The following is a sample of factors likely to influence student performance on these exams. Some of these factors are related to any examination, others may apply more specifically to End of Rotation exams and comparisons to national data.
- Student motivation. Could be related to a number of factors including weight of the exam relative to their overall grade, potential penalties articulated for poor performance, and general interest in the subject matter.
- Length and timing of the clinical experience. Student clinical training experiences in the discipline may vary from 4 weeks to 8 weeks depending on the program and overall length of time the student has been engaged in clinical training — is this their first clinical rotation or their seventh?
- Sequence issues. When did the testing occur in the overall course of the curriculum and which didactic experiences and content preceded the testing? Some PA programs may have advanced didactic education later in the curriculum after some (or all) of the clinical year.
- History. Students will sometimes prepare (mentally and emotionally) for End of Rotation exams based upon prior processes and procedures at the program. It is important that different testing methods (computer-based vs. paper and pen) and expectations are clearly communicated. In addition, written learning objectives that match the exam blueprint should be provided well in advance so that students have time to focus their study during the clinical rotation.
- Environmental factors. It is well known that knowledge is reinforced through application. Students will have different clinical experiences based on patient volume, acuity, and disease patterns that fluctuate by site and season. For example, students in a pediatrics rotation during the summer are less likely to encounter patients with influenza. In addition, the degree of preceptor engagement in student clinical knowledge development through oral quizzing and assignments may help reinforce content that may be on the exam.
- Testing. We expect that the administration of End of Rotation exams is done in a secure proctored setting, but this cannot be guaranteed. We also cannot guarantee that the data are representative of all programs and students across the country.
For these reasons and others, we do not set standards for End of Rotation exams, nor do we advise programs where to set their own performance bars for pass rates. These need to be established by each program at the local level through statistical standard setting or other processes.
For the time being, PA programs should continue to only compare the performance of students who have taken the same form. This will provide the students and the program with a more accurate indication of how the students performed on the different exam forms as well as how the exam forms performed. It will also provide the program with appropriate guidance for making grading and academic progress decisions.