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What Is on the Physician Assistant National Certifying Examination (PANCE)?

January 2, 2024

Becoming a physician assistant (PA) leads more quickly to a career treating patients than qualifying as a medical doctor (MD) (two years of postgraduate study as opposed to between seven and eleven years). Even so, PA training—acquired through a Master of Science in Physician Assistant Studies program, such as the one at the University of Pittsburgh—is a rigorous process requiring classwork, clinical rotations, and, at its culmination, the five-hour Physician Assistant National Certifying Examination (PANCE). 

PANCE pass rates are high. In the past five years, they’ve ranged from 98% (2018) to 92% (2022). This level of success is a testament to the quality of PA education programs, not to the exam’s difficulty level. Most physician assistants would readily agree that the PANCE presents a formidable challenge.

If you plan to become a PA, your future includes the PANCE. What should you expect to find on the exam? This article takes a close look at what it covers.

How Do You Become a Physician Assistant?

The pathway to a PA career starts with an undergraduate degree (with all prerequisite science courses completed), followed by qualifying patient care experience and graduate-level study. Once you’ve completed your Master of Science in Physician Assistant Studies, you can take the PANCE and earn your practice license. The steps you need to follow include: 

  1. Obtaining a bachelor’s degree from an accredited institution with an average GPA of 3.0.
  2. Completing the prerequisite science courses with a minimum GPA of 3.0.
  3. Finishing at least 500 hours of direct, hands-on patient care experience, e.g., working as a registered nurse, paramedic, or medical assistant.  
  4. Applying to a PA program and gaining admission.
  5. Earning your Master of Science in Physician Assistant Studies.
  6. Passing the National Commission on Certification of Physician Assistants (NCCPA)  PANCE.
  7. Acquiring a practice license in your home state.

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You must pass the NCCPA PANCE to earn the certification qualifying PAs to apply for state licensure. Only graduates of an accredited PA program may sit for the exam.  

The PANCE is administered throughout a 50-week test window; the only period during which it is not offered are the final 10–12 days of the calendar year. Candidates must pay a $550 fee with their application. They may not take the exam more than three times in one year or more than once every 90 days. Those who fail to pass the exam six times must repeat their PA graduate study. The majority of examinees pass on their first attempt. 

What Is on the PANCE?

The PANCE consists of 300 multiple-choice questions, administered over five hours. It focuses on the seven key PA competencies

  1. Knowledge for practice: Demonstrate knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to patient care.
  2. Interpersonal and communication skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
  3. Person-centered care: Provide person-centered care that includes patient- and setting-specific assessment, evaluation, and management and health care that is evidence-based, supports patient safety, and advances health equity. 
  4. Interprofessional collaboration: Demonstrate the ability to engage with a variety of other health care professionals in a manner that optimizes safe, effective, patient- and population-centered care. 
  5. Professionalism and ethics: Demonstrate a commitment to practicing medicine in ethically and legally appropriate ways and emphasizing professional maturity and accountability for delivering safe and quality care to patients and populations. 
  6. Practice-based learning and quality improvement: Demonstrate the ability to learn and implement quality improvement practices by engaging in critical analysis of one’s own practice experience, the medical literature, and other information resources for the purposes of self-evaluation, lifelong learning, and practice improvement.
  7. Society and population health: Recognize and understand the influences of the ecosystem of person, family, population, environment, and policy on the health of patients and integrate the knowledge of these determinants of health into patient care decisions.

The  PANCE blueprint offers further insight into the exam’s content. The exam is divided into two categories: 

  1. Knowledge of the diseases and disorders physician assistants encounter (medical content).
  2. Knowledge and skills related to tasks physician assistants perform when treating patients (task categories).

Medical content comprises 95% of the exam. Content categories include:

  • Cardiovascular system
  • Dermatologic system
  • Endocrines system
  • Eyes, ears, nose, and throat
  • Gastrointestinal system/nutrition
  • Genitourinary system (male and female)
  • Hematologic system
  • Infectious diseases
  • Musculoskeletal system 
  • Neurologic system
  • Psychiatry/behavioral science
  • Pulmonary system
  • Renal system
  • Reproductive system (male and female)

All medical content questions are coded to one of the task areas, except for the professional practice task category, which comprises 5 percent of the exam. Task categories included in the exam are: 

  • History taking and performing physical examination
  • Using diagnostic and laboratory studies
  • Formulating the most likely diagnosis
  • Managing patients
  • Health maintenance, patient education, and preventive measures
  • Clinical intervention
  • Pharmaceutical therapeutics
  • Supplying basic scientific concepts
  • Professional practice

In addition, up to 20% of the exam may be related to general surgical topics. 

The Physician Assistant Education Association (PAEA) offers a PANCE practice exam called the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) to help you prepare for the PANCE. The PACKRAT contains 225 questions updated annually based on the current PANCE content blueprint. All questions are written and evaluated by PA educators and peer-reviewed. 

What Happens Once You Pass the PANCE?

A passing grade on the PANCE confers NCCPA certification, which qualifies PAs for state licensure. Physician assistant scope of practice and regulations vary from state to state.

Maintaining certification requires 500 hours of continuing medical education over the ten years following certification. At the ten-year mark, PAs must pass the Physician Assistant National Recertifying Exam (PANRE) or the PANRE Longitudinal Assessment (LA). Both exams follow the same blueprint and question format. However, while the traditional PANRE is administered at proctored testing centers, the PANRE-LA is completed at home over three years, with 25 questions administered online each quarter. Test takers may consult online and print resources while taking the PANRE-LA; they receive an answer explanation and references after they have responded. Those who fail to pass the PANRE-LA must subsequently pass the PANRE at a Pearson testing center.

Earn Your Master of Science in the Physician Assistant Studies (PAS-Hybrid) Program at Pitt 

Prospective physician assistants seek high-quality training in a convenient format from a nationally recognized institution. The PAS Hybrid program at Pitt checks all the boxes. It offers a mixed-format curriculum that delivers content synchronously and asynchronously online combined with in-person clinical placements completed. 

You can complete the PAS-Hybrid program at Pitt in as little as two years, during which you’ll train in pharmacology, patient care, diagnostic and therapeutic procedures, health policy, surgery, and other essential areas. You should emerge from the program well-qualified for a variety of physician assistant opportunities and prepared for the PANCE exam.

If you are ready to take the next step towards becoming a physician assistant, contact a Pitt enrollment advisor to find out more about the program and application process.

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