how long should pe coursework be

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Duration of Anticoagulation Post-PE: Things to Consider

Expert analysis.

Pulmonary embolism (PE) is a common medical condition affecting over 250,000 patients in the United States each year. 1 For those patients diagnosed with PE in whom therapeutic anticoagulation is deemed appropriate, current guidelines recommend an initial treatment period of 3 months. 2 However, extending the duration of anticoagulation beyond this initial period requires careful consideration of multiple factors.

Identifying Provoked vs. Unprovoked PE

Identifying patients who may benefit from extended anticoagulation requires a careful history that permits clinicians to classify a PE as either provoked or unprovoked . Provoking conditions can be then classified into transient and persistent risk factors (Table 1). 3 This classification is vital because it is the key driver in determining risk of recurrence. Of note, history of long-distance travel is a question commonly asked of those patients presenting with PE; however, only flights with a duration greater than 12 hours have been associated with increased incidence of venous thromboembolism (VTE). 4

Table 1: Provoked and Unprovoked Conditions Related to VTE

Current guidelines recommend patients with provoked PE or those with transient risk factors, such as major surgery or immobilization, be treated for a duration of 3 months. This is driven by the fact that the risk for recurrent VTE in these patients is 1% in the first year after stopping anticoagulation and 0.5% per year after. 2 As long as patients with provoked PE return to their pre-PE baseline, anticoagulation can be stopped after this initial 3-month treatment. Conversely, indefinite anticoagulation is recommended in those patients with unprovoked PE or persistent risk factors. In those with unprovoked PE who elect to stop indefinite anticoagulation, the risk for recurrent VTE is 10% in the first year after stopping anticoagulation and 5% per year after. 2 Although indefinite treatment is recommended in these patients, it is important to reassess the risks and benefits of ongoing anticoagulation at regular intervals.

Special Patient Populations

Consistent with therapeutic anticoagulation for other disease processes, the benefit of treatment must be weighed against the risk of bleeding. As discussed above, the benefit of anticoagulation is directly related to the risk of recurrence of PE, and patients with unprovoked VTE are at high risk for recurrence if anticoagulation is stopped. Though not necessary for most patients, several tools including the HERDOO2 rule, DASH prediction score, and Vienna Prediction Model have been proposed to better quantify the risk of recurrent VTE after stopping anticoagulation in those patients with unprovoked VTE (Table 2). Male sex and an elevated D-dimer either during or just after discontinuing therapeutic anticoagulation is associated with a higher risk of recurrent VTE (>5% per year) and merit ongoing treatment. 5-10

Table 2: Risk Assessment Tools for VTE Recurrence

The risk for bleeding complications while on anticoagulation should be considered in all patients who are recommended indefinite anticoagulation. There are several validated tools that can be used to assess bleeding risk; however, many were developed by analyzing patients with atrial fibrillation on warfarin. Thus, these tools may not accurately reflect bleeding risk in patients with VTE or in whom a direct oral anticoagulant is used. 11 For those patients deemed to have a high bleeding risk (Table 3) and unprovoked PE or persistent risk factors, current guidelines recommend against extended therapy. 2 However, the decision to continue anticoagulation in patients with unprovoked PE and moderate or low risk of bleeding requires further analysis and discussion of the patient's values.

Table 3: Risk Factors for Bleeding With Anticoagulation and Estimated Risk of Bleeding 2

Given its role as a persistent risk factor, patients with active cancer are also recommended to continue indefinite anticoagulation. 3,12 Current data favor low-molecular-weight heparin over vitamin K antagonists; 13 however, ongoing studies are analyzing the safety and efficacy of direct oral anticoagulants in this patient population.

Finally, patients presenting with persistent unexplained dyspnea or exercise intolerance 6 months after a PE merit ongoing anticoagulation while additional workup is undertaken. Although these symptoms can be related to underlying comorbidities, patients should be assessed for the presence of new onset pulmonary vascular disease and chronic thromboembolic pulmonary hypertension because these disease processes not only increase the risk for recurrent VTE but can also be more effectively managed if identified early on. 14

Alternate Treatment Strategies

Current guidelines indicate that the choice of anticoagulant in the early phase of treatment can be continued for extended therapy. However, there are alternate medication and dosing options available to patients who require indefinite anticoagulation. In appropriate patient populations, such as those without active cancer or renal insufficiency, direct-acting oral anticoagulants can be considered for extended therapy given the relative reduction in bleeding risk over vitamin K antagonists. 2 Additionally, the AMPLIFY-EXT (Apixaban After the Initial Management of Pulmonary Embolism and Deep Vein Thrombosis With First-Line Therapy–Extended Treatment) trial and EINSTEIN-CHOICE (Reduced-Dosed Rivaroxaban in the Long-Term Prevention of Recurrent Symptomatic Venous Thromboembolism) trial showed comparable rates of VTE recurrence between higher and lower doses of apixaban (5 mg vs. 2.5 mg) and rivaroxaban (20 mg vs. 10 mg), respectively, suggesting lower-dose options can also be considered. 15,16 If patients with unprovoked PE elect to discontinue anticoagulant treatment entirely, the use of aspirin 81 mg daily may be benefical in reducing major vascular events by about one-third compared with placebo, but aspirin does not reduce the recurrence of PE. 17 Thus, it is important to counsel patients that the use of oral anticoagulants versus aspirin alone reduces the risk of recurrent VTE by approximately 81-92%. 18,19

Follow-Up After Discontinuation of Anticoagulation

For many patients, the decision to stop anticoagulation after the initial treatment course is dictated by concerns regarding anticoagulation and its interference in their daily lives. If a patient with an unprovoked PE and thus higher risk for recurrence elects to discontinue anticoagulation, routine follow-up and serial D-dimer testing at 2-3 weeks and then again at 1-2 months after stopping treatment are recommended. Those patients with elevated D-dimer on follow-up testing should be advised of the ongoing risk of VTE recurrence off anticoagulation. Among patients with elevated D-dimer levels after initial anticoagulation, those who discontinue anticoagulation have an increased hazard ratio for VTE recurrence of 2.27 (95% confidence interval, 1.15-4.46; p = 0.02) compared with those who continued anticoagulation. 19 Additionally, although the presence of a hypercoagulable disorder such as antiphospholipid antibody syndrome, protein C deficiency, or protein S deficiency does not significantly increase the already high risk of recurrence in patients with unprovoked VTE, it is reasonable to test for these disorders during the period after discontinuing anticoagulation so as to best inform the patient's decision. 21

