By Spc. Jeshua Nace [Public domain or Public domain], via Wikimedia Commons
By Spc. Jeshua Nace [Public domain or Public domain], via Wikimedia Commons
*In my Sophia Petrillo from the TV show Golden Girls’ voice* “Picture it, Brooklyn, 2001 a young bright-eyed and bushy-tailed PA student born in Panama but raised in Brooklyn is about to start his first rotation, which happens to be surgery. He is excited to be finally out of the classroom with no windows and the grueling hours and hours (and hours) of lectures and endless torture (I mean examinations). He is also excited about the prospect of seeing all of the diseases he read about in the fables of Lange and Harrison’s. He is also petrified because he feels as if he is not quite prepared to be “out there” yet, so he calls on the powers of his senior class that is about to graduate to figure out what life vests he will need not to drown in the surgery sea. His senior tells him to buy the book “Surgical Recall” because he will be drilled by the surgeons and the more he answers right, the more he gets to participate in the operating room besides the dreaded retraction. He sprints to Barnes and Nobles to pick up the book Surgical Recall. To prepare for his first big case, he reads the OR schedule and finds out his preceptor is going to do a laparoscopic cholecystectomy. He wants in on the case, so he quickly pulls out surgical recall and learns all about the anatomy and procedure. The players of the surgical rounds consisted of him, 2 other PA students from another school on their 5th rotation, 3 medical students, 1 resident and the attending/preceptor. Anyone who has done surgery rotations know it can sometimes be the equivalent of army boot camp, so the “Surgeon General” begins to spit out questions about cholecystitis and the procedures and we are all trying to answer frantically to get into his good graces. They all give about an equal amount of right answers, all trying to get the “one up” on each other. The Surgeon general then tells the team the patient has a history of sarcoidosis and what is the management for it. Everyone was kind of stumped.  As you can probably tell by now the bright-eyed bushy-tailed student was I. I remembered a mnemonic I used in didactic year to remember that the “S for sarcoid stands for steroids”. I blurted out the answer “Corticosteroids”, brimming with pride that the lowly PA student on his first rotation had the “one up” on the other PA students, the resident and the medical students. It was like the heavenly angels were singing a melodic chorus, the birds were chirping and cherubims were playing violins. This symphony came quickly to a screeching decrescendo when the attending turns to me and asks me “How do they work in Sarcoidosis?” I remembered the buzzwords but I didn’t remember how or why corticosteroids worked. Instead of complimenting me for being the only one who knew the right answer, the surgeon general yelled at me, the poor private PA student in front of everyone for 5 minutes (which felt like 5 lifetimes) saying “It makes no sense knowing something if you don’t understand it…etc etc” there were other expletives used (anyone who has ever gotten a verbal lashing during their surgical rotation will know exactly how that convo went). Sitting in the operating room retracting, it gave me a lot of time to decide that I never wanted to be yelled at again and I needed to learn how to understand the things I had learned better. There in the operating room gave birth to the concept of PATIENT-CENTERED LEARNING.

In the didactic year, most students survive by making up useful mnemonics, and cramming the information just to pass they myriad of exams that come at you like tidal waves while you are trying to swim out of the whirlpool of all day lectures. They cram, memorize and regurgitate the information and move onto the next test. They make it through the didactic year but then the clinical year poses a new, daunting challenge. Not only do you have to recall the information of the didactic year but also you have to now apply it clinically. This is where most PA students (often even the brightest ones in the class) have difficulties. Think of our brains as a computer and it will make total sense and then I will go into the PATIENT CENTERED LEARNING technique.

You don’t have to be a computer whizz to understand defragmentation, RAM and ROM

RAM: is our short-term memory, where information is crammed, stored temporarily and regurgitated. Most of us put the things we learn here. The problem with that is that although easier to access, the memory stored here is loss after the computer is turned off (meaning an after the exam or after that course).

ROM: is our long-term memory, where information is stored and retained. Ideally this is where we want most of the material to go because it leads to greater retention. This stays even after our computer is turned off (after an exam). What is not lost in RAM is then placed in ROM in many fragments and unrelated bits.

