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    How to Prepare for PANCE and PANRE: A PA Exam Prep Guide

    Physician Assistant Exam Tips for PA Certification Exams.

    If you're reading this PA exam guide, you're wondering how to prepare for the physician assistant certification exam (PANCE) or physician assistant recertification exam (PANRE). You're in luck. After 17 years of practice as a PA, I’ve learned a few things about PA certification exams, PA-C maintenance, and lifelong learning strategies for PAs. This PA exam prep guide is full of PA exam info, PA exam tips and tricks, valuable insight into the art of PA-C exam prep, and the inner-workings of the PA certification exams themselves. No matter which PA certification exam you're taking - this physician assistant exam guide will give you everything you need to know about how to pass your PA certification exam and maintain your PA-C credentials effectively.


    Looking for resources? Plan for your PA career, not just passing the PANCE / PANRE.

    Right now you're likely worrying about passing your PANCE / PANRE.  Totally reasonable. But the forward-thinking expenditure for "PA exam prep" should also include annual PA maintenance of certification resources. The best PA board reviews are built for this - and they save you a lot of stress and money down the road. Other PA-C career requirements include Professionalism and State CME Requirements.

    Preparing for PANCE / PANRE

    Follow these steps to ensure you are prepared for the PANCE and PANRE.

    1. Understand the Structure of the PANCE / PANRE

    Step one: Know what material is going to be covered in the exam. The NCCPA provides an exam blueprint detailing what material is represented on the PANCE / PANRE examination, with the percentage assigned per content category. Keep this in mind going forward to better focus and guide your study sessions.

    PA Certification Exam Blueprint (PANCE / PANRE)

    The PA certification examination is categorized in two dimensions:

    1. Knowledge of the diseases and disorders physician assistants encounter; and
    2. Knowledge and skills related to tasks physician assistants perform when treating patients.

    Cardiovascular System 13%
    Dermatologic System 5%
    Endocrine System 7%
    Eyes, Ears, Nose, and Throat 7%
    Gastrointestinal System/Nutrition 9%
    Genitourinary System (Male and Female) 5%
    Hematologic System 5%
    Infectious Diseases 6% 
    Musculoskeletal System 8%
    Neurologic System 7%
    Pulmonary System 10%
    Psychiatry/Behavioral Science 6%
    Renal System 5%
    Reproductive System (Male and Female) 7%

    TASK CATEGORIES Percent Allocation
    History Taking and Performing Physical Examination 17%
    Using Diagnostic and Laboratory Studies 12%
    Formulating Most Likely Diagnosis 18%
    Health Maintenance, Patient , Education, and Preventive Measures 10%
    Clinical Intervention 14%
    Pharmaceutical Therapeutics 14%
    Applying Basic Scientific Concepts 10%
    Professional Practice 5%

    PA Certification Exam Formats:

    PANCE Exam Format

    The Physician Assistant National Certification Exam (PANCE) is composed of 300 multiple-choice questions to be completed over five hours. PANCE questions are given in 5 blocks of 60 questions with 60 minutes allotted for each block. 45 minutes is allotted between each block for break.

    PANRE Exam Format

    The Physician Assistant National Recertification Exam (PANRE)  is composed of 240 multiple-choice questions to be completed over four hours. PANRE questions is given in 4 blocks of 60 questions with 60 minutes for each block. 45 minutes are allotted for breaks between each block.

    The PANRE, unlike the PANCE, has practice-focused content with choices. No matter which you choose, 60% of the questions will be primary medicine or generalist (144 Q’s) questions, while the remaining 40% can be geared toward more generalist questions in one of three areas:

    • Adult medicine (everything minus pediatric)
    • Surgery (women, ortho, CV, neuro, pediatric)
    • Primary care or generalist

    2. Plan Out a Study Strategy

    Studying for PANCE

    For me and even my current students, the key to successfully passing the PANCE is ongoing and progressive review. Instead of passing PA school and then cramming for the PANCE, I identified salient topics on the NCCPA blueprint and progressively studied those topics as part of my program curriculum.

    This type of slow-and-steady-wins-the-race approach was very helpful and provided a great deal of space recognition.

    Now when it comes to materials there are plenty of review books with a few questions at the back. For me the books and were fine, but eventually became stale and did not provide enough repetitions for me to be fully prepared. A nice complement to your preparation is to take some sort of interactive PANCE preparation course.

    Studying for PANRE

    As practicing PAs we not only need to obtain recertification, but we also need to constantly update our knowledge and skill set.  Add to this the need to rack up 50 hours category 1 CMEs and you can see where a continually-updated PANRE prep course with CME would be a lifelong asset.

