Physician Assistant National Certifying Examination Research Articles

Utility of Noncognitive Admission Variables in the Prediction of Academic Success

Background: Graduate healthcare education programs commonly rely on cognitive measures such as grade point average for admission to their programs. Noncognitive measures are also collected at the time of application, with less information known about their utility in prediction of academic outcomes. This analysis observed the following noncognitive admission domains and their relationship with PA student academic success: employment hours, shadowing experience hours, research hours, hours spent in extracurricular activities, healthcare related activity hours, leadership experience, patient care experience hours, teaching hours, and volunteerism hours.
 Objective: This archival analysis aims to determine if noncognitive admission variables are predictive of Physician Assistant National Certifying Examination (PANCE) failure or academic attrition at a West Texas Physician Assistant (PA) Program.
 Methods: Institutional Review Board exemption was obtained; then a series of univariate logistic regression models were constructed to predict using applicant self-reported cumulative experience hours. Five cohorts (n=235) were evaluated by noncognitive variables using R statistical software (version 4.1.2).
 Results: Patient care experience hours showed a positive association with PANCE failure, while healthcare and teaching experience had positive trends with attrition. High GPA was protective against attrition when controlled for employment, research, and shadowing experiences, and also when controlled for leadership and patient care experience. High GPA was not a protective factor for PANCE failures.
 Conclusion: Contrary to our hypotheses, increased self-reported experiences did not show a protective effect against PANCE failure or attrition but were instead detrimental.

Path Analysis of Admission and Program Achievement Variables to Predict Physician Assistant National Certifying Examination Performance: Results of a 6-Year Study

Purpose The primary aim of this study was the examination of relationships between students' preadmission achievement, intraphysician assistant (PA) program achievement, and Physician Assistant National Certifying Examination (PANCE) performance using path analysis regression. Second, this study explored the extent to which the theoretical model differed based on several key demographic variables: sex and undergraduate major. Methods This retrospective, single-institution study examined data from 2015 to 2022 (n = 322). Analysis included descriptive statistics, bivariate correlations, and path analysis using structural equation modeling to examine direct, indirect, and total effects of all predictors on the primary outcome variable, PANCE. Results PACKRAT-I demonstrated the largest total effect size on PANCE total score (β = .45). Total effect size on PANCE was small yet significant for prerequisite grade point average (GPA), Graduate Record Exam verbal and quantitative subscores, a comprehensive didactic cardiology examination, didactic and clinical year GPAs, and End of Rotation examination mean score (β < .25). The relationship between mean preceptor evaluation score and PANCE was nonsignificant. Subgroup analyses showed differences between female and male in the relationship between several didactic variables and preceptor evaluations. No differences were detected between groups based on undergraduate major. Conclusion This PANCE analysis revealed relationships among pre-PA and intra-PA performance metrics that may subsequently support data-informed strategies for programs to identify at-risk students, aid student success, and support the assessment of curriculum. Future studies should replicate the approach using a larger, multi-institution sample that examines additional preprogram and intraprogram achievement variables.

An Examination of Predictors of Attrition in Physician Assistant Programs

The purpose of this study was to explore the relationship between program characteristics and attrition rates. Program graduation rates, attrition rates, and Physician Assistant National Certifying Examination (PANCE) pass rates were extracted from program websites from February-March 2021 and summarized for 2018, 2019, and 2020. Means were compared across categories of independent variables. Attrition rates and PANCE pass rates were correlated. Prerequisites and attrition rate were evaluated with multiple regression. Mean attrition rates varied little across years. Significant differences in mean attrition were limited to a few US Census Bureau regions or divisions. No significant correlation between the total number of prerequisite courses or total prerequisite credits and attrition existed. In 2020, mean attrition rate was statistically significantly greater when biochemistry was required (M = 6.89, SD = 7.04) than when not required (M = 4.91, SD = 4.75) and was statistically significantly lower when an additional chemistry course was required (M = 3.65, SD = 4.00) than when not required (M = 5.93, SD = 5.82). No significant predictors of attrition were found with regression. The mean attrition rates have been relatively stable from 2018-2020, suggesting that the presence of prerequisite coursework has no significant impact on attrition rates. This suggests that specific prerequisites may not predict success in a program, supporting the idea of decreasing or eliminating prerequisites. Additional studies are needed to understand the factors, including specific combinations of prerequisites, that predict completion of a physician assistant program.

