DNP's failing the test????

prairienp · Mar 6, 2009

It wasn't you...
PA's get a general medical education, in the medical model. Our initial board exam, the PANCE, which was designed with input from the NBME, and administered by the NCCPA is 360 questions, and is supposedly modeled on the Family Practice board exam. If a PA chooses to specialize, then they must either complete post graduate program (residency) which vary in length from 12-20 months. Otherwise, they must find a physician that will be willing to train them "on the job" in whichever specialty they choose.
The confounding part for us, is that currently, we have to take our board exams EVERY six years, ,the PANRE, and it is still a 300 question board exam modeled on a family practice board. When I practiced Ortho, and then had to take my first PANRE, I was sweating, like REALLY sweating. What did Ortho have to do with Family Practice? LOL. I studied my *** off and passed, but it was a bit intimidating. Now with EM, it's different.

Please tell me I am wrong, but from what I understand there is a 95% (or close to this) passing rate on the PANRE.

physasst · Mar 6, 2009

Please tell me I am wrong, but from what I understand there is a 95% (or close to this) passing rate on the PANRE.

That sounds right, although I do not know the exact number. David may have more information, as I think he deals a little more with the NCCPA. You have to understand, and Dave, please correct me if I am wrong, that on the PANRE, the percentage required to pass is lower than on the PANCE. The PANCE is the hardest test for our profession, bar none, and the PANRE has similar questions, but only 300 vs 360, and the pass perecntage rate is lowered slightly, as the NCCPA recognizes that many PA's are practicing in specialties, and therefore will have a slightly harder time with an FP styled board. There used to be, although I heard it was a going away, a Pathway II way to re-board....which involved a marked increase in CME hours (we already have to do 100 every two years, or 50 hours per year), and a take home exam....now I know what you are thinking. Take home? Rest assured, I have many friends who went that route, and EVERY one of them swore that next time they re-certified, they were going to go sit for the PANRE, as that take home exam was the most difficult test you could imagine. Board certified physicians IN the specialties related to the questions couldn't answer them. I never did that route, as their stories all scared me into simply taking the PANRE. I've heard that the NCCPA is doing away with it anyway, and that in ADDITION to the PANRE, they may be starting to offer speciality board exams.

Spacklehead, MSN, NP · Mar 6, 2009

I'm pro-DNP. The ones who passed know their stuff and now it's official. The ones who didn't pass will learn from the experience and work harder for next time. What more is there to say?
The DNP is new - taking this exam is new. MD's and DO's know what to prepare for - NP's don't ... yet. In a brand new DNP program in my state, NP students will learn alongside Med students. Results will even out in a few years as students and programs learn from early results and tweak their focus accordingly.
What is there to be anti-about vis a vis the DNP anyway?? (Other than the childish "but I wanted a 'real doctor' ....." bit). If APN's have evolved out of the nursing profession what in the world is rationally wrong with taking this level of specialization to the doctoral level??

While I do agree with the first two parts of your reply, I'll comment on your third part. I, personally, am not "pro-DNP" just for the reason that MSN-prepared NPs have been practicing competently for years; and most of the dnp programs I have looked in to focus more on evidence-based practice and policies as opposed to gaining more clinical hours. Yes, most do provide the option for specialty-based clinical hours, but that can be done at the master's level without having to do another 40 or so credits (which are mostly research, policy, and evidence-based practice courses) at the doctorate level. All of those courses should have been completed at the master's level, and unless one is going to devote their life to research, they probably are not needed since we had the basics in our BSN courses with more of a focus in our MSN courses. It seems like those courses at the doctorate level are steps required in preparation for completing a capstone project which also is already done at many schools at the master's level.

Believe me, I am all for extra clinical hours and would love for NP programs to provide options for residencies in specialty areas. I just don't believe one needs to pursue a doctorate degree in order for this to occur. My belief is that it should already be done at the master's level. Now, if the doctorate degree programs focused more on a science-based curriculum such as going more in depth about the patho and treatment of diseases in your chosen specialty, then I would definitely be pro-DNP.

wowza · Mar 6, 2009

I do find it funny that a test that had such obvious political motives to serve as a launching board for DNPs to get more autonomy, has largely backfired.

AcuteCareinProgress · Mar 7, 2009

Now, if the doctorate degree programs focused more on a science-based curriculum such as going more in depth about the patho and treatment of diseases in your chosen specialty, then I would definitely be pro-DNP.

I would also be interested in what you describe. Are there no programs that do this?

Spacklehead, MSN, NP · Mar 7, 2009

I would also be interested in what you describe. Are there no programs that do this?

I've only really looked into dnp programs that are fairly local to me (covering about 3 states) because I was interested in the DNP at one point and I have not found one that is similar to what I have described. Now, there may be some out there that I do not know about which provide the opportunities I mentioned in my previous post, so if others on here know of any, I would love to hear about them.

core0 · Mar 7, 2009

Please tell me I am wrong, but from what I understand there is a 95% (or close to this) passing rate on the PANRE.

