Monday, April 7, 2014

Everything You Need to Know About the PANCE/PANRE

Everything You Need to Know About the PANCE/PANRE
Updated: 04/14/2016
Both the PANCE and PANRE are produced by a group of PAs and physicians selected based on their experience in technical writing, experience, and demographics. Each writer composes a number of questions, which goes through review. Some questions on each exam are noted for “pretesting,” which are not scored, but the examinee has no idea which questions they are. This allows NCCPA to know whether to include them on future PANCE/PANRE exams. Both exams are scored by giving 1 point for correct answers and 0 points for incorrect answers. Raw scores are then calculated. Then, the Rasch model is used to calculate a “proficiency measure” compensating for variability in difficulty across questions and versions of the exam. This proficiency measure is converted to scaled scores and compared with the scores of examinees who took the exam in the past. Below you can see a breakdown of the PANCE provided by the NCCPA.

  • To sit for the PANCE, you must graduate from a program that was accredited at the time of your matriculation
  • You are eligible to take the PANCE 6 times or up to 6 years after completing the requirements for graduation, whichever comes first.
  • The PANCE costs $475 and you must submit an application in advance. You can schedule your exam anytime depending on testing availability at a Pearson VUE testing center.
  • The exam is 5 hours and includes 300 multiple-choice questions in 5 blocks of 60 questions with 60 minutes allotted for each block. 45 minutes is allotted between each block for break. While taking the exam, you will be allowed a pencil and sheet of paper for notes or a dry erase board and marker. You will also be given earplugs and headphones for noise.
  • You cannot submit an application to test until 90 days prior to your expected program completion date. You are eligible to sit for the PANCE 7 days after the completion of your program. You can only take the PANCE once in any 90-day period or 3-times per calendar year. Tests are not administered December 20-31.
  • It can take up to 2 weeks to receive your PANCE scores.
  • PANCE scores are released every Thursday.
  • A PANCE score of 350+ is generally accepted as “passing,” however, passing scores can and do range from 350-392 depending on the Form (though passing scores are no longer published)
    • You can use the following formula to predict your PANCE scores
      • PANCE = [PACKRAT x 5.74] - 287.47
    • The highest score attainable is an 800
  • Familiarize yourself with the PANCE & PANRE content blueprint

  • The PACKRAT is a 225 question multiple choice exam similar to the PANCE with new versions released each fall
  • PACKRAT exams must be ordered online by program directors or representative faculty
  • Per PAEA Networker, there is no way to directly select which version of the PACKRAT exam will be assigned to each set of students. The most current version of the exam is scheduled by default.
  • The cost per exam per student is $40 for PAEA members and $45 for non-members

  • PANRE failure rates have been stable since 2011 and fluctuate between 7-9% (91-93% pass rate)
    • Second time PANRE takers have a 95% pass rate
  • The PANRE costs $350
  • You are eligible to take the PANRE if you are in the 5th or 6th (9th or 10th) year of the PA-C certification maintenance cycle, depending on your cycle
  • If you are in your 6th or 10th year, you only have 2 attempts to pass the PANRE. You must wait 90 days between exam dates. Take it sooner than later! No testing is allowed between December 20-31.
  • To clarify: You may take the PANRE only once in a 90-day window and only twice per year (which is 180 days from your first exam date) as long as that time-frame occurs before the end of your recertification expiration date. Your time frame (the 180 days) gets "shorter" if you apply later (closer) to your recertification expiration date, meaning, you'd only have the opportunity to take the exam once if you have less than 90 days left.
  • The 10-year recertification process begins at your recertification date if you are currently on a 6-year recertification track.
  • If you are taking the PANRE, it can take up to 10 days to receive your scores
  • The PANRE is a 4 hour exam consisting of 240 multiple choice questions 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
  • In 2013, the pass rate for the surgery focus was 85-87% while the pass rate for the adult medicine PANRE was 92-94%. These results are available by calling NCCPA.

