#ROADTOPLE An Almost Complete Guide To The PHYSICIAN LICENSURE EXAMINATION

#ROADTOPLE An almost complete guide to the PLE

 
-UPDATE: The photos from Dr. Elomina’s instagram account are not showing since I moved my site, will try to edit when I get free. For the mean time, happy rereading!!
 
 
It is common knowledge that Medicine takes someone’s prime years away; a lot of it in fact. After high school, one has to go through four years of college, four years of medical school, and one year of senior internship; all these years for that one examination that will decide whether or not we may practice our craft–the Physician licensure examination (PLE). If you are reading this, because you are about to take the PLE, congratulations; you have survived almost a decade of supraphysiologic functioning, without failing organ systems, hopefully. I am writing this at Nicole’s behest, to help future doctors on how to prepare for the PLE, and I hope you will find this at least entertaining, if not that useful.
 
 
 
For starters, let me tell you a few things about me. I’m Kevin, Kei for short, 25. I am an Isko (UPLB, Biology, Microbiology), and a Lasallian (DLSHSI, Medicine, post-graduate internship). I graduated with latin honors (cum laude) from both institutions. Basically, people consider me as one of the top students in class; but, this does not mean that what I am going to say for the next several hundred paragraphs (kidding!) will not be of use to other students. This is a one-size fits all kind of thing, trust me.
 
The second habit of highly effective people is, 

 

begin with the end in mind.

 

So, let me start this lengthy post with this :
 
Source: CNN Philippines
 
 
By the providence of God, and persistence in work and in prayer, I placed seventh, in the September 2016 PLE. My memory of the night of September 21, 2016 can definitely fuel a full-body patronus; too bad it does not exist (sobs). I am writing this because I want you to feel the same kind of high, come your time; so, in hindsight, these are the things I have done in order to prepare for the PLE .
 
 
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A lot of med board-inspired blog posts out there focus on limited aspects of the boards; most of these neglect the non-cognitive part of the preparation. It is because of this that I decided to write something I wished I would have read when I was in your shoes. This entry is divided into four parts:
 
1.      Personal preparation
2.       Review
3.       Actual examination
4.       Post-examination
 
Everything starts with personal preparation.
 

 

Personal preparation

 
Basically, this is your resolve to take the PLE, and of course, to overcome it. Here, you have to answer three questions: 1. What is my goal? 2. What am I willing to sacrifice in order to achieve my goal? and 3. How will I keep myself motivated? 
 
I have one general rule when it comes to goals:

 

Always aim for the best.

This is so because the first reality of life is, “nothing ever goes according to plan.” Therefore, set high goals, so that if you fall short of them, you would still achieve an acceptable result. In close relation to your goals are the necessary effort and sacrifices that you must do in order to attain your goal. Naturally, high goals require greater effort and sacrifice, and sustenance of your efforts necessitate strong motivation, and that is in the form of purpose. It is the one thing you return to when you feel like quitting.
 
Personally, I aimed for first place during my time, and I knew how bitter of a fight I had to put in order to make it happen. Let me quote some lines from my testimonial address, describing some of the personal compromises I have done for the boards:
 
“I did not dip my foot into the dating pool, which was really sad; I spent my off days reading textbooks and review books; I ditched on drinking sessions, which I thought I desperately needed, in hindsight, probably also because I was practically mouse poor during internship; and I channeled all my prayers into that one thing: placing in the boards.”  
 
Initially, every compromise may seem too much, because you have yet to see the reward. Looking back, all of the sacrifices I have done, bore fruit–although I did not place first, I landed seventh.
 
The hardest question to answer is probably the third one, “how to keep myself motivated?” The first step is to find your purpose, and one question that would help you find it is:
” Who or what are you doing this for? “
 
I used to put my family photograph on my study table, and whenever I feel exhausted, I would stop for a while, and look at it; and in some occasions, drop a call to my folks just to know how they have been. I went into medicine, partly because of them. For me, this is one form of emotional refueling. A word of caution, though–there is a fine line between emotional refueling and distraction when it comes to spending time with loved ones. Remember that the first order of business is reviewing, and you do not want a large chunk of your time alloted to matters other than studying, at least for the next few months.
 
