What is the End of Curriculum exam?
The End of Curriculum exam is a standardized test of general medical knowledge from the PA Education Association (PAEA), the organization that also writes PACKRAT and the End of Rotation exams. It is not an NCCPA exam. PAEA launched it on January 6, 2020.4 PAEA describes it as one measure of a student's readiness for graduation, and PA faculty from programs across the country write and peer review its questions.3,5
The exam has 300 multiple-choice questions in five 60-question sections. 250 are scored; the other 50 are unscored pretest questions that PAEA is trying out for future forms. Each section is 60 minutes, so testing time is 5 hours on one day, with four optional 10-minute breaks between sections and an optional 10-minute tutorial before you start.3
Questions use a one-best-answer format: usually a clinical vignette, a lead-in question, and four or five answer choices. PAEA publishes several equated forms and assigns each student one at random.3
Students with a time-based accommodation take the exam over two days, no more than seven days apart, in 30-question sections: 45 minutes per section at time and a half and 60 minutes at double time.3
When do you take it?
Within the final four months of your program. PAEA's system will not schedule the exam before that point, which is why programs need your graduation date to be correct. The exam must be given in person with a live proctor in PAEA's lockdown browser; remote proctoring is not allowed for this exam.6
The timing is deliberate. ARC-PA's accreditation standards require each program to complete a summative evaluation of every student within the final four months, verifying the competencies needed to enter practice, medical knowledge among them.7 PAEA built the End of Curriculum exam to serve as one component of that evaluation, not the whole of it.3
If a student does not meet the program's requirement, PAEA allows one retake, no earlier than 42 days (6 weeks) after the first attempt, on a different form.3,6 The PANCE comes after the program: NCCPA lets you test from 7 days after you complete it.8
What does the End of Curriculum exam cover?
Every scored question is coded to a content area (an organ system), a task area (the kind of clinical thinking it asks for), and one of PAEA's entrustable professional activities. The blueprint in effect since April 2026 has 12 content areas. Cardiovascular leads: the blueprint targets 33 of the 250 scored questions, followed by pulmonary and gastrointestinal at 27 each.3,9
The April 2026 update removed infectious diseases as its own area and spread its topics across the organ systems, added professional practice as a task area, raised diagnostic studies from 10 to 16 percent of the exam, and added rehabilitation as a patient setting.10 PAEA also sets targets for the whole exam: half the cases are outpatient, a fifth are pediatric and a fifth geriatric, and 90 percent of questions ask you to understand, apply, analyze or evaluate rather than recall.9 The content area list names example topics in each area and is not meant to be complete.11
The blueprint is PAEA's own, not NCCPA's. The PANCE blueprint keeps infectious diseases as a separate category at 7 percent and counts professional practice as a content category rather than a task.12 The two cover much the same medicine, so preparing for one serves the other, but the weights differ.
The April 2026 blueprint in questions
250 of the 300 questions are scored, and each is coded to one content area and one task area. PAEA also sets targets for the whole exam: the clinical setting, the patient's age and the level of thinking a question asks for.9
- Cardiovascular 33 questions, 13%
- Pulmonary 27 questions, 11%
- Gastrointestinal 27 questions, 11%
- Neurologic 23 questions, 9%
-
Psychiatric/
behavioral health 23 questions, 9% -
Rheumatologic/
musculoskeletal 21 questions, 8% - Endocrine 20 questions, 8%
- Eyes, ears, nose, oral cavity, and throat 20 questions, 8%
-
Gynecologic/
reproductive health 20 questions, 8% - Dermatologic 12 questions, 5%
- Hematologic 12 questions, 5%
-
Renal/
genitourinary 12 questions, 5%
Infectious diseases is no longer its own area. From April 2026 its topics sit inside the organ systems.10
- Diagnosis 48 questions, 19%
- History and physical 46 questions, 18%
- Diagnostic studies 39 questions, 16%
- Clinical therapeutics 36 questions, 14%
- Clinical intervention 31 questions, 13%
- Health maintenance 24 questions, 10%
- Scientific concepts 13 questions, 5%
- Professional practice 13 questions, 5%
Professional practice is new as a task area in April 2026.10
Across the whole exam
Setting
- Outpatient 50%
- Inpatient 20%
- Emergency department 16%
- Perioperative 10%
- Rehabilitative 4%
Patient age
- Pediatric (birth to 17) 20%
- Adult 60%
- Geriatric 20%
Thinking level
- Analyze and evaluate 40%
- Understand and apply 50%
- Remember 10%
How is the End of Curriculum exam scored?
