Demonstrating commitment to compassionate patient care, the health care team, & continued certification.

First, there are many similarities between the PANRE and the PANRE-LA. Both recertification exams are based on the same core content blueprint. The questions on both exams are written and reviewed by Board Certified PAs and medical editors. Both exams have passing standards that are based on recommendations developed by PAs who participate in standard-setting studies, and passing either the PANRE or PANRE-LA fulfills the recertification exam requirement to maintain the PA-C credential.

There are also several differences. The PANRE is administered in a five-hour timeframe at a proctored Pearson VUE test center, with four hours of testing time (which averages one minute per question), 45 minutes of break time, and 15 minutes to review the tutorial. PAs complete the exam during this one scheduled appointment and receive results typically within two weeks after completing their exam.

The PANRE-LA offers a more flexible and extended delivery format. Over a period of 12 quarters, PAs will be required to participate in a minimum of eight quarters. PAs will take the PANRE-LA online and can log in and out of the exam at their convenience, using a range of acceptable devices (tablets, cell phones, laptops, etc.) that are compatible with the exam delivery system. The timing allotment per question is five minutes. In addition, unlike the PANRE that is administered in test centers that does not allow the use of reference materials, PAs participating in the PANRE-LA are allowed to access printed or online reference materials to aid in selecting their responses to the exam questions. Consulting with other individuals on any of the exam content is not allowed and is a breach of the exam policies.

Scoring to determine if the passing standard has been reached will begin after eight quarters of participation. PAs who reach the passing standard will have met their recertification exam requirement and are exited from the process. PAs who haven’t met the standard at that time can continue taking additional quarters until the end of the three-year process, as needed. After each subsequent quarter, scores will be recalculated using the best eight quarters of performance to determine the pass/fail status.

The questions included on all NCCPA’s exams are written by Board Certified PAs. PAs from across the country, working in a wide array of clinical practice areas write the test questions and then convene to review and discuss every question. The topics covered on PANRE and PANRE-LA are based on the core blueprint that resulted from a practice analysis study that included surveying all Board Certified PAs to gather feedback on the content that would be appropriate for a core recertification exam. Results from these studies were reviewed by panels of PAs to develop the updated content blueprint that is used for both PANRE and PANRE-LA. The blueprint can be found here.

PAs who are currently certified may choose the PANRE-LA as their recertification exam process and may apply in the 6^th year of their certification maintenance cycle. Information on application dates can be found on our Key Dates webpage. PAs seeking to regain certification are not eligible for the PANRE-LA. PAs who participated in the Pilot Alternative for PANRE but were withdrawn or did not pass the Pilot in the 2019-2020 administration are not eligible to apply for the PANRE-LA to meet the exam requirements that were associated with the Pilot. However, they may be able to apply for the PANRE-LA for future recertification exam cycles. No exceptions will be considered for the eligibility requirements to participate in PANRE-LA.

PAs whose recertification is due in 2024 but who are not passing PANRE-LA by the end of 2024 will be given a 12-month extension to continue participating in 2025. If they do not pass after 12 quarters, they will be given an additional extension of 12 months and will have up to three attempts to take and pass the proctored PANRE before their certification expires.

Similarly, PAs whose recertification is due in 2025 but who are not passing PANRE-LA after 12 quarters will be given a one-time extension of 12 months and will have up to three attempts to take and pass PANRE before their certification expires. Please note that any extensions applied will not affect the next recertification cycle.

Yes, PAs who choose to participate in the PANRE-LA must continue to meet the two-year CME and certification maintenance fee requirements to remain eligible for the PANRE-LA and to maintain their PA-C credential. PAs who do not complete the CME requirements to maintain certification will be withdrawn from the PANRE-LA process and will lose access to all the PANRE-LA content and information.

PAs seeking to regain certification are not eligible to take the PANRE-LA and will need to take and pass the traditional PANRE to regain certification.

No, you can only be enrolled in one recertification assessment at a time.

Throughout the PANRE-LA process, NCCPA will be communicating with you via email to provide you with important information. Ensuring that your current email address is on file with NCCPA helps to ensure you get the vital information you need. 

PAs will apply for the PANRE-LA in the 6th year of their recertification cycle and will have access to the exam in January of their 7th year. Visit the Recertifying Exam Status section of the PA Portal Dashboard to find out when you are eligible to apply. Application windows can be found on our Key Dates webpage.

See our Key Dates webpage.

PAs will log in to their NCCPA Portal to complete the application process. NCCPA’s mobile app does not support the exam application at this time.

The fee for PANRE-LA is the same as PANRE, $350.00. The fee must be submitted for the application to be processed.

