If you are a PA student sitting an End of Rotation exam in the next two years, the ground is about to move under you. PAEA publishes updated versions of six End of Rotation exams on July 27, 2026 — Emergency Medicine, Family Medicine, Internal Medicine, Pediatrics, Psychiatric & Behavioral Health, and Gynecologic, Sexual, and Reproductive Health (formerly Women’s Health).
Legacy versions of the exams remain available for administration through July 2027, and programs transition on their own schedule. That means for roughly a year, two students in the same cohort could sit meaningfully different exams. The first thing you should do after reading this is ask your clinical coordinator which blueprint your program is using.
This article walks through every change, exam by exam, with the actual percentages taken from PAEA’s official blueprint crosswalks. But before the exam-by-exam detail, there are four changes that cut across all six exams — and they tell you something about where PA education is heading.
The four changes that affect every exam
1. Professional Practice is a new task area on all six exams
Every updated blueprint adds Professional Practice as a task area, weighted between 5% and 8% depending on the exam. This mirrors the change NCCPA made to the PANCE in January 2025, and it is the clearest signal of intent in the whole update.
On a 120-question exam, 6% is roughly seven questions. Most students will walk in having prepared for this not at all, because it did not exist when their upperclassmen took the exam and it is not what anyone thinks of as “studying medicine.” Do not make that mistake — this is free score for anyone willing to spend an evening on it.
2. Scientific Concepts is being cut everywhere
Scientific Concepts was 10% on every legacy exam. On the updated blueprints it drops to 5% (Emergency Medicine, Pediatrics), 6% (Family Medicine), 7% (Internal Medicine, Psychiatry), or 8% (GSR). Pathophysiology-for-its-own-sake is being deliberately de-emphasized.
3. Diagnosis is shrinking; Diagnostic Studies is growing
Diagnosis was 25% on every legacy exam — the single largest task area. On the updated blueprints it falls to 20% on four of the six exams (and 22% on Internal Medicine). Only Emergency Medicine holds it at 25%.
Meanwhile Diagnostic Studies climbs: 10% to 15% on Emergency Medicine, 10% to 14% on Family Medicine and Internal Medicine. The exam is shifting from “what does this patient have?” toward “what test do you order, and what does the result mean?” That is a harder question, and a more clinically honest one.
4. Psychiatry is being pushed into every rotation
This is the change nobody is talking about, and it is the one I would flag hardest.
- Emergency Medicine: Psychiatric/behavioral health rises 5% to 7%
- Family Medicine: rises 5% to 7%
- Internal Medicine: Psychiatric/behavioral health is added as a content area at 5% — it did not exist before
- Pediatrics: merged into a combined Neurologic/psychiatric/behavioral health area at 8%
- GSR: Psychiatric/behavioral health added as a content area at 6%
Behavioral health is no longer something you study for one rotation and forget. It is now tested on nearly every exam you take. If psychiatry is the rotation you were planning to cram and move on from, reconsider.
Emergency Medicine EOR — what changed
Headline: Infectious diseases becomes its own content area, and Diagnostic Studies jumps 50%.
| Content area | Current | Updated |
|---|---|---|
| Cardiovascular | 20% | 18% |
| Rheumatologic/musculoskeletal | 15% | 12% |
| Gastrointestinal | 10% | 10% |
| Pulmonary | 10% | 10% |
| Neurologic | 8% | 8% |
| EENOT | 7% | 7% |
| Psychiatric/behavioral health | 5% | 7% |
| Renal/genitourinary | 6% | 6% |
| Dermatologic | 5% | 5% |
| Gynecologic/reproductive health | 5% | 5% |
| Endocrine | 5% | 4% |
| Hematologic | 4% | 4% |
| Infectious diseases (NEW) | — | 4% |
Task areas: Diagnostic Studies 10% to 15%. Clinical Intervention 10% to 12%. Clinical Therapeutics 20% to 18%. Health Maintenance 10% to 5%. Scientific Concepts 10% to 5%. Professional Practice added at 5%. Diagnosis holds at 25% — the only exam where it does.
Infectious diseases previously lived scattered across organ systems. Now it stands alone: sepsis, meningitis, cellulitis and necrotizing infections, tick-borne illness, HIV-related emergencies. Cardiovascular is still the biggest content area by a wide margin and still deserves the most study time.
Family Medicine EOR — what changed
Headline: Urgent care is gone as a content area, and EENOT is now the second-largest.
| Content area | Current | Updated |
|---|---|---|
| Cardiovascular | 15% | 14% |
| EENOT | 8% | 10% |
| Gastrointestinal | 11% | 10% |
| Pulmonary | 12% | 10% |
| Dermatologic | 5% | 7% |
| Endocrine | 5% | 7% |
| Psychiatric/behavioral health | 5% | 7% |
| Rheumatologic/musculoskeletal | 8% | 7% |
| Gynecologic/reproductive health | 8% | 6% |
| Neurologic | 6% | 6% |
| Renal/genitourinary | 5% | 6% |
| Hematologic | 4% | 5% |
| Infectious diseases | 4% | 5% |
| Urgent care | 4% | REDISTRIBUTED |
Task areas: History & Physical 15% to 16%. Diagnostic Studies 10% to 14%. Diagnosis 25% to 20%. Health Maintenance 10% to 12%. Clinical Intervention 10% to 8%. Clinical Therapeutics 20% to 18%. Scientific Concepts 10% to 6%. Professional Practice added at 6%.
