5 Lessons from the PLE Experience

5 Lessons from the Physician Licensure Examination Experience

Doktor na talaga ako!”

I was so excited to say these words to my parents.

But the days leading up to the two weekends of the Physician Licensure Examination (PLE), I was still left feeling unprepared. When the time to take them came, the tests seemed more difficult than how they were described.

I wasn’t among the top students of our class. On those days of limbo there was no certainty of a good outcome. Only hope.

We waited day after day for the results to come out. It took unusually longer than in previous years. Friday finally came — the day we expected to receive our fate.

Since the PLE results frequently go online after office hours, I was glued to the PRC website and Twitter for updates since five in the afternoon.

Being stuck in Manila traffic on our way to Samar Study Center did not make the waiting more bearable. Around eight o’clock, I was becoming resigned that the results would not be released until after the weekend.

Then more rumors spread: 9 p.m. The results will be out in an hour. Our college was not the top performing school — meaning not all of us passed.

My heart rate started racing again. The anxiety was building up.

The silent retreat we were attending was starting. We went to the meditation in the dimly lit chapel. I tried not to be so distracted. I prayed for good news.

Right before supper, my phone rang with several messages and notifications. Many sent their greetings. It was like Christmas!

Then I finally saw with my own eyes that I passed the PLE. I was a licensed doctor now!

And so I called up my proud mom and dad to tell them, “Doktor na talaga ako!”

Now with the September 2017 Physician Licensure Exam as part of my personal history, I can talk about what the experience was like.

I’d like to share some lessons I learned along the way. Hopefully some future licensed physicians will find them useful.

Lesson #1: Rest is vital.

Contrary to popular notion that you should work yourself like a horse studying all day, rest is as important a consideration. For many if not most of us, studying for three-fourths of the entire day is just not possible.

You will be tired. And there will be days that you won’t be as productive as you’d like to. This was advice I got from my mentor and I can attest that it is true.

During the first week of my review, while I wasn’t able to finish what I planned, I felt that I was slowly making progress. Studying was actually quite fulfilling.

The following week however, my pace was even slower. My backlogs were just piling up. I could not focus as well as before.

I think this is where “buffer” days come in when scheduling. Unless you’re the type who is able to stick religiously to a rigorous schedule, you will need time to catch up because there will be unexpected “slow” days and times when you need a breather.

Expect the unexpected: rest is important when making one’s schedule.

As much as I wanted to sleep at most six hours, I found myself waking up much later especially when I would sleep way past midnight.

Sleep — especially REM sleep — is important for memory . Adequate sleep not only gives you the energy for concentration but also the right mood to face the day’s new challenges: the metabolic pathways, the life cycle of malaria, or maybe differentiating immune deficiencies.

Plus, we all know how it feels to be running on just a few hours of sleep and cups of caffeine.

Learn to let go. It sure can hurt but it can be good for you.

One more thing: take calculated risks. Yes, you need to cut down on unnecessary activities so you have more time to study. But I don’t agree with having yourself cloistered and away from all forms of social interaction.

For me, I had long considered going on a trip abroad with my family who I don’t see for most of the year. The week before the boards, I also attended a bioethics conference in Makati Med.

These were all calculated risks. I reminded myself of having to work harder since I “lost” study time. Yet these times were not wasted. The rest I got was beneficial for persevering and also important for my human flourishing.

Caveat emptor: You should know yourself and also learn to say “no” to yourself and others when it’s too much.

Enjoying Butterbeer at Universal Stuidos Japan before the physician licensure exam
Here I was enjoying Butterbeer in Universal Studios Japan while my classmates were industriously studying for the PLE. No regrets on this “pre-tox” and quality time with the family though!

Lesson #2: Have people to share your anxiety with.

The road leading to the PLE is really an emotional roller coaster.

I used to wonder why those studying for the boards were fretting so much when they had at least two months to review what they learned in five years of medical school and internship.

When it was my turn, I understood it very well! The feeling of inadequacy is true. The feeling of not knowing enough is palpable. The feeling of fear is real.

I personally would prefer studying by myself most of the time. I found it easier to focus and pace myself with less undue stress of comparing with how others were keeping up. However, I did make sure to see my friends regularly and have light conversations and sharing the usual “panic”.

Surround yourself with companions on the same journey. It helps to ease the anxieties.

While I believe that each one has his or her own pace and style, being with fellow board exam takers can give you a rough gauge of how you are doing.Plus, doing so would keep you in the loop with information such as deadlines for the PRC application, useful mnemonics and high-yield materials (more on “patok” later).