PAs who had extenuating circumstances that caused them to miss the December 18, 2024, deadline may request an exception to policy. The request must be submitted to NCCPA no later than April 30, 2025. If the request to extend the application deadline is approved, the PA will begin PANRE-LA in the first available quarter after the decision has been made and will not be allowed to make up the earlier missed quarter(s).

See our Key Dates webpage for all quarterly start and end dates.

“Removed” Test Items: A small number of items may be removed from circulation in the first half of each calendar year. These are questions that were identified as problematic during statistical analysis and key validation with a panel of clinically active Board Certified PAs. If a PANRE-LA participant received one or more such test items, the item(s) will have been removed from their score and marked as “Removed” on the PANRE-LA Progress and History pages.

“Replaced” Test Items: After the first quarter of the 3-year exam administration period, PAs receive five questions each quarter on topics they have previously seen. This is to help identify and close gaps in knowledge or, if there are insufficient questions with incorrect responses to choose from, to reinforce existing knowledge. When topics are repeated, the better of the two responses is scored and the other is removed from the cumulative score. PAs may see questions they answered correctly removed from their score and replaced with another question on the same topic that they also answered correctly; no correct answer will be replaced by an incorrect answer. The response that was removed from the score is marked as “Replaced” on the PANRE-LA Progress and History pages.

The PANRE-LA is administered over 12 quarters, and PAs are scored on eight quarters of questions. In each quarter, 25 questions are administered, with each having a five-minute time limit. After answering each question, PAs will receive immediate feedback on whether the question was answered correctly or incorrectly and will have access to a rationale that explains why the correct answer is the best response and why the other options are incorrect. PAs will also be provided with references in case they want to read more about the content of the question.

PAs must participate in at least one quarter in the first year and one quarter in the second year. Other than that, PAs may select the eight quarters they complete, and skip quarters based on their preferences and schedules. However, PAs are encouraged to participate in as many quarters as possible early in the process. After participating in eight quarters, PAs who have met or exceeded the passing standard will receive notification that they have passed and have met their recertification exam requirement. PAs who have not met the passing standard after eight quarters can continue participating until the end of the three-year process. After each subsequent quarter, scores will be recalculated using only the responses from the best eight quarters to determine if the passing has been met, and PAs will be notified when they have passed. This process allows PAs the opportunity to continue closing their knowledge gaps and improving their performance to hopefully achieve the passing standard before the conclusion of the PANRE-LA administration

PAs are required to participate in at least one quarter in the first year and at least one quarter in the second year of the PANRE-LA process. PAs who don’t meet this minimum participation requirement will be withdrawn and will lose all access to the PANRE-LA content and information. The PANRE-LA score will be based on eight quarters of exam questions. Other than these requirements, PAs have the flexibility to choose the quarters to participate in; however, they are encouraged to participate in as many quarters as possible early in the process to provide more opportunities to reach the passing score. PAs may be able to complete the exam with a passing score after participating in eight quarters.

No, the PANRE-LA is designed to incorporate the principles of spaced education, spaced assessment, and knowledge retention. Therefore, the structure of the process requires that the exam be administered in smaller sections over a more extended timeframe.

The timeframe for completing questions cannot be extended. If you have met the minimum participation requirement, you may continue in the process. The questions you didn’t answer will be scored as incorrect.

If at the end of the PANRE-LA process, you have not passed and you missed participating in a quarter due to personal health issues only, you may file a request for an exception to the policy. These exceptions to policy are limited to participation in up to two quarters and must be completed in the year immediately following the conclusion of the three-year PANRE-LA process. For additional information, see Exceptions to Policy and Exam Grievances and the PANRE-LA Operational Policies, Procedures, and Authorization.

The blueprint content categories are covered throughout the quarters. However, before each question is provided, PAs will receive information on the content category for the next question and whether that question includes an image. This way, PAs can make the choice of whether to proceed with opening the question to complete it, deferring the question until later in the quarter in case they want to review information on that content area, or wait to open the question because they want to use another device with a larger screen to view an image.

The exam score is based on the number of correct answers; there is no penalty for guessing, other than incorrect answers are marked as incorrect.

If you have selected a response prior to the time expiring, that response will be scored and marked as either correct or incorrect, based on the response you chose. If you have not selected response, the question will be marked as unanswered and incorrect.

Throughout the PANRE-LA process, NCCPA gathers data on PA performance combined with the feedback submitted after each question. Using this data, we are able to customize the exam somewhat, while still ensuring adequate coverage of the exam blueprint. For example, after the first quarter, PAs will receive five questions each quarter on topics they have previously seen. This provides PAs the opportunity to demonstrate they have improved their knowledge on the topic, or in cases where there are insufficient questions with incorrect responses to choose from, reinforce existing knowledge. In addition, we are also able to use the data to provide PAs with questions that are more relevant to their practice, again while still ensuring adequate blueprint coverage. In cases where topics are repeated, the better of the two responses submitted is scored and the other is removed from the PA’s score. Questions that have been removed from their score are marked as “Replaced” on the PANRE-LA Progress and History pages.

