unPACKing the RAT: What to Know About the PA Clinical Knowledge Rating & Assessment Tool

My classmates and I are nearing the end of didactic year (WOOHOO) and recently took the PACKRAT exam which is a “practice PANCE” that PA students can take to predict how they will perform when taking the boards. Every program is a little different but at UAB, we take it at the end of didactic year and again at the end of clinical year before taking the boards.

Before taking the exam, I did some googling for information about it but did not find much. There are endless resources and blog articles regarding the PANCE but not much about the PACKRAT. Also, after posting about PACKRAT day on my Instagram story, I received multiple questions about it so I thought it would make for a good blog article!

The Basics

First let’s talk about the basic set-up of the exam. It is a totally computerized exam consisting of 225 multiple choice questions and you have 4 hours* to take it with no built-in breaks. That math breaks down to roughly 1 minute and a few seconds per question. There is a list of normal lab value reference ranges to the side that you can open at any time. The breakdown of topics is similar to the PANCE with cardio and pulmo being the “heavy hitters.” I’ll list the actual percentages of each topic below.

  • Cardiovascular – 16%
  • Dermatology – 5%
  • Endocrinology – 6%
  • ENOT – 9%
  • GI/Nutrition – 10%
  • Hematology – 3%
  • ID – 3%
  • Neurology – 6%
  • OBGYN – 8%
  • Ortho – 10%
  • Psychiatry – 6%
  • Pulmonology – 12%
  • Urology – 6%

*The time you have to take your exam is adjustable between 4 and 6 hours depending on your proctor.

Test-Taking Tips

Now that you know what to expect, let’s talk about strategies for taking the exam. Of course, the PACKRAT is typically not taken for a grade or anything other than your own personal knowledge but I like to take practice exams as if they were the real thing. It’s important to know your strengths (and more importantly) your weaknesses so that you can improve before the real deal, make or break, board exam. (By the way, these are my best exam-taking strategies for any PA school exam, not just the PACKRAT!)

Read the END of the question first.

With limited time, it is critical to understand what the question is actually asking you. Rarely is the question asking for the actual diagnosis (that would be way too easy)! It might be asking you for the INITIAL STEP in management. It might be asking for the GOLD STANDARD diagnostic tool. It might be asking for which medication is CONTRAINDICATED. The options are truly limitless. This became problematic for me, as I read the vignettes and prepared an answer (typically diagnosis) in my mind, then got to the end of the question and answer choices and they were asking from something entirely different. Not only did I need to know the diagnosis, but I needed to know the initial screening and confirmatory tests or what the first step in management was. The answer choices included no diagnoses whatsoever! Of course, every question wasn’t like this exactly but you catch my drift. Find out what the question is asking to avoid wasting your already limited time. (Shout out to my classmate Jennifer for this helpful hint!)

Use your scratch paper (like really use it)

The vignettes are typically long and wordy with potentially extraneous information that is not relevant to the correct answer. Use your scratch paper with each question to jot down the most important (and easily overlooked) bits of information from the case. Don’t forget AGE! I often found myself confused by answer choices only to look back and see that the patient was a child. If you’re given lab values, quickly check the reference range and write down whether they are high or low (I typically use arrows for quick and easy interpretation, multiple arrows if they are VERY high or low). Is there a fever? What is the BP? You can narrow down answer choices using basic information like vitals before having to think critically about the options. Speaking of narrowing down answer choices, with every question, I write down ABCD and mark the letters off as I eliminate them as possibilities. Choosing between 2 good answers is much easier than 4, and you have a 50% chance of getting it right!

Go With What You Know

One of the most basic testing strategies in existence is to go through the exam and answer the questions you are sure about first before going back to the rest. With such a limited time frame, this is critical. Some questions are very straightforward, for example “What is the most common type of skin cancer?” Answer these first and forget about them. Don’t waste valuable time being bogged down on questions that are stumping you (& there will be questions that stump you)! Once your time is running down, attempt to answer those toughies the best you can and, worst comes to worst, just pick an answer. You are not penalized for incorrect answers but you ARE for unanswered questions. It is literally better to blindly guess than to leave any question blank.

Go With What You Know (Part 2)

We’ve all done it.. Chosen an answer on an exam only to go back and change it once or twice because you doubted yourself. Doubt is the enemy of exam-taking! If one particular answer choice jumps out at you after scanning the options, it truly probably is the right one. With the amount of knowledge crammed into our brains during didactic, it’s impossible to recall every factoid with perfect clarity. However, the topic is probably buried somewhere deep in your synapses and your brain knows more than you think it does! If you reread the question and KNOW you messed up, obviously change your answer but when in doubt, trust your gut!

Interpreting Your Results

Your results will be available as soon as your instructor decides to release them. Ours were released the next day but this varies depending on who is in charge of your exam. You will receive a raw score (which I believe is the total # of questions you got correct). It will also show you breakdowns of what percentile in each category you answered correctly. For example, you may have gotten 78% of all cardiology questions correct and 60% of all dermatology questions correct. This gives you an idea of where your weaknesses lie. There will also be reports generated after enough students have taken the PACKRAT that compares you to national averages of PACKRAT takers. (That has not been available to me yet because not enough students around the country have taken the exam at this time.) There are also various formulas for determining what your PANCE score would be based on your raw PACKRAT score. PAEA has confirmed NONE of these formulas nor do they comment on extrapolating PACKRAT to PANCE scores but here is the most widely-used one if you’re curious:  PANCE = [PACKRAT x 5.74] – 287.47  Do with that what you will. -shrug emoji-

If you made it to the end of this VERY long post, I assume that you are already the type of person who will perform well on the PACKRAT no matter what. If you have any questions that I didn’t answer, as always, drop a comment or email me! Follow my journey to PA-C on Insta @coutureinclinic and have a fantastic holiday season!

Love and light,



2 comments / Add your comment below

  1. About to take the PACKRAT for the THIRD (yes , third) time in a few weeks, not looking forward to it. That being said I hope I have improved since the last time which was before clinical year!

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