My Foolproof PANCE Study Strategy

Pummel the PANCE
I graduated from Clarkson University’s Physician Assistant program in May 2018 and am a Family Care Physician Assistant in a small, rural, underserved Upstate New York town. I took my PANCE 2 weeks after graduation and PASSED, so I started working on July 1st. All of my friends who graduated the year before me said the same thing: “You’ll feel like you failed when you walk out of the PANCE, but don’t worry, you’ll pass.” I didn’t want to feel like I failed and then wait 5–7 days for my results. I was super stressed about passing because I was tight for money and needed to start working immediately. Failure is also embarrassing! I wanted to do everything possible to prepare for the PANCE so I could feel confident when I finished. Here’s how I studied and PASSED my boards on the first try. 

How early did I start studying?

I began thinking about the PANCE in February (4 months before the PANCE = 16 weeks). I made a study plan calendar and broke it up into topics based on the PANCE blueprint. (Note: the 2019 blueprint has been updated):

  • Week 1: Cardiovascular (16%)
  • Week 2: Pulmonary (12%)
  • Week 3: Gastrointestinal (10%)
  • Week 4: Musculoskeletal (10%)
  • Week 5: EENT (9%)
  • Week 6: Reproductive (8%)
  • Week 7: Neurologic (6%) (3.5 days)
  • Week 7: Endocrinology (6%) (3.5 days)
  • Week 8: Genitourinary (6%) (4 days)
  • Week 8: Psychiatry (6%) (3 days)
  • Week 9: Dermatology (5%) (4 days)
  • Week 9: Hematology (3%) (3 days)
  • Week 10: Infectious disease (5 days) + practice exam 
  • Weeks 11, 12, 13: Complete all of Rosh Review (random order) + practice exam each week 
  • Week 14: Complete one practice exam sponsored by NCCPA, continue Rosh Review (random order)
  • Week 15: Review any weak areas and continue taking practice exams 

I completed all of the Rosh Review questions for each topic during these time frames and reviewed the answers and explanations. When I got close to exam month/day, I didn’t spend as much time going over explanations except for my weaker topics.


What resources did I use to study?
  • Rosh Review
    My main resource was Rosh Review, and I can confidently tell you that the questions are very similar to those on the PANCE. I even think I had some of the exact same questions during the PANCE. If anything, Rosh Review’s questions were a little harder and went a bit more in depth than the test questions. I usually didn’t have to think twice before choosing an answer on test day because Rosh Review made me confident. There are many ways to use Rosh Review, which I detail later. I also bought the extra Rosh Review practice test (all 300 questions, so each section is covered) along with one of the must-know additional extras (without the explanations), which are common and high yield.
  • NCCPA practice test
    I didn’t find this as helpful. NCCPA offers two different practice tests that you can take after registering for the PANCE, however, they do not include any explanations and are very expensive even though NCCPA markets them as being ONLY $50 each. I do think it’s worth buying and taking one of these exams because they are retired questions that were on a previous PANCE.

    Honestly, I got the same anxious feeling before taking this practice test as I did before the PANCE because it’s timed and you can only do it once (NO REVIEWING AFTER), so you don’t get to see the right answer. Even worse, they do not tell you what you got wrong. You can pause it, but it is best to treat it like the actual PANCE. Additionally, there are only 120 questions compared to the 300 on the PANCE, so it is not even half the length. The only result you get is your percentile, which tells you if you’re likely to pass the real PANCE. In this way, the practice test was helpful because I knew I was likely to pass the PANCE, which calmed my nerves. However, if it showed me being unlikely to pass, this would have added to my stress. If you take the practice test and score as unlikely to pass the PANCE, study the topics you feel weakest in, and consider buying the second NCCPA practice test to see if you improve.
  • A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants by Claire Babcock O’Connell
    I used this for the practice exams at the beginning of the book. If you have any resources with some type of practice exam, DO IT! If I haven’t already stressed this enough, practice exams are key! I used this book a lot in PA school for the review material, but I especially used the practice tests to study for the PANCE. The exam questions were definitely more in depth, longer, and more difficult than the PANCE, but the topics and distribution were spot on. This was a helpful resource.
  • Old PACKRAT exams
    I found old exams with answers online and used them as free practice tests. I timed myself taking the exam to mimic the PANCE then added up my score to see what percent I got correct, aiming for above 70%. These were nice practice exams since the length and type of questions were obviously similar to the PANCE. However, some of these questions were outdated since these were old exams.

How did I use Rosh Review?