No, working with others is prohibited. PAs are allowed to use printed or online medical references, but they are not allowed to discuss or share the content of the exam questions or materials with anyone. Doing so is a breach of the exam policies and may result in serious disciplinary actions from NCCPA, including the potential revocation of certification. Learn more about why exam security is a critical component of all NCCPA exams on our Exam Security webpage.

No, PAs only have access to the questions they opened during the PANRE-LA process. PAs who participate in a quarter but don’t open all the questions in that quarter will only have access to the content and critique for those questions that were opened.

PAs who don’t want to continue in the PANRE-LA process can submit a withdrawal request by email ([email protected]) to NCCPA at any time. PAs who have not accessed any exam questions and submit a written request to withdraw from PANRE-LA prior to the close of the first quarter  will receive a full $350 refund. No refunds will be issued after the closing of the first quarter of the PANRE-LA administration unless the PA has filed a request for an Exception to Policy that has been approved. PAs will lose all access to the PANRE-LA content and information when the withdrawal process is completed. The timeframe to apply for and take the proctored PANRE while still certified will vary depending on the timing of the withdrawal.

PAs may be administratively withdrawn from the PANRE-LA if they don’t meet the participation requirements in the first and second years or if they don’t complete their certification maintenance requirements (earning and logging CME and submitting the fee) that are due while enrolled in the PANRE-LA. In addition, PAs could also be removed from the program due to concerns with exam irregularities or disciplinary actions.

Since the PANRE-LA is not administered at testing centers and has a flexible delivery format, some of the routine accommodations (i.e., separate room, frequent breaks) are not applicable. The exam delivery system accommodates font size and color contrast adjustments. Therefore, the only accommodation provided for the PANRE-LA is extended time per question. The standard time allotment per question is five minutes. Based on documented disabilities, PAs may be approved for 1.5 or double-time to answer each question. For clarification, the extended time is per question and not on the overall window for completing each quarter’s questions.

One of the challenges of having a more flexible exam program that can be taken at PAs’ chosen location, on various devices, and flexible schedules is the potential for unstable internet connections or device problems. PAs are encouraged to take their exams in locations where they routinely have strong and stable internet service and on devices that are compatible with NCCPA’s system. We are unable to consider requests to reset questions for completion or to consider exceptions to policy related to internet connectivity or device issues.

PANRE-LA questions are written just like proctored PANRE questions – multiple choice, most with five answer options. But with PANRE-LA, you’ll receive immediate feedback on each question. You’ll see the correct answer, an explanation of why that answer is correct and the other options are not, and resources to support the explanation. Sample questions are available here.

Before any question is included for scoring on the exam, it undergoes rigorous review processes. Certified PAs write and review each exam question. When those questions are administered, we collect and analyze performance data. Questions that don’t perform within the expected statistical standards are reviewed by Board Certified PAs and may be removed from the scoring process based on the analyses and the content expert review.

However, if you have feedback on an item you received, please email [email protected]t. Please include the organ system the question is based on. Feedback will be reviewed first by NCCPA exam development staff and then will be presented to the PANRE-LA item writing committee (a diverse panel of practicing PAs) for review. Questions that are flagged as problematic based on feedback and/or question statistics will be removed from scoring. Please note that you will not receive individual follow-up on the item, but we appreciate your feedback.

Like the proctored exams, PANRE-LA is scored on a scale that accounts for the relative difficulty of the questions an individual PA receives. That means that the passing standard is not tied to a set raw score or percent correct – it will be different for each participant depending on the questions they receive. Your final score will be based on your cumulative performance across 8-12 quarters. In other words, you don’t need to meet the passing standard each quarter.

Additionally, to facilitate learning and reinforce your knowledge, you will receive five questions each quarter on topics seen in previous quarters. If you answer a repeat topic question correctly the second time you see it, we will discard the incorrect response and count the better of the two responses. This provides opportunities to improve your performance over time. We recommend reviewing your “PANRE-LA Item History” from time to time, paying closer attention to questions you answered incorrectly.

After each quarter, PAs will receive information on their performance. After participating in eight quarters, PAs who have met or exceeded the passing standard will receive notification that they have passed and have met their recertification exam requirement. PAs who have not met the passing standard after eight quarters can continue participating in PANRE-LA until the end of the three-year process. After each subsequent quarter, scores will be recalculated using only the responses from the best eight quarters to determine if the passing standard has been met, and PAs will be notified when they have passed. This process allows PAs the opportunity to continue closing their knowledge gaps and improving their performance to hopefully achieve the passing standard before the conclusion of the PANRE-LA administration.