  • First and foremost, there is not a “most effective” way to study for this exam, however, you should consult the blueprint provided by the NCCPA. Be aware that questions may fall outside of this blueprint, but that’s okay. Everyone will have their own method for learning whether it is self-studying or live courses.
  • You cannot learn every detail, medication, diagnosis for every subspecialty. The best you can do is review the areas you are weakest in.
  • Start by studying the “big five” (cardiology, pulmonary, GI, EENT, and either ortho or Oby/Gyn = 57% of the exam) and then study questions from each of them individually. Practice at least 60 questions/day.
  • Therapeutics is almost 20% of the exam - so study CV drugs, neuro/psych drugs and antimicrobials.
  • Aim for >70% on all sections of your PACKRAT.
  • Study your original PA school notes first, then resort to review books. Repetition! Time yourself!
  • Use your score sheets as blueprints to help you figure out where your weaknesses are and concentrate on studying those areas first
  • Don’t try to memorize the information. Instead, try to understand the concept of each disease.
  • Do the AAPA pre/post test questions  
  • Study diseases in more depth than what review books provide as newer questions have become more difficult than before
  • Don’t worry about the amount of time it takes to prepare. Take the test when you are thoroughly prepared. On that note, take the exam as soon as you feel prepared enough. Most students recommend within one week after your program ends.
  • Know your EKG’s and know your medications and their interactions
  • Study cardiology, pulmonary, occupational diseases, GI, know when to order which test, know the different fractures and casts, know your cranial nerves.
  • When taking the test, do not answer questions based on your own experiences. They are looking for the “best answer.”
  • Read each question carefully. Narrow down your choices and make the best educated guess if you are unsure. Do not leave any questions unanswered.
  • Take the PANCE on a Monday. You’ll get your scores that Thursday and you won’t have to wait.
  • You can check this website to see if you passed. They send you an e-mail when your actual test results are available.
  • Remember, you are limited to taking the PANCE 6 times in 6 years! If you’ve failed once, consult your program for a plan of action for how you’ll prepare yourself for the next one so you don’t waste your chances.

Disclaimer: The distribution of PAEA materials is prohibited and may not be reproduced, transmitted in any form by any means, electronic or mechanical, including photocopy or recording, or any information and retrieval system, without permission from PAEA. With that said, I will not personally distribute PACKRAT materials, but they are available on the internet if you search using Google and quotations. Stricter policies have limited the release of Forms 17 and 18 on the internet and you probably won’t find those or Forms 1-7 available online.

Click here for a PACKRAT Topic List released in 2015

PACKRAT Form 9 - Google search for it in quotations

PACKRAT Form 8-16 - available on ScribD by Mayer Rosenberg

PACKRAT Form 17 - Released 2012

PACKRAT Form 18 - Released Nov 6, 2013
Updates include:
  • Flexible testing time controlled by programs (up to 6 hours)
  • The use of images, electrocardiograms, and radiographs
  • Improved access to score reports
  • Lab reference sheet integrated into administration portal

PACKRAT Form 19 - Released November 2014

PACKRAT Form 20 - Released November 2015

PACKRAT Form 21 - Releasing November 2016

Personal Recommendations
Step Up to Medicine 3rd Edition by Agabegi and Agabegi
Pance Prep Pearls by Dwayne A. Williams
Current Medical Diagnosis and Treatment 2016 by Papadakis, McPhee, and Rabow

Other Books Recommended by Students/PAs
PANCE: Power Practice by Learning Express LLC
PANCE/PANRE Flash Review by Debbie Winberry PA-C
Swanson’s Family Medicine Review, 8e by Tallia, Scherger, and Dickey
Primary Care Secrets, 3rd Edition by Mladenovic
USMLE Step 2 Secrets, 4e by O’Connell

  • Organized according to the 2016 NCCPA blueprint by organ area and outline fashion
  • $14.99 for the e-book or $39.99 on Amazon
  • $199 at-home review course, including 1 year of unlimited access to audio review, lectures, 1700+ practice questions, the study guide, flashcards, matching quizzes and practice exams
  • Free trial with 500 practice questions, 1000 flashcards, and 4 hours of audio review

  • $149/year
  • 1500 NCCPA-style questions
  • Peer comparison & performance analysis
  • Score prediction & likelihood of passing calculations
  • Available on iPhone, iPad, and Android  

  • $595

  • 35 hours of Cat 2 CME
  • $349.95

Help Campus (same as Help Zebra and also known as Hancock)
  • 4,200+ questions
  • 3 Months of access - $324.95
  • 6 Months of access - $399.95
  • 12 Months of access - $400.95
  • 15 Months of access - $549.95
  • Davis PA Review included with every subscription

  • PDF handouts, practice tests, lectures
  • Uses ExamMaster
  • $390

  • $495 for 1 year of access
  • AAPA endorsed board review

Teaching to the by Jackie Kazik (book)
  • $59.95
  • Free subscription to PANCEMaster
  • 650 page text covering topic and task areas found in NCCPA blueprint
  • Updated guidelines for 2013