“DEFRAGGING OUR BRAIN”. A computer has to go through the process of defragmentation to work faster and more efficiently. The process of “defragging” your computer physically organizes the massive amounts of information into smaller regions of knowledge blocks (fragmentations), arranging them in a sequence for faster access to the information. It “fine tunes” and reorganizes it. A lot of what we learn in the didactic year is learned in these fragments but then are stored all over the place.

To make it real for you, we learn hypertension in cardiac lectures, we learn about pulmonary hypertension in pulmonary, causes of secondary hypertension (such as Cushing’s syndrome, hyperaldosteronism and pheochromocytoma) in endocrinology.   We learn about hypertensive emergencies in emergency medicine lectures, preeclampsia in OB/Gyn etc. But these are not learned at the same time, so we store them as individual fragments when we learn them, often not connecting the dots.   Faced with this unique problem of having to reorganize the information for the clinical year, I had to figure out: how can I learn this information so I don’t have to receive any verbal lashings, pass the end of rotation exams, pass the PANCE, be able to an efficient practitioner and be able to explain the diseases to the patients so they feel more knowledgeable about their own diseases and retain as much information over the long haul. My technique “Patient-centered learning” combines all of that into one process so it’s an efficient way to learn. If these diseases are difficult for us to learn despite having the extensive training we went through, imagine how much harder it is for our patients to comprehend their diseases.   I can’t tell you how many times in the emergency room I tell patients they have a fracture and then they make a sigh of relief and say to me ‘Ok. At least its not broken” and then when I tell them it is broken, their mouths drop until I explain to them it’s the same. So to help you and our patients, I will explain to you the patient centered learning concept in 3 easy steps:


  1. BREAK DOWN the disease first by explaining the disease (including the pathophysiology) IN YOUR OWN WORDS in one (maximum 2) sentences whenever possible. The sentence should be constructed as if you were explaining it to your patient for them to understand the disease. By breaking it down in your own words you are processing the information and relating it to your previous baseline of knowledge, which promotes retention. Make sure with this step that you understand the basic anatomy and physiology and pathophysiology pertaining to the disease as this is critical for this concept to work or else it is more memorization and less understanding. Remember that you want to limit rote memory and clogging up your RAM to more understanding to store it in your ROM.
  2. EXPLAIN as much of the history, physical exam findings, diagnostic studies with expected findings, treatment options, medications and mechanisms of actions of the medications pertaining to the diseases. Relate each of those things back to the sentence in rule 1. Relating it back one reinforces the sentence, your understanding and the connections between all the things about the disease to each other.
  3. CONNECT if possible to other disease with similar processes or the exact processes for comparison and contrast to allow the fragments to be grouped for easier access. Thus also helps you to understand medicine in a broader perspective and over a broad range of topics.

Now that you have the three golden rules I will give you two examples to drive the point home.

Example: Gastroesophageal reflux disease:

STEP 1: BREAK DOWN the disease first by explaining the disease (including the pathophysiology) IN YOUR OWN WORDS in one (maximum 2) sentences whenever possible.

If you have my book Pance Prep Pearls then I have pretty much already done the first step for most of the diseases in the book but if you don’t have the book, fear not. I can easily show you how to do it

Gastroesophageal reflux disease (GERD): decreased lower esophageal sphincter pressure due to relaxation, leading to reflux of the acidic contents of the stomach into the esophagus.

STEP 2: EXPLAIN as much of the history, physical exam findings, diagnostic studies with expected findings, treatment options, medications and mechanisms of actions pertaining to the diseases relating it back to the sentence in rule 1.


