Musings: Blog of the JAAPA Editorial Board


Blog of the JAAPA editorial board.

Monday, July 21, 2014

From graduation to certification: How to prepare for the PANCE

Kristine A. Himmerick, MPAS, PA-C

Graduation season is upon us. For PA students, this means robes, funny hats, proud families, and a big sigh of relief after surviving 2 to 3 years of intensive medical learning. Looming large just around the bend from the graduation stage is another monumental task…the Physician Assistant National Certifying Examination (PANCE). When the celebrations are over, the content blueprint will be waiting. High-stakes certification examination preparation can be a stressful time, and as a PA educator, I am often asked by students how to prepare for the examination.

The reality is that more than 90% of new graduates pass the PANCE on the first try. PA researchers have explored various measures as predictors of PANCE success. Performance on the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) is consistently the best, although far from perfect, predictor of performance on the PANCE across several studies.1-3 Other factors that have been less consistently correlated with PANCE scores are program-specific summative examinations, results of previous multiple-choice examinations in the didactic year, grade point average before and during the PA program, graduate record examination scores, years of healthcare experience, grades on prerequisite courses, and demographics.1-4 None of these predictors can guarantee individual success and a structured study strategy is important to guide preparation for the examination.

One problem students have in preparing for the PANCE is trying to use too many resources. I recommend that you depend on one high-quality resource from each of three categories: a review book, a primary medical reference, and a question book or website. Depending on three main references will help keep studying focused and avoid desktop clutter.

I recommend selecting one board review book. Many PANCE preparation review books are available. Select a review book that has been recently published, covers the NCCPA content blueprint topics, and follows an outline format that you find intuitive.

Next, select one primary medical reference as a go-to book for everyday studying. This might be the medicine text that you studied from in your didactic year, such as Harrison’s Principles of Internal Medicine, Cecil Textbook of Medicine, Current Medical Diagnosis and Treatment, UpToDate online, or many others. Choose a medical reference book with a format that fits your learning style.

Finally, select a single practice question resource. Many vendors are happy to take your money to provide you with practice PANCE questions. You do not need them all! Choose one book or online source that is easy to use and fits your budget.

Once you have selected these three main study references, use these four tips to develop a good study plan:

• Write out a schedule to cover all NCCPA blueprint topics between now and the date of the examination. Plan to spend more time on the largest topics on the blueprint (cardiology, pulmonology, gastrointestinal, and musculoskeletal) and topic areas that are difficult for you.

• Spend time every day studying from each of the three categories. First, use your review text to read about one blueprint topic (or portion of a topic for larger categories). Then move to indepth reading from the medicine text. End each study session with practice questions.

• Take practice questions every day. Preparing for the examination requires learning the question format and style. Complete practice questions in learning mode (reading the answer and rationale after each question) and in test mode (complete 30+ questions at a 1-minute-per-question pace). Writing your own questions is a great way to learn to be a better test taker.

• Keep your study time active. Know your learning style and capitalize on your strengths. For example, don’t spend hours writing flashcards if you are an auditory learner. Find ways to study by comparing and contrasting diseases and treatments. Think about patients you saw during clerkships that embody the disease process you are studying.

Those very patients are awaiting your arrival on the scene as a certified PA. So take a couple days to celebrate the accomplishment of graduating with a highly coveted PA degree, clean up the confetti, and then hit the books (again)!


1. Higgins R, Moser S, Dereczyk A, et al. Admission variables as predictors of PANCE scores in physician assistant programs: a comparison study across universities. J Physician Assist Educ. 2010;21(1):10-17.

2. Massey SL, Lee L, Young S, Holmerud D. The relationship between formative and summative examination and PANCE results: a multi-program study. J Physician Assist Educ. 2013;24(1):24-34.

3. Ennulat CW, Garrubba C, DeLong D. Evaluation of multiple variables predicting the likelihood of passage and failure of PANCE. J Physician Assist Educ. 2011;22(1):7-18.

4. Brown G, Imel B, Nelson A, et al. Correlations between PANCE performance, physician assistant program grade point average, and selection criteria. J Physician Assist Educ. 2013;24(1):42-44.

Kristine A. Himmerick is an assistant clinical professor in the PA program at Northern Arizona University’s Phoenix Biomedical Campus. The views expressed in this blog post are those of the author and may not reflect AAPA policies.