Shelf Exams

How To Effectively Prep For End Of Rotation Exams (Study Plan)

Are End of Rotation exams looming? Take control of your study schedule with this guide on how to prep effectively on your upcoming exams.

Jun 24, 2024

Shelf Exams

How To Effectively Prep For End Of Rotation Exams (Study Plan)

Are End of Rotation exams looming? Take control of your study schedule with this guide on how to prep effectively on your upcoming exams.

Jun 24, 2024

Shelf Exams

How To Effectively Prep For End Of Rotation Exams (Study Plan)

Are End of Rotation exams looming? Take control of your study schedule with this guide on how to prep effectively on your upcoming exams.

Jun 24, 2024

man drinking coffee and reading - End Of Rotation Exams
man drinking coffee and reading - End Of Rotation Exams
man drinking coffee and reading - End Of Rotation Exams

Are you feeling overwhelmed as you approach the end of your rotation exams? How long are shelf exams, and what can you do to prepare for them effectively? Preparing for the end-of-rotation (EOR) exams in physician assistant (PA) school can stress you out; this blog will provide valuable insights to help you easily navigate the complexities of EOR exams.

Otio, our AI research and writing partner, is here to help you ace your EOR exams and achieve your physician assistant (PA) school preparation goals.

Table of Contents

About The End Of Rotation Exams

woman working hard for End Of Rotation Exams

End-of-rotation (EOR) exams are standard evaluations PA students take during their clinical year. The Physician Assistant Education Association (PAEA) develops the EOR exams from a standard blueprint and topic list, which are made public to aid students as they prepare for the PANCE exam.

Questions are typically presented in vignette format so the exams can better assess problem-solving and critical thinking. 

  • Each End of Rotation exam consists of 120 multiple-choice questions, 100 of which are scored. 

  • The other 20 questions are unscored pre-test questions used to gather statistics, which aid in future exam construction.

  • The End of Rotation exam contains two 60-question sections. 

  • Each End of Rotation exam has at least two forms, providing the option for a re-test form should a student fail the first administration. 

Family medicine has three forms available for administration. This allows programs with two family medicine rotations to test twice with End of Rotation exams and retain a third form for re-testing.

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How Many End Of Rotations Are There?

man with bunch of papers - End Of Rotation Exams

Students will take seven unique End-of-Rotation (EOR) exams during their clinical. These exams are specific to different medical specialties, including:

  • Emergency Medicine

  • Family Medicine

  • General Surgery

  • Internal Medicine

  • Pediatrics

  • Psychiatry and Behavioral Health

  • Women's Health

There are seven unique EOR exams students will take during clinicals. 