 
One day, I will have a white coat of my own, with my name on it, and with an M.D. after my name. One day.
 
 
Sustenance of inspiration requires consistency.  You should allow yourself to be reminded of your inspiration everyday. Like I said before, my family photograph is placed in an area where I always study. For some, they make a collage consisting of photographs of their inspiration and their goals, and they place it in front of their study table. Some set an inspirational quote, or a guiding Bible verse as their phone wallpaper. There are many hacks out there, and you have free rein to use any of those, whichever works for you.

 

Time and schedule

 
Your schedule will ultimately depend on how much time do you have. In my time, we have four months of preparation; the first two months were allotted for self-study, and so my general objective was to finish reading everything (except for Legal Medicine and Preventive Medicine) in that period. Then, I just went with the flow of the lectures, and formulated another study schedule during mastery period (this time, depending on the schedule of the subjects in the actual boards).
 
Schedule will matter more during self-study days, because if you are enroled in a review center, you have to follow their timetable to maximize your study time. In general, there are two types of schedule: 1. daily; and 2. block. 
 
Daily schedule sets daily tasks that you should accomplish, and sets definite number of hours in a day for different functions, like this:
 
Schedule
Daily routine
Date
Subject
Topic
Time
Activity
July 5, 2017
Physiology 1
Chapters 1-2
06:00 – 07:00
Morning routines and breakfast
July 6, 2017
Physiology 2
Chapters 3-4
07:00 – 12:00
Study time
July 7, 2017
Physiology 3
Chapters 5-7 in BRS
12:00 – 13:00
Lunch
July 8, 2017
Pathology 1
Chapters 1-9
13:00 – 14:30
Nap
July 9, 2017
Pathology 2
Chapters 10-18
14:30 – 15:00
Snack
July 10, 2017
Pathology 3
Chapters 19-28
15:00 – 18:00
Study time
July 11, 2017
Biochemistry 1
Day 1 notes: General metabolism and CHOs
18:00 – 19:00
Dinner
July 12, 2017
Biochemitsry  2
Day 2 notes: Lipids
19:00 – 00:00
Study time
July 13, 2017
Biochemistry 3
Day 3 notes: Proteins and Nucleotides
00:00 – 06:00
Rest
 
These type of schedule is reserved for persons with sufficient discipline to comply with daily demands, and for individuals with non-fluctuating productivity. If you are a person who is not wired to follow such strict schedules (like yours truly, HAHA), making a timetable like this almost feels like you have your ducks in a row, but it would really be a struggle, if not impossible, for you to adhere to this. Once you start accruing backlogs because of non-compliance, there will be a sense of loss of control, and this lowers your morale.
 
The other type of schedule, the block schedule, allots definite number of days per subject, without specific chapters to finish. Also, it does not assign definite number of hours for daily tasks. For example, if you allot five days in Pathology, then by all means, finish everything by then. This is ideal for persons whose productivity comes in waves, and for those who are not reared to exercise daily routines (like yours truly, HAHA).
 
The basic rule on formulating schedules is:
 
Make something you can follow.
 
Subjects
 
There are 12 subjects in the PLE: Biochemistry, Anatomy and Histology, Microbiology and Parasitology, Physiology, Legal Medicine, Pathology, Pharmacology and Therapeutics, Surgery, Internal Medicine, Obstetrics and Gynecology, Pediatrics and Nutrition, and Preventive Medicine. Of these subjects, where is the best point to begin?
 