Rosh Review has several ways to study: You can go through questions by category (system) or do a mix of questions. You can also practice by using test mode (answers only after you have completed all of the questions) or study mode (you see answers and explanation after each question). I went through all of the Rosh Review questions (more than 2,500) 2 full times, and I had a different approach each time. The first time you complete Rosh Review questions, do it on study mode and really read through all of the answers and explanations. Take notes on things you don’t know. Try to do 100 questions a day.

Next, break your studying up by section (cardio, pulmonary, etc). The third time, go through every question in mixed-up chunks of 60 questions each to mimic the PANCE. One of the hardest parts of the PANCE is sitting in a room and taking a test for up to 5 hours. Mimic your breaks to how you plan to take them on your test day: no using your phone or internet web browser or studying. Basically, all you can do is walk around, eat a quick snack, take a few sips of water, or go to the bathroom. 


Anything to avoid?

Avoid making flashcards unless they are for high-yield information, and don’t make more than 200. Most people who make flashcards spend most of the time doing just that—making the flashcards—when really reviewing and quizzing with the flashcards is what is most beneficial. If you were to make flashcards for the PANCE you would probably have over 1,000 cards, which is difficult to review frequently enough to be worth it. 

Also, avoid only reading review books, as this does not use the same parts of your brain as taking the test. Active studying and answering questions is the best way to study and prepare for an exam like the PANCE. Honestly, you have been preparing for the PANCE for the past 2+ years while in PA school. You have studied and passed many PAEA EOR™ and other PA exams, so now you need to focus on training your mind to answer 300 questions in a row in 5 hours. You know the information, but how often have you taken a 300-question test in your life? Train like you would for a marathon by doing a similar pattern/exercise.

Any other tips while studying?

Do some sort of exercise once a day as a break. I signed up for a fitness class and also started doing yoga to learn some deep breathing calming techniques that I used on test day before each section began.


What to do the day before the test

DO NOT STUDY! Take a break. I went to the beach with a friend. YOU WILL FEEL WEIRD ABOUT IT. I felt guilty and anxious about not studying, but my mind definitely needed the break. Drive to the town where you’re taking the test (mine was 1.5 hours away from where I lived) and spend the night in a hotel. I did not sleep well at all (you probably won’t either), but it will be okay. Rosh Review had just added 300 more questions, which gave me some anxiety since I hadn’t completed them, but I ignored this.

What to do on test day

Take some deep breaths, get up, eat breakfast, head to the test center. DO THE THING! Then celebrate—YOU DID IT! Go with your gut and try to think of the first answer that comes to your head after reading the question, then scan the answers and find your answer. If it is not there, go through each option and pick the best choice. Try not to overthink it! They are not trying to trick you on the PANCE like they may have been on school PA exams. Take breaks after each section as needed. If you feel like you are on a roll and can complete two sections back to back, do what feels right for you.


How did I feel during/after the PANCE?

Honestly, I felt really good about the PANCE. When I left I felt like I had passed, which was reassuring. Then doubt started to kick in a few days later as I would remember a question and think “Oh no, I answered that one wrong,” but it’s always easier to remember the questions you didn’t know. Try to relax and enjoy yourself until results come in! Easier said than done, but there is nothing you can do about it now, and worrying won’t make it any better. You’ve worked hard these past few months, you deserve a break! 

How many days until test results? 

I found out 4–5 days after taking my exam. You will get an email that your results are in, then log into the NCCPA website; if you passed, your login will look different. I was expecting to log in and open the results tab, but the site says PA-C and “log your CME hours” if you’ve passed, so I did a happy dance and looked at my results to see my final score!


Now what?

Make sure you’ve applied for your state license, wait for your official state license to come in, then contact your employer so they can start credentialing on their end. Tip: you can send in the license application information to your state before taking the PANCE and just insert your test date, which will make your license approved quicker! Then log into NCCPA and fill in your state and give permission for them to send your PANCE results directly to your state. 

I hope you found this blog post helpful and I know that you will love Rosh Review. They add more questions periodically, which is great because the more active studying and practice questions you take the better! Good luck on your PANCE!


Find out more information about Rosh Review’s Physician Assistant Qbanks.

Pummel the PANCE Series shares the experiences, insights, and perspectives of PA students preparing for the PANCE. The goal of the series is to provide you with actionable information and key takeaways to help you not only prepare for but to excel on the PANCE.

You might also like these blogs:
Why You’re Mentally Ready to Take the PANCE
The PANCE Study Plan They Don’t Teach You in PA School
PANCE Prep Tips
How to Increase Your PANCE or PANRE Score by 100 Points


Rosh Review, LLC is not sponsored or endorsed by, or affiliated with, the National Commission on Certification of Physician Assistants (NCCPA), Physician Assistant Education Association (PAEA), or the End of Rotation Exam™ (EOR). All trademarks are the property of their respective owners.


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