PANCE Exam in 2026: What It Tests, How It Is Scored and How PA Students Prepare

Published · By VMS, Alehundred Studios

The PANCE exam is the Physician Assistant National Certifying Examination: a 300-question, five-hour test from NCCPA that every graduate of an accredited PA program must pass to become a Board Certified PA (PA-C). It covers 14 organ systems plus professional practice, is scored from 200 to 800, and the passing score is 350.

What is the PANCE exam?

It is the national certification exam for physician assistants (also called physician associates), written and run by the National Commission on Certification of Physician Assistants. In NCCPA's words, the PANCE "assesses the clinical knowledge, clinical reasoning and other medical skills and professional behaviors that have been deemed important for entry-level practice as a PA" (NCCPA, Become Certified).

Three facts frame everything else:

The road to that exam is long. According to the American Academy of Physician Associates, admission requires "a bachelor's degree and completion of courses in basic and behavioral sciences as prerequisites," and incoming students bring "an average of more than 3,000 hours of direct patient contact experience." The programs themselves are "approximately 27 months (three academic years)," with "classroom instruction and more than 2,000 hours of clinical rotations."

How long is the PANCE exam and how many questions does it have?

The PANCE has 300 multiple-choice questions in five blocks. NCCPA's official description: "PANCE consists of five blocks of 60 questions with 60 minutes to complete each block. There is a total of 45 minutes allotted for breaks between blocks and 15 minutes to view a tutorial. Candidates are responsible for managing their break time. The testing time is six hours, and the total exam is five hours."

That works out to one minute per question. Break time is a shared pool, so a long break after block one leaves less for the end of the day, when fatigue is highest.

What is on the PANCE blueprint?

The PANCE Content Blueprint sorts every question two ways: by organ system and by the clinical task it tests. NCCPA built it from "the results of the most recent profession-wide practice analysis." The current version is also the 2026 blueprint: NCCPA lists it "For all PANCE administrations beginning in January 2025."

The medical content categories and their share of the exam:

  1. Cardiovascular System: 11%
  2. Pulmonary System: 9%
  3. Gastrointestinal System/Nutrition: 8%
  4. Musculoskeletal System: 8%
  5. Infectious Diseases: 7%
  6. Neurologic System: 7%
  7. Psychiatry/Behavioral Science: 7%
  8. Reproductive System: 7%
  9. Endocrine System: 6%
  10. Eyes, Ears, Nose, and Throat: 6%
  11. Hematologic System: 5%
  12. Renal System: 5%
  13. Dermatologic System: 4%
  14. Genitourinary System: 4%
  15. Professional Practice: 6%

"Medical content comprises 94% of the exam," and every medical question is also coded to a task category: History Taking and Performing Physical Examination (16%), Using Diagnostic and Laboratory Studies (10%), Formulating the Most Likely Diagnosis (18%), Health Maintenance, Patient Education, and Preventive Measures (11%), Clinical Intervention (16%), Pharmaceutical Therapeutics (15%) and Applying Foundational Scientific Concepts (8%). The blueprint adds that "Some questions on the exam will cover surgical topics (8% to 10%), and some will focus on conditions in pediatric patients (12% to 15%)."

Each category comes with a topic list. Cardiology, the largest, covers cardiomyopathy, conduction disorders and dysrhythmias, congenital heart disease, coronary artery disease, heart failure, hypertension, hypotension, lipid disorders, shock, traumatic, infectious and inflammatory heart conditions, valvular disorders and vascular disease.

Two patterns are worth noticing. Cardiology and pulmonology together make up a fifth of the exam. And the three tasks that happen before any treatment (history and physical, diagnostic studies and the diagnosis itself) add up to 44% of the questions.

Why do clinical skills matter on a written exam?

Because the PANCE tests clinical skills on paper, and History Taking and Performing Physical Examination is one of its largest task categories. The History Taking and Performing Physical Examination category (16%) lists knowledge of "General physical examination components and techniques" and "Significant physical examination findings," and skill in "Identifying pertinent physical examination information" and "Triaging patients based on recognition of abnormal vital signs, examination findings, and/or general observations."

Formulating the Most Likely Diagnosis (18%) builds on the same foundation, with knowledge of the "Significance of physical examination findings as they relate to diagnosis" and skill in "Incorporating history, physical examination findings, and diagnostic data into medical decision-making."

How is the PANCE scored and how many questions can you miss?