    Passing the physician assistant national recertification exam is very similar to taking the PANCE. As with PANCE courses, PANRE courses may be live or online, but if you're going to use a board review course you may as well get CMEs in the process.

    One thing is different about the PA recertification exam — it may have been years since you have reviewed some of the material. If you work in ENT there is a good chance that you haven’t thought too much about heart failure. Consequently, it is important to find and fix any weakness in your knowledge base.

    When colleagues asked me the best way to prepare for an upcoming recertification exam, I'll tell them to do some type of diagnostic run. Take a comprehensive test, identify your weak points and then focus on those weak points as you gradually review the rest of the material relevant to your line of practice.

    Although the future of recertification may change, I personally think that preparing for and taking the full PANRE is a great way to objectively assess and maintain one’s knowledge base.

    Bottom Line of Preparing for PA Exams

    Basically, in both PANCE and PANRE review, I found that what I needed was not primary learning (watching lectures or reading book chapters) but to find out where the holes in my education were and figure out how to fill those holes.

    To accomplish this, I think it's best to use physician assistant exam question banks that are evidence-based and provide remediation feedback. This format allows for the identification of knowledge gaps, and if explanations and remediation materials are high quality you can efficiently round out your education.

    Take the time to assess the content you need to cover, and portion it out into manageable increments. Once you’ve grasped the breadth of the material, schedule times throughout your day dedicated solely to the topics and sections you’ve chosen to focus on.

    Set a Schedule

    Setting a strict schedule and mapping out a plan of attack from the get-go will not only help you manage time and stress, it also ensures that you cover all relevant material.

    3. Find an Adaptive PANCE / PANRE Question Bank

    Exposing yourself to NCCPA practice exams early on will warm you up to the content you should expect to see on the exam, as well as help you assess your strengths and weaknesses. Be sure your study time is mapped to your chosen exam and offers case-based questions that emulate the Q&A format seen on the actual exam.

    Best Question Bank for PANCE / PANRE?

    One popular online course for PANCE / PANRE prep is Med-Challenger's PA exam review course - and it kinda does EVERYTHING...

    • 100% Pass-guaranteed PANCE / PANRE board exam prep with adaptive learning
    • Includes 15 separate "end-of-rotation" Exams for PAs in training
    • Over 2600 board-style Q&A organized and weighted upon the National Commission on Certification of Physician Assistants exam specifications (NCCPA)
    • Adaptive self-assessment with guided remediation
    • Continually updated and CME ready for annual requirements use
    • 195 AMA PRA Category 1 Credits built-in (NCCPA-approved credits)
    • 20 AAPA-approved Category 1 CME credits required annually by physician assistants as part of new maintenance of certification requirements

    You can cover your exam needs - and your future MOC needs - all in one.

    Here's a great PA exam study plan:

    Basically, break up your PA exam blueprint and allocate time accordingly using your review resources.  This example spaces all areas of the exam and final step "exam simulation" over a 4 month study period (16 weeks).

    The first few months is where you'll go through each section or "chapter" of the PANCE / PANRE blueprint, topic by topic.  This is where you learn and refresh - it's also the foundation of knowing where you should spend your attention ongoing.

    Once you've done a complete walk-through of the exam material using whatever materials you choose. Later, you'll use more advanced tools and strategies to "throw it all together," culminating in an exam-ready outcome.

    • Week 1: Cardiovascular (16%)
    • Week 2: Pulmonary (12%)
    • Week 3: Gastrointestinal (10%)
    • Week 4: Musculoskeletal (10%)
    • Week 5: EENT (9%)
    • Week 6: Reproductive (8%)
    • Week 7: Neurologic (6%) (~3.5 days)
    • Week 7: Endocrinology (6%) (~3.5 days)
    • Week 8: Genitourinary (6%) (~4 days)
    • Week 8: Psychiatry (6%) (~3 days)
    • Week 9: Dermatology (5%) (~4 days)
    • Week 9: Hematology (3%) (~3 days)
    • Week 10: Infectious disease (~5 days)
    • Weeks 11, 12, 13: Throw it all together. Complete all of Med-Challenger PA (chapter exams in random order) + do a "comprehensive exam simulation" each week (the Med-Challenger PA exam simulator gives you 100 questions per attempt, mapped to the PA exam blueprint allocations - so you always get the right amount of questions per topic respectfully.  Retake the exam sim - and it will promote missed and unseen questions automatically! Same with Chapter exams. Save your time!)
    • Week 14: Complete one NCCPA practice exam, continue Med-Challenger (exam sims)
    • Week 15: Review any weak areas and continue taking practice exams

    4. Practice & Re-Practice

    As you work your way through your PA review courses and practice exams - expect to not score well, at least at first.  Don't freak out if the questions are "too hard."  The most valuable review courses are geared toward enriching you as you study.

