Is there a national End of Didactic exam?
PAEA does not offer an exam called End of Didactic, and what programs give at this point varies. The PA Education Association (PAEA), which writes standardized exams for PA programs to use during school, offers three: PACKRAT, the End of Rotation exams and the End of Curriculum exam.1 None of them is called End of Didactic. The PANCE comes after graduation.
Accreditation does not prescribe one either. ARC-PA's standards require programs to evaluate students frequently and objectively in both the didactic and clinical phases, in ways that let the program find and address a deficiency in time, and to publish their academic standards for progressing in the curriculum along with their remediation, deceleration and dismissal policies.2 The standards also require a summative evaluation in the final four months of the program that covers several domains, including medical knowledge, clinical skills, clinical reasoning, interpersonal skills and professional behaviors.2 Programs may use PAEA's End of Curriculum exam, given in that period, as one medical knowledge component of it.3
So "End of Didactic exam" is a program's name for its own checkpoint. Its length, content, passing score and consequences are set by your program. Check your student handbook or course syllabus, or ask program staff, for the details.
What do programs give at the end of didactic year?
Programs combine a few kinds of assessment at this point. PAEA designed PACKRAT for transition points in training, most often the end of the didactic phase and the end of the clinical phase,4 and some programs give it alongside their own exam. Two published examples show the range:
- Elon University (2025-2026 handbook) describes two assessments at the end of the didactic year: PACKRAT, used only as a student self-assessment with no course grade attached, and a cumulative written summative exam covering the knowledge needed to progress into the clinical phase.5
- Marshall University lists what students must do to move from the didactic to the clinical phase: earn a C or better in every course, keep a 3.0 GPA, complete the end of didactic phase program evaluation, and take PACKRAT.6
One program pairs a self-assessment with its own cumulative exam; the other asks students to sit PACKRAT but ties progression to grades. Neither describes a single national exam.
- A cumulative written exam The program writes it or assembles it from a question bank. It covers the whole didactic curriculum at once rather than one course at a time.
- PACKRAT PAEA's 225-question self-assessment, compared with students nationally at a similar point in training.4,7
- Skills and professionalism Some programs also assess clinical skills, for example with an OSCE, and review professional behavior before rotations.
Is PACKRAT the End of Didactic exam?
Not by PAEA's rules, even when the two are given the same week. PAEA's exam policies describe PACKRAT as a self-assessment tool and say its scores should not be used to give students a grade or approval for advancement; they should be used to measure progress and find areas to improve.8 PACKRAT also has no passing score.4
So if your program has a pass-or-fail exam that decides whether you start rotations, it is most likely a separate exam the program writes or chooses. PACKRAT is still a useful national reference at this point: 225 questions, all scored, with national means for students more than 10 months from graduation. See PACKRAT scores to place your result.7
What does an end of didactic exam cover?
- Cardiovascular 32
- Pulmonary 27
- Gastrointestinal 25
- Rheumatologic/musculoskeletal 18
- Eyes, ears, nose, oral cavity, and throat 18
- Gynecologic/reproductive health 18
- Neurologic 18
- Psychiatric/behavioral health 18
- Endocrine 18
- Renal/genitourinary 11
- Dermatologic 11
- Hematologic 11
Whatever your program taught in the didactic phase, weighted the way it chooses. Ask for its blueprint or content outline. If none is shared, two national blueprints map much of the same ground:
- PACKRAT's blueprint, in the version PAEA introduces in November 2026, spreads 225 questions across 12 content areas, led by cardiovascular at 32 questions.9 It folds infectious diseases into the organ systems and adds professional practice as a task; earlier forms used PAEA's 2018 blueprint.10,11
- The PANCE blueprint sets the content of the board exam, led by the cardiovascular system at 11 percent.12
Both blueprints code each question by the task it asks for, such as making a diagnosis or choosing a treatment, as well as by organ system.9,12 Reviewing by task as well as by system prepares you for either kind of exam.