1. Emergency Medicine

  • 20%   Cardiovascular

  • 15%   Orthopedics / Rheumatology

  • 10%   Gastrointestinal / Nutritional

  • 10%   Pulmonology

  • 8%   Neurology

  • 7%   ENOT/Ophthalmology

  • 6%   Urology / Renal

  • 5%   Dermatology

  • 5%   Endocrinology

  • 5%   Obstetrics / Gynecology

  • 5%   Psychiatry / Behavioral Medicine

  • 4%   Hematology

2. Family Medicine

  • 15%   Cardiovascular

  • 12%   Pulmonology

  • 11%   Gastrointestinal / Nutritional

  • 8%   ENOT / Ophthalmology

  • 8%   Obstetrics / Gynecology

  • 8%   Orthopedics / Rheumatology

  • 6%   Neurology

  • 5%   Dermatology

  • 5%   Endocrinology

  • 5%   Psychiatry / Behavioral Medicine

  • 5%   Urology / Renal

  • 4%   Hematology

  • 4%   Infectious Diseases

  • 4%   Urgent Care

3. General Surgery

  • 50%   Gastrointestinal / Nutritional

  • 12%   Preoperative / Postoperative Care

  • 9%   Cardiovascular

  • 8%   Endocrinology

  • 5%   Dermatology

  • 5%   Neurology

  • 5%   Urology / Renal

  • 3%   Hematology

  • 3%   Pulmonology

4. Internal Medicine

  • 20%   Cardiovascular

  • 15%   Pulmonology

  • 12%   Gastrointestinal / Nutritional

  • 12%   Orthopedics / Rheumatology

  • 8%   Endocrinology

  • 8%   Neurology

  • 8%   Urology / Renal

  • 7%   Critical Care

  • 5%   Hematology

  • 5%   Infectious Diseases

5. Pediatrics

  • 15%   Dermatology

  • 15%   ENOT / Ophthalmology

  • 12%   Infectious Diseases

  • 12%   Pulmonology

  • 10%   Cardiovascular

  • 10%   Gastrointestinal / Nutritional

  • 6%   Neurology / Developmental

  • 6%   Psychiatry / Behavioral Medicine

  • 5%   Orthopedics / Rheumatology

  • 3%   Endocrinology

  • 3%   Hematology

  • 3%   Urology / Renal

6. Psychiatry & Behavioral Health

  • 18%   Depressive Disorders; Bipolar and Related Disorders

  • 18%   Anxiety Disorders; Trauma- and Stress-Related Disorders

  • 14%   Substance-Related Disorders

  • 12%   Schizophrenia Spectrum and Other Psychotic Disorders

  • 10%   Disruptive, Impulse-Control and Conduct Disorders; Neurodevelopmental Disorders

  • 8%   Personality Disorders; Obsessive-Compulsive and Related Disorders

  • 8%   Somatic Symptoms and Related Disorders; Nonadherence to Medical Treatment

  • 8%   Feeding or Eating Disorders

  • 4%   Paraphilic Disorders; Sexual Dysfunctions

7. Women’s Health Gynecology

  • 15%   Menstruation

  • 12%   Infections

  • 10%   Neoplasms

  • 8%   Disorders of the Breast

  • 5%   Structural Abnormalities

  • 5%   Other


  • 16%   Prenatal Care / Normal Pregnancy

  • 15%   Pregnancy Complications

  • 8%   Labor & Delivery Complications

  • 6%   Postpartum Care

Note: The “topic list” for each medical specialty is not intended to be all-inclusive.

These EOR exams comprehensively evaluate students' knowledge in each medical specialty, ensuring they are well-prepared for clinical practice. 

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How To Study For End Of Rotation Exams

man studying alone - End Of Rotation Exams

1. Understand the Exam Format

Begin by understanding the format of the exam. This includes:

  • Knowing whether it will be a written exam

  • Oral exam

  • Practical skills assessment or a combination

Knowing the exam format will help you tailor your preparation accordingly.

2. Review Rotation Materials

Review your notes, textbooks, and materials provided during your clinical rotation. Pay close attention to the following:

  • Key concepts

  • Diagnoses

  • Treatment plans

  • Common conditions relevant to the rotation.

3. Create a Study Schedule

Plan your study schedule in advance. Allocate dedicated time each day or week to review the material. Consider breaking down your study sessions into manageable chunks to cover all relevant topics.

4. Practice with Clinical Cases

Clinical cases are often a central part of end-of-rotation exams. Practice diagnosing and managing cases related to the specialty. You can find case-based resources online, like Med-Challenger for physician assistants, which includes assessment and case-based questions, or in textbooks.

5. Review Patient Encounters

Reflect on your patient encounters during the rotation. Consider the cases you were involved in and how you managed them. This can help reinforce your clinical reasoning skills. Also, ensure to take notes during rotations.

6. Follow PAEA topic lists and blueprints

Make sure to look at each of the topic lists and blueprints for your specific rotation exam. Y

  • You’ll see the breakdown of topics for each rotation exam—cardiology and pulmonology. 

  • You will also find the percentages of each organ system covered.

  • You will get an idea of the percentage of question types that will be asked (history and physical, diagnostic studies). 

Use this as a checklist to review your proficiency in the areas you’re proficient in, especially the topics you struggle with. This will help you focus your studies on material that needs more attention. 

7. Group Study

Collaborate with peers who are also preparing for the same rotation exam. Discuss cases, ask each other questions, and simulate clinical scenarios to enhance your understanding.

8. Take Care of Yourself

Ensure you get enough rest, eat well, and engage in physical activity. A healthy lifestyle can enhance your cognitive abilities and overall performance. It's important to note that the specific details of end-of-rotation exams can vary from one PA program to another. Considering the tips above, you can take some of the stress out of these exams.

