PANCE
Overview
Physician assistants must pass the Physician Assistant National Certifying Examination (PANCE) after graduation in order to practice clinically. It is a 300-question, multiple-choice exam required for first-time Physician Assistant licensure in the U.S., testing core medical/surgical knowledge across organ systems and clinical tasks over five hours (five 60-minute blocks). Administered by the NCCPA, it covers diseases, diagnosis, treatment, and patient management, with highest weight on cardiovascular, pulmonary, and GI systems, and tasks like diagnosis formulation and history-taking. Passing is crucial for certification, allowing for practice as a PA.
PANCE Exam Blueprint
Nearly all standardized licensure examinations are constructed around what’s called an exam blueprint. An examination development group uses a content blueprint to guide the construction of an examination, referring to the blueprint to make decisions about what content to assess and what the emphasis of the exam should be. The NCCPA groups the tasks you will be tested on using seven categories and has set the percent of items in the PANCE Exam that will be devoted to each category.
1. History taking and performing physical examinations
These items assess your knowledge of:
- Pertinent history for important medical conditions
- Risk factors for developing important medical conditions
- Signs and symptoms for important medical conditions
- Physical examination techniques
- Physical examination findings associated with important medical conditions
- Appropriate physical examination for important medical conditions
- Differential diagnosis associated with presenting symptoms or physical findings
These items also assess your critical thinking in:
- Conducting comprehensive, focused interviews
- Identifying relevant historical information
- Performing comprehensive, focused physical examinations
- Associating the current complaint with history
- Identifying relevant physical examination information
2. Using laboratory and diagnostic studies
These items assess your knowledge of:
- Indications for initial and subsequent studies (diagnostic or laboratory)
- Cost-effectiveness of diagnostic studies or procedures
- Relevance of common screening tests for selected health conditions
- Normal and abnormal diagnostic ranges
- Risks associated with diagnostic studies or procedures
- Appropriate patient education concerning laboratory or diagnostic studies
These items also assess your critical thinking in:
- Safe and appropriate use of diagnostic equipment
- Choosing appropriate diagnostic or laboratory studies
- Collecting specimens for diagnostic or laboratory studies
- Interpreting the results of diagnostic or laboratory studies
3. Formulating most likely diagnosis
These items assess your knowledge of:
How to interpret patient history with respect to differential diagnosis
How to interpret physical findings with respect to diagnosis
How to interpret diagnostic and laboratory studies with respect to diagnosis
These items also assess your critical thinking in:
Correlating normal and abnormal diagnostic data
Establishing the differential diagnosis
Selecting the most likely diagnosis in with regard to the data presented
4. Health maintenance
These items assess your knowledge of:
- Epidemiology of important medical conditions
- Early detection and prevention of important medical conditions
- Relative merits of common screening tests
- Appropriate patient education regarding preventable conditions or lifestyle modifications
- Healthy lifestyles
- Prevention of communicable diseases
- Immunization schedules and recommendations
- Immunization risks and benefits
- Human growth and development
- Human sexuality
- Occupational and environmental exposure
- Effect of stress on health
- Psychological manifestations of illness and injury
- Effects of aging and changing family roles on health maintenance and disease prevention
- Signs of abuse and neglect
- Barriers to care
These items also assess your critical thinking in:
- Techniques of counseling and patient education
- Effective communication with patients to enhance health maintenance
- Adapting health maintenance to the patient’s context
- Use of informational databases
5. Clinical intervention
These items assess your knowledge of:
- Management and treatment of important medical conditions
- Indications, contraindications, complications, risks, benefits, and techniques for selected procedures
- Standard precautions and special isolation conditions
- Sterile technique
- Follow-up and monitoring of therapeutic regimens
- Medical emergencies
- Indications to admit or discharge
Discharge planning - Available community resources
- Appropriate community resources
- Appropriate patient education
- Roles of other health professionals
- End-of-life issues
- Risks and benefits of alternative medicine
These items also assess your critical thinking in:
- Formulating and implementing treatment plans
- Recognizing life-threatening emergencies and initiating treatment
- Demonstrating technical expertise related to performing specific procedures
- Communicating effectively
- Using counseling techniques
- Promoting patient adherence and active participation in treatment
- Working effectively in multidisciplinary teams
6. Pharmacological therapies
These items assess your knowledge of:
- Mechanism of action
- Indications for use
- Contraindications
- Side effects
- Adverse reactions
- Follow-up and monitoring of pharmacologic regimens
- Risks for drug interactions
- Clinical presentation of drug interactions
- Treatment of drug interactions
- Drug toxicity
- Methods to reduce medication errors
- Cross-reactivity of similar medications
- Presentation and treatment of allergic reactions
These items also assess your critical thinking in:
- Selecting appropriate pharmacologic therapy for important medical conditions
- Monitoring and adjusting pharmacologic regimens
- Evaluating and reporting adverse drug reactions
7. Applying basic science concepts
These items assess your knowledge of:
- Human anatomy and physiology
- Underlying pathophysiology
- Microbiology and biochemistry
These items also assess your critical thinking in:
- Recognizing normal and abnormal anatomy and physiology
- Relating pathophysiologic principles to specific disease processes
- Correlating abnormal physical examination findings with a given disease process
- Correlating abnormal results of diagnostic tests with a given disease process
NOTE: The PANCE Exam content also may be understood in terms of the diseases, disorders, and medical assessments that you might encounter during the examination.
Purpose of the PANCE Exam
The purpose of examinations is to measure knowledge and understanding, promote discipline and time management, prepare one for real-world challenges, provide fair and objective assessments, motivate academic excellence, get ready for future exams, and advance one’s critical thinking and problem-solving skills.
PANCE Exam Eligibility
To be eligible for the PANCE, you must graduate from a Physician Assistant (PA) program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). After graduation, you have a window of up to six years or six attempts (whichever comes first) to pass the exam, taking it no more than once every 90 days or three times a year, and must apply at least 180 days before program completion.
Core Requirements:
Education: Must have graduated from an ARC-PA accredited PA program.
Application Timing: Apply at least 180 days (about 6 months) before your expected program completion date.
Exam Timing: You can take the exam as early as 7 days after your program completion and must take it within 6 years of graduation.
Attempt & Time Limits:
Attempts: You get up to 6 attempts within the 6-year window.
Frequency: Once every 90 days, or a maximum of 3 times in a calendar year.
After Graduation:
Verification: You must apply to the National Commission on Certification of Physician Assistants (NCCPA) for verification of your graduation.
Temporary License: Once verified, you can request a letter from the NCCPA to get a temporary license from your state board.
Test Day ID Requirements:
Two IDs: Present two valid forms of identification.
Primary ID: Must be a government-issued photo ID (like a driver’s license or passport) with your printed name and signature.
Secondary ID: Another valid ID with your printed name and signature (e.g., another government ID, student ID).
How we assist candidates in clearing this exam.
Exact examination Q&A bank
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Direct certificate:
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