You will receive quarterly feedback that reflects your cumulative performance in relation to the passing standard and to other PANRE-LA participants. Your cumulative performance is presented in the form of a graph that will be updated quarterly. In the first quarter of the year, scoring is delayed for data collection and item analysis. You will receive a score no later than the start of the second quarter. Beginning in quarter 2, your score will update immediately upon completion of your 25 questions. This video talks more about PANRE-LA scoring.

The PANRE-LA is administered during years 7-9 of the certification maintenance cycle. Therefore, PAs who do not pass the PANRE-LA will have up to three opportunities to take and pass the traditional PANRE in year 10 of the certification maintenance cycle before their certification expires.

No, once a passing score has been achieved following eight quarters of participation, PAs are exited from the PANRE-LA process. This helps to reduce exposure to exam content and preserves the integrity of the exam process.

Yes, PAs who choose to participate in the PANRE-LA must continue to meet the two-year CME and certification maintenance fee requirements to remain eligible for the PANRE-LA and to maintain their PA-C credential. PAs who do not complete the CME requirements to maintain certification will be withdrawn from the PANRE-LA process and will lose access to all the PANRE-LA content and information.

Yes, the AAPA has approved participation in the PANRE-LA as a Category 1 Self-Assessment activity. For each quarter that you complete all 25 questions, you will receive two Category 1 Self-Assessment CME credits. For NCCPA certification maintenance requirements, NCCPA will automatically apply the 50% bonus for self-assessment activities, but keep in mind this bonus only applies to NCCPA CME requirements. Awarding CME credits for the PANRE-LA process recognizes the important element of learning that is incorporated into the longitudinal assessment format.

The AAPA determines whether a self-assessment activity will qualify for Category 1 CME credit, based on data about learning outcomes of that activity. As indicated by its name, the Pilot Alternative to PANRE, was a pilot program conducted in 2019-2020 to help NCCPA gather information to inform future decisions on developing an official alternative recertification process for PAs. While implementing the Pilot Alternative to PANRE, NCCPA conducted extensive analyses on the data obtained as PAs progressed through the assessment to complete the exam questions. One important factor that we analyzed was how PAs performed over time, throughout the Pilot administration, and we looked at this data based on a variety of demographics, such as specialty and years of certification. The result of our analyses showed that every subgroup demonstrated improvement, or learning, throughout the Pilot process. Once we had this information, and as we moved forward with adopting the longitudinal assessment as an official alternative for recertification, we were able to apply to the AAPA to seek approval for the PANRE-LA as an accredited Category 1 Self-assessment CME activity. This data was not available prior to the completion of the Pilot, and it would have been premature for us to apply for approval for Category 1 CME credit at that time. However, PAs who participated in the Pilot could record that time as a Category 2 CME activity.

As noted above, the AAPA determines whether a self-assessment activity will qualify for Category 1 CME credit, based on data about learning outcomes of that activity. The new PANRE-LA is designed to cover core medical content deemed important for all certified PAs to know, as reflected in the content blueprint for PANRE and PANRE-LA.  The PANRE-LA process also incorporates the principles of “assessment for learning” which are integral to the longitudinal approach for knowledge assessment. The PANRE-LA, which is administered over an extended period, requires PAs to self-reflect on their level of confidence in their knowledge on each questions/topic covered on the exam, and the PANRE-LA also offers a robust educational component by including explanations and references for each question. This systematic and standardized process facilitates PAs identifying areas on the content blueprint where they may have knowledge gaps or weaknesses and provides information to help strengthen those areas. The entire process epitomizes self-assessment CME, as defined by AAPA:

• Self-assessment is the process of conducting a systematic review of one’s own performance, knowledge base or skill set, usually to improve future performance, expand knowledge or hone skills. Self-assessment activities, in their most common form, are simply an in-depth medical knowledge test that provides feedback on your performance and the opportunity to learn from the experience.

The AAPA has established criteria that are used to determine if activities are approved for Category 1 CME credit. Based on the design of the PANRE-LA and the information provided to PAs who participate in the process, the AAPA has approved participation in the PANRE-LA as a Category 1 Self-assessment activity. Independent self-directed study would typically not meet AAPA’s criteria for approval of Category 1 CME credit.  Of course, PANRE-LA is just one of a multitude of activities that PAs choose to participate in for earning Category 1 CME, and PAs should choose the CME offerings that are most meaningful and relevant to their practice.

The fee is $350.00, and the fee must be submitted for the application to be processed.

PAs who have not accessed any exam questions in the first quarter that the exam launched and wish to be withdrawn from the PANRE-LA may request a refund of their $350 fee by submitting a written withdrawal notice and refund request to [email protected] prior to the close of the first quarter. No refunds will be issued after the closing of the first quarter of the PANRE-LA administration unless the PA has filed a request for an Exception to Policy that has been approved.