  • $75.99

  • 4 months - $99.95
  • 13 months - $119.95
  • 25 months - $134.95

  • Flashcards
  • Studyguide
  • Practice Test
  • Review

  • $519 Print or Digital Non-Member
  • $889 Complete Package Non-Member

  • 20 sessions - $1,250
  • 10 sessions - $700
  • 6 sessions - $450
  • 4 sessions - $350
  • All include PPT presentations and study guides

247 Tutoring (San Diego, California)
  • Pro Tutors - $40/hour
  • Silver Tutors - $99/hour
  • Diamond Tutors - $299/hour

  • 150 hours of online video lectures
  • $79.99 for 60 days of access
  • $99.99 for 90 days of access
  • $129.99 for 180 days of access
  • $199.99 for 1 year of access
  • $299.99 for 2 years of access

  • Note: the PANRE has 60% of the same content as the PANCE
    • The remaining 40% is categorized as adult medicine, surgery, and primary care

100% Money Back Guarantee
Monthly Fee
Annual Fee
# of PANCE Qs
# of PANRE Qs
SmartBanks by TrueLearn
Kaplan’s Qbank
$199 lasts until your exam
PANCE Master
$65, lasts until your exam
NCCPA Practice Exams
Not stated
$50 each/180 days
May purchase multiple times
120 Qs/exam
2 PANCE exams available
120 Qs/exam
2 PANRE exams available
Exam Master
Not stated
2,900 Qs in Q-bank
One 300-Q practice exam
PA Easy (McGraw Hill)
Not stated
Med Challenger

Data Chem
Not stated

$1,099 for lifetime review
The Physician Assistant Life
$45 for 2 weeks

  • Specialized question bank of over 800 PANCE and 1,000 PANRE specific questions and counting
    • PANCE or PANRE = 1 month ($79), 3 months ($129), 6 months ($199), 1 year ($249)
  • Explanations and references with key learning points for each question
  • Board style vignettes reflective of actual PANCE/PANRE style questions
  • Ability to create your own exams with content specific to your weaknesses
  • Exam content matches the NCCPA Content Blueprint  
  • Realistic testing interface, similar to exam day with analytics revealing peer-peer question performance, subject-specific performance, and overall performance
  • Question specific analysis to analyze when you change an answer (correct to incorrect vs. incorrect to correct)
  • The same content utilized by over 90% of D.O. programs for all board exams

  • 1,200+ questions and explanations, interactive and designed for visual learners (300 testable clinical photos)
    • Page references to Van Rhee’s review book and AAPA review book
    • Explanations for each correct and incorrect answer, bottom line recap
    • Create exams by topic or unused/incorrect questions to target weaknesses and track progress
    • One month subscription: $99
    • “Until Your Test”: $199 (use as often as you’d like, until your exam date)
  • Live instruction from Yale’s program director and author, James Van Rhee ($799)
    • 25 hours of CAT-1 CME ($40)
    • Covers blueprint content in 25+ hours

  • 1,300+ questions
  • $65 subscription (previously $55)
  • Customize your studying to your own pace and preferences
  • One-time fee grants access until you pass your exam

  • 2 PANCE and 2 PANRE Exams
  • Now $50 per exam (previously $35)
  • You only have the exams for 180 days, but you may repurchase them unlimited amounts of times
  • Students are only eligible to purchase them 90 days prior to graduating

  • $14.99 for study guide (PDF) or hardback ($39.99), contains a very skin and bones version perfect for PANCE/PANRE preparation
  • Board review accessible from any computer or electronic device
    • Lectures (videos and podcasts), quizzes, pre- and post-tests for each topic area
  • 100% PANCE/PANRE pass rate for 2015
  • Free trial or $199 for 1 year of unlimited access (includes study guide)
    • 3000+ question bank with explanations
    • 10 hours of audio review
    • 1000+ flash cards

  • $116 for 1 month, $350 for 1 year (previously $19.99 for 60 days)
  • 2,900 questions and explanations
  • Personalized score reports - by subject or topic area
  • Flash cards
  • Generic brand drug review with commonly prescribed medications
  • Also offers a comprehensive practice exam with 300 Qs for $49.99
  • Mobile App $19.99