There is no fixed number of questions you can miss. PANCE scores run from 200 to 800, the passing standard is 350 (NCCPA, Exam Development & Scoring), and NCCPA uses scale scores "to adjust for small differences in difficulty of the set of questions an examinee receives," so "the number of correct answers required to meet the passing standard will vary from one examinee to another."

The passing score itself comes from a panel of practicing PAs using the modified Angoff method, in which panelists "decide whether someone who is just barely qualified to practice would be able to answer the question correctly." Some questions do not count at all: PANCE includes "both scored and pre-test items, and examinees have no way of distinguishing between the two types of items." Treat every question as if it counts.

What is the PANCE pass rate?

Recent first-time pass rates sit above 90%. NCCPA's five-year pass rate report shows:

The same report counts 201,038 certified PAs as of December 31, 2025, and 12,963 PAs passing the PANCE in 2025. The gap between the overall and first-time rates hides the repeat takers. Subtracting NCCPA's first-time figures from the totals, the 1,524 repeat attempts in 2025 passed at roughly 62%, so the first attempt is the one to prepare for.

How hard is the PANCE?

Most graduates pass on the first try, but the exam is broad by design. The blueprint itself warns that "It is not possible to include all topics on a single exam, and it may be possible that some questions on the exam cover content that is not listed in the examples." The difficulty is less about any single question and more about holding 14 systems, seven clinical tasks, surgery and pediatrics in your head for five hours at one minute per question.

A mean score of 458.65 in 2025 against a passing standard of 350 says the typical graduate clears the bar with room to spare. The blueprint's weights also show where a weak spot costs the most: a gap in cardiology (11%) or pulmonology (9%) touches far more questions than one in dermatology or genitourinary (4% each).

How many times can you take the PANCE?

Up to six times in six years. NCCPA's rule: graduates "will be eligible to take PANCE for up to six years after completing the requirements for graduation from that program. During that six-year period, PANCE may be taken a total of six times." When either limit runs out, eligibility ends, and "The only way to establish new eligibility is to complete an unabridged ARC-PA accredited PA educational program again."

Timing rules apply too: "You may only take PANCE once in any 90-day period or three times in a calendar year." The earliest test date is seven days after your program completion date, and you have 180 days from the start of your exam timeframe to test.

Does PA school have an OSCE?

Every accredited program must test your clinical skills before you graduate, and an OSCE is one of the tools programs use to do it. The ARC-PA Standards, Sixth Edition, effective September 1, 2025, require a summative evaluation "within the final four months of the program to verify that each student meets all program-defined competencies required to enter clinical practice, including: a) clinical and technical skills b) clinical reasoning and problem-solving abilities." The curriculum must include instruction in "performing complete and focused physical examinations across all age groups."

How programs meet that standard varies. At Gardner-Webb University, for example, students return to campus for a week, and the summative course includes "Objective structured clinical examination testing," "Skills competencies testing" and a "Standardized multiple-choice exam." The summative OSCE and the PANCE test the same competencies from two sides: one watches you examine a patient, the other asks what the findings mean. For how OSCE checklists are scored and how to turn them into practice scenarios, see our OSCE station checklist guide.

How do you study for and pass the PANCE?

Study by the blueprint, test yourself early and keep your hands on patients. Four steps that follow NCCPA's own structure:

  1. Map your gaps against the blueprint. Rate each of the 14 systems and seven tasks, and give cardiology, pulmonology and diagnosis the time their weight deserves.
  2. Use NCCPA's own materials. NCCPA posts PANCE sample questions and offers official practice exams in your NCCPA account.
  3. Practice one minute per question in 60-question blocks, with breaks counted against a single pool.
  4. Practice whole encounters, not just facts. Rehearse the full sequence the blueprint follows: history, focused exam, tests, most likely diagnosis, plan.

Simulated patients are a good place for step 4. In a study using the online patient simulator eCREST, 54 PA students and 159 medical students worked through two simulated cases with lung symptoms; the authors found "suggestive evidence that medical and PA students had similar clinical reasoning styles," and "Both student groups improved in their diagnostic accuracy during the cases" (Thorpe et al., JMIR Medical Education). At the Philadelphia College of Osteopathic Medicine, a PA program added a high-fidelity obstetrical simulation, and the authors concluded that it "improves student preparation and comfort prior to real-life situations during clinical rotations" (Griffin et al., BMC Medical Education).