    Odds are you will do shockingly bad on your first few "practice test" runs. But that's fine. And normal. Answering incorrectly may be one of the most effective learning tools at your disposal, as it requires remediation, which in turn reinforces learned information and improves recall through active engagement.

    Never expect to get by knowing only the bare minimum. Don't think you're done once you get a single passing score on a practice test. Simply working your way through all content areas relevant to the NCCPA Exam Blueprint will not be enough.  In times of stress, you don't rise to the occasion - you fall to your highest level of preparation. Go back - do it again. This is why the best PA question banks, like Med-Challenger PA, have 5-10x the number of questions you'll see on the actual PANCE or PANRE.  The goal is to assess your strengths and weaknesses. Identifying your knowledge gaps early in the process frees up time for the actual study and review.

    5. Identify & Attack Weak Areas

    Once you've worked your way through the entirety of your study material several times and have familiarized yourself with what areas you are and are not confident in, it's time to focus on the relevant material with which you are least comfortable and familiar.

    Not all PANCE / PANRE question banks are the same.

    Some online PANCE / PANRE question banks will provide you "a bunch of questions" where you make your own tests. It's basically flashcards on a screen. It's something, but there are more effective question banks.

    A "smart" PA exam review question bank will automatically adapt to your answers and focus your attention and time to areas where you don't know the information well.  If you simply have "a bunch of questions," it's all on you and you can lose track of what you don't know well.

    Adaptive learning exam simulations give you instant remediation and guidance to additional materials as you complete practice exam simulations.  You don't waste time on subject matter you know well and you get prepared faster.

    Consider leaning on an adaptive assessment / prescriptive learning platform. With adaptive learning, not only are you assured to properly utilize all materials available, your time is spent exactly where it needs to be spent with every use, thereby producing a more effective individual review, with no wasted value, all in less time.

    And remember: Always keep the blueprint of the exam you'll take in mind!

    6. Treat Your Body Right

    Preparing for the PANCE / PANRE will push you to your limits – you will be stressed, burnt out, and oftentimes exhausted. But like they say: It’s a marathon, not a sprint. In the long run, it won’t do you any good to sacrifice your physical and mental well-being.

    At least every 3 hours, allow yourself a break to relax and unwind. Stay hydrated throughout the day. Remember to eat and nourish your body with healthy meal options. Exercise will help maintain healthy circulation and oxygenation to your brain. Take some time to meditate. And perhaps most importantly, maintain a healthy sleep schedule, especially the week before your exam.

    7. During the PANCE / PANRE

    The PANCE / PANRE exam uses multiple-choice questions - and most will have one best answer. These question items have a “stem” that presents the background information necessary for answering the question, which usually comes at the end of the stem. 

    Be sure to read the stem carefully. As you proceed, make note of information that seems especially relevant. Read every answer option carefully. First use the process of elimination to filter out what you know is incorrect, and go from there.

    Focus on addressing each question individually. Take a deep breath every now and then. If you are completely stumped by a question or unsure you answered correctly, flag it and come back later.

    That having been said, also consider that the first thoughtful answer an examinee makes is usually the best answer. Second-guessing yourself is not likely to help your performance unless you fully realize that you've misread or misunderstood the question. This will help you maximize your time.

    Capitalize on Common Exam Question Writing Flaws

    1. Pay attention to grammatical cues. Grammatical cues: one or more answer choices (distractors) don’t follow grammatically from the lead-in.
    2. Focus on logical cues. Logical cues: one or more answer choices don’t logically fit in with the other choices. Once you understand the goal of the question writer to create answer choices that are supposed to discriminate knowledge, it is easier to exploit technical flaws and improve the odds of getting a question correct.
    3. Look for answer choices containing absolute terms. Absolute terms: terms such as “always” or “never.” When used in the answer options, these terms usually indicate an incorrect answer because they cannot hold up to scrutiny in all situations.
    4. Keep an eye out for a long correct answer. Many times the correct answer is longer, more specific, or more complete than the other options. Correct answers can be longer than the other options and may be the only "double option." Question writers tend to pay more attention to the correct answer than to the distractors and write long correct answers that include additional instructional material, parenthetical information, and caveats.
    5. Notice when a word repeats. Word repeats: a word or phrase is included in the stem and in the correct answer.

    Making sure you have identified and fixed your areas of weakness will not only help you prepare for and excel on your exam, it will help you expand your core knowledge. Then, on test day, use the above techniques to identify common flaws in questions, which will increase your chances of getting a question correct.

    Long answers + language match = 😉

    Board exam questions usually have tell-tale indicators of what the correct answer option is likely to be.  Typically, correct answers tend to be a bit longer and echo language and exact details used in the question stem.  

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