In PA school, one of the standardized exams that the Physician Assistant Education Association (PAEA®) gives accredited programs to administer is the PACKRAT®. The PACKRAT is a 225-question exam covering almost everything you learn in PA school, from psychiatry to pediatrics to pharmacology. Typically offered at the end of the didactic year, and if necessary, students can take it up to twice a year. Most schools use it to determine who’s likely to pass the PANCE and the EOC exam, but some schools will also count it as an “exam” grade.
I remember feeling sheer panic and terror whenever my professors brought up the dreaded PACKRAT exam. However, studying was made so much easier through some of the amazing features Osmosis offers! Here are three of my favorite tips on how to study to get a fantastic PACKRAT score.
Clinical Sciences: Not Just for Clinical Year
One of the things that helped me was reviewing the material that Osmosis covers in their Clinical Sciences library (part of the Osmosis Suite). This collection offers more in-depth information than what’s covered in Basic Sciences and integrates information from sources like UpToDate as well as current clinical guidelines. That alone made it super helpful for treatment-specific questions. Additionally, there are clinical decision-making trees for each topic that make it so much easier to determine the best course of action for every scenario.
For example, let’s say you’re confused about the screening recommendations for cervical cancer (which always used to trip me up). Osmosis has a specific video for cervical neoplasms that goes through this, which made it twenty times easier for me to understand and remember.
For example, here’s the decision-making tree for cervical neoplasms:

What’s also great about this series is that it’s been updated to reflect current material and knowledge. As of September 2024, Internal Medicine, Surgery, OBGYN, Pediatrics, and Family Medicine content are available, with Psychiatry and Emergency Room on the way. I’ll definitely be tuning in to see what comes next!
Practice, Practice and More Practice (Questions)
I don’t want to sound like almost every professor I’ve had in PA school, but it’s true what they say – practicing for the exam is one of the best ways to study. I found that I retained more material when I tested my knowledge and then went back to review what I didn’t know. What’s super helpful is that the Clinical questions are similar to the types of questions on the PACKRAT regarding both wording and difficulty.
To give you an idea, here’s one quick example:
“A 27-year-old woman is evaluated in the emergency department for a two-day history of diffuse headache, fatigue, and gingival bleeding on brushing her teeth. She is otherwise healthy and takes no medications.
On physical examination, she is alert and oriented but has a fever and appears to be in considerable distress from the headache. Funduscopic examination is normal. A few scleral hemorrhages and mild icterus are noted. Petechiae are visible on the lower extremities. Cardiopulmonary and abdominal examination findings are normal.
Hemoglobin 8 g/dL (80 g/L)
Platelet count 34,000/µL (34 × 109/L)
Reticulocyte count 12% of erythrocytes
Prothrombin time Normal
Activated partial thromboplastin time Normal
Thrombin time Normal
Lactate dehydrogenase 2000 U/L
Serum creatinine Normal
A peripheral blood smear is shown.
Which of the following is the most likely diagnosis?

- Heparin-induced thrombocytopenia
- Thrombotic thrombocytopenic purpura
- Hemophilia A
- Immune thrombocytopenia purpura
- Autoimmune hemolytic anemia”
Another thing that helped me was that a good portion of Clinical Sciences topics have questions directly linked to them, so if you finish a video, you can test what you learned right after watching. This practice is very helpful; it allows you to see how a topic may appear on the exam and determine how much information you’ve retained.
The Night Before
Finally, one of the best tips I can give for how to best prepare for the PACKRAT is the same advice you’ll hear everyone say – go to bed early, get some sleep, eat a good breakfast so that you arrive for the exam with the least amount of stress possible. You are less likely to do well if you get super stressed during the exam (trust me, I’ve done it), so have the confidence that you’ve studied in advance, and don’t be afraid of getting things wrong.
After you take the exam, PAEA will email you and your school once your score is finalized with a document containing your score and an outline of how you did on specific topics. It’s broken down into systems and tasks (i.e., treatments, diagnosis, etc). What’s also great is that at the end of the document, they outline the specific topics you were tested on and which ones you got incorrect. For example, if you get a question wrong on the treatment of patent ductus arteriosus, they’ll have something along the lines of “Cardiology – Clinical therapeutics, patent ductus arteriosus,” which makes it so much easier to review for future exams.
And a quick word about the scoring – don’t fret if the score isn’t what you were expecting or hoping for. Be proud of how hard you worked, no matter the outcome. I remember being super stressed when getting that email from PAEA, and, in the end, I realized I was stressed for no reason. Don’t let one score define you! Just know that hard work will always pay off in the end. (And for those curious about that practice question, the answer is B!)
About the Author
Madison Donnelly is a member of the OHLI program as well as a clinical-year PA student at Hofstra University. She hopes to one day work in neonatology and neonatal critical care along with PA education. She loves baking, reading, coffee, and the color pink.
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