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4 Useful Resources For The End Of Rotation Exams

woman reading a book - End Of Rotation Exams

1. Surgical Recall by Dr. Lorne Blackbourne

I used this during my general surgery rotation and for some elective surgical rotations, and it was by far the most beneficial textbook. It is great for recalling surgical information, hence the title. It uses a Q&A format for common surgeries, making it easy to quiz yourself. 

This book will prepare you for those tough-to-answer questions that your surgeon will try to challenge you with. I vividly remember being asked about a Meckel diverticulum in the operating room, and thanks to this textbook, I answered the question immediately.

2. PANCE Prep Pearls by Dwayne A. Williams

I also highly recommend this book, which is great for reviewing PANCE or PANRE topics and helpful for reviewing topics for your rotation exams. The book is broken down into body systems using the PANCE/PANRE blueprint. Use this for condensed information and to review tough topics.

3. The Case File Collection

The Case Files Collection is a great resource for clinical rotations and PANCE review. It was one of my favorite resources while studying for the PANCE and PANRE. There is a book for almost every specialty, each containing dozens of practical clinical cases covering the most relevant topics. 

Each case includes:

  • A complete discussion

  • Clinical pearls and references

  • Definitions of key terms

  • PANCE-style review questions with detailed explanations of the correct answers

If you’re lucky, your program may have access to these if it subscribes to Access Medicine. If not, it would be expensive to purchase them all. I recommend internal, family, and emergency medicine, as they cover much of the NCCPA blueprint.

4. Smarty PANCE

Smarty PANCE follows the NCCPA and PAEA blueprints and focuses on practice questions. The content is concise yet covers all the most pertinent information on each topic. It can be used for a quick review or more in-depth study.

How Will I Know Which End Of Rotation Exam Version Is Being Used?

college student on his laptop - End Of Rotation Exams

While score reports no longer state the exam version or form administered, the End of Rotation exams that have been in use since the Assessment Center launch on 8/23/2023 is Version 8. PAEA will announce when new End of Rotation exams are being published again so programs can be aware of any changes in national statistics. Still, the emphasis on version and form number will be phased out. 

A benefit of using scale scores is that when looking at any individual specialty exam (i.e., Family Medicine or General Surgery), scores from forms within the same year and across years are comparable because they are reported on the same metric.

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One crucial aspect of medical education that often overwhelms students is the end-of-rotation exams, also known as shelf exams. These assessments are vital in gauging a student's understanding of core clinical knowledge at the end of a rotation, typically lasting between four and eight weeks. 

In medical education, shelf exams are designed to test how well students can apply their knowledge to patient scenarios, which is a testament to the value of these exams in the grand tapestry of medical education.

Understanding Shelf Exams

When navigating shelf exams, consider the length of these assessments. Typically, shelf exams consist of 110 to 140 multiple-choice questions, covering a wide range of topics relevant to the rotation. End of Rotation exams can be quite challenging, as the questions are formulated to test students' knowledge, critical thinking, and clinical reasoning skills. Thus, they are a valuable tool to assess students' overall preparedness as they embark on their medical journey.

Building a Strong Foundation

If you're a student preparing for shelf exams, preparation is key. Since shelf exams cover many topics, have a solid study plan. This includes:

  • Reviewing core textbooks

  • Attending lectures

  • Completing practice questions

  • Engaging in clinical reasoning exercises

Study resources like question banks and review books can be valuable assets in your preparation journey.

Revolutionizing Shelf Exam Prep

With the advent of advanced study tools like Otio, knowledge workers, researchers, and students can now streamline their study process efficiently and effectively. Otio's AI-native workspace provides a one-stop solution for researchers, enabling them to:

  • Collect data from various sources

  • Extract key takeaways

  • Create draft outputs seamlessly

This innovative tool can revolutionize students' preparation for shelf exams, offering a more organized and efficient study experience.

Conquering Shelf Exams: Confidence, Preparation, and Tools

While shelf exams may seem daunting, proper preparation, strategic study methods, and leveraging innovative tools like Otio can significantly enhance your performance. So, dive into your study routine confidently, armed with the right resources and techniques to excel in your End of Rotation exams.

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