How do programs use the result?
| Ask your program | Why it matters |
|---|---|
| How many questions, in how long? | Sets your pace. PACKRAT, for comparison, allows 225 minutes for 225 questions.4 |
| What content outline does it follow? | Tells you how to weight your review. |
| What score passes? | A percentage, a scaled score or a rank, set by the program. |
| What happens if I fall short? | Remediation, a retest date, or a change to your rotation start. |
| What feedback will I get? | A breakdown by system or topic is the most useful for planning rotations. |
Programs must publish their standards for progressing in the curriculum and their policies for remediation, deceleration and dismissal,2 so the general rules are available before you sit the exam. Details for a specific exam may be in your handbook or a course syllabus, or you may need to ask program staff. Depending on the program, the result can be:
- a condition for starting supervised clinical practice experiences (rotations)
- the trigger for a remediation plan and a retest
- one input to a decision about deceleration
- feedback for advising, with no grade attached
Read the policy before the exam, not after it. If something is unclear, ask your advisor or program director; the questions on this page are a starting list.
Does the end of didactic exam predict the PANCE?
For a program's own exam, we found no published evidence that applies across programs: any link to the PANCE depends on that program, its exam and its students. For PACKRAT taken at the end of the didactic year, published studies find a moderate to strong relationship:
- Wichita State University, 2006. In 84 students from one program, the correlation between PACKRAT 1, taken at the end of the didactic year, and PANCE score was 0.602. The author cautioned that the sample is too small to generalize beyond that program.13
- One program, 2022. In 27 students, PACKRAT I was a significant predictor of PANCE score, and PACKRAT I and II together explained 77.0 percent of the variance.14
- Five programs, 2019. In 1,014 students, the composite of PACKRAT 1 and 2 had the strongest association with PANCE score, and the association differed significantly between programs.15
PAEA says its exams are not intended to predict PANCE performance.8 With a year or more before the PANCE, the result is most useful as a list of gaps to close during rotations, when programs may use PAEA or program-written End of Rotation exams after selected rotations.1
How to prepare in the weeks before
Course exams test one block at a time. A cumulative exam mixes every system in one sitting, months after you studied some of them, so the main work is retrieval across the whole curriculum.
- Get the specifications first: length, time, content outline, passing score and retest rules.
- Start from your own record. List the systems where your course exam scores were lowest, and the topics you remember least from the first semester. Breeze Ed's performance analytics show the same thing from your practice questions, by system, topic and condition.
- Weight by the outline. If your program uses no outline, PACKRAT's blueprint is one starting point, though your program's exam may weight material differently. In the version PAEA introduces in November 2026, cardiovascular, pulmonary and gastrointestinal, the largest areas, make up 84 of its 225 questions, and six more areas have 18 each.9 Because each program sets its own exam, practice that follows your program's outline is worth more than a generic set. Breeze Ed's custom exam builder narrows from a system to its topics and down to individual conditions, with didactic-level questions in timed exam mode, so you can rebuild your outline as a practice exam.
- Practice mixed sets. Switching between systems from one question to the next is what a cumulative exam asks of you, and what single-course exams rarely do.
- Practice by task. Questions ask for more than the name of the disease: the next diagnostic study, the first-line treatment, the screening or prevention step. Review each for the conditions you study.
- Rehearse the length. Sit at least one timed block as long as the real exam, so pacing and focus in the last hour are familiar. Breeze Ed's Didactic plan ($24.99 a month) includes a 225-question End of Didactic practice exam in three timed sections. Through November 30, code NOV25 takes 25% off your first payment.
- Four weeks out Collect the exam's specifications. Take a mixed, timed set to find your weakest systems.
- Three weeks out Review the two weakest systems, with mixed practice every day to keep the others fresh.
- Two weeks out Review the next systems. Sit a full-length timed practice exam and review every miss.
- Final week Revisit missed questions and high-yield tables. Keep practice short and sleep normally.