Also, talk to those who have already traversed the same road successfully. While the scope of their board exams may be nowhere near yours (believe me, this may be true for several subjects), the tips and encouragement from our seniors give a little push of confidence. If they made it through, you can too.

If you’re enrolled in a review program such as Topnotch Medical Board Prep, a mentoring program might be offered (though arguably this may be more coaching rather than mentoring). According to an article in Academic Medicine, a mentor is “someone of advanced rank or experience who guides, teaches, and develops a novice”.

Fortunately, I already had a personal mentor even before who is also a physician. Having a mentor can help you stay on track and keep going. Mentors understand your situation and they know how rough it can get. While sharing your worries with fellow examinees can help, discussing them with a mentor can give you a different — perhaps more “mature” — perspective.

The psychological stress can manifest bodily. Many of us experienced insomnia especially during the final days before the PLE. It was the first time for me and was as bad as staying awake in bed for up to three hours on certain days. (Trying to study was not helpful.) I tried all sorts of sleep hygiene and relaxation techniques but eventually needed pharmacologic sleep aids under medical advice.

For those of us who need the increased dose of caffeine, the symptoms of gastroesophageal reflux and dyspepsia may be exacerbated by the stress.

It is okay to feel nervous, unprepared, anxious, distracted, inadequate, worried and fearful. You’re not the first to do so. But don’t be paralyzed. Accept this challenge as part of the journey. Find healthy ways to deal with it and keep moving forward. Be with people you trust (whether physically or virtually) to talk to and to feel more secured. Have more faith — in God and in the ability given to you.

Physician licensure exam triad: gastroesophageal reflux, insomina, diarrhea
I call this the Physician Licensure Exam triad: gastroesophageal reflux (from the caffeine and the stress), insomnia and diarrhea.

Lesson #3: “Day before” preparations are just as important.

For weeks and months, you’ve been (hopefully) preparing hard and putting into practice the schedule and strategy you’ve committed to following after reading a guide to the Physician Licensure Exam or two.

Now to make sure that everything is optimal, don’t neglect preparing well the day before.

Most would advice to stop studying one day prior to the start of the board exams. But okay, we really couldn’t really spend that final day without studying. At least make sure that you drop the review materials by evening, put into order the things you’ll be bringing and go to bed early enough.

I personally blocked off late Friday afternoon of my schedule as “obligatory rest”. My dad and I went to Mass and did some last minute trips to the drug store and supermarket.

My medicine kit included NSAIDs and analgesics, antacids, antihistamines and antimotility agents. On the morning of the exam, I took an antidiarrheal “prophylactically” but during the day I could still feel my bowels rumbling from the anxiety.

Medications
My medication kit had analgesics, antidiarrheals, antacids, decongestants and H2 receptor antagonists among others. Better be prepared! You wouldn’t want anything to ruin your shot at the PLE.

Sharpen your pencils (or have others sharpen them for you) and have enough extras. Bring a black pen, eraser and sharpener with you. Check if your non-programmable calculator is allowed by PRC. Put them all in your bag including review materials to breeze through during the break (because that time is also valuable).

Many schools have a tradition of distributing all sorts of giveaways to those about to take the PLE. They may contain candies and chocolates — anti-hypoglycemia packs, if you will (since you may eat during the exams), pencils and notes of encouragement.

I’ll say this again: try to sleep early. The night before the PLE, my friend experienced insomnia. Sleep deprivation lends no good favor for the next day’s performance. Have your bag and things prepared (if possible days before), set your best alarms on and get yourself to hit the sack earlier than usual.

Scientific calculators
You are allowed to bring a calculator during the physician licensure exam (which you’ll probably need for the Preventive Medicine and Public Health exam). Make sure your scientific calculator is on the Professional Regulation Commission (PRC) list of allowable calculators.

Lesson #4: Study hard and study smart.

When we were interns, a topnotcher from our college had this advice to tell us: “You start studying for the boards on the first day of medical school.”

Hearing this can be disappointing for many. We should have read books when we were reading transcriptions. We should have committed high-yield facts and concepts to long-term memory rather than just figuring out how to pass the next exam.

Whether you opt to enroll for review classes or not, preparing for the PLE still boils down to one’s quality of self-study. (Case in point: Those who self-reviewed from our class and the previous batch all passed the boards.)

It is tempting to get a copy of all the recommended review books (which differ depending on who you ask). However, a regular student will not be able to finish reading everything.

