Study Tips

PANCE® Review Essentials: The Osmosis Ultimate Guide

Osmosis Team
Published on Jul 29, 2020. Updated on Apr 9, 2021.

The PANCE® exam is what stands between a physician assistant student and certification. This five-hour, 300-question exam covers the breadth of content a PA student learns in school. 

Though it can be challenging to study for the PANCE given the volume of content you’re expected to know, Osmosis has a rich, thorough body of resources that will put you on the path to success, including thousands of videos, flashcards, notes, and case questions. 

This blog post will detail everything you need to know to pass the PANCE exam with flying colors!

In this review of the PANCE exam, we’ll cover:

  • What does PANCE stand for?

  • What topics are on the PANCE exam?

  • How long is the PANCE exam?

  • How do I register for the PANCE?

  • How do I study for the PANCE?

  • What is a passing score on the PANCE?

  • How many times can I take the PANCE?

  • What happens if I fail the PANCE?

  • How has COVID impacted the PANCE exam?

  • How can Osmosis help me succeed on the PANCE?

What does PANCE stand for?

Following graduation from an accredited program, a physician assistant (PA) must take the Physician Assistant National Certifying Exam to be licensed. The PANCE exam is administered by the National Commission on Certification of Physician Assistants (NCCPA).

The preliminary PANCE was taken by new PAs in 1973, roughly a decade after the first formal physician assistant training program was established due to increased demand for primary care services. Of course, the PANCE has evolved since its inception; in fact, the latest content update became effective in January 2019.

PANCE should not be confused with PANRE, which recertifies a practicing physician assistant!

What topics are on the PANCE exam?

The PANCE exam has an intimidating reputation, and for good reason: it comprehensively assesses medical and surgical knowledge required to become a physician assistant. According to the NCCPA, the exam has two categories:

  1. Knowledge of diseases and disorders; and

  2. Knowledge and skills related to tasks PAs perform.

What subjects does it cover?

The PANCE exam covers medical topics mapped to task categories, outlined below. 

  • Cardiovascular system

  • Dermatologic system

  • Endocrine system

  • Eyes, ears, nose, and throat

  • Gastrointestinal system/Nutrition

  • Genitourinary systems

  • Hematologic system

  • Infectious diseases

  • Musculoskeletal system

  • Neurologic system

  • Psychiatry/Behavioral science

  • Pulmonary system

  • Renal system

  • Reproductive system

This topic list may seem enormous, but never fear: most students pass the PANCE on the first try, and with some elbow grease and determination, you can too.

Medical Content

Medical content comprises 95% of the exam. It goes without saying that you should devote most of your energy to nailing your understanding of the following categories!

Osmosis illustration outlining the medical content on the PANCE exam.

Skills and Tasks

Though the PANCE exam consists primarily of medical content questions, all medical content questions also map to one of the task categories, except for professionalism (which accounts for the remaining 5% of the exam). This highlights the importance of studying for the PANCE holistically by reviewing your medical knowledge in the context of the following skills.

Osmosis illustration outlining skills and tasks on the PANCE exam.

For an exhaustive content breakdown, view the most up-to-date PANCE blueprint here. Refer to this blueprint as a “checklist” while you study—check off items you’ve finished reviewing them.

*Percent allocations may vary on exams.

How long is the PANCE exam?

The PANCE exam is five hours long and begins with an optional 15 minute tutorial. 300 multiple choice questions are administered in five 60-minute blocks of 60 questions each. Between blocks, you’re responsible for managing your own break time (45 minutes total). When you take practice exams for the PANCE, make sure to test out different break schedules to determine what works best for you.

Remember that during a block, any break you take will be considered “unscheduled,” and you’ll lose time allotted for answering questions. Be careful to monitor the clock and follow on-screen break instructions!

Osmosis illustration of a PA student writing a practice PANCE exam.

How do I apply for the PANCE?

Before applying for the PANCE, the NCCPA must certify you as eligible by confirming your graduation date with your program director (make sure you’ve checked with your program director before applying). You must graduate from an accredited Physician Assistant program. Once confirmed, your eligibility to take the PANCE lasts for six years, during which you can take it up to 6 times. Note that you can’t apply to take the PANCE until 90 days prior to your expected program completion date!