  1. heart burn (pyrosis) hallmark: burning sensation in the chest or upper abdomen due to reflux of acidic contents into the esophagus.
  2. Regurgitation & water brash: due to reflux of acidic contents into the mouth
  3. Cough especially worse at night: reflux of acid into the esophagus and mouth with aspiration of acidic contents stimulating the cough irritant receptors. This also explains the development of possible aspiration pneumonia and asthma-like symptoms (bronchospasms also limits further damage from acidic contents).
  4. Hoarseness: due to reflux of acidic contents causing inflammation of the vocal cords


  1. Esophagitis: due to reflux of the acidic contents into the esophagus, leading to inflammation.
  2. Esophageal stricture: the damage from the refluxed acid and chronic inflammation can lead to narrowing of the esophagus
  3. Barrett’s esophagus: the esophagus tries to compensate for the chronic exposure by the migration of gastric cells proximal esophagus. This chronic exposure can lead to metaplasia and eventually esophageal cancer.
  4. Adenocarcinoma of the esophagus: (see Barrett’s).


  1. Clinical diagnosis
  2. Endoscopy: used to evaluate persistent symptoms, look for complications listed above
  3. Esophageal manometry: used to see if lower esophageal pressure is present.
  4. Ambulatory pH monitoring: used to see if the pH lowers throughout the day (acid has a low pH). Currently the gold standard. Note all the diagnostic studies are still related to the original sentence you created.


  1. Lifestyle modifications: all used to reduce reflux and speed up GI transit (ex. elevation of the head of the bed, avoiding recumbency for 3 hours after eating, eating small meals, decrease fat and alcohol intake etc).
  2. H2 receptor blockers: reduces acid production by blocking histamine-induced gastric acid production
  3. Proton pump inhibitors: reduces acid secretion by blocking proton hydrogen ion release
  4. Nissen fundoplication: surgical procedure to reinforce the closing function of the lower esophageal sphincter.

Again note all the management is still related to the original statement.

For step 3, you can tie the information to Peptic Ulcer disease, another disease that may present with epigastric pain and that H2 blockers and proton pump inhibitors are used in that disease as well.

Now you see that with the one (or two) original sentences, the basics of GERD can be remembered easier because you tie it all to one or two sentences. Your brain can package and organize the information so that you can do less memorization/regurgitation and more retention because you tie all the details to a bigger picture as opposed to small tidbits of information.

Now let’s try one more to make sure you have the concept.   Asthma


STEP 1: BREAK DOWN the disease first by explaining the disease.

Asthma: reversible (1) hyperirritability of the airways, leading to (2) airway narrowing (bronchoconstriction) & (3) airway inflammation obstructing the movement of air out of the lungs.

STEP 2: EXPLAIN as much of the history, physical exam findings, diagnostic studies with expected findings, treatment options, medications and mechanisms of actions pertaining to the diseases relating back to the sentence in rule 1.


  1. Dyspnea: shortness of breath due to airway narrowing and inflammation increasing the work of breathing.
  2. Wheezing: sounds made as air moves through the narrowed airways. Also explains the chest tightness
  3. Cough: hyperirritability of the airways stimulates the cough irritant receptors.


  1. Peak flow meter: assesses the level of obstruction of the movement of air out of the lungs. Most objective noninvasive way to assess severity.
  2. Pulse oximetry: measures oxygenation and level of obstruction of airflow
  3. Metacholine challenge test: a test done to cause bronchoconstriction (you have to remember from basic physiology that acetylcholine/parasympathetic stimulation leads to bronchoconstriction and sympathetic stimulation leads to bronchodilation). This concept will also be helpful in understanding the medications. Metacholine is an acetylcholine-like drug.
  4. Pulmonary function test: gold standard to look for reversible


Remember the 3 components of the disease from the stem sentence:

Bronchodilators (addresses the bronchoconstriction)

  1. Beta 2 agonists (Ex albuterol): Beta-2 activation stimulates the sympathetic system, leading to bronchodilation of the lungs, increasing airflow. Side effects are due to sympathetic stimulation (including the beta 1 receptor of the heart) leading to palpitations tachycardia CNS stimulation.
  2. Anticholinergics (ipratropium/Atrovent): central acting bronchodilator that blocks acetylcholine-mediated bronchoconstriction. Acetylcholine activation causes increase bronchoconstriction, salivation, lacrimation, urination, digestion and pupillary constriction. Side effects are the opposite of those including: dry mouth, urinary retention, dry mouth, and exacerbation of glaucoma.
  3. Theophylline: bronchodilation
  4. IV magnesium: Magnesium antagonizes calcium-induced contraction of the muscles in the airway leading to bronchodilation.

