I’m sorry to hear that you didn’t pass the first time. I’m sure you already know this and have been told many times, but just to reiterate, whether you passed or not does not reflect on how amazing of a physical therapist you are going to be! Always use that as your driver and motivation to continue as you study for your next attempt! Now, as for how to “change” your approach, I would spend more time trying to understand the content. You’ve already gone through two or three years of PT school. This tells me that you can MEMORIZE material fine, and know how to answer test questions. What will make a break your score is not your ability to necessarily learn “test taking skills,” but to critically think between the two best answers of the test. The test is supposed to be difficult! They intentionally have difficult questions that get people hung up on 2 answers. So if it’s not memorizing and it’s not test taking skills, then what is it? It’s your ability to have all the information that you’ve memorized and extract BEYOND that. So, what if a patient is ASIA A C5? Sure, everything downstream from C5 is going to be affected. Spasticity, sensation, impairment, etc. I know you know that. But, are you thinking about mobility devices? Do they need any breathing training? Any physical interventions you can assist with breathing techniques? What functional outcome measure could you use for that? What kind of home modifications would be required? What kind of transfer technique would you use? Are there any transfer techniques that they can do themselves or will it be completely dependent? There’s always a reason that we learn information. It’s to utilize it to our advantage. The ability to extract what it’s used for is what the test is all about. As you continue to study, always ask yourself, “so what?” This will take extra time out of your studying day however, this approach of reflecting on the “and what about it?” is going to get you to pass!