With your eligibility certification in hand, you’ll submit a $550 payment and be assigned a 180 day timeframe within which you can schedule your exam. The earliest date you can take the PANCE exam is seven days after your program completion. Make sure to be cognizant of deadlines, your expected program completion date, and available test dates so when you apply for the PANCE exam, it's a smooth, easy process.

Other things to note 

Book your testing time early. Many testing centers will be booked 6–8 weeks in advance.

Make sure you have documentation from your healthcare providers regarding any testing accommodations you may need, such as extended time. The NCCPA will need this information before you are even allowed to book your test time. 

How do I study for the PANCE?

When it comes to PANCE review, you’ll need three things: great resources, robust planning, and execution.

Assess your timeline

Take the time you need to study for the exam. Some students begin studying 36 weeks in advance by devoting a few hours a week to reviewing relevant material or practicing. Others study for the PANCE only 8 weeks in advance.

Your timeline depends on you. If you’re taking the PANCE soon after graduating from PA school when all your knowledge is relatively fresh, you may feel that it’s unnecessary to rigorously review material months out from the exam. If you’re a nervous test-taker, feel unconfident about your foundational knowledge, or have already graduated from PA school, you may want to begin earlier. Either way, it’s important to establish your timeline months out from exam day so that you can register, choose your resources, and execute your plan in an organized way. The more airtight your plan, the better.

Osmosis illustration of a high-impact PANCE study plan.

Gather your study materials

Of course, if you use great resources effectively, you’ll establish a strong knowledge base. That’s why choosing your study materials is key to passing the PANCE! Here’s what we recommend.

1. Osmosis Prime

Osmosis Prime has absolutely everything you need to excel. By signing up for Osmosis, you’ll get access to:

  • 1,600+ videos for learning and reviewing concepts

  • High-Yield Notes for Pathology and Physiology that contain diagrams, illustrations, and tables. Combine videos with High-Yield Notes to reinforce your knowledge

  • 16,000+ premade didactic flashcards are useful for reviewing bite-sized pieces of information, and implementing spaced repetition review

  • 6,000 didactic case questions for practice

  • Integration with Picmonic for concepts that you need help reinforcing with a visual story

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2. Pance Prep Pearls 

Pance Prep Pearls is a well-organized study aid. Consider purchasing it if you’re looking for a textbook supplement.

3. SmartyPANCE 

At SmartyPANCE, learn from video cases, and apply your knowledge using the question banks. Bonus—SmartyPANCE is integrated with Osmosis!

4. Hippo PA

Hippo PA is a great PANCE crash course, offering video lectures, written summaries, audio review, and more. Learning material is delivered in a lighthearted, accessible style, and you can earn CME credits for completing the material.

4. NCCPA Practice Exam 

To test your knowledge and simulate an exam environment, consider purchasing the NCCPA’s practice PANCE.

5. NCCPA PANCE Blueprint

The PANCE blueprint is an essential study guide. Make sure to check off topics on the list as you review them.

Create a new PANCE study plan

Now that you have a timeline and your study materials, it’s critical to make a great plan. Here are some tips for creating a plan customized to your needs.

Determine your strengths and weaknesses

Since you’ve gone through PA school, you have some sense of your strengths and weaknesses. Make sure to plan around spending extra time reviewing any areas of weakness.

Use time-blocking to develop a schedule

Consider using the time-blocking technique. Start with a to-do list and assign each task to an hour-long block. Research shows that single-tasking (the foundation of time-blocking) boosts productivity. Also, plan to complete your most intensive tasks during the “block” of time during the day when you feel most productive and sharp.

Make sure to build review time into your plan 

Try spaced repetition, an evidence-based learning technique that helps you remember information. New and difficult cards are reviewed more frequently than old or easy ones. Luckily, you can use Osmosis premade flashcards to implement spaced repetition review!

Regularly monitor your performance

Don’t just passively watch videos or read written materials. Make sure to complete practice questions—this is how you’ll assess what knowledge you need to reinforce. You can use Osmosis case questions for practice!

Check things off of the PANCE blueprint as you progress

This is worth restating. The PANCE blueprint amounts to an official study guide. Make sure to cover all the material listed!

Take good care of yourself

Preparing for the PANCE should not consume you so thoroughly that you have no time to take care of yourself. It’s essential to prioritize your well-being and cultivate good mental health.

Here are some healthy lifestyle tips to put into practice:

  • Sleep at the same time nightly for 7-8 hours per night; quality rest is restorative.