Family Medicine is the exam where Health Maintenance rises (10% to 12%) while it falls or vanishes elsewhere — which makes sense for the specialty. Dermatology, endocrine, and psych all gained two points each.
Internal Medicine EOR — what changed
Headline: Critical care is gone. Psychiatry is in. Endocrine, neuro, and renal all jump to 10%.
| Content area | Current | Updated |
|---|---|---|
| Cardiovascular | 20% | 20% |
| Pulmonary | 15% | 15% |
| Gastrointestinal | 12% | 12% |
| Endocrine | 8% | 10% |
| Neurologic | 8% | 10% |
| Renal/genitourinary | 8% | 10% |
| Rheumatologic/musculoskeletal | 12% | 8% |
| Hematologic | 5% | 5% |
| Infectious diseases | 5% | 5% |
| Psychiatric/behavioral health (NEW) | — | 5% |
| Critical care | 7% | REDISTRIBUTED |
Task areas: Diagnostic Studies 10% to 14%. Diagnosis 25% to 22%. Health Maintenance 10% to 7%. Clinical Therapeutics 20% to 18%. Scientific Concepts 10% to 7%. Professional Practice added at 7%.
The single biggest loser is musculoskeletal, down four points. Critical care topics have not disappeared — they have been redistributed into the organ-system areas, so you will still see the septic shock and the DKA, just classified differently.
Pediatrics EOR — what changed
Headline: Growth and development is a brand-new 10% content area. This is the biggest single change on any exam.
| Content area | Current | Updated |
|---|---|---|
| EENOT | 15% | 12% |
| Pulmonary | 12% | 12% |
| Dermatologic | 15% | 10% |
| Gastrointestinal | 10% | 10% |
| Growth and development (NEW) | — | 10% |
| Infectious diseases | 12% | 10% |
| Cardiovascular | 10% | 8% |
| Neurologic/psychiatric/behavioral health | 6% + 6% | 8% |
| Endocrine | 3% | 5% |
| Hematologic | 3% | 5% |
| Renal/genitourinary | 3% | 5% |
| Rheumatologic/musculoskeletal | 5% | 5% |
Task areas: History & Physical 15% to 18%. Diagnosis 25% to 20%. Health Maintenance 10% to 14%. Clinical Therapeutics 20% to 15%. Scientific Concepts 10% to 5%. Professional Practice added at 8% — the highest of any exam.
Growth and development at 10% means roughly twelve questions on material that was not a discrete content area before: milestones, well-child checks, growth charts, screening schedules, anticipatory guidance. Combined with Health Maintenance rising to 14% and History & Physical to 18%, the Pediatrics exam has pivoted hard toward wellness and normal development, and away from therapeutics (down five points). Dermatology, historically a Peds EOR staple at 15%, drops to 10%.
Psychiatric & Behavioral Health EOR — what changed
Headline: Health Maintenance is removed entirely, Clinical Intervention doubles, and Sleep-wake disorders is a new content area.
| Content area | Current | Updated |
|---|---|---|
| Depressive; Bipolar and related disorders | 18% | 17% |
| Substance-related; Addictive disorders | 14% | 15% |
| Trauma- and stress-related disorders; Abuse and neglect | 18%* | 13% |
| Anxiety; Somatic symptom-related disorders | —* | 11% |
| Schizophrenia spectrum and other psychotic disorders | 12% | 11% |
| Feeding or eating disorders | 8% | 8% |
| Neurodevelopmental; Dissociative disorders | 10% | 8% |
| Sleep-wake disorders (NEW) | — | 7% |
| Human sexuality | 4% | 5% |
| Personality; Obsessive-compulsive and related disorders | 8% | 5% |
| Somatic symptom; Nonadherence to medical treatment | 8% | REDISTRIBUTED |
*The legacy blueprint combined Anxiety with Trauma- and stress-related disorders in a single 18% category; the update splits them.
Task areas: History & Physical 15% to 16%. Diagnostic Studies 10% to 11%. Diagnosis 25% to 20%. Health Maintenance 10% to REMOVED. Clinical Intervention 10% to 20%. Clinical Therapeutics 20% to 20%. Scientific Concepts 10% to 7%. Professional Practice added at 6%.
Clinical Intervention doubling from 10% to 20% is the most dramatic task-area shift on any of the six exams. The Psychiatry exam is now heavily weighted toward what you actually do — therapy modality selection, crisis intervention, level-of-care decisions, involuntary hold criteria — rather than pure diagnosis. Sleep-wake disorders appearing at 7% is a genuine new study burden.
