“In medicine and life, change is the rule, not the exception.”

When I heard NCCPA CEO Dawn Morton-Rias speak at the North Carolina Academy of Physicians Conference she used the term “disruption.” She said her goal in taking over was disruption within our industry.

That’s a good thing. Disruption is a good thing in business. Uber disrupted the taxi industry and the transportation industry’s better for it.

Dawn said she wanted to disrupt the PA industry and make it better, and she has. Over the last few years, tremendous changes occurred. We made self-assessment performance improvement mandatory and then made it optional. We went from a six-year cycle to a 10-year cycle for recertification. We made the high-risk exam an alternative option for the PANRE. Wow. Disruption.

Now, it’s happening again. I believe disruption is good thing, but you have to prepare for it. In 2019, there will be a new blueprint for the PANCE. If you are a student taking your boards in 2019, you will have to study differently.

This is my passion! My full-time job is to get people to pass their boards. I can help you with this because I have a breakdown of what the changes are. Your faculty members may not know how to help you because the changes are so new. If you’re a faculty member, I’m glad to help your program with this. This is really important, because the changes are significant. It’s not a little thing; it’s a big thing.

Changes to the 2019 PANCE Blueprint

We know that up to and including 2018, the breakdown was as follows: the big four (cardiac, pulmonary, GI and musculoskeletal) are 48% of your boards. Now there’s a new blueprint. The big four all drop. They’re de-emphasizing cardiac, pulmonary, GI and musculoskeletal topics and spreading those points out among other topics.

In 2019, we will have an increased focus on neurology, endocrine, hematology and infectious disease. If you look at the chart above, you can see that infectious disease is going to double, but I’m telling you it will actually more than 6% of your PANCE.

Now, they’re saying renal is a completely new category. It’s really not, it’s just categorized differently. When you look at the old blueprint, genital urinary covered a lot of renal issues. Now, GU and renal are going to be a very big topic when you look at them together (10%).

Studying for the 2019 PANCE

If you’re taking your PANCE in 2019, you should assume to know everything on the 2018 blueprint, plus the following:

• Cardiovascular: sinus arrhythmia and AV malformations have been added.
• Dermatology: folliculitis, stasis dermatitis, vascular abnormalities and pemphigus are added in.
• EENT: infection of the cornea and keratitis, globe rupture, amaurosis fugax (which I think really falls under neurology, because that’s like a TA), amblyopia, scleritis and deep neck infections like Ludwig’s angina.
• GI: nutritional, obesity, Paget’s, PKU, rickets, GU, peroneus disease, penile cancer, hypospadias, epispadias, urethra prolapse and stricture.
• Renal: horseshoe kidney, end stage renal disease, and potassium hypo and hyper, are a really big deal. Hyponatremia can be very tricky. You’ll need to study hemochromatosis and transfusion reactions, infectious disease, MRSA and rheumatic fever.
• Musculoskeletal: they’re now talking about rib fractures and deformities, osteoporosis, thoracic outlet syndrome and torticollis.
• Neuro: we have traumatic brain injuries, cranial nerve palsies, encephalopathic disorders and tumors. Now they moved carpal tunnel syndrome to a neurological peripheral nerve issue and AV malformations.
• Psych and human sexuality are seen in a bunch of different places, as is sexual abuse. Sleep/wake disorders are also included.
• Pulmonary: know that they added sleep apnea and Pickwickian disease, or obesity hypoventilation syndrome.
• Reproductive: questions still fall pretty heavily on the female side, with a focus on pregnancy and complications such as breach, prolapse, shoulder dystocia, human sexuality, trauma and ovarian torsion.

Infectious Diseases

Previously, Rocky Mountain spotted fever was on the blueprint under spirochetal diseases and every time I teach board review courses I think, “That’s not a spirochetal disease, but it’s on the blueprint that way.” They’re now noticing that. They moved RMSF to a bacterial infection, not a spirochetal disease. With spirochetal diseases, think Lyme and syphilis. Those are the two spirochetal diseases and the reason why they’re so specific to spirochetal diseases is that they both have three different presentations. An initial presentation, a secondary and a tertiary.

Trichomoniasis, prenatal transmission of diseases like varicella, HSV, HPV, and Zika virus. Now we’re going to talk about sepsis and SIRS, Systemic Inflammatory Response Syndrome.

On the top of this chart are the 13 categories that are on the 2018 PANCE blueprint. If it’s yellow, it’s infectious disease. On the 2018 PANCE, there are about 551 different diseases and 127 of them are infectious disease, so infectious disease is an absolutely huge part of your boards. That’s why we have a very distinct separate video on bugs and drugs, and it’s the second lecture of our conference, because it’s one of the biggest things that’s covered on the boards.

What I always teach is that infectious disease is one of the biggest things on your boards, because if I said, “Otitis media,” you’d say, “Well, that’s infectious disease.” No, it falls under EENT. If I said, “Pneumonia.” “Well, that’s infectious disease.” No, it’s classified as pulmonary. Meningitis is designated as neuro.

All this stuff has got to be studied, because it’s going to be on the 2019 blueprint. This information is going to be on the exam and it wasn’t there before.

New for the 2019 PANCE: Professional Issues

We also have a completely new category: professional issues. This is a really big deal because it makes up 5% of the exam. Let’s break down what exactly professional issues are.

History taking and performing physical exams are included, because we have to be better at our H&Ps.

Patient care and communication are included, as are affordable and effective care, cultural diversity and religious diversity. We need to study for questions about patient provider responsibilities, patient satisfaction, advice on informed consent and refusal, and end of life decisions. We have legal and medical ethics, cultural and religious beliefs, informed consent refusal, living wills, advanced directives, organ donation, code status, DNR, DNI and power of attorney. Medical legal issues, patient provider responsibilities, HIPAA and caring for people with cognitive disorders are a part of the professional issues category.

Physician and peer relationships are also important, including professional and clinical limitations and scope of practice. You should prepare for questions on supervision parameters such as malpractice, reporting, conflicts of interest, what to do in cases of an impaired provider and other ethical questions. The topic of professional issues also addresses effective communication between our supervising doctor and consultants.

We have medical information, so billing and coding, as well as appropriate documentation and using appropriate information sources. We should be able to critically analyze evidence-based medicine, as well as identify and interpret medical resources and use epidemiology to evaluate the spread of different diseases. We need to know what CME options are available.

Public health will also be included. Basic disaster preparedness, infectious control and response to outbreaks, occupational health, population health, travel health and epidemiology of disease states is important. You’ll also need to study how to protect vulnerable populations and recognize disparities in provisions of and access to healthcare.

Risk management, quality improvement, patient safety, resource stewardship, and ensuring patient safety and reducing medical errors will be addressed on the 2019 PANCE.

Prepare for Your 2019 PANCE with CME4LIFE

Overall, how does your preparation for the 2019 PANCE look? The bottom line is that we have to deemphasize the big four. We have to remember that GU and renal is much more important. Infectious disease is absolutely huge. Less pharmacology and a completely new category: professional issues. It is a game changer.

Allow CME4LIFE make it easy for your students to succeed on the 2019 PANCE. Together, we’ll tackle those professional issues and other new areas of focus. Our resources will make it simple for you to teach your students what they need to know for their board reviews.