Anti-inflammatories: addresses the inflammation and hyperirritability:

  1. Corticosteroids, mast cell inhibitors, leukotriene modifiers: inhibit inflammation at different levels

STEP 3: CONNECT if possible to other disease with similar processes. There are many connections that can be made from this but to give you an example:

Anticholinergic atrovent sounds like atropine (an anticholinergic used to increase the heart rate in bradycardia.

You can even connect it to glaucoma by remembering acute glaucoma can be exacerbated pupillary dilation, which is why anticholinergic drugs (that cause pupillary dilation) can exacerbate glaucoma and why cholinergic drugs (such as pilocarpine) can be used to treat glaucoma and Sjrogen’s syndrome (by increasing salivation).

You can also connect it to benign prostatic hypertrophy by realizing that anticholinergic can promote urinary retention in patients with BPH and can exacerbate the symptoms.

You can also connect anticholinergics to why they work in urge incontinence by decreasing bladder detrusor muscle contractions, improving the symptoms as well as why tricyclic antidepressants m ay also be used (due to their anticholinergic effects).

You can connect the magnesium sulfate used in asthma by remembering it is used in seizures, to treat torsades de pointes, ventricular tachycardia, and for tocolysis (anti-contraction to prevent premature birth). Why the same drug for these very different diseases??

Asthma: Magnesium antagonizes calcium-induced contraction of the muscles in the airway leading to bronchodilation.

Torsades de pointes and ventricular arrhythmias: antagonizes calcium-induced heart muscle contractions and blocks neurotransmission of cardiac neuromuscular impulses, prolonging conduction times and stabilizing cardiac membranes.

Eclampsia: blocks neuromuscular transmission producing anticonvulsant effects reducing the seizure potential as well.

Tocolytic: antagonizes calcium-induced uterine contractions, decreasing labor contractions, preventing premature labor.

Laxative: promotes osmotic retention of fluid in the colon, causing distention, leading to increased peristalsis and bowel evacuation.

Now you have tied that drug and how it works to cardiac, pulmonary, obstetrics, gynecology, neurology and gastrointestinal. So your brain can now make those stronger, more lasting connections.

You can use this technique for almost all medical diseases and the more you start to do it the faster that you will become at doing it. It takes a little while to get used to doing it this way but you will find that when you review it this way, you will retain more each time you review it. It is also helpful to use that one-liner (sometimes simplified) to explain the nature of the condition to your patient, why they develop certain side effects and symptoms. Which symptoms to look out for that are considered “alarm” symptoms. Why they are taking the medications you prescribe to them and some side effects they should look out for.  This will make the patient feel empowered because they know more about their condition and things they can do to improve it and why they are doing it. You become a better clinician, you will pass your PANCE/PANRE, you will become more effective at communicating with your patients and increase their understanding and you will do less memorizing and more understanding and retention of the material. A win-win for all!!!

All my best

Dwayne A Williams

Dwayne A. Williams is the author of Pance Prep Pearls and Pance & Panre Question Book  .  He is also author of the Medical Mnemonic Comic Book.





By LaurMG. (Cropped from "File:Frustrated man at a desk.jpg".) [CC-BY-SA-3.0 (], via Wikimedia Commons
By LaurMG. (Cropped from “File:Frustrated man at a desk.jpg”.) [CC-BY-SA-3.0 (, via Wikimedia Commons


As a professor for both clinical and didactic year at 2 PA schools for 12 years, I have seen a lot of students come and go.  PA school is one of the hardest things I have done in my life, but if I had a better roadmap when I was a student, the task would not have been as daunting.  I started undergrad with 4.0 average and upon starting PA school, I quickly learned that what I did to get the 4.0 had to be DRASTICALLY remodeled for PA school or I would have kept drowning.  Here are some tips to help new PA students stay afloat and survive the medical monsoon that is PA school.  Before jumping into tips, one must have a complete understanding of the unique problems of PA school…