You receive a scale score from 1200 to 1800, not a percentage correct. PAEA converts the raw score to the scale through equating, so a given score means the same level of performance on any form and in any year. PAEA chose the range so it would not be confused with the scales used for End of Rotation exams, PACKRAT or the PANCE.3
PAEA also places each score in one of three performance levels. For forms given from April 27, 2026: Limited medical knowledge from 1200 to 1434, Satisfactory from 1435 to 1544, and Advanced from 1545 to 1800.2 A panel of 31 PA educators set these cut scores, and PAEA's board approved them in October 2025.13
The cut scores have moved twice. At launch, Satisfactory began at 1400 and Advanced at 1525;14 from January 2022, Advanced began at 1555;15 and in April 2026 Satisfactory rose to 1435 while Advanced fell to 1545. PAEA told programs to expect fewer students in the Satisfactory level.13 Program policies written before then may still quote the older numbers.
Example: the current forms (national mean 1520, SD 50)
Mean ± 1 SD: 1520 − 50 = 1470 to 1520 + 50 = 1570
Under a normal model, about 4 percent of scores would fall in Limited, 64 percent in Satisfactory and 31 percent in Advanced.
What does the score report show?
- Cardiovascular: Diagnostic studies, Aortic stenosis
- Neurologic: Clinical therapeutics, Myasthenia gravis
- Cardiovascular: Clinical intervention, Atrial fibrillation
Every student receives a scale score, the national mean and the performance level of their score. Subscores compare you with the national average by content area and task area, and feedback is also given by entrustable professional activity, patient setting, life course and Bloom's level.2,3
Starting with administrations on April 27, 2026, the student report also lists keyword feedback for scored questions you missed, in the form "content area: task area, keyword." The report can be downloaded as a PDF for you and your faculty to review together.3
You see your results once your program releases them to you.6 PAEA cautions that subscores rest on few questions each and are most useful when read alongside other exams, such as your End of Rotation and PACKRAT reports.2,3
Is there a passing score?
- What score does my program require? A scale score, a performance level, or a share of a summative grade. Check which standards it quotes: 1400 is no longer where Satisfactory begins.
- What happens if I fall short? Ask about remediation, the date of a retake, and whether graduation or your PANCE date could move.
- When will I see my report? Your program releases it, and it decides when. Ask for the keyword feedback to plan your PANCE review.
Not a national one. PAEA sets the three performance levels but leaves it to each program to decide how to use them and what counts as successful completion, and it encourages programs to set a passing score from several sources of their own data.2,3 PAEA also discourages using the exam as a stand-alone summative evaluation: it measures medical knowledge only, one part of graduation readiness.3
In practice, programs differ. Some require a minimum scale score to graduate, some fold the score into a summative course grade, and some use it to decide who needs remediation before a retake. Your program must publish its academic standards, remediation policy and requirements for completion,7 so the student handbook or summative course syllabus is the place to check.
On retakes, PAEA's current rule is one retake no earlier than 42 days after the first attempt.6 PAEA's 2023 policy required 60 days,16 and some pages still say so.
Does the End of Curriculum exam predict the PANCE?
PAEA says its exams are not intended to predict PANCE performance.6 Published studies do find that End of Curriculum and PANCE scores rise together, strongly. Two are summarized here from their published abstracts.
- One program, 2022. Massey and colleagues studied 27 students in a single cohort. The End of Curriculum score was among the strongest predictors of PANCE score (r = 0.78). PACKRAT I and II together explained 77.0 percent of the variance in PANCE scores, the best predictor in the study.17
- Six programs, 2026. Ditoro and colleagues studied 789 students from 6 programs in the 2021 to 2023 graduating cohorts. The correlation between End of Curriculum and PANCE scores was 0.709. Each 10-point increase in the End of Curriculum score went with 47 percent higher odds of high PANCE performance (OR 1.47) and 42 percent lower odds of failing (OR 0.58).18
Read these as evidence about groups, not a forecast for you:
- A correlation is not a conversion. Neither study gives a formula that turns your End of Curriculum score into a PANCE score, and a strong correlation still leaves room for individual students to land well above or below the trend.