  • 1,200 Questions
  • 1-Month $79.00, 3-Month $139.00
  • Adaptive learning technology to personalize test prep based on individual needs
  • Dashboard with latest test scores to track progress and resume test prep from previous point
  • Personal study plan, allowing individual to customize and schedule studying, as well as set and achieve goals
  • Skill report shows proficiency in every subject area
  • Detailed explanations for each question with feedback stats on total test performance
  • Mobile app available

  • 2000+ PANCE/PANRE Qs with detailed explanations and references
    • Topic-based segments (Q&A, review, and quiz modes)  
  • Board exam stimulation with prescriptive output that identifies weaknesses
  • Includes 195 Cat-1 NCCPA CME credits and 20 Cat 1 AAPA credits
  • Bonus prep exam
  • PANCE or PANRE board review: $325
  • Premium Membership: $199/year
    • Includes annual renewal of CME credit availability and ongoing content updates
  • Accessible online or offline

  • 840 Questions
  • 13 Topic Areas
  • Individual License - $169

  • $19 for 1 month of access, $26 for 1 year of access
  • 4 midterm exams (each 30 questions) + two-120 question final exams
  • Two 90 minute timed exams each with 60 questions
  • Five 225 question PANCE/PANRE practice exams (1,125 questions total)
  • Ten topic area specific question banks (over 1,021 questions)
  • Two realistic based exams for PANCE and PANRE, mimicing actual testing environment and timed
  • Flashcard sets for the PANCE and PANRE with 226 and 330 questions respectively  
  • Audio and flashcard sets
  • Mobile app
  • 90 question daily email, PANCE/PANRE audio review course (4 h podcast)

You can either choose to use AAPA’s CME Calendar Search tool, or use the list below for easy reference. Be aware that AAPA’s search tool may not have all of the courses listed below.

  • Live or Online ($349)
  • Course + Exam Master = $449

  • 36 hours Cat 1 CME
  • Hosted in Atlanta in September
  • Wednesday-Saturday (7 AM - 5:30 PM)
  • $650 early/$675 regular/$600 on site

  • Hosted in May (near Philadelphia)
  • Early bird - $475
  • Regular - $550
  • On-site Price - $625
  • PA Student Rate (weekend only) - $125

  • $75 non-MWU students/$350 Physician Assistants
  • Hosted in May in Glendale, Arizona
  • Monday-Thursday 8 AM- 5 PM

  • Price ranges from $300-$525 depending on when you register and your credential status

  • Hosted in Albuquerque, New Mexico
  • 3 day course, 26 hours Cat 1 CME
  • Students: $199.95 early/$249.95 regular
  • Physician Assistants: $399.95 early/$449.95 regular

  • New graduates - $350 early/$400 regular
  • Physician Assistant - $545 early/$570 regular

  • Hosted in August in Portland
  • OHSU New Graduates - $250 early/$280 regular
  • Non-OHSU New Graduates - $380 early/$430 regular
  • All others - $535 early/$710 regular

  • $150 registration fee
  • $50 Advanced EKG, BLS, or Radiology workshop
  • $75 PANRE Practice Exam

  • Hosted in April in Sun Valley, Idaho
  • 20 hours Cat 1 CME
  • $370 for members/$510 for non-members

  • Non-member: $515 early/$565 regular
  • Students: $35/day

  • For licensed PA’s only
  • $695 early bird/$795 regular

  • 3-Day PANCE/PANRE Review
  • $350 for students/$425 for PAs
  • 32 hours of Cat 1 CME
  • 1,000 questions (7 exams)
  • Includes breakfast and lunch, shuttle from airport, and lodging

  • 42 hours Cat 1 CME
  • $350 for 3-Day
  • 5-day Layout
    • Day 1: critical thinking, cardiology I, gastroenterology, hematology, women's health
    • Day 2: cardiology II, endocrinology, ophthalmology, cardiology IV, nephrology, EKG
    • Day 3: cardiology III, urology, rheumatology, pediatrics, dermatology
    • Day 4: pulmonology, antimicrobial, pharmacology, infectious disease
    • Day 5: Neurology, psychiatry, orthopedics, ENT
    • 4 sample exams, 120 questions each
  • Gives you a practice test each night to ensure you are focusing on the right area of study

  • 22 hours Cat 1 CME
  • Hosted in Oklahoma City in August
  • $295 new graduates/$400 Physician assistants

PA Board Review Program (Irvine, California)
  • 3 day course, 8 AM - 4 PM
  • $295

  • $399 - DVDs + eLearning

  • Includes the Mayo Clinic Internal Medicine Review book and Q&A book
  • Includes 2 free MOC sessions
  • $1,199


