is correct? With exam questions of this type, test takers should choose the response that is the most immediate cause of E, not the initial cause. Thus, in this example, the correct answer to the question of what causes E would be D. The best way to deal with this is to be sure you know exactly what the question is asking by reading carefully and not making quick assumptions. Be on the alert.


A question may require knowing how a specific member of a group with shared features is different from the other group members. These questions are commonly asked in subjects such as pharmacology, microbiology, and disease groups, such as the anemias. Questions may ask what is unique to a member of one of these groups or may require the test taker to know the shared or common features in that group.


Before you insist that when you change answers you invariably change from correct to incorrect, do the math. Make a mark (e.g., a delta—Δ—in the margin) so that you will be able to spot all items where you changed your initial answer. Now tally the three possibilities:

  • Column 1: Wrong to wrong
  • Column 2: Wrong to right
  • Column 3: Right to wrong

You may discover that most changed answers end up in Column 1. These reflect knowledge gaps. If the sum of Column 2 is greater than that of Column 3, then you are using good judgment and should change answers as you see fit. Only in relatively rare cases in which the sum of Column 3 is greater than that of Column 2 is there evidence of an answer-changing problem, and the solution is simple: Adopt a rule, based on the data you’ve collected and analyzed, that you will never change an answer.

Knowledge Gaps

Are many of the errors you make referring to a common topic or similar kind of material? For example, you might notice that test after test, you tend to miss items that ask you to calculate an answer. This pattern clearly signals its own solution—if you want to improve, you must spend more time working with calculations and memorize a few formulas. Perhaps you notice that you often miss items that present an image, such as a photomicrograph, and require you to recognize structures within the image. This signals that you need more visual review. Failing to note how rare or common diseases are, what lab tests are appropriate, and how to interpret lab results all are common problems when students study material without thinking about how they might be asked about what they’re studying. The obvious solution is to adjust your study efforts accordingly, putting more time into and practicing more dynamically with the problematic aspects identified in your error analysis.

Other Obstacles

The potential patterns identified in error analyses can’t all be described here. Some will be unique to an individual, whereas others might be related to which professor taught a particular topic. Not every test error will fall into a pattern. But if you have adopted active, sound study strategies, you are trying to anticipate what you might be asked, and your test performance is still not improving, then scanning your performance for patterns is a worthwhile exercise.