• Patients diagnosed with PE who are deemed appropriate candidates for therapeutic anticoagulation should be treated for an initial period of 3 months.
• In general, those patients with unprovoked PE or those with persistent risk factors should be considered for indefinite anticoagulation with routine follow-up to assess ongoing benefit.
• Validated tools exist to quantify risk of recurrent VTE and may be helpful in patients with unprovoked PE who have an intermediate bleeding risk or in those who choose to discontinue anticoagulation.
• Serial D-dimer testing is a useful tool to detect recurrence and inform the decision to restart anticoagulation after the initial 3-month period in patients with unprovoked PE.
• Patients with unexplained persistent dyspnea or exercise intolerance merit ongoing anticoagulation while undergoing workup for new onset pulmonary vascular disease such as chronic thromboembolic pulmonary hypertension.
• Heit JA. Venous thromboembolism: disease burden, outcomes and risk factors. J Thromb Haemost 2005;3:1611-7.
• Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016;149:315-52.
• Kearon C, Ageno W, Cannegieter SC, et al. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost 2016;14:1480-3.
• Kuipers S, Cannegieter SC, Middeldorp S, Robyn L, Büller HR, Rosendaal FR. The absolute risk of venous thrombosis after air travel: a cohort study of 8,755 employees of international organisations. PLoS Med 2007;4:e290.
• Rodger MA, Le Gal G, Anderson DR, et al. Validating the HERDOO2 rule to guide treatment duration for women with unprovoked venous thrombosis: multinational prospective cohort management study. BMJ 2017;356:j1065.
• Rodger MA, Kahn SR, Wells PS, et al. Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy. CMAJ 2008;179:417-26.
• Tosetto A, Iorio A, Marcucci M, et al. Predicting disease recurrence in patients with previous unprovoked venous thromboembolism: a proposed prediction score (DASH). J Thromb Haemost 2012;10:1019-25.
• Tosetto A, Testa S, Martinelli I, et al. External validation of the DASH prediction rule: a retrospective cohort study. J Thromb Haemost 2017;15:1963-70.
• Eichinger S, Heinze G, Jandeck LM, Kyrle PA. Risk assessment of recurrence in patients with unprovoked deep vein thrombosis or pulmonary embolism: the Vienna prediction model. Circulation 2010;121:1630-6.
• Tritschler T, Méan M, Limacher A, Rodondi N, Aujesky D. Predicting recurrence after unprovoked venous thromboembolism: prospective validation of the updated Vienna Prediction Model. Blood 2015;126:1949-51.
• Barnes GD, Kanthi Y, Froehlich JB. Venous thromboembolism: Predicting recurrence and the need for extended anticoagulation. Vasc Med 2015;20:143-52.
• Kearon C, Spencer FA, O'Keeffe D, et al. D-dimer testing to select patients with a first unprovoked venous thromboembolism who can stop anticoagulant therapy: a cohort study. Ann Intern Med 2015;162:27-34.
• Lee AY, Levine MN, Baker RI, et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003;349:146-53.
• Wan T, Rodger M, Zeng W, et al. Residual pulmonary embolism as a predictor for recurrence after a first unprovoked episode: Results from the REVERSE cohort study. Thrombosis Res 2018;162:104-9.
• Agnelli G, Buller HR, Cohen A, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med 2013;368:699-708.
• Weitz JI, Lensing AWA, Prins MH, et al. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism. N Engl J Med 2017;376:1211-22.
• Brighton TA, Eikelboom JW, Mann K, et al. Low-dose aspirin for preventing recurrent venous thromboembolism. N Engl J Med 2012;367:1979-87.
• Schulman S, Kearon C, Kakkar AK, et al. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism. N Engl J Med 2013;368:709-18.
• Winters JP, Morris CS, Holmes CE, et al. A multidisciplinary quality improvement program increases the inferior vena cava filter retrieval rate. Vasc Med 2017;22:51-6.
• Palareti G, Cosmi B, Legnani C, et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006;355:1780-9.
• Baglin T, Gray E, Greaves M, et al. Clinical guidelines for testing for heritable thrombophilia. Br J Haematol 2010;149:209-20.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Anticoagulation Management and Atrial Fibrillation, Anticoagulation Management and Venothromboembolism, Atrial Fibrillation/Supraventricular Arrhythmias, Pulmonary Hypertension, Hypertension

Keywords: Warfarin, Anticoagulants, Venous Thromboembolism, Risk Factors, Heparin, Low-Molecular-Weight, Aspirin, Protein C Deficiency, Protein S Deficiency, Atrial Fibrillation, Antiphospholipid Syndrome, Vitamin K 2, Follow-Up Studies, Pyridones, Pyrazoles, Pulmonary Embolism, Venous Thrombosis, Risk Assessment, Renal Insufficiency, Hypertension, Pulmonary, Comorbidity, Dyspnea, Neoplasms

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This is How Long You Should Study for the PE Exam

Preparing for the PE and wondering how long you should study for the PE exam? I’ve been there before, twice actually. And I’ve also looked at a lot of data from other engineers to find out how long you should study to pass the PE exam.

Generally, you should study for the PE exam for about 200-300 hours if you want to pass. The average study time is around 215-230 hours over a 3-month period. Few engineers study less than 100 hours or over 300. You may think you need less time, but studying more is worth it if it means you pass.

How you study, including where, when, and what, has a major effect on how much time you have to put in to pass. If you choose the right resources, it will be easier to make an effective study plan and pass on your first (or next) try. 

Making a study plan isn’t easy, unless you get outside help. Other engineers might give you recommendations for their study plans, but by far the easiest way is to just purchase a prep course. I highly recommend School of PE . It’s how I passed and how many of my friends did, too!

I’ve done some research to find out what other engineers’ experiences were while studying. I also found some tips on how to plan your study and make it more effective.

Let’s get into it!

How Long Other Engineers Have Studied

I looked at a few different sources online to see how many hours other engineers studied for the PE exam. I calculated averages of all the good answers I could find on each thread. Here’s a summary of what I learned from each:

• This EngineerBoards thread showed that the average time people studied was about 230 hours . There were some older responses from around 2010 in here, so I mostly included those in recent years.
• One Reddit thread I found had an average of 215 hours studied . There were a lot of these and I didn’t average all of the threads I could find, just one of the most recent.
• A survey of those that took the Power PE showed that the most common amount of study time was 200-300 hours , with over 500 hours coming in second. That surprised me as anything over 300 was an outlier in my other sources.

While this isn’t the best way to get the exact statistical average of how many hours people study for the PE, it’s the next best thing. Most of the answers gave a range anyway, and most people didn’t actually record how much they studied. 

So this may not be precise, but it’s accurate enough to give you an idea of how long you should study, which is all you really came for, right?

There were a few other things I learned while scanning through the comments that were golden advice for studying, which we’ll get into now.

Advice for How Long You Should Study for The PE Exam

By far the most common thing people said when talking about how long you should study was “it depends.” That’s a sort of cop-out answer, which is why I’ve focused on the numbers. But in the end this is really the truth. 

How long you need is really up to your confidence levels. But like I mentioned earlier, you are going to be much happier over studying than understudying. If I had studied more hours and passed the PE on my first try I would have made thousands of dollars more from getting my license sooner than I did. 

A lot of the comments confirmed this, too. They didn’t mind the extra work because they were much happier feeling completely confident on test day than if they had just tried to wing it. I had a cousin go in without studying much and he really regretted it! Thankfully he passed on his second try though.

Another huge piece of advice I saw was that it’s way easier if you take a course . And I completely agree. This is the #1 advice I’d give you if you were in the room with me right now asking for tips on passing the PE. I only passed after I invested in School of PE , and I don’t think I would have passed if it weren’t for them! I’ll talk more about that in a minute though. 

I also saw that those who studied under 100 hours didn’t usually pass on their first try. Even then, there were not very many people who had studied that little and passed. They were the outliers. I’d say maybe 1 in 20 of the answers I saw mentioned studying less than 50 hours. So don’t think you can get by easy, it’s pretty rare to be able to pass with so little practice!

