A pretty common question when it comes to the PANCE. I thought I’d share it with you from this email that came in.
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Recently I came across with a practice question about lung cancer screening. The question was about a 62 yo with a 40 year smoking pack history. He quit 10 years ago and his exam and review of systems were unremarkable. The answer was: no screening needed since he is asymptomatic and a former smoker.
Checking the guidelines by the American Society of Cancer, this patient will require screening. Here is a summary:
Not recommended for average risk but for high risk smoking patients. Screening may be right for you if you are ALL of the following:
55-74 yo
In fairly good health
At least 30 year pack history and either currently smoking or stopped within the last 15 years
I’m wondering if this are the guidelines the PANCE is going to use or if there is another one (I have found discrepancies online).
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The short answer is… There is now way to know, so stop worrying.
This is really, really, really hard. Let it go. When you study, you want to perseverate over minutiae. You want to know it is worth spending the time to learn something. You need to get it right. Unfortunately, you’re not going to know. There are tons of reasons for discrepancies. The guidelines are always changing. We are learning new things and things get updated. Science is a method of looking at a problem. Science is rarely concrete answers. Sometimes, but way less than we think. When do those updates occur for the exam? Who knows?
As a student, you think that everything in your textbooks is correct and set in stone. Read a little medical history and start to realize that it’s all in flux. That we don’t know what we’re talking about. We do experiments and try to get our preconceived ideas out to of the way and be objective. Then practice with what works.
We are better than we’ve ever been, but we don’t know lots and lots of things.
Should you eat the egg yolks or not eat the egg yolks? 🙂
We were initially told not to wear masks during COVID, now we should.
Do lock downs work to stop the spread of the COVID?
Is the cure worse than the disease?
Who writes the guidelines? Is there only one group assigned to do that? I hope not.
The American Academy of Family Practitioners puts out their guidelines for treating gestational diabetes and the American College of Obstetricians puts out a similar set of guidelines. They overlap a lot, but not 100%.
Who’s right? Which one do you study? How do you know?
The very simple answer is that you don’t.
So, stop focusing on it. Stop worrying about it.
Worrying about stuff like this sucks up a lot of time and energy. It makes you feel like you’re wasting time if you work on one or the other. All it does is drag you down.
Everyone knows that certain topics have multiple or even conflicting standards, especially the people who write the tests. So I have two very freeing opinions on this:
1) They are not out to trick you
2) There are 300 questions on the exam
Point one – they don’t want you to fail on a nitpicky issue. They want you to pass. If there are two or three possible answers, test writers will likely stay away from those questions altogether. Even those topics. I point that out in the podcast all the time. Certain things they just won’t ask because the treatment is too vague.
Take plantar fasciitis. If you google plantar fasciitis, you will come up with 1000s of treatments. Because none of them work very well. They won’t ask, “What’s the best treatment for plantar fasciitis?” It isn’t going to happen.
Point 2- Even if that happens (and it might), one or two questions out of 300 isn’t going to change anything.
(Yes, I do hear from people who fail by one point, but that’s like blaming the umpire for losing a game. One question shouldn’t make or break you if you know your stuff).
Spending a week worrying about one question and the guidelines associated with it makes no sense. Get that one wrong and move on. You don’t have infinite time to study. That time can be put to much better use.
Spend your time on things that will be on the majority of your test. The things that will be 50 or 75% of the exam. Not the things that might be .01%
The Final Step is designed to cover the most likely material on your exam and drill it into your head. Know that material and, when you come across a question on the exam that you know has multiple answers, pick C and keep moving.
Brian Wallace
P.S. If you’ve got student loans and you’re hoping to land a big job to take care of a bit of a mess, I’ve got something for you coming on Wednesday. Keep your eyes peeled.