Studying to Pass the Pilot Alternative to PANRE

By July 17, 2018 November 19th, 2020 No Comments

The question I’m asked the most these days about PANRE review is, “How should I study for the Alternative Pilot PANRE that over 12,000 physician assistants have signed up for?”

Natural vs. Social Systems

Here’s the deal. If I’ve learned anything in life, it’s that there’s a natural system and a social system. You work as a physician assistant and you got good at your job via a natural system. That means you have to know your stuff deeply. It’s like fitness and farming, in that you can’t manipulate it. If you’re fit, it means that you’ve put the time into exercise and discipline your diet. If you’re successful on a farm, you’ve planted, watered and fertilized seeds, and the crops grew over time. It’s a natural system that you cannot manipulate.

A social system is a system that can be manipulated. As I’ve taught PANRE review over the last six years, approximately 60 times at live courses, as well as personal mentorships and coaching with hundreds of others, I realized that studying for the PANRE is similar to getting good grades in PA school. Ask me, “How do I get straight As in a physician assistant program?” I wouldn’t tell you to deeply learn the content. Sure, that’s part of the deal. You have to be able to reproduce content, but because it’s a social system, you have to know the game.

You have to know the rules about how you’re going to be tested and how the questions are being generated. At CME4Life, we’ve dissected the process with all the known information from what the NCCPA has released on their websites and emails, as well as direct conversations with people at the NCCPA who make the test and have the answers, in order to optimally prepare you for the Pilot PANRE.

The Alternative to the PANRE

Understand that the test itself will be drastically different.

As you know, you will receive 25 questions per quarter for a total of two years. This is fantastic for our profession. It allows the best of all worlds, meaning that you are being tested in a way that’s acceptable to the community and outlying agencies. We are being trained and tested according to a very high standard. By doing this, we also maintain lateral mobility, which the NCCPA has vowed to preserve. You’ll have to study consistently for two years. A number of PAs that I’ve spoken with feel that’s a bit of a burden, yet it’s less stressful than a high-risk exam.

The test is going to be written by clinicians and not academics. My experience in PANRE review over the last six years is that the test has become so difficult and tricky because academics are writing questions based on textbooks instead of clinical experience. That’s incredibly frustrating to physician assistants who have been practicing for a while. First and foremost, it’s going to be much more clinical, but they’ve also narrowed the breadth of information we need to study, from the general knowledge PA students need to know to core knowledge.

This is fantastic because again, it makes the PANRE more clinically relevant. I don’t care what field of medicine you’re in, you have to know what a melanoma looks like because it’s going to put us in a position to save lives. Does an orthopedic PA need to know anything about dermatology? Well, the answer is if they’re examining an ankle and they see a suspicious lesion that looks like melanoma, the PA needs to be in a position to say, “That doesn’t look right” and get the appropriate consultation for the patient. Everybody benefits, so it’s good for our profession.

Lastly, to study for your PANRE, you now have different levels of content. The NCCPA has said it’s level one, level two and level three, but we’re referring to it as red light, green light or yellow light. A red light is level one, a yellow light is level two, and a green light is level three. Just like if you’re in clinical practice, you know that we have to seek out expert consultation differently based on different disease processes. If it’s a level one disease, we need to stop what we’re doing and get the appropriate consultation immediately. We don’t need to make a definitive diagnosis.

We need to make a probable diagnosis based on signs, symptoms and risk factors. An example of that would be cauda equina syndrome. If we have a presumptive diagnosis of cauda equina syndrome, we need to go get help immediately as a sequela is significant. Same thing with a thoracic dissection. If we feel someone has a thoracic dissection, we need to go get help immediately.

If it’s a level two or a yellow light problem, this is a medical condition where we need to make a diagnosis and know first-line diagnostic testing and first line therapeutics. That would be something like a tension pneumothorax. We need to know that it’s a clinical diagnosis made by physical exam of the patient who’s in shock with tracheal deviation and jugular venous distension and no lung sounds on one side of their body. We need to know that we put a needle in their chest at the second intercostal space in the midclavicular line going above the rib and that will save their life.

A level three or green light disease is a disease that we need to know everything about and that means pathophysiology, presentation, diagnosis, and treatment as well as how to monitor and manage co-morbid risks. These are diseases like atrial fibrillation, diabetes, hypertension, and GERD.

Studying for the PANRE

The million-dollar question is, “How do I study for the PANRE?” I’m not convinced you need a board review course. In talking to the NCCPA, they made it very clear that people are going to fail this exam. There’s going to be a bell curve-like distribution, but the exact pass rate is not yet known. Make sure you’re preparing accordingly.

If you’re going to take this exam and you work in primary care medicine, I think you’re going to be fine. I feel you need to review content that you’re unfamiliar with, but make sure you study based on the level of content that it is. My concern is that people are going to over study for this and not appropriately study. You need to know what level every disease is and study to that level. Therefore, your studying will be much more concise and efficient. If you don’t have a list of what diseases are at what levels, you will over study the content.

If you work in a specialty field, you have to study your walking around knowledge of these diseases. This can be done through review books. If you’re like me, that can be a little bit tricky because I don’t like to sit and read for a prolonged of time. Life is very distracting to me, having a family and working in clinical medicine. I need an immersive environment, where I get away to a live conference for a number of days and block myself off from the world to study in depth. We have board review courses specifically designed to give you the knowledge you need for the PANRE.

We also have board review videos specifically made to teach to the level necessary for the Alternative Pilot PANRE. We also have a review book that color codes all of the diseases, so you have the depth of the disease you need to know right in front of you. If I can be of any help to you, please do not hesitate to contact me at



iPANRE is a team of certified physician assistants and experienced board review instructors excited about helping you prepare for the new, innovative PANRE. Tune in to learn more about this innovative PANRE and start preparing today!

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