Subjects vary in how much of analysis and memory work they require for mastery. In general, the subjects that ought to go first are those that require a higher level of understanding, and the subjects that should go last are those that demand higher level of memory work. This is so because of two reasons: 1. In studying subjects that demand higher level of learning, you accustom yourself into functioning and prcoessing information at a higher level, and this leads to more efficient retention, and increased ability to integrate concepts; and 2. Subjects that require more understanding incidentally require less memory work, for concepts tend to stay longer in one’s mind; and thus, are safe to go first. Also, the three most important disciplines, in my opinion, are the subjects that can explain, to the minute level, most, if not all concepts in medicine, namely: Physiology, Biochemistry, and Pathology. The two subjects that require the least effort, but can pretty much define your fate in the boards are: Legal Medicine and Preventive Medicine; and for me, these should go last, for several reasons: 1. these require more memory work; and 2. these are hard to integrate with other disciplines. So, you have five subjects whose order you already have figured out; the rest of the order of the subjects are up to you.
 
Suggested materials
 
There are a myriad of materials for each subject, and my most important take-home point is:
 
Commit to a maximum of two main materials for each subject.
 
You have limited time, and reading a lot of materials for one subject lessens your available time for the others. Here is a short list of the materials I have used during my review excluding sample exams, and also the materials I wished I had read back then (because they were claimed to be high-yield).
 
Subject
Material
Physiology
·         BRS Physiology
·         Ganong’s Review of Medical Physiology
·         Guyton and Hall Textbook of Medical Physiology
·         Topnotch Physiology Pearls Handout
Biochemistry
·         Harper’s Illustrated Biochemistry
·         Topnotch Biochemistry Handout and Pearls
Pathology
·         BRS Pathology
·         Robbins and Cotran Pathologic Basis of Disease
·         Topnotch Pathology Handout, Pearls and Supertable
Anatomy and Histology
·         BRS Gross Anatomy
·         Snell Clinical Anatomy by Regions
·         Gonzales and Esteban Textbook of Histology
·         Topnotch Anatomy Handout and Histology Pearls
Microbiology
·         Microbiology MRS
·         BRS Microbiology and Immunology
·         Topnotch Microbiology Supertable
Legal Medicine
·         Topnotch Legal Medicine Handout and Pearls
Pharmacology
·         BRS Pharmacology
·         Topnotch Pharmacology Handout and Pearls
Surgery
·         Topnotch Surgery supplement handout
·         Schwartz Principles of Surgery Absite and Board Review
·         Surgery Absite
Internal Medicine
·         IM Platinum
·         Harrison’s Principles of Internal Medicine
·         Topnotch IM pearls
Obstetrics and Gynecology
·         Topnotch OB-GYN handout and Pearls
·         William’s Obstetrics
Pediatrics
·         Topnotch Pediatrics Handout and Pearls
·         Nelson’s Textbook of Pediatrics
Preventive Medicine
·         Pre-test
·         Topnotch Preventive Medicine Handout and Pearls
·         Local clinical practice guidelines for common diseases
* –  Materials I have not personally used
 
From this list, you would notice three things:
 
1.       I read textbooks. For those who are starting early, read your textbooks. You would be surprised at how some of your most-dreaded textbooks are actually reader friendly. Some of the best textbooks I have read are Guyton, Harper and Robbins. Interestingly, they correspond to the top three disciplines I mentioned a while ago;
 
2.       I am a fan of BRS. For me, BRS offers the following advantages: 1. It is easy to read; and 2. It has examinations that are good for practice, because the questions are cased-based, and answering them require analysis; and
 
3.       I use Topnotch materials. It follows because I was enroled in it.
 

 
 
General principles of studying
 
                Now that you have already decided on the order of the subjects and your materials, the next order of business is how are you going to study for these. Every good student must already have his or her own set of study habits. This part will be of most benefit to those who are just starting out to determine what habits work for them. We have our own eccentricities when it comes to studying, but I will enumerate some points that I believe, apply to everyone:
 
Do activities that require the most energy when you have the most energy.
 
The ideal time to study is the time when you have the greatest energy, such as after a nap, or after sleep. During lecture days, I usually do not have enough energy left to study, so after dinner, I immediately go to bed, and wake up at around two or three in the morning to study. A well-rested mind absorbs information faster than a worn-out head. Most of you would empathize with me when I say that after a long lecture, if I attempt to read, I would be stuck on the same page for several hours.
 