The most interesting comment I saw was something that I felt even after I’d bought School of PE’s course. The person mentioned how they were 100 hours in and went from feeling good and even ahead of schedule at times to feeling completely hopeless at others . I think this kind of thing is inevitable and you should be prepared for it. Even when you’re on the right track that sudden fear that you’re not going to pass will strike randomly.

I hated when I felt this way, especially because I’d invested so much time and money into preparing. But this brings me to one last piece of advice that I’ll end this section with. 

You’re going to need to ignore how you feel and just keep working if you want to pass the PE exam. Even when you’re imperfect. Especially when you’re missing a lot of problems. Don’t let discouragement and fear make you give up. Keep working and you will pass!

How Many Hours I Studied For The PE Exam

I studied for 126 hours on the first try and failed, then over 300 hours on my second attempt and passed. On my second attempt I took School of PE’s course and it was way easier. I didn’t have to waste time making a study plan and finding resources to study, which probably took the first 5-10 hours of my study time on my first attempt. 

School of PE is worth the money if you want to pass the PE exam. Check out my review of them right here to learn more about how they helped me. Or you can just go to their website and sign up for a trial to see what it’s like!

Planning Your Hours and Study Time

Most of the people in these threads mentioned they started studying around 3-4 months before test day . Any earlier than that and they’d forget some of what they’d study at the beginning. And any later and they’d end up with not enough time. 

3-4 months was about right for me too. I took the test in April and October of 2019. I started studying in January for the April exam and in June for the October one. I wish I’d had more time for my attempt in April though, so to be safe you should go with four months.

A lot of the time what people will do is study in the morning, evening, or on weekends. You want to take your available free time and just plan on using it for hours of studying. It’s tough to do when you’re working full-time, but it’s well worth it to become a PE.

1-2 hours in the evening and 4-6 hours on weekends seemed to be pretty common for most people. 

Say you plan to study for 3 months. If you put in 2 hours each evening and 6 hours on weekends, that comes to 264 hours of studying. That’s perfect, especially because it leaves you with some wiggle room. You’ll need that for days that you’re too tired or weekends you want to take a break and go on vacation!

While you’re studying, it’s vital that you maintain your health . Spend time with other people , exercise , and get enough sleep in the hours that you’re not studying. Don’t just sit around your house and watch YouTube. Help your brain get the recovery it needs and it will reward you with an awesome performance on test day.

Wrapping Up

No matter how many hours you put in, working hard to become a PE is worth the effort. It feels amazing, as well, to know that you took on a massive challenge like this and beat it. I know that’s how I feel after passing the PE and getting my license!

If you want to pass the PE, shoot to study for about 230 hours. Start 3-4 months before the exam and use weekends and evenings to study. And to make it all way easier, buy a course to help!

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PULMONARY EMBOLISM OVERVIEW

Pulmonary embolism (PE) occurs when a blood clot (thrombus) dislodges from a vein, travels through the bloodstream, and lodges in the lung (where it is called a "pulmonary embolus"). Most blood clots originally form in one of the deep veins of the legs, thighs, or pelvis; this condition is known as deep vein thrombosis (DVT). (See "Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)" .)

If a clot blocks the blood flow to parts of the lung, it prevents oxygen from reaching the brain and body. Pulmonary emboli are uncommon, but can be deadly if not identified and treated promptly. In the United States, it is estimated that over 50,000 people die every year as a result of a PE. Recognizing and treating a PE quickly can reduce the risk of serious complications and death.

PULMONARY EMBOLISM RISK FACTORS

There are a number of factors that increase a person's risk of developing PE.

Surgery and related conditions  —  Surgical procedures, especially those involving the hip, pelvis, knee, or brain and spine increase a person's risk of developing a blood clot. During the recovery period, prolonged inactivity can also increase the risk of developing a blood clot. Measures to help reduce the risk of blood clots are discussed below. (See 'Pulmonary embolism prevention' below.)

Medical conditions or medications  —  Some medical conditions and medications increase a person's risk of developing a blood clot:

● Immobilization (eg, due to hospitalization, recovery from injury, bedrest, or paralysis).

● Previous deep vein thrombosis (DVT) or PE.

● Increased age.

● Pregnancy.

● Certain medications (eg, birth control pills, hormone replacement therapy, tamoxifen, thalidomide, erythropoietin, cancer chemotherapy medications). The risk of a blood clot is further increased in people who use one of these medications and also have other risk factors.

● Heart failure.

● Kidney problems, such as nephrotic syndrome. (See "Patient education: The nephrotic syndrome (Beyond the Basics)" .)

● Coronavirus disease 2019 (COVID-19). (See "Patient education: COVID-19 overview (The Basics)" .)

Cancer  —  People with cancer, especially if they are receiving treatment (eg, with chemotherapy or radiation therapy), are at particularly increased risk for developing DVT or PE.

Inherited thrombophilia  —  Inherited thrombophilia refers to a genetic problem that causes the blood to clot more easily than normal. Various factors in the blood clotting process may be involved, depending on the type of genetic problem present.

An inherited thrombophilia, such as deficiencies of antithrombin, protein C, or protein S, is frequently present in people who develop a venous blood clot before the age of 50, and who do not have another clear cause (eg, surgery). Other factors, such as factor V Leiden or the prothrombin gene mutation, increase the risk of venous thrombosis in all age groups. However, venous blood clots are infrequent before adolescence.

If a person is found to have a PE and there is no known medical condition or recent surgery that caused the PE, it is possible that an inherited condition is the cause, although this is rare. This is especially true in people who have more than one PE or if a family member has also experienced a PE. In these cases, testing for an inherited thrombophilia may be recommended. (See 'Determining the cause' below.)

Acquired thrombophilia  —  Some types of thrombophilia are not inherited, but can increase a person's risk of developing a blood clot:

● Certain disorders of the blood, such as polycythemia vera or essential thrombocythemia

● Antiphospholipid antibodies (antibodies in the blood that can affect the clotting process) (see "Patient education: Antiphospholipid syndrome (Beyond the Basics)" )

Elevated clotting factors  —  Having an increased level of one or more factors involved in blood clotting increases the risk of a blood clot.

PULMONARY EMBOLISM SYMPTOMS

The signs and symptoms of PE can vary from one person to another. Common signs and symptoms of PE include the following:

● Shortness of breath or needing to breathe rapidly

● Chest pain, especially sharp, knife-like pain while taking a deep breath

● Coughing or coughing up blood

● A rapid heart rate

● Dizziness or fainting

Any of these symptoms along with leg pain or swelling increases the likelihood of PE. In rare cases, the person might pass out.

PULMONARY EMBOLISM DIAGNOSIS

If your history, symptoms, and physical exam suggest a PE, you will get tests to confirm the diagnosis. Tests to diagnose or rule out PE include D-dimer blood testing and imaging tests (most often a CT scan with pulmonary angiography). These tests are described in more detail below.

Some patients with a suspected PE will also undergo testing to determine if deep vein thrombosis (DVT) exists, which is described in detail separately (see "Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)" ). If a DVT is diagnosed, further testing to determine if a PE is present may not be necessary because, most of the time, both conditions are treated in the same way.