COME TO TERMS WITH IT!!! Many people can cram, study and just regurgitate memorized material & many other skills to get a 4.0 in undergrad however, won’t get MOST people far in PA school because:

  1. You a learning A TON OF INFORMATION IN A SMALL AMOUNT OF TIME.   You are constantly learning new material while being tested on old material – there isn’t just one focus on one area.
  2. You have more time & less material in undergrad so it didn’t require a lot to get a lot (in terms of good grades).
  3. MOST of PA school is application learning:

Classes like anatomy may be heavy on memorization but many core classes require learning how to apply the information in a clinical scenario, not just pure memorizing the material.  This requires a much deeper understanding of the material compared to undergrad.


  4.  THE CLASS SCHEDULE IS USUALLY NOT STATIC:  Classes easily change day to day & week to week so you must adapt more often to changes and lengths of class.


   5.  There isn’t much FREE TIME:

  •          Schedules are hectic with little breaks.  Sometimes have multiple in exams in the same week while learning new material.


  • You can easily fall behind & hard to catch up.  Many students have the false notion that, like undergrad, it will be easy to catch up to speed with a little hard work.  Once you fall behind it becomes harder and harder to catch back up without compromising learning and retaining new material.
  • A lot of the material is CUMULATIVE:  Unlike undergrad, it is not about learning for an exam and then forgetting it.  You have to maintain a working knowledge and retention of the diseases .  “Old” material is never “old”  disease processes or diseases will come back in other classes = what I call the  OVERLAP phenomenon.


I hope by now that I convinced you that PA school is different.  But chances are if you are already in PA school, you have already learned the hard way.  Now that you realize it is different, MOST of you will  have to approach it DIFFERENT than you did  in undergrad.   Again, what you did to get a  4.0 in undergrad often will not work (or may not be enough to get a great grade in PA school).  So how do you alter or rearrange your once useful or semi-useful techniques to make you a stellar PA student??

  • The most fundamental principle of efficient studying  – the best use of your limited time – requires ACTIVE not passive learning.


  • ACTIVE LEARNING: requires MAKING ACTIVE, INTUITIVE  DECISIONS about the material.  Questions you must ask yourself is:
    • “WHY Is this important?” 
    • “What is the BIG PICTURE?”


                  What is the LITTLE PICTURE ?”

    • “WHERE have I seen this before?? (to make connections with things you have learned before).    
    • “Where does this fit into the ‘BIG PICTURE?”    How to organize material?



The LITTLE PICTURE  are the necessary components and details of a disease or group of disease.  This requires:

    • Understanding basic anatomy & physiology:   STUDENT MYTH: IF I AM NOT STUDYING FOR AN ANATOMY OR PHYSIOLOGY TEST AND IT IS CLINICAL MEDICINE, I CAN SKIP THIS BECAUSE IT’S “NOT NECESSARY.”    REALITY:   This is a critical mistake PA students make in an attempt to figure out when studying what should the focus on and what can fall by the wayside.  Now, I am not saying to remember every single page of anatomy and physiology from the book but you do need to know the basics of that to apply to the disease.  This is because when you understand the basic anatomy and physiology.  You can make sense of the pathophysiology of the disease.  Understanding the pathophysiology often will explain clinical manifestations and (9 times out of 10) the medications used to treat the disease, the mechanism of action of the medications as well as some of the side effects of the medications used or why some medications are first line for a disease where it isn’t in other diseases that it may be used for.  For example: understanding that heart failure is a condition where the body tries to compensate for the failing heart by stimulating the renin angiotensin system, which over time leads to decompensation and heart failure.   ACE inhibitors are first line for heart failure because they directly inhibit the effects of the renin angiotensin system.  Side effects of ACE inhibitors are they can cause hyperkalemia (because from physio you remember that if you block aldosterone, you get rid of sodium but you hold onto potassium and hydrogen ions – which also explains another possible side effect of ACE inhibitors, metabolic acidosis).  Understanding this also helps you to understand other disorders.  For example, the disease hyperaldosteronism (meaning that too much aldosterone action is occurring) will present with hypertension, hypokalemia (since aldosterone holds onto sodium in exchange for potassium and hydrogen ions) and metabolic alkalosis (since you are getting rid of hydrogen ions).  And why patients with Addison’s disease (a condition that you don’t produce enough aldosterone) will have hypotension and hyperkalemia as presenting symptoms.  Again different diseases with the same connecting principle.  Often students learn these thoughts in isolation and focus on these little details because in getting the little picture (of the details) they miss the big picture – but I am getting ahead of myself!  Back to the little picture:  Understanding the basics takes a little more time initially but the pay off is when you understand it, the other details make more sense and you don’t have to memorize as much because you can talk it out as to what is going to happen so it is easier to retain. The more you understand, the less you have to memorize!  This means that you don’t have to study as much and the time that you do use to study is used more efficiently!