Always seek the highest level of learning. 
 
Synthesis and integration of concepts should be your ultimate goal in studying, not just for the boards, but in general. Information shoved into your brain with brute force, and without understanding, is not expected to last after its intended use. Remember that as physicians, before anything else, we are good for how much we know, and these concepts are not just answers to an exam; these are concepts that when applied during the right situation, would save a person’s life.
 
Cramming never helps.
 
In medical school, there are a few breed of truly gifted cram artists that can make miracles overnight (not the kind of miracle you’re thinking, HAHA). They pass, and in some occasions, even ace exams with only one all-nighter. I regard myself as one of those people; however, for PLE, it never passed my mind to cram. For me, this is something that was too important to rush. I started reviewing for PLE after internship, and I attempted to cover one subject per week on my light rotations, to serve as my first reading. Then, the two months of self-review after internship served as my second reading; the lecture proper served as third reading; and mastery period served as fourth reading.
 
Do anything that would help you concentrate and remember.
 

 
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Attention span is something that is highly variable across individuals, but there are strategies some people use to prolong theirs. For me, I listen to classical music (Chopin, Bach, Tchaikovsky, Beethoven, Brahms, Rachmaninoff, among others), for it allows me to improve and sustain my concentration. One strategy that I have found to be effective for me in remembering things is writing and drawing (especially in Anatomy), so I always write things on index cards, and on my handouts.  I used to have a record book with drawings of blood supply, venous drainage, nerve plexuses, and nerve branches for Anatomy; a collection of index cards with noteworthy concepts in the major organ systems for Physiology; and some illustrations of pathways with important notes on control points and clinical correlations in Biochemistry.
 
Rest is part of review
 
Everybody has intrinsic physical limitations. Some people are wired to function optimally, in spite of limited hours of sleep. Others have a weak consitution that precludes them from pulling off all-nighters for review. There is no hard and fast rule regarding the number of hours for study, and the number of hours for sleep. The general rule is, “quality over quantity”.  You cannot extend the number of hours in a day, but you can make every moment of it count.
 
General conduct during review
               
                Review classes are good for nothing, if you do not know how to maximize every minute of it. Here are some prescribed practices to make your class as good as one reading:
 
Come early and leave early. 
 
Being punctual is one of a physician’s necessary traits. Always remember, “every second you are late, a patient dies.” During the review, every second you are late, the more good seats get taken, and during the boards, every second you are late, the lesser the time you have to carefully answer the exam.” You get the idea. Once the class is over, if you have nothing else important to do outside, then I suggest you go straight home to study. There are only 24 hours in a day, so don’t dawdle.
 
Pay attention.
 
You are not going to class to chat with your friends, or stare at your crush. Give your utmost attention to listening to the lecturer, and studying your notes. The rest of the world can wait. The boards just ask for a few months from you. Give it your all during this time. This is actually one of the means to maximize the quality of your classes.
 
Eat. 
 
 

 
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If there are two things that you should not withhold from yourself during the review, then those would be: 1. rest; and 2. food. Our brain depends only on two compounds for energy: 1. glucose, and 2. ketone bodies (in cases of prolonged fasting i.e. ~2-3 weeks). For optimum brain function, we must ensure that there is an adequate source of glucose for our brain to utilize.
 
Never leave the room as long as you have unanswered questions.
 
Once you do not understand something, have the humility and the initiative to ask the lecturer to answer your question, or let him/her explain the concept to you again. There is no harm in asking if you do not understand something; it just demonstrates your wisdom to acknowledge your limitations, and your love for learning.
 
Rest, when you can. 
 


 

 
 

Actual examination

 
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The longest two weeks of your life has finally come. As you well know, the PLE is held every September and March, starting September 2016. It lasts for four days; two consective Saturdays and Sundays for September; and Sundays and Mondays for March. Every day, you take three subjects (according to the order of the twelve subjects I mentioned beforehand). Each exam lasts for two hours, with an hour of break in between. The first day requires the examinees to come earlier than usual, because the filling of forms happens at this time. The night before the first day is always the most stressful, because you don’t have any clue as to what kind of demons you will face starting tomorrow. After this, the feeling would be pretty much familiar. These are some of the things that I encourage you to do during the actual boards:
 
Pray.  
 