Yes, there are many apps available out there, but there are also very good reviews of these apps available on a website called iMedical Apps. You can check these two out here and here posted by PhysicianAssistant’s Twitter account for physician assistants.  
Epocrates - Free drug content, $159.99 disease content

Medscape by WebMD - Free

UpToDate - Free

AgileMD - Free

Micromedex - $2.99 annual subscription

Diagnosaurus (McGraw-Hill) -$1.99

PANCE Flashcards - Lange - Free, Expansion Pack - $34.99

Physician Assistant LANGE Q&A - Free download, $49.99 for access
  • Contains 1,211 questions from

Physician Assistant Exam Review McGraw-Hill - $49.99

PEPID - Free

Physical Exam Essentials (HippoSoft) - $2.99

iTriage - Free

ErRes - $4.99

  • Cardiology, GI, Neurology, Ophthalmology, nephrology, and hematology
  • HIV, psychiatry medications

  • Pulmonary




  1. I'm can't believe I failed the PANRE with a score of 373 a few months prior. I prepared this time and worked on 800+ practice questions but felt no better when I walked out of this 2nd round of testing. The 2014 PANRE test seemed much more difficult than any of the prior two tests. What's worse is 6 years ago when I went to recertify I did no prep and had a score of 458. Does anyone feel like the PANRE is more difficult now?

  2. yes.. never had any issues with passing. The test this year was all over the place and very very specific with multiple "possible" correct answers. I would bet my license (apparently i have) that the average scores for this years test is much lower than the previous 5 tests I have taken.

  3. I also agree. This year was much more difficult compared to 6 years ago. 6 years ago I got a score of 691. I will be interested to see what the score from last week ends up being. I felt like I was guessing on every other question and I work in Cardiology.

    1. Why would you say so...pls?

      Is it the lenght? how long or short are they?

  4. How do you calculate a PACKRAT score? I was given practice PACKRAT tests, so I know what percentage of questions I got right, but I don't know how to convert that to an actual score. Thanks!

    1. A PANCE score of 350+ is generally accepted as “passing,” however, passing scores can and do range from 350-392 depending on the Form (though passing scores are no longer published)
      You can use the following formula to predict your PANCE scores
      PANCE = [PACKRAT x 5.74] - 287.47

  5. Says right up at the top:
    "A PANCE score of 350+ is generally accepted as “passing,” however, passing scores can and do range from 350-392 depending on the Form (though passing scores are no longer published)
    You can use the following formula to predict your PANCE scores
    PANCE = [PACKRAT x 5.74] - 287.47
    The highest score attainable is an 800"

    I find the formula is not that accurate however. I got a 184 (about 82%) on a PACKRAT which equates to a 769... A little higher and the formula would give me a number over 800... an impossibility

    1. Hi anonymous,

      Thanks for replying to the above comment. The formula was created using a small sample size of students and was not intended to be perfect. It does not equate 100% with every student's score and every PACKRAT test taken. PACKRATs are all going to be different and vary in difficulty. Please take that into consideration.

  6. I hate to self promote, but you are missing a resource that is blazing a new path in the PA world. Look up
    It's knocking people's socks off. Tell me what you think...

  7. Hi...could you please guide me...On the exam what is a good rule of thumb

    Generally how long are the exam questions? (Longest)

    And how short can the exam questions be? (Shortest)


    1. Hi anonymous, I'm not sure what you mean by longest and shortest, but I think generally they take between 2-5 minutes to complete.

    2. Sorry for the confusion....I mean't as to what is the

      Number of lines (Longest question)? (What % of the exam does it comprise roughly)

      Number of lines (Shortest question)? (What % of the exam does it comprise roughly)

      To practice for the exam in order to properly simulate it?

      Many Thanks.

  8. Thank you for this information! as an FYI, NCCPA practice PANCE tests are now $50 each

  9. Hey there ..... do you know where I might be able to get copies of Packrat form 16-21. Scribd only goes to 15.

    Thanks PA student Hoop

  10. Hello there, I want to go for PANCE and using resource for educational purpose. Very helpful to learn these facts! Keep sharing such stuff!

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  12. What program from the listed above do you recommend for the PANCE or do you think is the best? What would be the top 3 resources you would utilize to study for PANCE? It seems that 1 top resource is Brian Wallace podcast. Can you email me at with an answer too please along with posting it on this discussion board?

  13. What do you consider the best qbank for PANCE? Please email answer to


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