PA students are likely aware there is a new PANCE Blueprint that will take effect in 2025.
The National Commission on Certification of Physician Assistants (NCCPA) is the certifying organization for physician assistants. They are responsible for developing the Physician Assistant National Certifying Exam (PANCE). They also publish the PANCE Blueprint, which outlines the content and practice areas covered on the PANCE. PA students use the PANCE Blueprint to study and prepare for the exam.
Periodically, NCCPA conducts practice analysis studies to ensure the PANCE includes appropriate and updated content. The last update was in 2019. however a new PANCE Blueprint will take effect in 2025
What does this mean for PA students?
For those taking the exam in 2024, it means nothing. These PA students should feel comfortable using the 2019 Blueprint to study. PA students taking the exam in 2025 should use the new Blueprint. However, PA students adapting to the new PANCE Blueprint should not have much to worry about, as the changes are fairly inconsequential.
First of all, NCCPA has a disclaimer on the Blueprint that states there is no guarantee all topics will be included on the exam, and there may be some topics not on the Blueprint that are on the exam. PA students should remember the PANCE Blueprint is only a guide.
Secondly, in my review of the updated PANCE Blueprint, the changes are minor.
A look at the changes
The Blueprint designed to guide PA students preparing for the PANCE. The PANCE exam is categorized into two dimensions: knowledge of diseases an disorders and knowledge of skills related to physician assistant practice.
The Blueprint is also divided in two categories: medical content and task categories. The medical content category simply breaks down questions by body system. Task categories outline the skills tested.
The 2025 Blueprint, largely unchanged from 2019, is as follows:
| Medical Content Categories | Task Categories |
| Cardiovascular System | History Taking and Performing Physical Examination |
| Dermatologic System | Using Diagnostic and Laboratory Studies |
| Endocrine System | Formulating Most Likely Diagnosis |
| Eyes, Ears, Nose and Throat | Managing Patients |
| Gastrointestinal System/Nutrition | Health Maintenance, Patient Education, and Preventive Measures |
| Genitourinary System (male and female) | Clinical Intervention |
| Hematologic System | Pharmaceutical Therapeutics |
| Infectious Diseases | Applying Basic Scientific Concepts |
| Musculoskeletal System | Professional Practice |
| Neurologic System | |
| Psychiatry/Behavioral Science | |
| Pulmonary System | |
| Renal System | |
| Reproductive System (male and female) | |
| Professional practice |
New Categories
While the medical content and task categories remain largely unchanged, they did add professional practice as a medical content area and not just a task category like it was previously. Professional practice questions cover topics such as
- legal/medical ethics
- informatics
- patient care and communication
- the PA role in professional practice
- professional development
- public health
- risk management
Professional practice now makes up 6% of the exam instead of 5%.
Other changes include surgical topics now comprise 8-10% of questions (down from 20% in 2019) and 12-15% of questions will focus on pediatric patients (previously this percentage was not known).
Topic Changes
Minimal changes were made to the topics within the medical content categories. Most of these changes were really more of a reorganization of topics that were always covered on the exam.
For example, here’s a comparison of the topics that fall under Conduction disorders/arrhythmias:
| 2019 | 2025 |
| Atrial fibrillation/flutter | Atrial fibrillation |
| Atrioventricular block | Atrial flutter |
| Bundle Branch Block | Atrial tachycardia |
| Paroxysmal supraventricular tachycardia | Atrioventricular block |
| Premature beats | Bradycardia |
| Sick sinus syndrome | Bundle branch block |
| Torsades de pointes | Idioventricular rhythm |
| Ventricular fibrillation | Junctional rhythms |
| Ventricular tachycardia | Premature contractions |
| QT Prolongation | |
| Sick sinus syndrome | |
| Sinus arrhythmia | |
| Torsades de pointes | |
| Ventricular fibrillation | |
| Ventricular tachycardia |
The 2025 Blueprint is more specific as they’ve added more arrhythmias. But these added topics fall within the broad topics on the 2019 Blueprint, and exam takers were always responsible for knowing them.
Subcategory changes
Another change is recategorization of some topics and subtopics. For example shock used to be under hypotension, but is now its own category with specific types of shock listed.
| 2019 | 2025 |
| Hypotension | Shock |
| -Cardiogenic shock | -Cardiogenic |
| -Distruvtive | |
| -Hypovolemic | |
| -Obstructive |
Another example is coronary artery disease is now classified more consistently with how it’s managed in the clinical setting. In the new Blueprint STEMI, NSTEMI and angina all fall under acute coronary syndrome. Previously they fell under the subcategories of acute myocardial infarction and angina.
| 2019 | 2025 |
| Coronary artery disease | -Acute coronary syndrome |
| -Acute myocardial infarction | –Angina pectoris |
| –Non-ST-segment elevation | –Non-ST-semgent elevation myocardial infarction |
| –ST-segment elevation | –ST-segment elevation myocardial infarction |
| -Angina pectoris | –Unstable angina |
| –Prinzmetal variant | -Atherosclerosis |
| –Hypertensive emergencies | |
| –Secondary hypertension |
Take home message
Additional minor changes are noted throughout the new 2025 PANCE Blueprint. In the grand scheme of things, they are overall minor and should not significantly impact how PA students prepare for the PANCE.
Here at All Things PA-C, we are aligning our new study materials with the 2025 blueprint and will start going back to recategorized our Qbank with 2025 tags as well as the 2019.