Believe in your God, and believe in the preparation that you did. Amen, I say to you: Faith moves mountains. As a Roman Catholic, I have offered daily novenas to St. Jude Thaddeus, and my number one prayer warrior, my mom, offered daily novenas to Our Mother of Perpetual Help. We offered one novena for each week of the boards, and we offered Holy Masses as well.
 

 
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Get plenty of rest.
 
This is something that is really hard to do, because you are nervous, and you tend to kill the anxiety by doing something productive, and something that will make you feel secure, like studying. You had a lot of time for that, and the night before the exam is definitely not one of those. The day will be physicially, mentally, emotionally, and spiritually taxing, and you might want to scratch off that “physically” at least. If you cannot sleep on your own, a cup of chamomile tea and melatonin supplements can help.
 

 
 
Prepare your things.
 
You do not want to forget your notice of admission (basically, your test permit), and other important things during the boards. That would be an additional source of stress. For OC persons (like yours truly), being organized lets some of the tension off, because of sense of control over things.
 
Presence of mind is a must.
 
Be mindful of the instructions of your proctor, and follow their instructions to the letter. You do not want to waste your months of preparation, and fail just because of an identifying mark on your answer sheet, or an unshaded set letter.
 
Be still and calm.
 
Every exam that you finish is something that is already out of your control. Ask for the grace to surrender it to your God, and rest your head for the next examination. Proceed through the day with a clear mind and heart; free of your fears, as well as your dreams. Surrender them to your God as well, because it is only when you are devoid of any preoccupations, that you can achieve perfect focus, which you need to answer the problems in front of you. After the day, do not forget to thank your God, and commend yourself for surviving through the day.
 

Post-examination

 
If you have not quit midway and braved through all twelve exams, congratulations for finishing the PLE. You can rest your neurons now, for at this point, your EQ is going to be of more importance than what you know, because you already laid your answers on your scantron sheets. This part is divided into the waiting game, dealing with the results.
 
The waiting game
 
If the board exam is the longest two weeks of your life, then the waiting game is the longest three days of your life. The usual minimum turnover time for the results is about three days. How you spend your waiting time, I will leave to your discretion, but let me tell what I did. I am a devotee of Mama Mary, and I promised Her twenty mysteries every day for the next three days, as a gesture of my gratitude for Her intercession. I stayed at home, and made up for lost time with my family. As part of my sacrifice, I maintained myself clean–I did not drink, and I did not attend parties. I gave myself the rest I owed my body for the past several months.
 
Dealing with the results
 
On September 21, 2016 at around 7:30 P.M., my dear friend Dr. Harold Henrison Chiu, delivered the good news to me on our correspondence on Facebook. He said that we both placed; he placed fourth, and I placed seventh, and the rest is history. So, how should one deal with the outcome? Naturally, it depends on the results.

 
 
 
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There are three general fates after the boards; it is either: you place; you pass; or you do not make it. Regardless of the outcome, these are things that you should not forget to do: the first one is to thank your God for sustaining you through this trial. Offer a prayer by yourself, or together with your family. The next one is to thank everyone who have lent their support to you, in any way; and the last is to pray for those who did not make it; that they would have the grace to make sense of what has happened, and the courage to try again.
 