The failure rate has been between 4-6% for the last few years. In part this reflects the consequences of not passing. For many states not passing the PANRE results in loss of license.

In reality most of us practice a fair bit of medicine. Even those that are in specialties get exposed to the basics. The only ones that would have a lot of problems are those that work in procedural specialties ie Derm or First assist only). I would guess that since we all have to have 50 hours of CME every year they concentrate their CME there. Also there are very good review classes that help identify areas where you need more study.

The entire exam is based on the blueprint which is a document which shows what all PAs are supposed to know as a baseline. This is developed between AAPA, ARC-PA, PAEA and NCCPA. From the blueprint the questions are assigned to PA and Physican exam writers. The questions are then validated by having them rated by PAs in practice in all specialties as well as a variety of practice settings and regions. Finally the questions are inserted into the PANRE as non-scored test questions. Once they are validated they go into the test bank and are available for use in the test. The test uses a random selection of questions from each blueprint category. The scoring is very complex and is best answered here:

It is probably the most scientific and rigorous model out there currently.

David Carpenter, PA-C

sandnnw, BSN, MSN, EMT-B, APRN · Mar 8, 2009

Just to stir things up:

"Position 3: Licensing and certification exams for nurse practitioners should be developed by the discipline of nursing, based on standardized training involved in graduating from advanced practice nursing programs and scope of practice statutes and regulations. ACP therefore opposes use of Step 3 of the U.S. Medical Licensing Exam and certification by the National Board of Medical Examiners (NBME) for the DNP."

from:

American College of Physicians. Nurse Practitioners in Primary Care. Philadelphia:

American College of Physicians; 2009: Policy Monograph. (Available from American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.)

BabyLady, BSN, RN · Mar 8, 2009

Something tells me that exam was a little watered down from Step 3 USMLE. Regardless, this is not an exam that should be difficult to pass considering the vast clinical experience that NP's have over those green interns. The interns don't even really have much time to study for it-- as they say in med school, "Two months for Step 1, two weeks for Step 2, and a number 2 pencil for Step 3."

But at the same time, medical students have more.

The scope of practice for a physician vs a DNP is not the same. I fully support the DNP degree (but feel it's an unnecessary move), but feel that to make them take an exam that medical students take is overkill.

When someone with a DNP starts doing surgery and can directly admit to the hospital and administer care at the hospital (in my state, unless you are an ACNP or an NNP you cannot), then I might feel differently.

It's comparing apples and oranges.

wowza · Mar 12, 2009

But at the same time, medical students have more.
The scope of practice for a physician vs a DNP is not the same. I fully support the DNP degree (but feel it's an unnecessary move), but feel that to make them take an exam that medical students take is overkill.
When someone with a DNP starts doing surgery and can directly admit to the hospital and administer care at the hospital (in my state, unless you are an ACNP or an NNP you cannot), then I might feel differently.
It's comparing apples and oranges.

I'm not quite sure what you were trying to say about medical students have more... time? clinical experience?

The people who make the DNP are pushing for similar rights to a physician but do not want to have to jump through any of the hoops that medical students have to. They want to have their cake and eat it too.

Frankly it seems like a very political move to me. If they really wanted to advance the education, why make a doctoral degree? Why not just keep the masters and just make it a bit longer? Because they want the name "doctor" so that they have an easier time making headway further into the medical field. Were the education similar I think I would have a much easier time swallowing this but it is not and as I have posted earlier it is full of worthless courses that do not add to the core foundation of medical knowledge.

CraigB-RN, MSN, RN · Mar 12, 2009

Thanks, I was wondering about that. I really am surprised that there seems to be different rules in different states etc. It's hard to know what is fact, what is only applicable in some states etc. One (of many) reasons I am getting my DNP, is bc I would like to get involved in nursing and NP policy reform etc. But now I feel I am over my head. I don't even know where to start learning all of this. I guess I need to become part of a professional organization. I am just AACN. I think that will help. I definately think there needs to be some continuity etc.

I would think that if you want to get involved in policy reform the PhD would be a better way to go. You could focus on just the policy and not have to worry about the clinical stuff. the DNP is supposed to be a Clinical Degree.

oldiebutgoodie, RN · Mar 12, 2009

Anyone can make a specialty certification. For $35 I could organize the Federation of Academic Teaching Society Organizations. I could then develop my own DNP exam, get some friends to be on the board and pay the USMLE to help develop and exam and then administer it. Would that make it legitimate? If you are going to be pro-DNP you should critically examine the test and think about whether its best for your profession and the legitamacy of the profession.
David Carpenter, PA-C

Federation of Academic Teaching Society Organizations: FATSO

haha Love it.

Okay, I'll be serious now.

Oldiebutgoodie