A Clinical Year PACKRAT Score That Identifies Risk of Physician Assistant National Certifying Examination Failure: A 10-Year Analysis.

A 10-year analysis to identify a Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) score that identifies students at risk of poor performance on the Physician Assistant National Certifying Examination (PANCE) was performed. A total of 712 student PACKRAT scores were analyzed to identify a score that would indicate those students at risk of failing the PANCE. Students with scores of 145 or lower were identified as a risk after the completion of clinical rotations. Remediation to strengthen knowledge deficits was implemented for those with scores of 145 or lower. After 9 years of remediating those students identified as at-risk according to their PACKRAT score, the program's average PANCE pass rate increased from 92.1% to 96.7% with pass rates of 100% over the last 2 years.

Comparing the Physician Assistant National Certifying Examination Pass Rate of Graduates From Programs Utilizing Distance Education to the National Average.

The goal of this study was to compare the Physician Assistant National Certifying Examination (PANCE) pass rate of graduates from physician assistant (PA) programs utilizing distance education to the national average of PANCE pass rates. The Physician Assistant Education Association online PA program directory was used to obtain the name and number of physician assistant (PA) programs that offered distance education in their curriculum. The National Commission on Certification of Physician Assistants PANCE Exam Performance Summary Report was reviewed for each PA program that offered distance education. The 5-year first-time taker mean pass rate for all PA programs offering distance education was calculated and compared to the 5-year national first-time taker average for all PA programs in the United States over the same 5-year period. The mean 5-year first-time taker pass rate for PA programs offering distance education was 96.9%. The 5-year national first-time taker average pass rate for all PA programs was 96.0%. The results of this study show that graduates from PA programs utilizing distance education are effectively prepared to pass the PANCE and do so at a rate that is higher than the national mean for all PA programs.

Citation and Characteristic Analysis of Physician Assistant Programs Placed on Accreditation-Probation, 2015-2017.

The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) is responsible for accrediting the current 236 entry-level physician assistant (PA) programs in the United States. This study analyzes citations levied against PA programs by the ARC-PA and how those citations relate to the commission's ultimate accreditation decisions; in addition, this study compares PA program characteristics and assesses those characteristics as they relate to recent accreditation outcomes. This study used citations for specific violations of ARC-PA Standards to analyze the ARC-PA's accreditation decisions from September 2015 through September 2017. The institutional characteristics of programs that received an accreditation-probation decision were compared with those that received an accreditation-continued or accreditation-provisional decision. Where possible, outcome decisions were benchmarked using national data obtained from publications distributed by the Physician Assistant Education Association. On average, programs that were placed on accreditation-probation during the time frame of this study had received their initial accreditation 16 years before being placed on probation. Altogether, 393 citations were levied against those programs (range: 2-60 citations; median: 13.5 citations). Physician assistant programs that were awarded provisional or continued accreditation were cited for slightly different Standards violations than PA programs that were placed on probation. The average 5-year pass rate for students taking the Physician Assistant National Certifying Examination for the first time was not very different for students from PA programs that were placed on probation and all other programs. Faculty members, institutions, and entities that support PA program development can use this information to compare PA programs. The results of this study can help PA programs identify areas of frequent noncompliance with the ARC-PA's Standards; provide context that PA programs can use to assess their performance against other programs in the accreditation process; and help PA programs identify areas in need of priority attention nationwide.

Key Factors Leading to Program Selection: A Survey of Physician Assistant Program Interviewees.