Diagnostic tests

D-dimer  —  D-dimer is a substance in the blood that is often increased in people with PE. D-dimer levels are abnormal in 95 percent of patients with PE; a person with a normal D-dimer level is unlikely to have a PE. If the D-dimer test is negative and the patient is thought to have a low risk of PE based upon their signs and symptoms, PE is unlikely and further testing may not be needed.

Computed tomography pulmonary angiography  —  This is a type of computed tomography (CT) scan that involves getting a special dye injected into your arteries before the scan is taken. The dye shows up on the images and allows your doctor to identify any blood clots or blockages in your lungs and sometimes your leg veins.

CT pulmonary angiography (also called CTPA) may not be suitable for people with poor kidney function or who are allergic to contrast dye. Occasionally, medications for a contrast allergy may be needed to complete the test.

Other imaging tests  —  In some cases (for example, if it is not possible to perform CTPA for some reason), another imaging test may be done. Options include a ventilation/perfusion lung scan (in which you inhale and have an intravenous injection of a small amount of a radioactive dye, then get tested to see how it is distributed in your lungs); ultrasonography of your legs (which uses sound waves to generate pictures of the blood vessels); and catheter-based or magnetic resonance pulmonary angiography.

Determining the cause  —  After determining that a PE is present, your healthcare provider will want to know what caused it. In many cases, there are obvious risk factors such as recent surgery or immobility (see 'Pulmonary embolism risk factors' above). In other cases, the person may be tested for inherited or acquired thrombophilia. (See 'Inherited thrombophilia' above and 'Acquired thrombophilia' above.)

People with an acquired or inherited abnormality may require additional treatment or preventative measures (eg, long-term treatment with an anticoagulant medication) to reduce the risk of future blood clots. Some experts recommend that the family members of a person with an inherited thrombophilia be screened for the inherited condition if this information would impact their care, although this issue is controversial. If you have a genetic condition, or are concerned that you might have one, your doctor or a genetic counselor can talk to you about what it means as well as the pros and cons of screening other family members.

PULMONARY EMBOLISM TREATMENT

Treatments for PE aim to prevent the clot from becoming larger, prevent new blood clots from forming, and prevent long-term complications.

The primary treatment for venous thrombosis is anticoagulation. Other treatments include thrombolytic therapy, embolectomy (removal of the clot), and placing a filter in one of the major blood vessels (the inferior vena cava).

Anticoagulation  —  Anticoagulants are medications that are commonly called "blood thinners." They do not actually dissolve the clot but rather help to prevent new blood clots from forming. There are several different medications that might be given after a deep vein thrombosis (DVT) diagnosis (referred to as "initial anticoagulation"), including:

● Direct oral anticoagulants – These are available in pill form; those available, depending on the country, for initial anticoagulation are rivaroxaban (brand name: Xarelto) apixaban (brand name: Eliquis), dabigatran (brand name: Pradaxa) or edoxaban (brand name: Savaysa).

● Low molecular weight (LMW) heparin, which is given as an injection under the skin – Options include enoxaparin (brand name: Lovenox), dalteparin (brand name: Fragmin), and tinzaparin (brand name: Innohep).

● Fondaparinux (brand name: Arixtra), also given by injection.

● Heparin, which is given into a vein (intravenously) or as an injection under the skin – This may be the preferred choice in certain circumstances, such as if a person has severe kidney failure.

Initial anticoagulation usually consists of 5 to 10 days of treatment with LMW heparin, unfractionated heparin, or fondaparinux. After that, long-term anticoagulation is continued for at least 3 months (see "Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)", section on 'Duration of treatment' ). The direct oral anticoagulants (sometimes called "DOACs") are also an option for long-term anticoagulation; these pills include rivaroxaban (brand name: Xarelto), apixaban (brand name: Eliquis), dabigatran (brand name: Pradaxa), and edoxaban (brand name: Savaysa). An advantage of initiating treatment with a DOAC is that some DOACs (rivaroxaban, apixaban) can be started right after a clot is diagnosed without the need for an initial 5 to 10 days of an injectable blood thinner (eg, LMW heparin). In some situations, another oral medication called warfarin (sample brand name: Jantoven) can be used for long-term anticoagulation. Warfarin is typically started during the initial 5 to 10 days of treatment with an injectable anticoagulant. If you take warfarin, you need to get regular blood tests to monitor how well your blood is clotting; this is not needed for patients on direct oral anticoagulants (see "Patient education: Warfarin (Beyond the Basics)" ). Less commonly, a person does not take warfarin or any of the DOACs but takes a daily injection of heparin or fondaparinux for the entire treatment period. In rare circumstances, unfractionated heparin as an injection can also be given.

The choice of anticoagulant depends upon multiple factors, including your preference, your doctor's recommendation based on your situation and medical history, and cost considerations.

Duration of treatment  —  Anticoagulation is recommended for a minimum of three months in a patient with DVT.

● If you had a reversible risk factor contributing to your DVT, such as trauma, surgery, or being confined to bed for a prolonged period, you will likely be treated with anticoagulation for only three months or until the risk factor is resolved.

● Expert groups suggest that people who develop a DVT but do not have a known risk factor may need treatment with an anticoagulant for an indefinite period of time. However, if this is your situation, you should discuss the pros and cons with your doctor after three months of treatment. If the decision is made to continue anticoagulation, your doctor will continue to reassess on a regular basis. Some people prefer to continue the anticoagulant, which may carry an increased risk of bleeding, while others prefer to stop the anticoagulant at some point, which may carry an increased risk for repeat thrombosis.

● Most experts recommend continuing anticoagulation indefinitely for people with two or more episodes of venous thrombosis or if a risk factor for clotting persists (eg, antiphospholipid syndrome, cancer).

Thrombolytic therapy  —  In some severe life-threatening cases, a clinician will recommend a medicine to dissolve blood clots (ie, a "clot-busting" medication). This is called thrombolytic therapy. This therapy is reserved for people who have serious complications related to PE or DVT, and who have a low risk of serious bleeding as a side effect of the therapy. The response to thrombolytic therapy is best when there is a short time between the diagnosis of DVT/PE and the start of thrombolytic therapy.

Embolectomy  —  Embolectomy is the medical term for removal of PE from the lung. It may be performed using catheters that are placed into the blood vessel that contains the clot or with a surgical procedure that is similar to open heart surgery. This procedure may be considered if a person is in serious condition as a result of the PE (eg, persistent low blood pressure due to PE). In this situation, thrombolytic therapy may be attempted first, but if thrombolysis fails or is not an option, embolectomy may be attempted.

Inferior vena cava filter  —  An inferior vena cava (IVC) filter is a device that blocks the circulation of clots in the bloodstream, especially the movement of clot from the legs to the lungs. It is placed in the inferior vena cava (the large vein leading from the lower body to the heart) with a catheter that is inserted into a vein in the groin and threaded through the blood vessels. An IVC filter is often recommended in patients with PE who cannot use anticoagulants because of recent surgery, a stroke caused by bleeding, or significant bleeding in another area of the body. However, IVC filters can be used along with other therapies such as anticoagulation, thrombolysis, or embolectomy when these are appropriate.