A good rule of thumb would be to choose and master one or two review materials per subject. They say that the goal is two read them at least twice or thrice. I admit to not having finished most once. (I’m not a very good example, haha!)

I think the key to studying smart is to discern what is high-yield. (For example, one lecturer shared his technique of remembering the “counter-intuitive” details.) Aim for understanding but do not underestimate the value of memory devices.

If you have review classes, listen as best as you can to the lecturers and utilize the materials they’ve prepared. (Make the most of what you’re paying for!) Often they will point out the most tested concepts.

It’s not enough to spend numerous hours studying. You also have to study smart. Have a battle plan when approaching study. Prioritize topics to cover. Answer sample exams if that helps you. Dedicate effort to memorize certain facts.

Saint Josemaria Escriva once wrote: “Study. Obedience: non multa, sed multum — not many things, but well.”

Knowing that you have limited time to prepare for the boards, seek to do “much” and keep to doing those things as best as you can. Don’t despair that there is still a gamut of things that you do not remember. Neither should you fool yourself that you already know a lot.

The enemies are self-confidence and self-defeat. These are probably the pitfalls that underlie failure apart from extraordinary circumstances of course.

Despite your diligent preparation, there will still be occasions where you will need to rely on testmanship.

Perhaps you’ll face a question that you have no clue about.  You may encounter numbers of republic acts that are just unfamiliar. Spot and eliminate choices that are too similar. Extreme numbers may not be the answer. Take advantage of the question construction and give your best guess with Lady Luck.

A word of caution on what’s “patok“. It’s true that all sorts of rumors and materials spread like wildfire during PLE season. It may not hurt to see what the buzz is about but the hearsay may also distract you from your already good study strategy and rob you of your peace. Remain vigilant and prudent.

In the end, if you prepared well enough for this, you will make it through.

@drbrainhacker: "PLE takers and anyone else taking exams, please take this new beta blocker: testmanshipparinmgaolol"
Our neurology consultant (@drbrainhacker) reminds us of this  clinically proven drug for exams: testmanship.

Lesson #5: The PLE is not an end but a beginning.

While the PLE is probably the most important test a physician has to take in his career, it isn’t the end.

While reviewing for the boards, I wasn’t feeling what our seniors have told us: that you will feel your “smartest” right before the boards.

I was seeing that it’s true that the more you come to know, the more you realize how much you don’t. The reality is that there is just so many things to know in medicine (even for a GP).

I had this idea that the day after the physician licensure exam, I would probably not be any smarter. There would still be so much for me to learn. And that’s the lifelong learning part of being a physician.

Passing the PLE actually opens up a door of new possibilities. It’s the beginning of the rest of our lives as full-pledged physicians.

Then you will make major decisions that will direct your life or career. Will you pursue residency training? Are you going to do primary care as a moonlighting general practitioner? Will you take a “year off” to pursue other passions — travel, research, public health and whatnot? Is tying the knot and starting a family a consideration in the near future? These choices will have to be made sooner than you think!

Recent realization: PLE is the beginning for the rest of our lives as doctors
The physician licensure exam is not an end but the beginning of the rest of our lives as full-pledged physicians.

#roadtoPLE

The seven to nine years you spent to becoming a doctor was surely no walk in the park. And the PLE journey may also be an ordeal.

There will be the “highs” of excitement and the enjoyment of learning. (Things will start to make sense: “Aha, kaya pala!“) But there will also be the “lows” of frustration with your pace and worry of failing.

Hang in there! The pains of the board exam experience should be more like the purifying fires of purgatory rather than hell. As long as you persevere in study, keep your health and sanity, and pray hard (don’t neglect this and turn your study into prayer), you can be a licensed physician in the end.

And when you finally pass the PLE: rejoice and give thanks! Thank God who gave this blessing and challenge to you. Thank the saints who interceded for you. Thank the people who surrounded you, supported you and prayed for you. Be grateful that you’re now a licensed physician!

Don’t worry about the scores you’ll get as long as you did your best. Apart from residency programs and your closest friends, you probably won’t be asked your board rating anyway — not by your patients especially.

There is a saying that goes: “What do they call the guy who finishes last in medical school? Doctor.”

I look back at the road to the physician licensure exam with gratitude. That experience of several months was like no other, and it has taught me some humble but valuable lessons.

Now it’s your turn: what did you learn along the #roadtoPLE? Or if you’ll still be taking the boards, let me know what you think of these lessons in the comments below.

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