The purpose of this study was to determine which factors had the greatest influence on physician assistant (PA) interviewees' decision to choose a PA program to attend. The information in this article may assist PA programs in making their program more attractive to potential applicants and also may help applicants identify programs that will best fit their needs. Applicants who interviewed with a PA program were asked to rate 33 different influential factors when choosing a program to attend. Respondents most highly endorsed quality of faculty and staff, first-time Physician Assistant National Certifying Examination pass rates, and morale of faculty and staff. Results varied by demographics, including marital status, age, and sex of respondent. Results also varied from pre-PA students. Although there are numerous factors involved in program selection, PA programs may want to focus on the quality and morale of their faculty and staff to help improve the likelihood of attracting and retaining the highest quality applicants.

Board Review Course as Intervention: Impact on PANCE Performance.

To analyze the effectiveness of an independent commercial 3-day Physician Assistant National Certifying Examination (PANCE)-Physician Assistant National Recertifying Examination (PANRE) board review course to improve first-time pass rates on the PANCE. Data were extracted from academic files at 2 universities over 2 years. In the first year (2014), the universities had not implemented a requirement for participation in a commercial board review course. In the second year (2015), both universities required participation in the course. There were 116 students at Idaho State University and 85 students at the University of Utah. Multiple regression analyses with PANCE score as the outcome variable were conducted with number of days to PANCE, number of practice tests, location of review course, Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) II performance, first-time PANCE pass rates, and first-time PANCE scores. After controlling for demographics, PACKRAT II scores, and students' home university, the study found that participation in the board certification course did not seem to affect student performance on the PANCE (R change = 0.000, p = .728). Post hoc analysis revealed a significant main effect for number of tests (F(3,94) = 3.35, p = .022, (Equation is included in full-text article.)= 0.097). Although not statistically significant, differences between on-site and off-site attendance may be of practical significance. There were no significant differences in PANCE performance of PA students who participated in a program-sponsored board review course and the performance of those who did not participate the previous year. We offer suggestions for future research to maximize the utility of a board review course.

Early Predictors of Students at Risk of Poor PANCE Performance.

The purpose of this study was to identify early predictors in the physician assistant (PA) program curriculum that could be used to identify students "at risk" of failing the Physician Assistant National Certifying Examination (PANCE), allowing for early intervention. Previous literature implicates grades on foundational coursework as promising early predictors of PANCE performance. Secondary data analyses were performed using student data from 2003 to 2014 school years in the PA program at a large university. Path analysis indicated that grades from foundational coursework were the strongest early predictors of PANCE performance, accounting for over half of the variance in PANCE performance. Although admission criteria provide some indication of how a student might perform on the PANCE, foundational coursework is the best early predictor of PANCE performance based on this research. Remediation strategies may be most successful when targeting students who have difficulty in these classes during their first year.

Relationship Between Physician Assistant Program Length and Physician Assistant National Certifying Examination Pass Rates.

This study was conducted to examine the relationship between physician assistant (PA) educational program length and PA programs' 5-year average Physician Assistant National Certifying Examination (PANCE) first-time pass rates. This was a retrospective correlational study that analyzed previously collected data from a nonprobability purposive sample of accredited PA program Web sites. Master's level PA programs (n = 108) in the United States with published average PANCE scores for 5 consecutive classes were included. Provisional and probationary programs were excluded (n = 4). Study data were not normally distributed per the Kolmogorov-Smirnov test, P = .00. There was no relationship between program length and PANCE pass rates, ρ (108) = -0.04, P = .68. Further analyses examining a possible relationship between program phase length (didactic and clinical) and PANCE pass rates also demonstrated no differences (ρ [107] = -0.05, P = .60 and ρ [107] = 0.02, P = .80, respectively). The results of this study suggest that shorter length PA programs perform similarly to longer programs in preparing students to pass the PANCE. In light of rapid expansion of PA educational programs, educators may want to consider these findings when planning the length of study for new and established programs.

Predictors of student success on the physician assistant national certifying examination.