An IVC filter is also recommended in some patients who develop recurrent PE despite anticoagulation. It may also be recommended for patients whose condition makes them susceptible to life-threatening complications if another PE were to occur. IVC filters are generally removed at a later point in time.

PULMONARY EMBOLISM PREVENTION

During hospitalization  —  Some people who are in the hospital, either for surgery (especially bone or joint surgery and cancer surgery) or because of a serious medical illness, may be given anticoagulants to decrease the risk of blood clots. Anticoagulants may also be given to females at high risk for venous thrombosis during and after pregnancy.

In people who are hospitalized and have a moderate to low risk of blood clots, other preventive measures may be used. For example, some people are fitted with inflatable compression devices after surgery. These devices are worn around the legs during and immediately after surgery and periodically fill with air. These devices apply gentle pressure to improve circulation and help prevent clots. Compression stockings may also be recommended.

In all cases, walking as soon as possible after surgery can decrease the risk of a blood clot.

Extended travel  —  Prolonged travel (for example, taking a long airplane flight or car ride) appears to increase the risk of developing blood clots, although the risk is very small. There are a few tips that may be of benefit during extended travel ( table 1 ).

SPECIAL PRECAUTIONS FOR PEOPLE WITH PULMONARY EMBOLISM

Risk of developing another clot  —  People who have had a PE are at an increased risk for developing another blood clot, although this risk is significantly smaller when an anticoagulant is actively being used. Watch for signs of a new PE, including new chest pain with difficulty breathing, a rapid heart rate, or lightheadedness. Recurrent PE can be life-threatening and requires immediate attention . If you have any of these symptoms, call for help right away (In the United States and Canada, call 9-1-1 for an ambulance.)

Bleeding risk  —  Anticoagulants such as heparin and warfarin can have serious side effects and should be taken exactly as directed. If you forget or miss a dose, call your healthcare provider or clinic for advice. Do not try to take an extra dose or change the dose yourself unless your doctor specifically tells you to. If you get a refill of your medication and the pills or tablets look different from the last bottle, let your doctor or pharmacist know right away. If you take warfarin, there are other things you need to be aware of as well; these are discussed in detail in a separate topic review. (See "Patient education: Warfarin (Beyond the Basics)" .)

You are more likely to bleed easily while taking anticoagulants. Bleeding may develop in many areas, such as the nose or gums, excessive menstrual bleeding, bleeding in the urine or feces, bleeding or excessive bruising in the skin, or vomiting material that is bright red or looks like coffee grounds. In some cases, if there is internal bleeding, you may not notice right away. Bleeding inside the body can cause you to feel faint, or have pain in the back or abdomen. Call your healthcare provider right away if you have these symptoms. It's also important to call immediately if you have an injury that could cause internal bleeding, such as a fall or a car accident. Even minor head injuries can be dangerous for people on anticoagulants and should be evaluated by a doctor.

Wear an alert tag  —  While you are taking anticoagulants, wear a medical bracelet, necklace, or similar alert tag that includes the name of your anticoagulant at all times. If you end up needing treatment and are unable to explain your condition, the tag will alert responders that you are on an anticoagulant and at risk of excessive bleeding. Many anticoagulants have good antidotes or reversal agents available, so it is important for responders to know the name of the anticoagulant you are taking.

The alert tag should list your medical conditions as well as the name and phone number of an emergency contact. One device, Medic Alert, provides a toll-free number that emergency medical workers can call to find out your medical history, list of medications, family emergency contact numbers, and healthcare provider names and numbers. You can also store this information in your smartphone, if you have one.

Reduce the risk of bleeding  —  Some simple modifications can limit the risk of bleeding at home:

● Use a soft bristle toothbrush.

● Use a humidifier to help reduce nosebleeds (if you live in a cold or dry climate).

● Take care when using scissors or knives.

● Avoid potentially harmful activities (eg, contact sports, skiing).

● Do not take aspirin or other NSAIDS (eg, ibuprofen, Advil, Aleve, Motrin) while taking warfarin (unless specified by your clinician). Other nonprescription pain medications, such as acetaminophen (sample brand name: Tylenol), may be a safe alternative.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site ( www.uptodate.com/patients ). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information  —  UpToDate offers two types of patient education materials.

The Basics  —  The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Deep vein thrombosis (blood clot in the leg) (The Basics) Patient education: Pulmonary embolism (blood clot in the lung) (The Basics) Patient education: Pleuritic chest pain (The Basics) Patient education: Choosing an oral medicine for blood clots (The Basics) Patient education: Taking oral medicines for blood clots (The Basics) Patient education: IVC filter placement (The Basics) Patient education: How to give an anticoagulant shot (The Basics) Patient education: Warfarin and your diet (The Basics) Patient education: D-dimer test (The Basics) Patient education: Lowering the risk of a blood clot (The Basics) Patient education: Clot-dissolving medicines for heart attack or stroke (The Basics)

Beyond the Basics  —  Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient education: Deep vein thrombosis (DVT) (Beyond the Basics) Patient education: The nephrotic syndrome (Beyond the Basics) Patient education: Antiphospholipid syndrome (Beyond the Basics) Patient education: Warfarin (Beyond the Basics)

Professional level information  —  Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Factor V Leiden and activated protein C resistance Use of anticoagulants during pregnancy and postpartum Deep vein thrombosis in pregnancy: Clinical presentation and diagnosis Venous thromboembolism in pregnancy: Prevention Venous thromboembolism in pregnancy and postpartum: Treatment Clinical presentation, evaluation, and diagnosis of the nonpregnant adult with suspected acute pulmonary embolism Clinical presentation and diagnosis of the nonpregnant adult with suspected deep vein thrombosis of the lower extremity Approach to thrombolytic (fibrinolytic) therapy in acute pulmonary embolism: Patient selection and administration Placement of vena cava filters and their complications Prevention of venous thromboembolism in adults undergoing hip fracture repair or hip or knee replacement Epidemiology and pathogenesis of acute pulmonary embolism in adults Overview of the causes of venous thrombosis Heparin and LMW heparin: Dosing and adverse effects Treatment, prognosis, and follow-up of acute pulmonary embolism in adults Chronic thromboembolic pulmonary hypertension: Pulmonary thromboendarterectomy Overview of the treatment of proximal and distal lower extremity deep vein thrombosis (DVT) Venous thromboembolism: Initiation of anticoagulation

The following organizations also provide reliable health information.

● National Library of Medicine

     ( https://medlineplus.gov/healthtopics.html )

● National Heart, Lung, and Blood Institute

     ( www.nhlbi.nih.gov/ )

● American Heart Association

     ( https://www.heart.org/ )

ACKNOWLEDGMENT

The editorial staff at UpToDate acknowledges Charles Hales, MD (deceased), who contributed to earlier versions of this topic review.

About the NCEES PE Exam, or Professional Engineer Exam

Taking the NCEES PE exam is a big step in your professional career. Understanding the details of the PE exam is an important part of your preparation to sit for the exam. 

What is the NCEES PE exam?

You can take the PE exam after passing your FE exam and gaining at least 4 years of relevant post-college work experience. Once you pass, you are able to put the designation “P.E.” after your name, indicating that you are a Professional Engineer.