    • Also understand the basic terminology used: I can’t tell you how many students can tell me that they see Kussmaul’s sign in certain diseases but when I ask them to describe it they can’t.  Often on exams, they may either write out the name of the terminology or describe it, so it is good to be able to understand the terminology you are using in a disease.  If you don’t know it, make sure to look it up!
    • STUDENT MYTH: ” IF I UNDERSTAND ALL THE LITTLE DETAILS THEN I WILL MASTER THE TOPIC”.  Wrong!  There is no little picture if you can’t see the big picture!!!



The BIG PICTURE is making the connections of all the little details to see the underlying theme of that disorder and how that concept can apply to other disorders.  This is the one of the hardest part for students because they concentrate so much on memorizing the little details they can’t pick their head up to see the connections, so they learn everything in an isolated bubble.  It is like driving to a destination.  if you just look at the road of the highway without looking at the signs, you will eventually get lost.  The big picture is like the GPS.  it tells you how the little roads that you learn are connected to get you to the destination.  Rather than aimlessly drive and ending up in detours, you take the fastest route to the end destination while maximizing your retention.   Why is the big picture Important??? Funny you should ask, well I am here to tell you!

    • Knowing the big picture helps to understand the little details moreFor most students this concept seems counterintuitive.  But when you understand the big picture, you understand the purpose and the principles of all the details you learned


    • Knowing the big picture helps you to relate other diseases to a common theme: For example Sinusitis (sinus openings get blocked and the flora that is already there along with the mucus builds up,  leading to an infection), Appendicitis (fecalith blocks the appendix leading to infection/inflammation), Cholecystitis (stone blocks the cystic duct, leading to infection/inflammation), Diverticulitis (fecalith blocks the diverticulum leading to inflammation/infection), Saliolithiasis (salivary stone…well you get the picture now).  Also other diseases that have the same processes are connected.  For example: atherosclerotic disease in the coronary arteries happen throughout other arteries in the body not just the coronary.  Whenever there is decreased blood flow we call it ischemia, when there is death due to prolonged ischemia, we call it infarction.  Ischemia in the coronary artery is called angina, cell death is called a myocardial infarction.  Atherosclerosis in the carotid arteries of the neck can lead to brain ischemia (TIA – Transient Ischemic Attack) or brain cell death (Cerebrovascular accident/Stroke).  Atherosclerosis in the arteries that supply the leg can lead to ischemic leg pain (claudication) or cell death (gangrene).  Atherosclerosis in the arteries of the GI tract can lead to ischemia (Chronic mesenteric ischemia often called intestinal angina) or acute ischemia that can lead to bowel gangrene, etc.


