Understanding the NCCPA Blueprint for PANCE/PANRE

Before we begin our exploration of the NCCPA blueprint for PANCE/PANRE, it’s important to understand that no blueprint is exhaustive, and no one can know exactly which questions will appear on the Physician Assistant National Certifying Exam (PANCE) or the Physician Assistant National Recertifying Exam (PANRE).

Introduction to the NCCPA Blueprint: Two Dimensions

The NCCPA blueprint for PANCE/PANRE was developed to provide an overview of the topics, knowledge, and skill areas that appear in the exams. There are two dimensions to the NCCPA blueprint to aid you in preparing your study and review strategy for PANCE/PANRE. Each blueprint outlines the following elements, which are covered in both exams:

1. Organs and organ systems, as well as the diseases, disorders, and medical assessments of these systems.
2. The knowledge and skills a typical Physician Assistant will require in order to practice medicine, regularly encountering those diseases, disorders, and assessments.

NCCPA Blueprint for Content: Organs, Organ Systems, Diseases, and Disorders

The NCCPA blueprint concerning organs, organ systems, diseases, and disorders is fairly straightforward; the table below contains a list of the types of organs and organ systems that will be covered, as well as the approximate percentages of exam content that will be devoted to each topic.

Content blueprint:

For the certification and recertification exams taking place in 2015 and beyond, PAs should be aware of the following changes from the NCCPA:

• content blueprints
• disease and disorder lists
• psychiatry-related terminology as it appears in exam questions

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which was published in 2013, contains revised terminology for classifications and diagnostic criteria. The PANCE/PANRE exam questions, content, blueprints, and other related materials will be updated accordingly, over the course of 2 years in a two-step process:  If you are taking PANCE/PANRE in 2015, you will see exam questions that include the DSM-5 terminology followed by the previously-accepted DSM-IV-TR terminology in parentheses when psychiatry-related terminology is called for.  For example, you would see the following listed: illness anxiety disorder (hypochondriasis).

If you are taking PANCE/PANRE in 2016 and afterward, the previously used terminology will not be included. All psychiatry-related terminology within exam questions will follow the DSM-5 guideline. For example, you would see only the following listed: illness anxiety disorder.

Integration with the NCCPA Task Area Blueprint

PANCE/PANRE test not only your knowledge of organs, systems, and diseases, but also your knowledge of the essential tasks a Physician Assistant performs in the daily practice of medicine.  The NCCPA conducted intensive analysis of a Physician Assistant’s practice to determine the knowledge and skill areas that a PA would need to practice medicine safely and successfully. Therefore, each question on PANCE and PANRE will address both an organ system and a task area.

These tasks include:

Below is a brief summary of each task area so that you understand what will be expected of you on the certification and recertification exams.

History Taking and Performing Physical Examinations explores your ability to ascertain a patient’s pertinent historical information and risk factors for certain medical conditions, as well as signs and symptoms. You will be expected to know techniques and findings for physical exams, specifically which physical examination techniques are appropriate for selected medical conditions. The cognitive skills for this section mirror the task and include conducting interviews and physical exams, identifying pertinent information from history and physical exam, and associating current complaint with presented history and symptoms.

Using Laboratory and Diagnostic Studies examines your ability to determine the proper indications for initial and subsequent diagnostic or laboratory studies and procedures, taking into account issues such as cost effectiveness, relevance, normal/abnormal diagnostic ranges, potential risks, and adequately informing/educating the patient.  You will need to demonstrate cognitive skills in using diagnostic equipment safely, selecting the right studies or procedures, collecting specimens, and interpreting results.

Formulating Most Likely Diagnosis tests your knowledge of diagnostics. You will be expected to understand and be able to answer questions about the significance of history, physical exam findings, and diagnostic and laboratory studies, as they relate to diagnosis. Your cognitive skills in normal/abnormal diagnostic data correlation, differential diagnosis formulation, and the selection of the most likely diagnosis (taking the available data into account) will come into play for this task area.