This study examined the association between academic performance in undergraduate science courses - chemistry I, pathophysiology, and biochemistry - and student scores on the PANCE. Covariates gender, age, and admission GPA were included in the analysis to identify factors predicting student passage of the PANCE. A retrospective cohort study of student records of first-attempt chemistry I, pathophysiology, and biochemistry course grades and first-attempt PANCE scores for PA graduates from D'Youville College (n = 155) from 2006-2010 were included, along with age, gender, and admission GPA. Pathophysiology (P < .001) and biochemistry (P = .01) had significant positive regression coefficients, predicting higher PANCE scores of 62.13 points and 33.82 points, respectively, for every one unit increase in pathophysiology and biochemistry course grade (ie, B to A) after controlling for age, gender, and admission GPA. Admission GPA had a significant (P = .02) positive regression coefficient, suggesting that for every unit increase in admission GPA, PANCE score will increase 50.48 points when controlling for age and gender. Higher first-attempt PANCE scores were predicted by higher admission GPA and first-attempt grades achieved in pathophysiology and biochemistry. Identifying predicting factors of PANCE passage may help to identify a student's ability to pass the PANCE early in the curriculum, as well as improve program quality and graduate success.

The Relationship Between Formative and Summative Examinations and PANCE Scores; Can the Past Predict the Future?

This paper describes how a systematic analysis of students at risk for failing the Physician Assistant National Certifying Examination (PANCE) may be used to identify which students may benefit from intervention prior to taking the PANCE and thus increase the likelihood of successful completion of the PANCE. The intervention developed and implemented uses various formative and summative examinations to predict students' PANCE scores with a high degree of accuracy. Eight end-of-rotation exams (EOREs) based upon discipline-specific diseases and averaging 100 questions each, a 360-question PANCE simulation (SUMM I), the PACKRAT, and a 700-question summative cognitive examination based upon the NCCPA blueprint (SUMM II) were administered to all students enrolled in the program during the clinical year starting in January 2010 and concluding in December 2010. When the PACKRAT, SUMM I, SUMM II, and the surgery, women's health, and pediatrics EOREs were combined in a regression model, an Rvalue of 0.87 and an R2 of 0.75 were obtained. A predicted score was generated for the class of 2009. The predicted PANCE score based upon this model had a final correlation of 0.790 with the actual PANCE score. This pilot study demonstrated that valid predicted scores could be generated from formative and summative examinations to provide valuable feedback and to identify students at risk of failing the PANCE.

Admission Variables as Predictors of PANCE Scores in Physician Assistant Programs: A Comparison Study Across Universities

The purpose of this study was to create a model of cognitive and noncognitive measures that could estimate the probability of achieving a given level of performance on the Physician Assistant National Certifying Examination (PANCE). A retrospective records review of admissions information used by six universities was conducted to discover which factor had the most impact on the dependent variable of the PANCE score. Multiple predictors were measured: undergraduate grade point average (uGPA), graduate GPA, prerequisite grades, Graduate Record Exam (GRE)-verbal, GRE-quantitative, GRE combined, interview scores, years of health care experience, age, gender, and first-year scores on the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT). While PACKRAT scores are not applicable to admission selection, they are a strong midpoint predictor of PANCE performance. Multiple regression analysis was used to develop prediction equations. Expectancy tables were developed to provide estimation of PANCE performance, given the various score ranges on each of the predictor variables. Four predictors made a significant contribution to the final regression equation: GPA, GRE-verbal, GRE-quantitative, and PACKRAT scores. The PACKRAT scores were consistently the best predictors of performance on the PANCE. Each of these four predictors can be plugged into predictability tables to estimate the probability of achieving various score intervals on the PANCE. A model of equations and predictors can be used to project how successful a physician assistant (PA) graduate will be on PANCE performance. Years of health care experience, grades on prerequisites, and demographics were not significant predictors across programs but did have significance in certain individual institutions. Future research should examine which specific noncognitive traits measured in interviews can add value to predictability.