Why become a PE?

Passing the PE exam doesn’t just signal to others that you are at the top of your field; it’s also a gateway to pay raises, promotions, and career opportunities like consulting and stamping designs. Beyond personal gain, obtaining your PE license benefits the public by ensuring that important engineering activities are only completed by those who have the proper knowledge and training.

Engineers challenge themselves with the important task of protecting public safety, and obtaining your PE license is a pledge to uphold the high standards of the profession. Professional Engineers help keep our communities healthier, safer, and more efficient. Pursuing PE licensure is an honorable and responsible path for any engineer.

What is the deadline for the PE application?

The application deadline varies significantly by state, ranging from 45 days to more than 180 days before the exam date. Check with your state board for your deadline.

Do the PE exams differ from state to state?

When do i choose the subject of my pe exam.

Regardless of which PE exam you are taking, you must choose your exam subject upon registration. This applies to all sessions of every PE exam.

What is the format of the NCEES PE exam?

The NCEES PE exam is an 8-hour exam with 80 questions, with the exception of the PE Chemical CBT exam and the PE Electrical and Computer CBT exam. See the NCEES website for more details.

What subjects are on the PE exam?

Take a look at the NCEES exam specifications to see the subjects for your discipline. Irrespective of the published exam structure, the exact number of questions that will appear in each subject area cannot be predicted reliably. There is no guarantee that any single subject will occur in any quantity. One of the reasons for this is that some of the questions span several disciplines. You might consider a pump selection question to come from the subject of fluids, while NCEES might categorize it as engineering economics.

What is the typical question format?

NCEES intends the questions to be unrelated. Questions are independent or start with new given data. A mistake on one of the questions should not cause you to get a subsequent question wrong. However, considerable time may be required to repeat previous calculations with a new set of given data.

Is the exam tricky?

Preparing for the pe exam test your skills with a free sample quiz. choose your discipline: pe civil , pe electrical , or pe mechanical ., what makes the questions difficult.

Some questions are difficult because they defy the imagination. Three-dimensional structural questions and some surveying curve questions fit this description. If you cannot visualize the question, you probably cannot solve it. Some questions are difficult because the computational burden is high, and they just take a long time. Pipe networking questions solved with the Hardy Cross method fall into this category. Some questions are difficult because the terminology is obscure, and you just do not know what the terms mean. This can happen in almost any subject.

What reference material is permitted in the exam?

See What to Bring to the PE Exam for details on what you should and shouldn't bring to the exam.

Are tabs permitted on my exam references?

Most states will allow you to use “permanent” (glued or taped on, not easily removable) tabs on your references. Some states even allow Post-It® notes. Check with your state board to confirm its policy on tabs.

What is the exam’s calculator policy?

The NCEES often changes their calculator policy. Click here for the current calculator policy.

What is the exam’s pencil policy?

NCEES will provide you with the mechanical pencil you must use for the exam. The supplied pencils use 0.7 mm lead. You may bring extra lead and your own eraser.

Do you need a prep course?

A course structures and paces your review. It ensures that you keep going forward without getting bogged down in one subject. A course focuses you on a limited amount of material. Without a course, you might not know which subjects to study. A course provides you with the questions you need to solve. You will not have to spend time looking for them. A course spoon-feeds you the material. The course instructor can answer your questions when you are stuck. You probably already know if any of these advantages apply to you.

How long should you study for the PE exam?

We have all heard stories of the person who did not crack a book until the week before the exam and still passed it with flying colors. Yes, these people really exist. However, I am not one of them, and you probably are not either. A thorough review takes approximately 300 hours. Most of this time is spent solving problems. Some of it may be spent in class; some is spent at home. Some examinees spread this time over a year. Others try to cram it all into two months. Most review courses last for three or four months. The best time to start studying will depend on how much time you can spend per week.

Wondering where to start?

Ready to ace the pe exam, industry insights.

Featured Clinical Reviews

• Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement JAMA Recommendation Statement January 25, 2022
• Evaluating the Patient With a Pulmonary Nodule: A Review JAMA Review January 18, 2022

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Treatment Duration for Pulmonary Embolism

• Original Investigation Duration of Oral Anticoagulation After PE Francis Couturaud, MD, PhD; Olivier Sanchez, MD, PhD; Gilles Pernod, MD, PhD; Patrick Mismetti, MD, PhD; Patrick Jego, MD, PhD; Elisabeth Duhamel, MD; Karine Provost, MD; Claire Bal dit Sollier, MB; Emilie Presles, MS; Philippe Castellant, MD; Florence Parent, MD; Pierre-Yves Salaun, MD, PhD; Luc Bressollette, MD, PhD; Michel Nonent, MD, PhD; Philippe Lorillon, PharmD; Philippe Girard, MD; Karine Lacut, MD, PhD; Marie Guégan, MS; Jean-Luc Bosson, MD, PhD; Silvy Laporte, MS, PhD; Christophe Leroyer, MD, PhD; Hervé Décousus, MD; Guy Meyer, MD; Dominique Mottier, MD; for the PADIS-PE Investigators JAMA
• JAMA Diagnostic Test Interpretation Computed Tomography Pulmonary Angiography for Pulmonary Embolism Grégoire Le Gal, MD, PhD; Marc Righini, MD; Philip S. Wells, MD, MSc JAMA

The type and duration of treatment for pulmonary embolism can vary from person to person.

What Is Pulmonary Embolism?

Pulmonary embolism ( PE ) is the presence of a blood clot ( embolus ) that blocks an artery in the lungs. Usually the clot comes from a piece of another blood clot inside a vein of the legs ( deep vein thrombosis [ DVT ]) that has broken off and traveled to the lungs. Pulmonary emboli can range from very small and causing no symptoms to very large and causing symptoms of shortness of breath, chest pain, and dizziness. Some large pulmonary emboli can be fatal.

How Long Should You Take Blood Thinners After Pulmonary Embolism?

Blood-thinning medication is the main treatment for PE. How long to thin the blood depends on where the clot that went to the lung came from and why it formed.

Deciding how long treatment should last requires carefully weighing the risks and benefits of thinning blood for each individual person. Taking a blood thinner for too short a time can result in a clot returning after treatment is stopped. Taking a blood thinner for too long can increase the risk of bleeding as a side effect. The ideal duration of treatment depends on the individual’s risk of having another blood clot compared with the individual’s risk of bleeding, which the doctor takes into account. Currently, the recommended treatment duration ranges from a minimum of 3 months to a maximum of lifelong treatment.

A study published in the July 7, 2015, issue of JAMA addressed this question. This study was a randomized clinical trial involving more than 350 people who had a first-ever PE that was unprovoked . Unprovoked PE means there was no clear risk factor such as recent travel, surgery, or trauma to cause the clot. Having unprovoked PE means there is a higher risk of having another blood clot in the future compared with clots caused by a reversible, temporary risk factor (such as a long airplane ride).

The study compared the effects of giving blood-thinning medication for 6 months compared with 2 years. The study looked at how often people in each group had (1) another blood clot and (2) major bleeding as a side effect. The results showed a significantly lower risk of having another blood clot in the group that received the treatment for longer (2 years), without a major increase in bleeding risk.