    • Finding the “big picture”  will help keep you on track during the lecture This is a fine tune skill that not all students will subscribe to because they will say that they don’t have time.  But if you read a lecture a few 5 minutes before class, it won’t be the first time you are hearing the material and then you can begin to formulate questions to ask your professor during the lecture of the material which is needed to effectively learn the lateral.
    • Knowing the big picture can maximize your study of the material later while reducing the time you have to study for it to make it stick:  it helps you to rewrite your notes in an outline form (which is very helpful for a quick study especially before an exam.  So is creating flow charts, lists or diagrams that organize the needed material in a visual way.  Not all of us are visual learners but you will be surprise that you remember that some information you needed to answer a question was in the upper left section of your chart or you can visualize your simplified chart in determining which way to go to treat the person.  Actively memorizing these flow charts are a quick way to review the material and then when you add the little picture to your big picture, you can see the work of art you created.


Here is an example of the big picture study strategy and how it helps you understand the disease better. Click on this for a sample:  BIG PICTURE.


Now that you have created your work of art, how do you know study it?



1.  MEMORIZATION: Some things need to be memorized and most students handle that part okay.  Difficult things that you need to memorize can sometimes be made simple with a mnemonic.  For example, I tell my students that Multiple

Myeloma is the main hematological malignancy that directly affects the bone.  So I teach them Bones “BREAK” with multiple myeloma to help them remember the cardinal findings in patients with Multiple Myeloma.

Bone pain – due to calcium remodeling.  This also helps them to remember the “punched out” lesions of the bone on the skull in patients with Multiple Myeloma

Recurrent Infections –  the plasma cells that make up the malignancy crowd out the bone marrow that the marrow can’t make other cell lines such as red blood cells

Elevated Calcium – Hypercalcemia due to bone remodeling

Anemia – the plasma cells that make up the malignancy crowd out the bone marrow that the marrow can’t make other cell lines such as red blood cells

Kidney Failure  – due to increased protein excretion damaging the glomerulus.  This also helps them to remember to look for Bence Jones Proteins in the urine

    •  Don’t put off memorizing material until just before the exam!      NOOOOOO CRAMMING!!!  Remember that tactic helped us in undergrad but it won’t help us here because you can’t commit things you cram into long term memory and remember medicine isn’t about forgetting what you learned and moving on, it is cumulative knowledge.  You won’t remember everything but you have to remember a lot of it or be able to recall it from your long term memory.  If you cram the night before, you won’t remember it in a week.
    • Frequent review of the material leads to more retention.  The more you review a packet over and over again, the more things will start sticking or making sense and you get an idea of what you know and what you don’t know.



Another Student MYTH: “I JUST DON’T HAVE ENOUGH TIME  TO GET IT RIGHT”.   I get it.  The hours are long, there isn’t much time to study, you need to sleep… yada yada….(insert violin player and sad woe-is-me music).  But this is what you signed up for.  You can’t learn all of medicine in a couple of years without time and sacrifice.  It is all about maximizing the little time you do have.  A few tips on how to do so…….

    •  Set aside adequate time for studying: Even with study tips, they are tips to help you STUDY (the operative word here).  You have to put in the time.
    • PRIORITIZE AND ORGANIZE TO MAXIMIZE  the time you have by using it more efficiently.  In other words if you decide you have 6 hours of study time  (I know I know how often does that happen) and you have 4 exams that week and you are going to study every day, do 2 hours of the exam coming first  and then an hour for the other exams.  As the exam passes and you have new material, then always re prioritize which should get more of your time.  A big mistake students make is using all 6 hours to study all the material in one exam and that will hurt your scores in the other exam.  Some people prefer to set aside the most important topics in the beginning when the brain is freshest or some at the end (because they retain what they look at last better).  You have to figure out which type you are to maximize the learning.  Now you didn’t hear this from me, but for those who are caught in a hairy predicament.  the have fallen  behind and you have 4 exams this week but 3 of them counts for the same class and you have lets say 6 exams in that course that count to your final grade but the 4th exam you have that week is for a  course that only has 2 exams and you didn’t do well on the first one (and if you don’t pass the second one, you will have to take a remedial or fail the course), then you need to prioritize that exam so that in the long run you are in better academic standing.  If you don’t do as well on an exam where getting a bad grade in the long run won’t affect your overall score then you have to think about the long-term.  Again you didn’t hear it from me and if you did all the things that I mentioned before, you wouldn’t find yourself in that dark, dark place.