Evaluation of Multiple Variables Predicting the Likelihood of Passage and Failure of PANCE

A significant positive correlation between the Physician Assistant National Certifying Examination (PANCE) and the PAEA Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) has been found in previous studies. This study's goal was to improve prediction of PANCE failure using other predictive measures, alone and in combination, with the PACKRAT. Correlation and discriminate and regression analyses were conducted on 3 years of data (2007-2009) collected from Chatham University PA Studies graduates, with convergent results. Significant positive correlations between the PANCE and each of the assessment measures were found (in order of significance): (1) the PACKRAT exam; (2) a summative multiple choice question exam given near the end of the clinical (second) year; (3) average multiple-choice-question-exam results from the didactic (first) year; (4) prerequisite preadmission GPA; and (5) overall preadmission GPA. Discriminant analyses revealed the combined solution of PACKRAT, SUMM, and MCQ to most accurately differentiate between the "pass" versus "fail" groups on the PANCE. Most importantly, regression analyses revealed the combined solution of SUMM and MCQ to most accurately predict PANCE performance at the low end of the scale. This research suggests that all assessment measures tested can provide helpful estimates of PANCE performance; however the combined SUMM and MCQ solution provided the most reliable and accurate prediction of PANCE performance for "high risk" students. Other physician assistant programs could develop analyses of their internal testing assessments to identify students at risk of PANCE failure and allocate institutional and program resources to improve rates of PANCE passage.

Performance Improvement Assessment of the Interservice Physician Assistant Program (IPAP)

Purpose. The Interservice Physician Assistant Program (IPAP) located at Fort Sam Houston, Texas, provides the education for the majority of all Army, Navy, and Air Force physician assistants. As such, ensuring that program maintains premier performance to support combat and peacetime healthcare is vital to the interests of the Department of Defense. To support this mission, an analysis of structure, process, and outcomes for the program was conducted using survey data and Physician Assistant National Certifying Examination (PANCE) scores. Methods. Methods employed included Chi Square analysis, regression, small multiple comparisons. Graphical and statistical results provided evidence of program strengths and weaknesses.Results. Analysis of survey data (33% response rate) revealed that students who had graduated four or more years ago were more likely to self-report that IPAP prepared them for clinical work (Chi-Square = 8.16, p<.006, Odds Ratio: 3.1:1). Students reported high-confidence in the disciplines of EENT, orthopedics, and dermatology as well as low-confidence in hematology and dentistry. Analysis of performance deltas provided statistically significant and practically relevant results (F(16,48) = 17.59, p < .001, adj. R^2 = .806). IPAP student first-time test-takers routinely performed above the national average; however, performance in recent years has declined. Areas of strength identified in the analysis included EENT and dermatology confirming student self-assessments. One area of weakness identified was psychiatry and behavioral health.Conclusions. Based on the analysis of structure, process, and outcome, IPAP leadership is evaluating specific performance improvement initiatives to maintain program strengths and address weaknesses.

A Novel Approach to Ranking Physician Assistant Programs

US News & World Report (US News) is the only known media publication that ranks physician assistant (PA) educational programs. In 2007 US News ranked only 73 schools based on a subjective survey of PA school faculty and administration. This study presents a new approach to the ranking of graduate PA programs. The 73 PA schools included in the 2007 US News ranking were ranked based on each school's current Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) accreditation length, student-to-faculty ratio, percentage of faculty with doctoral degrees, and the most recent 5-year average Physician Assistant National Certifying Examination (PANCE) pass rates. The top three ranked schools were, in order, University of Wisconsin-La Crosse, Oregon Health & Science University, and the University of Iowa. There was a weak-positive relationship between the standardized rankings and scores and rankings by US News (r = 0.40, r = 0.41, respectively). This novel approach to ranking of PA programs provides a basis for improving the methods of future rankings.

