I would highly recommend the review course. I believe they may offer it online now. I took the review course, then took the exam in October of 2016. I do not deal with everything the exam covers, so I made sure to focus on the things that I do not work with. I went to those areas and observed, and asked questions. I also took the week off before my exam and went to the library every morning, and would stay all day. I did read and study for about a year leading up to the test, but for a cram session towards the end it was helpful to get away from distractions. There are a few different versions of the test...mine had several nuc med questions. But I passed!