If you have had a first-time PE without a clear cause, you may benefit from longer treatment with blood thinners than the usual 3 to 6 months. Talk to your doctor about your individual risks and benefits for taking blood thinners vs having another blood clot.

For More Information

Centers for Disease Control and Prevention www.cdc.gov/ncbddd/dvt/index.html

To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA ’s website at jama.com . Many are available in English and Spanish. A Patient Page describing how blood thinners work was published in the December 18, 2013, issue; one on DVT was published in the May 26, 2015, issue; and one on PE was published in the February 6, 2013, issue.

Source: Couturaud F, Sanchez O, Pernod G, et al. Six months vs extended oral anticoagulation after a first episode of pulmonary embolism: the PADIS-PE randomized clinical trial. JAMA . doi: 10.1001/jama.2015.7046 .

Topic: Drug Therapy

See More About

Jin J. Treatment Duration for Pulmonary Embolism. JAMA. 2015;314(1):98. doi:10.1001/jama.2015.7431

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Download our simplified GCSE PE NEA Criteria for AQA, Edexcel & OCR

We've put together these simplified criteria for the pe gcse coursework component..

Our simplified criteria are available as downloads to give you and your pupils an easy-to-follow overview of the course requirements, needs of each component, and actions for students to move forward. These can be used in lessons and 1-2-1 conversations with your students. 

What's included in the downloads?

Simply fill in the form, and then choose which exam board to download.

Level Descriptors (Teacher Resource) - Both Analysis and Evaluation Criteria

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• How to Make Your Coursework as Good as It Can Possibly Be

Many GCSE and A-level subjects are assessed in part by coursework in addition to exams, meaning that the mark you receive for coursework contributes to your overall grade. Many students prefer coursework, because it’s a chance to showcase your academic abilities away from the high-pressured environment of the exam room, making it ideal for those who don’t perform to the best of their abilities in exams. However, the time you have available for coursework, in contrast with the time constraints of the exam room, can lull some students into a false sense of security. Coursework is arguably just as challenging as exams, just in different ways – and, given the fact that you have more time, much higher standards are expected of you in coursework than in exams. Careful planning and research are needed for successful coursework, as well as strong data-gathering and essay-writing skills. In this article, we look at how to produce excellent coursework, from planning to proofreading. This information might also be useful to you if you’re planning on attending an Oxford Summer School this summer.

What is coursework?

GCSE and A-level coursework typically takes the form of an extended essay or project. Its objectives vary from one subject to another, but there’s usually an emphasis on the student conducting independent research into a topic of their own choice. Thus coursework often takes the form of some sort of investigation; it may, therefore, help to have your ‘detective’ hat on as you explore, investigate and analyse your topic. You can usually work on your coursework at home, though it’s sometimes completed under controlled conditions through sessions at school. To give you a better idea of how coursework varies from one subject to another, here are some examples:

• English – English coursework usually takes the form of an extended essay with a title of your choice. You’re usually given a choice of themes and/or texts to explore, and you could choose a format such as a comparison between a set text and another one.
• Geography – Geography coursework usually focuses on the gathering, reporting and interpretation of data designed to answer a particular geographical question. You could investigate usage of a shopping centre, for example, or look at erosion on a particular beach.
• Sciences – coursework for science subjects often takes the form of a scientific project or experiment that you conduct and report on yourself.

Before you start work on your coursework, it’s essential that you have a thorough understanding of the rules. Failing to conform to the rules – inadvertently or not – may result in your coursework (or possibly even your entire qualification) being disqualified, so it’s a serious matter.

• No plagiarism – this is particularly dangerous given the ready availability of relevant information on the internet these days. Make sure everything is in your own words; you’ll need to sign a declaration stating that it’s your own original work.
• There’s only so much help your teacher can give you . They can provide guidance on what you need to include, and on what the examiners will be looking for. You can ask them questions, but they’ll usually only be able to check through your first draft once and offer broad hints on updating it.
• Check the word count , and stick to it. Find out whether footnotes, appendices and bibliographies are included in the word count.
• Check what topics you’re allowed to do your coursework on; if there’s an exam on this topic, you’ll almost certainly have to choose a different one for your coursework.

Choose your topic wisely

Ideally, choose something you’re genuinely interested in, as your enthusiasm will come across and you’ll find it more enjoyable to write. If there’s something you’ve been working on for the course so far that you’ve particularly enjoyed, you may be able to focus more on this as part of your coursework. For science coursework, you’ll need to choose something to investigate that you can measure, change and control; it should be what’s called a ‘fair test’, meaning that you have to acknowledge all the controls you use in the experiment and why. Try not to pick a topic for which the scope is too vast, as you’ll struggle to research it properly and you’re unlikely to do it justice, and it’ll be hard to keep within the word limit. Ask your teachers for some guidance on choosing your topic if you’re not sure what to write about; they might even tell you a bit about what previous students have done to give you some inspiration.

Plan how long it’s going to take

Never leave your coursework until the last minute, even if this is your normal approach to essays and it usually works for you. Make sure you understand when the deadlines are, including time for submitting a first draft for comments from your teacher. Then schedule blocks of time for working on it, allowing plenty of time before the deadline to cater for any unexpected delays. Allow ample time for making corrections based on teacher feedback on your first draft, and keep some time aside before the deadline for final editing and proofreading. Because actual deadlines are few and far between, you’ll need to take responsibility for the writing process and impose some deadlines on yourself to ensure it’s finished in time. Write down your deadlines on a calendar, with the coursework broken into stages and dates assigned to each, by which time each task should be complete. You can base your stages on the next few points in this article – research and data gathering, a structure plan for the piece of work, writing up, and so on.

Conducting your research and gathering data

As coursework is primarily a research exercise, the research phase is crucial, so don’t be tempted to skimp on it and go straight to writing up. Use as many different resources as you can to gather data: books, journals, newspapers, television, radio, the internet and anything else you think might be relevant. For science and Geography coursework, you’ll need to base your work on a hypothesis, so the research stage should start by coming up with at least one hypothesis, otherwise your research will lack direction. The research phase for some subjects may involve site visits for gathering data, so allow plenty of time for this, particularly if you need your parents to drive you somewhere to do so. If it’s a scientific experiment you’re conducting for your coursework, you’ll need to pay careful attention to planning the experiment using rigorous scientific methods (also noting what Health and Safety precautions you are taking), as well as reading up on the background and theory so that you have an idea of what to expect from the outcome of your experiment. In the research stage, make notes about what you expect to happen, so that you can later compare your expectations with what actually did happen. The experiment itself also forms part of the research and data-gathering stage for your science coursework; in the write-up stage, which we come onto shortly, you analyse and write up the results.

Plan your structure

Once you’ve completed your research, the process of writing up begins. Before you get down to the actual writing, however, it’s advisable to write a plan for how you’re going to structure it – essentially an essay plan for English coursework and other subjects for which the coursework is based on an extended essay. It’ll look slightly different from an essay plan for science subjects and others that revolve around project work, but the principle is the same: plan out what order you’re going to present your information in. For big projects, this is particularly important, because with a lot of information to convey, you risk being disorganised and waffling.