Using practice analysis to improve the certifying examinations for PAs

A practice analysis is a tool that bridges knowledge and clinical performance into a format that permits assessment. For physician assistants (PAs), this contributes to a psychometrically sound examination administered by the National Commission on Certification of Physician Assistants (NCCPA). The 2004 practice analysis of 5,282 completed PA surveys (13.4% out of 39,517 sent) was representative of the PA population in years experience, geographical distribution, and practice specialty. The survey revealed 8 content domains with formulating the most likely diagnosis, basic science concepts, and pharmaceutical therapeutics as the three skills needed for most scenarios. The data were also analyzed by patient acuity (acute limited, chronic progressive, life-threatening emergency). As a result, NCCPA's test item pool and content blueprint for assessing core knowledge of American PAs on the Physician Assistant National Certifying Examination (PANCE) and the Physician Assistant National Recertifying Examination (PANRE) has been enhanced.

The Effects of an Interactive Learning System on PANCE Performance

The purpose of this paper is to describe the overall effects of a comprehensive, interactive learning system (ILS) on student performance on the Physician Assistant National Certifying Examination (PANCE). This outcome measure is particularly important for physician assistant (PA) educators as they mentor their students with the ultimate goal of obtaining board certification upon graduation and practicing high-quality medicine. Utilizing a learner-centered approach, PA students incorporate a comprehensive, interactive learning study system into their didactic and clinical education. Using this learning system the learner constructs a concise high-impact review note on every disease item in the NCCPA PANCE blueprint during their training. The impact of ILS on the PANCE performance of MCPHS-Manchester students is presented and it demonstrates significant improvement from 2005-2007, in pass rates, mean scores, and system specific scores.

Evaluation of the Relationship between Student Performance on the PACKRAT And PANCE Examinations

Purpose: The purpose of this study is to determine the relationship between student scores on the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) and performance on the Physician Assistant National Certifying Examination (PANCE). Methods: PACKRAT scores from students enrolled in the Interservice Physician Assistant Program (IPAP) following their didactic year of training were compared to the PANCE scores by the same students. The PACKRAT examination was administered to students within the last few weeks of their first year of training, just prior to beginning their clinical rotations. The PANCE scores represent the first attempt by IPAP graduates to attain certification shortly following completion of their second phase of training (clinical rotations). The study included those students that began their training in May of 1999 through May 2001. The first didactic year is divided into three separate trimesters and a new class of students begins each four months. This represents students included in seven different classes (n = 375). The relationship between the scores was evaluated by determination of the correlation coefficient. Analysis of the predictive value of PACKRAT results with respect to passing the PANCE was accomplished using logistic regression. Results: Correlation between PACKRAT and PANCE scores showed a correlation coefficient of 0.668 (P<0.001). Logistic regression showed a significant relationship between PACKRAT scores and PANCE performance (P<0.001). A PACKRAT score of < 55% (raw score = 124) had a sensitivity of 77.2% and specificity of 83.3%. Conclusions: The scores obtained by the students on the PACKRAT examination correlated well with those obtained on the first administration of the PANCE. In addition, PACKRAT scores proved to have a strong predictive value of student pass/fail performance on the PANCE.

The Impact of Age and Gender on the Physician Assistant National Certifying Examination Scores and Pass Rates

Purpose: Demographic characteristics may influence individual performance on the entry-level Physician Assistant National Certifying Examination (PANCE). The purpose of this study was to investigate the influence of age and gender on PANCE performance. Methods: PANCE scores were obtained from the National Commission on Certification of Physician Assistants (NCCPA) for three cohorts: all first-time PANCE takers from the years 1990, 1995, and 2000. The total study population equaled 9,247. Results: In each of the 3 years studied, there was a statistically significant (P<.0001) negative correlation between age and PANCE score, indicating that lower scores were obtained by older examinees. Failure rates of the examinees reveal a statistically significant (P<.0001) and moderately positive relationship (r=.21) between age and likelihood of failure. In each of the 3 years examined, female examinees significantly outperformed males (P<.0001). The correlation between the PANCE score and age within the female examinee population was r=-.10 (P<.0001), and for the males r=-.23 (P<.0001), yielding a weighted average correlation of r=-.16 (P<.0001 - r2 = .03). The relationship between age and score was significantly more pronounced in the male examinees (P<.0001).