  • Eat a healthy diet rich with fruits and vegetables. Prepare meals in advance and avoid unhealthy, impulsive snacking.

  • Exercise daily! Exercise boosts energy levels and is great for cognitive health. Try this student’s no-equipment, at-home workout routine, bike around the neighborhood, or take a brisk walk.

  • Practice mindfulness, which can alleviate anxiety. Try this 10 minute meditation once a day.

Osmosis illustration of a PA student practicing mindfulness.

What is a passing score on the PANCE?

The maximum score on the PANCE is 800, but you need at least 350 to pass.  Because there are different versions of the PANCE, and since they are scaled with different levels of difficulty, a passing score on one version may be 350, while on another version it could be closer to 500. 

Remember: you’re awarded one point for every correct answer and zero points for incorrect answers, so there’s no penalty for guessing. Make sure to answer every question!

The percent of first time test takers who pass is consistently over 90%, which is good news. Your actual score (given that you’ve passed) largely does not matter. Once you’ve passed, you’re ready to get licensed by the state you reside in and begin practicing as a certified physician assistant. Congratulations! 

How many times can I take the PANCE?

Your eligibility to take the PANCE lasts for ten years, during which you can take it up to six times. However, note that you can only take the PANCE once in any 90-day period, or three times in a calendar year. In other words, if you fail, you’ll need to wait about three months to retake the exam.

The only circumstance under which you should retake the PANCE is failing the exam. If you’ve passed, even if it’s with a relatively “low” score, it’s best to move on and begin your career.

What happens if I fail the PANCE?

Failing the PANCE can feel devastating. It’s difficult to feel as though the hard work you put in hasn’t paid off. But just because you failed the test doesn’t mean you’re a failure. This is a minor setback on your path to becoming a licensed PA, and despite the difficult emotions you’re experiencing, you can overcome this obstacle—and you will!

Take some time off to recoup

Given that you can only take the PANCE once every 90 days, you can afford a few days to recover from the stress of the exam and the shock of receiving your score. Spend some time with family, participate in activities you enjoy, get some fresh air and sunlight, and cultivate a positive outlook. This isn’t over, and you will be a practicing PA very soon!

Assess your subscores

You will receive content area subscores with your score report. This will give you some insight into your weaknesses, and what content areas you need to spend time reviewing for your next try.

Create a new plan

Now that you’ve (hopefully) taken a few days off and come back to the drawing board with a clear head, it’s time to recreate your plan. Make sure that the content areas you received low subscores in take center stage in your new plan. Evaluate where you went wrong last time, and rectify those mistakes.

Build your confidence

Often, standardized tests are a huge source of anxiety. Perhaps you got hit with a bad bout of panic or anxiety on test day. Implement a mindfulness practice and speak to yourself with words of affirmation. You can do this!

How has COVID impacted the PANCE exam?

Initially, during the onset of the COVID-19 pandemic, PAs were unable to schedule exams with Pearson VUE (the test administration center). This only lasted for ten business days, as PAs are essential medical service providers; Pearson VUE opened up test delivery for PAs effective April 1, 2020. However, test centers are implementing best practices for cleaning, disinfecting, and social distancing, limiting appointment availability.

These circumstances are likely to evolve as the situation changes, so it’s important to double check which test centers are open before you schedule your exam. Make sure to check your email frequently for any emails from NCCPA and Pearson VUE. Remember that you must also wear a mask at the testing facility, so make sure to have one on hand, or you won’t be able to test!

To find an available center, check Pearson VUE. For detailed answers regarding scheduling your exam and accommodating these new COVID-related changes, check the NCCPA COVID-19 Resource Center.

How can Osmosis help me succeed on the PANCE?

Osmosis has a rich body of resources to help you pass the PANCE with flying colors. In addition to thousands of videos, premade didactic flashcards, and High-Yield Notes, Osmosis helps you test your knowledge with 6000 didactic case questions. While the PANCE exam is a stressful undertaking, you can be sure that Osmosis will give you the confidence you need to tackle it effectively and pass. Sign up here!



When it comes to PANCE review, it’s important to be organized and use great resources. Hopefully, this blog post gave you the insight, confidence, and tips you need to succeed. See you on the other side!



PANCE® and PANRE® are registered trademarks of the National Commission on Certification of Physician Assistants (NCCPA®). Osmosis is not affiliated with NCCPA.

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