Writing up your project

For any coursework, but particularly coursework based around an extended essay, you’ll need to perfect your essay-writing abilities. For science coursework, writing up your project also involves data analysis, as you interpret the results of your experiment and work your notes into formal scientific language. Follow the links below to find lots more useful advice on writing great essays.

• How to write dazzlingly brilliant essays
• How to write more original essays
• Techniques from creative writing that can improve your essays

When you’re writing up, it’s important to find a place where you can work quietly, without distractions that could cause you to make careless errors. You wouldn’t want noise or distractions when you were in an exam room, so treat your coursework with the same reverence.

Supporting materials and images

For some subjects, namely the sciences and Geography, it would be appropriate to include images, graphs, charts, tables and so on in your coursework. For example, for Geography coursework, your extra material could include annotated images and maps of the site you’re talking about, plus tables, graphs and charts. An appendix could then detail your raw data; if, for example, your coursework focused on the results of a survey, you could put the raw survey responses in an appendix and provide summaries and analysis in the main body of the coursework.

Footnotes and bibliography

As we said earlier, it’s important that you always use your own words in your coursework to avoid the possibility of falling foul of plagiarism rules. However, it’s acceptable to quote from another source, as you would in any piece of academic writing, but you must make sure that you state where it is from and use quotation marks to show that it’s a quote from somewhere else. The best way of citing another work is to use a footnote; word processors will allow you to insert one, and it just puts a little number at the end of the sentence and another in the footer of the document, into which you put the name of the author and work, and the page within that work that the quote can be found. At the end of your piece of work, include a bibliography that includes a list of every external source you’ve used in the creation of your coursework. Stick to a set formula when including books. A common format is: Author Surname, Initial. (Date) – Title of Book , page number For example: Lewis, C.S. (1960) – Studies in Words , p. 45 When you get to university, you’ll be expected to include footnotes and bibliographies in all your essays, so it’s a good habit to get into and coursework gives you good practice at it.

The final pre-submission check

Having completed a first draft, received feedback from your teacher, and honed your work into a finished piece of coursework, have a final check through it before you send off your coursework for submission.

• Sense check : have a read through your completed piece of work and check that it all makes sense. Make sure you haven’t contradicted yourself anywhere, or repeated yourself, or laboured the point. If there are any facts that you may have meant to look up to double check their accuracy, do so now.
• Word count : ensure that the completed work falls within the word count, and double check whether the bibliography should be included in the word count. If you’ve exceeded it, you’ll need to work through the piece and tighten up your writing, omitting unnecessary information, reordering sentences so that they use fewer words, and so on.
• Proofread : check your spelling and grammar, and ensure that there are no typos. Don’t just use the spellcheck – go through it with a fine toothcomb, manually, and if you can, ask someone to read through it for you to see if they spot anything you haven’t.
• Formatting : check that you’ve included page numbers, and that the font and line spacing is consistent throughout the work. Ensure that the font is plain and easy to read, such as Arial or Times New Roman.
• Bibliography : check that you’ve included everything, that the format is the same for all sources mentioned, and that the right information is included for each.

Once this stage is complete, you’re ready to submit your coursework along with your declaration that it’s entirely your own work. Get ready for a feeling of immense satisfaction when you finally send off your hard work!

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GCSE PE Coursework Guide Booklet

Subject: Physical education

Age range: 14-16

Resource type: Unit of work

Last updated

9 September 2018

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The booklet has been tailored to support the teaching and learning for the GCSE PE coursework specification. It includes a step-by-step guide for students to complete in order to simplify whilst also enrich the course process. The booklet includes a contents page, specification checklist, glossary of terms, connective words, key words and examples to help differentiate for students.

I would suggest filling out the coursework booklet as you teach the content, for example when teaching components of fitness there are pages that allow the students to fill in and analysis/evaluate their fitness strengths and weaknesses. As you progress through the GCSE theory content you the pupils will be able to progress through the booklet. This also acts as a way to consolidate their knowledge (AO1), understanding (AO2) and analysis (AO3).

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What time is the 2024 solar eclipse? Here's when you should look up in your area

On Monday, April 8, the sky will momentarily darken for millions of Americans in the path of totality during the 2024 solar eclipse .

This is the first total solar eclipse to pass through North America in seven years, and the next one will not be seen from the contiguous U.S. until Aug. 23, 2044 , according to NASA .

The exact time the solar eclipse will occur will vary, depending on the state and the time zone. And of course, eclipse visibility will also be dependent on Monday's weather .

Whether you're experiencing the path of totality from home or traveling to witness it in person, here's what to expect for the exact eclipse time.

Solar eclipse 2024 live updates: See latest weather forecast, what time it hits your area

What time is the 2024 solar eclipse?

The eclipse will begin in Mexico at about 11:07 a.m. PDT, Monday, April 8 before crossing into Texas at 1:27 p.m. CDT. It will end in Maine at 3:35 p.m. EDT. Even if you're not in the path of totality and won't see the full eclipse, you may still see a percentage of it.

To find out exactly when the eclipse will be happening in your area, you can search by USA TODAY's database by zip code for a viewing guide.

Even if you still see a fraction of the eclipse, you can use the database to search the time, duration, peak and percentage in your area.

Here are the major cities in each state where you can expect to experience totality in the United States (note that the included times do not account for when the partial eclipse begins and ends):

• Dallas, Texas: 1:40-1:44 p.m. CDT
• Idabel, Oklahoma: 1:45-1:49 p.m. CDT
• Little Rock, Arkansas: 1:51-1:54 p.m. CDT
• Poplar Bluff, Missouri: 1:56-2:00 p.m. CDT
• Paducah, Kentucky: 2-2:02 p.m. CDT
• Carbondale, Illinois: 1:59-2:03 p.m. CDT
• Evansville, Indiana: 2:02-2:05 p.m. CDT
• Cleveland, Ohio: 3:13-3:17 p.m. EDT
• Erie, Pennsylvania: 3:16-3:20 p.m. EDT
• Buffalo, New York: 3:18-3:22 p.m. EDT
• Burlington, Vermont: 3:26-3:29 p.m. EDT
• Lancaster, New Hampshire: 3:27-3:30 p.m. EDT
• Caribou, Maine: 3:32-3:34 p.m. EDT

Where is the 2024 total solar eclipse?

The eclipse begins in Mexico , and then crosses over into the U.S. through Texas. From there, the path of totality, which is approximately 115 miles wide, extends northeast, crossing through 13 states. In the U.S., totality will end in Maine, but the eclipse will eventually enter the maritime provinces of Canada.

Other major cities along the eclipse's path of totality include San Antonio and Austin, Texas; Indianapolis; and Rochester and Syracuse, New York.

Contributing: Eric Lagatta, Ramon Padilla and Karina Zaiets, USA TODAY.

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How One Family Lost $900,000 in a Timeshare Scam

A mexican drug cartel is targeting seniors and their timeshares..

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Warning: this episode contains descriptions of violence.

A massive scam targeting older Americans who own timeshare properties has resulted in hundreds of millions of dollars sent to Mexico.

Maria Abi-Habib, an investigative correspondent for The Times, tells the story of a victim who lost everything, and of the criminal group making the scam calls — Jalisco New Generation, one of Mexico’s most violent cartels.

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How a brutal Mexican drug cartel came to target seniors and their timeshares .

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