How does VMS help PA students practice clinical skills?

VMS, the Virtual Medical Simulator, lets you rehearse the encounter the PANCE writes questions about, on a PC with mouse and keyboard or in VR with a laser pointer. You choose the Physician Assistant program, and every case runs as an OSCE station: one virtual patient, a step-by-step checklist and a score from 0 to 100%.

In each encounter you introduce yourself, gain consent, wash your hands or put on gloves, examine the patient with your hands (palpate, auscultate, take a pulse) and with tools such as the stethoscope and reflex hammer, and close the encounter. Each case is tagged with the PANCE area it trains, such as Cardiovascular or Pulmonary, and the VMS case library includes 581 PA cases built around the conditions in the PANCE content blueprint, opening in the simulator as they are released. Teach mode walks you through a case, Train mode lets you practice it, and Test mode scores you with no hints and a time limit. The OSCE exam button picks a random patient from your program in Test mode, much like a summative OSCE station you did not choose.

Every attempt is saved to your account, and educators set up cases on the web and see results per student. Play solo or in multiplayer with your class, with an educator running the room as an option. VMS comes with 3 free cases, so you can try the whole workflow without paying. A subscription unlocks every case, and a subscriber can share their cases with friends or classmates in multiplayer, as long as the subscriber hosts the session and stays connected.

FAQ

How many questions are on the PANCE exam?

300 multiple-choice questions in five blocks of 60, with 60 minutes per block. Some are unscored pre-test items, and you cannot tell which ones.

What score do you need to pass the PANCE?

350 on a scale from 200 to 800. Because scores are scaled to the difficulty of your question set, the number of correct answers needed varies from one examinee to another.

Is the PANCE adaptive?

NCCPA describes a set of 300 questions in five blocks of 60 and scales each score to the difficulty of the set of questions an examinee receives. Its exam pages do not describe a computer-adaptive format, so plan your pacing for all 300 questions.

What happens if you fail the PANCE?

You can retake it after 90 days, up to three times in a calendar year and six times within six years of graduation. Rebuild your plan around the blueprint categories where you felt weakest.

Can you practice for the PANCE for free?

NCCPA posts official PANCE sample questions on its Become Certified page. For clinical skills, VMS includes 3 free cases you can run as OSCE stations on your PC or in VR.

Can I take the PANCE without going to PA school?

No. Only graduates of an entry-level PA program accredited by ARC-PA are eligible, and a candidate who runs out of attempts or years can regain eligibility only by completing an accredited PA program again.

Is a PA basically a doctor?

No. AAPA describes PAs as "licensed clinicians who practice medicine in every specialty and setting," trained in a master's-level program modeled on the medical school curriculum, and adds that "PAs are committed to team practice with physicians and other healthcare providers."

What is the difference between the PANCE and the PANRE?

The PANCE is the initial certification exam you take after PA school. The PANRE is NCCPA's recertification exam for PAs who already hold the PA-C, with its own passing standard of 379.

Sources

  1. National Commission on Certification of Physician Assistants. Become Certified. NCCPA, 2026.
  2. National Commission on Certification of Physician Assistants. Content Blueprint for the Physician Assistant National Certifying Examination (PANCE). NCCPA, 2025.
  3. National Commission on Certification of Physician Assistants. Exam Development & Scoring. NCCPA, 2026.
  4. National Commission on Certification of Physician Assistants. Five Year Pass Rates for Physician Assistant National Certifying Examination (PANCE). NCCPA, 2026.
  5. Accreditation Review Commission on Education for the Physician Assistant. Accreditation Standards for PA Education, Sixth Edition. ARC-PA, 2025.
  6. American Academy of Physician Associates. What is a PA?. AAPA, 2026.
  7. Gardner-Webb University. Summative Evaluation, Physician Assistant Studies Handbook. Gardner-Webb University, 2026.
  8. Thorpe A, Kassianos AP, Plackett R, Krishnamurthy V, Kambouri MA, Sheringham J. Comparison of Physician Assistant and Medical Students' Clinical Reasoning Processes Using an Online Patient Simulation Tool to Support Clinical Reasoning (eCREST): Mixed Methods Study. JMIR Medical Education, 2025.
  9. Griffin AD, Daher NK, Bohensky JE. Incorporating obstetrical simulation into physician assistant didactic curriculum. BMC Medical Education, 2025.