Health Maintenance concerns the epidemiology and early detection and prevention of selected medical conditions as well as how patients can maintain health through lifestyle choices and access to medical care. You must demonstrate knowledge of the relative value of common screening tests, factors that impact health such as occupational environmental exposure, stress, abuse and neglect, and barriers to medical care. You must also be able to educate patients on healthy lifestyles and lifestyle changes, prevention of selected medical conditions and communicable diseases. Immunization comes up in this task area, and you will be expected to answer questions on the risks, benefits, and the recommended schedules of immunization for infants, children, adults, and foreign travelers. Finally, you will be expected to have knowledge of human growth and development, sexuality, issues related to aging, and psychological issues due to illness and injury. Cognitive skills include counseling and patient education techniques, effective communication and bedside manner, adaptability, and ability to research the sources available to you in informational databases.

Clinical Intervention covers the management and treatment of medical conditions. If treatment includes surgical procedures, you will be expected to demonstrate knowledge of indications, contraindications, complications, risks, benefits, techniques, and technical expertise for selected procedures, as well as sterile technique, standard precautions, special isolation conditions, hospital/medical facility admission indications, and discharge planning. There will also be questions concerning therapeutic regimens (specifically follow-up and monitoring); the formulation and implementation of treatment plans (especially issues of patient adherence and participation); counseling, educating, and communicating with patients; connecting patients with available and appropriate community resources; and collaborating with other health professionals and multidisciplinary teams. The concept of medical emergencies appears in this task area: recognizing them and initiating the proper treatment. This task area also includes alternative medicine (its role, risks, and benefits) and end-of-life issues.

Pharmaceutical Therapeutics tests your knowledge of pharmacologic therapies, including mechanism of action, indications and contraindications, effects and adverse reactions, and monitoring and follow-up. You will answer questions on drug interactions, including potential risks, clinical presentation, and treatment. Drug toxicity will also be addressed in this task area, with attention paid to medical cross-reactivity and recognizing and treating allergic reactions. You will demonstrate cognitive skills including methods to reduce errors in prescription, selecting the appropriate drug therapy for medical selected conditions, monitoring and adjusting regimens, and handling adverse drug reactions through evaluation and reporting.

Applying Basic Science Concepts examines your ability to  apply your training in human anatomy and physiology, pathophysiology, microbiology, and biochemistry to your practice of medicine. This includes cognitive skills such as correlation of abnormal physical exam and diagnostic findings to a given disease process, recognition of normal and abnormal anatomy and physiology, and the ability to relate pathophysiologic principles to specific disease processes.

These task areas will appear in each question as they relate to your general knowledge. The task blueprint, with its emphasis on process and cognitive skills, is the vehicle by which you demonstrate your comprehensive understanding of the content blueprint, with its topics and information on organs and organ systems.

PANCE and PANRE: Similar Exams, Different Purposes

It’s important to note here that although the questions on the certification and recertification exams cover the same material, the questions do differ slightly. This is because each of these exams has a different function: The purpose of PANCE is to assess basic medical and surgical knowledge for newly trained PAs, and the certification provides you with the credentials needed to inspire trust as you begin your practice of medicine. Therefore, the questions are more specific, especially as they relate to applying basic science concepts. The purpose of PANRE is slightly different: it’s about measuring your abilities in the daily practice of medicine and maintaining the skills and knowledge you learned in training.

The assumption here is that you now have more clinical experience and specialized knowledge from a daily medical practice, and questions on the recertification exam will cover more general clinical concerns. Therefore, although 60% of the exam is comprised of general knowledge-based questions, 40% of the exam is a practice-focused component. With PANRE, you have a choice:  the practice-focused component of the exam is directed to general questions in 3 areas of medicine: adult medicine, surgery, and primary care (which is the “default” option). In this way, you can rely on the knowledge you’ve gained from your clinical experience to focus more of the exam on your practice area, if you wish.

For more information on the PANCE/PANRE blueprint, including sample questions and a full-length practice exam, go to the NCCPA website. Our NEJM Knowledge+ website also has information on exam blueprints and how our learning platform can help you review for the PANCE or PANRE easily and effectively.