- Both studies predate the April 2026 forms. The scale is the same, but the blueprint and cut scores changed, and the samples come from particular programs.
- The most useful part is the detail. With a few months left before the PANCE, your weakest content and task areas tell you more about what to study than the overall number does.
End of Curriculum vs. PACKRAT vs. PANCE
All three are written to cover the breadth of PA practice, and many programs give all three. They differ in who writes them, what they are for, and how they are scored. For more on the other two, see PACKRAT scores and PANCE scores.
| Feature | End of Curriculum | PACKRAT | PANCE |
|---|---|---|---|
| Who writes it | PAEA | PAEA | NCCPA |
| Purpose | One measure of graduation readiness5 | Self-assessment; no grade or advancement decisions6 | Certification |
| When | Final four months of the program6 | Set by the program, often at the ends of the didactic and clinical phases19 | From 7 days after you complete the program8 |
| Questions | 300, of which 250 scored3 | 225, all scored19 | 30020 |
| Testing time | 5 hours: five 60-question sections | 3 hours 45 minutes: three 75-question sections | 5 hours: five 60-question blocks, plus 45 minutes of break time |
| Score | Scale score, 1200 to 18002 | Raw score, 0 to 225 | Scale score, 200 to 80021 |
| Passing standard | None from PAEA; three performance levels, and your program sets its requirement | None | 350 |
| Retakes | One, at least 42 days later6 | Without restriction6 | At least 90 days apart, up to 3 a year8 |
How to prepare in the last weeks
The End of Curriculum exam covers the same medicine as the PANCE, a few months earlier, so the work you do for one serves the other. PAEA writes its questions from several evidence-based sources and does not recommend a reading list; use the references your program uses.3 A plan for the final weeks:
- Get your program's rules first: the date, the score it requires, how a retake works, and how the result counts toward graduation.
- Start from the data you have. Your End of Rotation keyword feedback, PACKRAT report and practice exams already show which systems and tasks you miss most. Breeze Ed's performance analytics add the topic and condition, and the task category, for every practice question you answer.
- Weight by the blueprint. The blueprint targets 33 cardiovascular questions and 12 each for dermatologic, hematologic and renal/genitourinary. A gap in a large area costs more. Breeze Ed's custom exam builder narrows from a system to its topics and down to individual conditions, so you can aim timed sets at the large areas where you are weakest.
- Practice the workup. The blueprint targets 133 questions across these three task areas: diagnosis, history and physical, and diagnostic studies, out of 250 scored questions. Diagnostic studies rose to 16 percent in April 2026.
- Cover the smaller targets. The blueprint now targets 13 professional practice questions, and pediatric and geriatric patients each make up a fifth of the exam.
- Rehearse the day. Take at least one full-length, timed exam: five 60-question blocks at about a minute per question, with short breaks, so the fifth hour is not new. Breeze Ed's Clinical plan includes a full-length End of Curriculum practice exam in this format. Through November 30, code NOV25 takes 25% off your first payment.
- 300 questions in 5 hours Sixty minutes for each 60-question section: about one minute per question, the same pace as the PANCE.
- 133 of 250 scored questions is the blueprint's target for questions that ask for a diagnosis, a history and physical finding, or a diagnostic study.
- 42 days The shortest gap PAEA allows before a retake, which gives you and your program time for a remediation plan.
Common questions
Is the End of Curriculum exam an NCCPA exam?
What is a good End of Curriculum score?
Is 1400 still a passing score?
Can I take it from home?
Will I see the questions I missed?
Who pays for it?
Is the End of Curriculum exam harder than the PANCE?
Published national comparison data
| Statistic | Forms from April 27, 2026 |
|---|---|
| National mean | 1520 |
| Standard deviation (SD) | 50 |
| Mean ± 1 SD | 1470 to 1570 |
| Reliability | 0.88 |
| Standard error of measurement (SEM) | 17 |
PAEA publishes a national mean, standard deviation, reliability and standard error of measurement (SEM) for the forms given from April 27, 2026.1 The score tool at the top of this page uses the mean and standard deviation.
The SEM describes how precise a single score is. With an SEM of 17, one SEM around 1500 is roughly 1483 to 1517; it illustrates measurement uncertainty, not a guaranteed range.