Gynecologic, Sexual, and Reproductive Health EOR — what changed
Headline: The exam was renamed and the content areas were completely rebuilt around anatomy rather than the old gynecology/obstetrics split.
This is the most thorough reorganization of the six. Women’s Health is now Gynecologic, Sexual, and Reproductive Health (GSR), and the old structure — Gynecology subdivided into menstruation, infections, neoplasms, breast, structural; Obstetrics subdivided into prenatal, complications, labor — has been replaced entirely.
| Updated content area | % |
|---|---|
| Prenatal care/pregnancy | 20% |
| Uterine/cervix | 12% |
| Fertility management (NEW) | 10% |
| Sexual health & development (NEW) | 10% |
| Labor & delivery | 9% |
| Postpartum care | 8% |
| Breast | 7% |
| Vulva/vaginal/pelvic floor | 7% |
| Psychiatric/behavioral health (NEW) | 6% |
| Infections | 6% |
| Ovary/adnexa | 5% |
Task areas: Diagnosis 25% to 20%. Clinical Therapeutics 20% to 16%. Diagnostic Studies 10% to 11%. Health Maintenance 10% to 11%. Clinical Intervention 10% to 11%. Scientific Concepts 10% to 8%. Professional Practice added at 8%.
Three genuinely new content areas — Fertility management (10%), Sexual health & development (10%), and Psychiatric/behavioral health (6%) — account for 26% of the exam between them. Topics have been redistributed rather than deleted: menstruation, for example, now lives inside Sexual health and development, while neoplasms and structural abnormalities have been spread across several anatomical areas. If you study from an old Women’s Health resource organized around the gyn/OB split, you will have gaps.
What about Surgery and the End of Curriculum exam?
Neither is part of the July 2026 release. The Surgery EOR was already updated in September 2024, and it was the exam that introduced the new content-area and task-area structure that the other six are now adopting. The End of Curriculum (EOC) exam also already reflects the new structure. If you want to know what the updated exams feel like, the Surgery blueprint is the closest existing model.
What you should actually do
Ask your clinical coordinator which blueprint you are sitting. Legacy exams remain available through July 2027. Until PAEA publishes the new exams on July 27, 2026, programs should continue preparing students against the current blueprints. After that date, it depends on your program’s transition plan. This is a two-minute email and it determines how you study.
If you are on the updated blueprint, spend an evening on Professional Practice. It is 5–8% of your score, it is new, and almost nobody prepares for it. That is the highest return per hour available to you anywhere on this exam.
Do not neglect behavioral health outside your psych rotation. It is now tested on five of the six exams. The days of studying psych once and forgetting it are over.
Practice interpreting tests, not just naming diagnoses. Diagnostic Studies is up on five of six exams while Diagnosis is down on five of six. Get comfortable with “which test, and what does this result mean” as a question format.
Check whether your prep resource has been updated. Any question bank or review course still weighted to the legacy blueprint will have you studying the wrong proportions. Ask the vendor directly when their content was last aligned. Many will not have done it yet.
Frequently asked questions
When exactly do the new EOR exams launch?
July 27, 2026.
Will I definitely take the new version?
Not necessarily. Legacy exams remain available for administration through July 2027, and each program decides when to transition. Ask your coordinator.
Which exams are changing?
Six: Emergency Medicine, Family Medicine, Internal Medicine, Pediatrics, Psychiatric & Behavioral Health, and Gynecologic, Sexual, and Reproductive Health. Surgery was already updated in 2024.
Are the exams still 120 questions?
Yes. Each EOR exam remains 120 multiple-choice questions, of which 100 are scored and 20 are unscored pretest items, with a two-hour limit.
Is Women’s Health being discontinued?
No — it is being renamed to Gynecologic, Sexual, and Reproductive Health (GSR) and substantially restructured.
Where can I read the official documents?
PAEA publishes the updated blueprints, topic lists, and crosswalks on its End of Rotation Blueprints & Topic Lists page. Every percentage in this article is taken directly from those crosswalks.
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- Gynecologic, Sexual & Reproductive Health EOR
- General Surgery EOR
- PACKRAT
- End of Curriculum (EOC)
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About the author
Jeremy Boroff, MPAS, PA-C is a practicing Emergency Medicine Physician Assistant with 24 years of clinical experience and more than 20 years as an APC Director of an emergency department. He is the author of Emergency Medicine End of Rotation (EOR) Exam Review and Test Prep, Ace the Psychiatry & Behavioral Health EOR, and Gynecologic, Sexual, and Reproductive Health End of Rotation (EOR) Exam Review. He founded CME Review Courses and created the PAtopia app to help PA students prepare for the PACKRAT, all seven End of Rotation exams, the End of Curriculum exam, and the PANCE.
All blueprint percentages in this article are taken from PAEA’s official 2025 Blueprint Crosswalk documents, published September 2025. PAtopia and CME Review Courses are not sponsored by, endorsed by, or affiliated with PAEA or NCCPA. End of Rotation™, PACKRAT®, and End of Curriculum™ are trademarks of the Physician Assistant Education Association.