 
I won’t post my name or my face, because it’s pretty much everywhere; thanks to everyone’s heartwarming posts. Allow me to post this, instead. This is my rosary made of rose petals I got four or five years ago. They say that praying sustains it. It still is as bright and fragrant as I got it then. It’s always been by my side in my most terrible battles, and I have emerged from everything unscathed. God, I have always strived to follow Mama Mary, as She completely trusted in Your will to carry Jesus. I am truly humbled that You smiled on me, a mere sinner trying to seek You; and that Mother Mary, actually found me worthy and spoke to me, and whispered to me the word, “Believe.” My life is a testament of how total reliance to the Lord brings out the best in you. This is God’s work. I am truly blessed. 🙏🏻
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For those who did not make it, let me quote some lines from my testimonial address:
 
Having the courage to stand in a hall, with a lot of people in white coats who seemed to know a lot more than you do; who felt confident that they were going to make it; while you were even questioning yourself if you can get through a single day alive, is definitely not a small feat. Remember that you have the right attitude, and that’s half the battle won. I want you know that you are definitely not a failure, but a success in the making. 
 
Enough said.
 
 
How PLE has changed me
 
PLE is really a life-changing experience, because you would already have your own license to pratice the art of healing. PLE, is more ideally viewed as the start of a road with many possibilities in terms of your career of choice; but, the more profound change placing in the PLE had done to me, is that I have resolved myself to a lifetime mission of helping our medical graduates to become full-pledged physicians, as my debt of gratitude to God and to all who have helped me reach where I am now. Currently, I am a part of the Topnotch Family as part of Pathology instruction team, and a resident mentor to section La Salle, and other sections as well. Through my affiliation, I am able to touch more lives, and help more people. I also write inspirational articles, such as this, for those who I cannot personally reach.
 
Conclusion
 
Before it is a test of wits, PLE is a test of character. How you prepare; how you conduct yourself through the actual examination; and how you handle the outcome, are all vital in shaping your character as a physician, and as a person in general. The med boards is a rite everybody must go through, and you will overcome, as we did before you. Have faith, persevere, and you will never fail. To the one whose eyes reached this point, thank you; and I want you to know that my prayers are with you.
 
God bless.
 
Facebook: Kevin Elomina
Instagram: @keielomina
 


 

Hey guys! First, I want to thank Dr. Kevin Elomina, you have and will have helped a lot of future doctors because of this article. Sabi ko nga sa sarili ko, I can retire blogging after this, because this content is what is needed, not only for Filipinos, but all medical students who will take licensure exam in yet to come. There is very limited or almost none, of published write-ups out there pertaining to the Philippine Medical Board Exam. And if you research them now, it will even date back to the early 2000s. Thank you so much for saying yes to all you can share and impart  to us, your knowledge, hacks,  techniques. The mere fact of having this, as a source of motivation and inspiration, to everyone of us who will be taking the boards in the future. Thank you so much doc!

 
As always, please let me know if there’s anything I can do to help or clarify. Feel free to comment down below or send a message on Student Doctor Diary’s Facebook page I’m here to help you guys! ♡ Alright won’t make this post any longer.😁


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To everyone, who will be taking the boards this September 2017,
 Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go. –Joshua 1:9
xo,
 
 
P.S.
 
Thank you for all the sweet messages you have sent me. I started this whole process to inspire and encourage others, I’m glad you find my posts helpful.  If you have questions to Dr. Kevin, I linked his social media accounts. He’ll be glad to answer and help you. Make sure to follow him too! 😙
 
 
 
Facebook: Kevin Elomina
 
Instagram: @keielomina
 
 
@maartist.md
 
Good luck ate and kuya docs!!
 
The author is a Laboratory Medicine Resident Physician of the De La Salle University Medical Center, 7th placer on the September 2016 PLE, DLSHSI-CM Batch 2015.
 

  • Thank you!! 🙂 Will re-read this again when it’s my turn na hehe

    • mndenolo@gmail.com

      I super love your recent videos ate, lalo na yung OB rotation. Will look forward pag ikaw naman gagawa nito for boards. I’m sure madami kami mapupulot. :))
      Super flooded kami sa paperworks ngayon, ganito pala pag third year. I can’t really blog something bec of all the cases, not complaining though, pero babawi tlga aq pag may time. 🙂 And ate Aura, huhu self-hosted website na yung blog ko, finally… I won’t really have an idea, if we haven’t met. Thank you so much! 🙂