New Surgery End of Rotation™ Exam

The new Surgery exam was developed by PA education experts charged with evaluating the appropriateness of the General Surgery exam blueprint in response to the new ARC-PA 5^thedition requirement that “supervised clinical practice experiences must occur with preceptors who enable students to meet program-defined learning outcomes for surgery” (5^th edition B3.07). Whereas the existing General Surgery exam places a heavy emphasis on gastrointestinal topics, the new Surgery exam covers a wider array of topics that better align with current surgical experiences for both students and practicing PAs.

The new Surgery exam can be scheduled now to be taken on or after September 4, 2024. The General Surgery exam will remain available for a period to allow programs time to map the new blueprint and topic list to program-specific learning outcomes and objectives and time to align the administration of the new exam with the start of a clinical cohort. The last day to schedule a General Surgery End of Rotation exam will be December 30, 2025. Starting January 1, 2026, the new Surgery End of Rotation exam will be the only End of Rotation exam covering surgery topics.

Deciding which exam to schedule for your students during this overlap window will be up to your program. While there may be many important factors to consider, we have included a few prompting questions below to help you in your decision.

• Is it important for your entire student cohort to take the same exam? If yes, take the time needed to conclude your current cohort with the General Surgery End of Rotation exam. Switch to the Surgery End of Rotation exam with the start of your new cohort. If no, then you may choose to start the Surgery exam at a time point that works the best for your program, as long as your last General Surgery exam is scheduled on or before December 30, 2025.
• Do your students’ rotations include a focus on any specialized surgery skills and experiences? If yes, it may be a good idea to consider moving them to the new Surgery End of Rotation exam, sooner rather than later. The new Surgery exam is a better assessment of all surgery skills, and less focused on the “General Surgery” curriculum.

Once you have decided which exam your students will be taking and when, see below for templates to help communicate these decisions to your students.

Programs can now schedule the new Surgery End of Rotation™ exam to be taken on or after September 4, 2024. Schedule the exam using the Assessment Hub.

A popup will appear when you select General Surgery or Surgery from the exam selection dropdown to confirm that you are choosing the exam you intend to deliver to your students.

The current General Surgery exam blueprint places heavy emphasis on Gastrointestinal/Nutritional topics. For the new Surgery exam, the decision was made to reduce the overall number of Gastrointestinal/Nutritional questions to allow for questions related to Breast Surgery, Trauma/Acute Care, and Pain Medicine/Anesthesia to better reflect the types of clinical rotation experiences available to students.

In the new Surgery exam, Preoperative/Postoperative Care was removed as a content area, but the topics were incorporated as cross-cutting perioperative setting targets. The Surgery exam now includes three cross-cutting perioperative setting targets (preoperative at 35%, intraoperative at 25%, and postoperative at 40%). These targets are set across all content and task areas to ensure the exam is inclusive of the types of cases PAs may see in a surgical clinical experience.

For the purposes of this exam, each perioperative setting is defined as:

• Preoperative – The period of time leading up to surgical intervention; occurring or performed prior to surgical intervention; from evaluation to entry into the operating room
• Intraoperative – The period of time in operating room suite; occurring or performed during the course of surgical intervention; from entry into operating suite to arrive in the post-anesthesia care unit (PACU)/recovery unit
• Postoperative – The period of time after surgical intervention; occurring or performed after surgical intervention; from arrival in PACU/recovery unit to discharge and beyond

The Professional Practice task area was added to replace the Health Maintenance task area. Professional Practice questions are scenario-based questions that test a student’s knowledge of professional best practices and ethical guidelines. An example of a surgery-related Professional Practice might be an item related to obtaining informed consent before a surgical procedure. See the core tasks and objectives, including those for Professional Practice, for more information.

The Health Maintenance task area was removed from the new Surgery exam given its similarity to the Professional Practice task area. Both emphasize core components of PA practice such as risk management and navigating professional challenges. The decision to shift to the Professional Practice task area was due to the types of scenarios presented in surgical practice and their alignment with the core tasks and objectives.

In short, no. Because of the substantial change in the blueprint, scoring a 400 on the General Surgery End of Rotation exam and a 400 on the new Surgery End of Rotation exam will not mean the same thing. A good score on the General Surgery exam indicates strength of knowledge mainly in Gastrointestinal topics. A good score on the Surgery exam is less focused on Gastrointestinal, and now includes topics of Breast Surgery, Trauma, and Pain medicine.

Exam statistics for the new Surgery exam have now been posted along with PAEA’s other End of Rotation exam statistics. Please note the mean and standard deviation presented represent a projection of student performance on the new Surgery exam based upon the historical performance of students on the pretest items included in the current General Surgery exam. The data will be updated to reflect actual performance after there have been enough administrations of the Surgery exam to achieve a sufficient sample size.

PAEA will be sharing more educational content related to the upcoming Surgery End of Rotation exam publication in the coming weeks. In the meantime, if you have questions, please reach out to PAEA Assessment at exams@paeaonline.org or join us for one of the upcoming Coffee Chats detailed below.