About the PANCE

To become certified as a physician assistant, you must first graduate from a training program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). This requirement also applies to those who have earned a medical degree outside the United States. Graduation from an accredited program makes you eligible to take the PANCE, an acronym that stands for Physician Assistant National Certifying Exam. The National Commission on the Certification of Physician Assistants (NCCPA) was created to serve as the certifying body for the profession and functions as an independent testing body, autonomous from any particular school or training program. The PANCE, prepared by the NCCPA, is a test of minimum competency designed to assess whether examinees have the knowledge and skills needed for entry-level practice.

PANCE Overview

Examination length: 5 hours and 45 minutes (administered in five 60-minute blocks plus 45 minutes for breaks)

Number of questions: 300 total (approx. 1 minute per question)

Question types: Multiple choice

PANCE 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 PANCE 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

The PANCE content also may be understood in terms of the diseases, disorders, and medical assessments that you might encounter during the examination. The percent of questions for various organ systems is shown in below.


No standardized licensing exam is 100% predictable, and question writers work hard to create questions that require understanding and integration of the material. So the best overall goal in reviewing is to aim for genuine understanding of major concepts, key definitions, and integration of that knowledge across subject areas.

By multiplying the proportional contribution of each disease category by the proportion of the exam dealing with each knowledge/skill area, one can form a matrix that illustrates the relative emphasis for various topics to be tested. Many students find that this is a rough but helpful way to determine how much study time to invest in reviewing one topic versus another.

The ultimate decision about the amount of time you will need to invest in becoming test-ready for each topic is yours. You must consider your own unique subject strengths and weaknesses.