    • BREAK UP THE STUDY WITH SOME BREAKS Another big mistake students make (especially those who found themselves in that deep dark place of academic issues) is they study for hours on end, thinking that the chunk of time will allow them to learn it.  I sometimes teach my students for 7 hours straight.  The first 45 minutes they are into the lecture and then close to the  hour, they  begin to nod their heads, look at me with puppy dog eyes to have mercy on their souls, some snore loudly, some snore silently but drool a lot, and their brain starts shutting down etc.  So I give them a break every hour and I do activities where they move around or do case studies or presentations just to get the brain to learn a different way and to give the brain a rest.  You won’t learn if you are completely tired or if you don’t give yourself a break!  Students fail to realize those breaks make those 45 minutes in between much more efficient.  For example, lets say you have those 6 hours as above and you are studying for Pharmacology, Infectious Disease, Anatomy and Pathology (the dreaded test you didn’t do well on the first one and there are only two for that course)  and you are one of the ones whose brains are fresh in the beginning.  then your study should look like this:
  • Pathology 12p -1p (break 1:15-1:30p)
  • Pathology 1:30 – 2:30 (break 2:30 – 2:45p)
  • Pharmacology 2:45p- 3:45p (break 3:45p-4:00p)
  • Infectious Disease 4p- 5p (break 5p – 5:15)
  • Anatomy 5:15-6:15p


And when you take a break, walk away from the study area, take a walk, catch up on your social website, pet your dog, cat or pet tiger, listen to music, call and cry to a fellow student that I am making you study for 6 hours.   But do something to temporarily take your mind off the material and that is relaxing.


    • GET SOME ZZZ’S TO GET SOME AAA’S: Another big mistake students make  is to study all through the night and go to the exam with only 2 hours of sleep.  While this strategy may work for very few and far between, fatigue means you are more likely to make smaller mistakes and your brain won’t function at its peak when you are sleepy.  Do you want a sleep bus driver driving you to PA school??? Probably not (unless you want to use the excuse the bus accident delayed you from taking the exam).  You should be well rested so you can perform at your best on the exam.


    • STUDY GROUPS ARE NOT THE TIME TO STUDY…WELL SORT OF:  Study groups are not for everyone.   Many people do better studying on their own.  But if you decide that study groups are good for you (which many are, you also have to maximize what you get out of that.   Though it is called a study group, most of your studying should have been done before you go to the group.  You want to be able to contribute to the group and if someone doesn’t understand a concept, you may be able to explain it in a way that they can get it.  in you explaining it, you reinforce that concept in your head.  Also since you studied, you know which issues you need help with to pinpoint your focus in the group.  And no one likes that person who is slowing down the group because they are trying to write down everything being said because they have no clue what is going on.  Make sure the socializing is limited.  It is a study group not a social group.    No talking about TV or who is hottest guy or girl  in the PA class etc.  That cuts into study time.  Quiz each other, break up tasks areas and assign each person so they can tackle a subject and quiz each other make up some scenarios to apply the information you learned clinically.  When a question is answered wrong, try to help explain why it was wrong to help each other learn.    Sometimes you think you understand a topic until you get a question wrong sand you realize that you may not have totally understood a key concept that you thought.  Plus, students discussing topics may have made you realize there was key area that you missed but them discussing it brings your attention to that detail.



    • Not all technique works for all people – find which ones works for you
    • If you try a technique and it works, use it
    • If it doesn’t work, assess if it needs to be utilized better, altered or changed
    • Don’t become too discouraged, it takes time to get an effective


With this information you can cruise and soar above the waves instead of sinking into the deep abyss!  And have a blast learning medicine at the same time!


Great Studies to you!!!!

Dwayne A Williams is a clinical professor at two PA programs and the author of Pance Prep Pearls, a study guide for the PANCE and PANRE available on   For more information, visit