The physician assistant (PA) profession is rapidly growing and ranked second (#2) in Best Health Care Jobs, and fifth (#5) in the 100 Best Jobs by U.S. News and World Report in 2024 [1]. With a 10-year projected job growth of 31.3% [2], the profession has a bright future that makes it attractive to many prospective applicants. However, with the limited number of seats available for training future PAs, the admissions process has become highly competitive [3]. Given such a competitive process, selecting applicants who can successfully complete a rigorous PA training program and go on to pass the Physician Assistant National Certifying Examination (PANCE) is of utmost importance. One area of debate in the PA admissions process is the value of prerequisite coursework in relation to student success in PA training.

One of the most extensively measured metrics of student achievement in PA education is the PANCE. Over the last 14 years, a review of PA education literature yielded mixed results regarding whether prerequisite science courses correlated with better student outcomes, namely the PANCE. In 2010, Higgins and colleagues showed that a student’s prerequisite course grades did not contribute significantly to their performance on the PANCE [4]. However, Ennulat et al. in 2011 found that a student’s prerequisite grade point average (GPA) did correlate with performance on the PANCE [5], while Brown’s team in 2013 found no correlation between student success and science prerequisite GPA [6]. Mixed results continued with Andreeff in 2014 showing higher scores in pathophysiology and biochemistry correlated with higher PANCE scores [7], while Butina and colleagues in 2017 found prerequisite GPA had no meaningful effect on PANCE performance [8]. Recently, an analysis of data compiled from the PA Education Association (PAEA) Prerequisite 2021 Report demonstrated that a diverse set of prerequisites existed across 273 PA programs. Notably, the analysis revealed substantial differences in the prerequisite coursework, in both the type of course and the quantity, underscoring the challenge of discerning which courses, if any, are indispensable for a student’s academic success [9].

The DO and MD literature also have mixed results regarding the value of prerequisite coursework. For example, in 2004, Dr. Donna Dixon with the New York College of Osteopathic Medicine of New York Institute of Technology found no correlation between science and nonscience undergraduate GPAs and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1 and Level 2 scores when looking at one cohort of 171 students [10]. Similarly, Wong and colleagues noted in 2009 that the number of preadmission elective upper-level science courses was not significantly correlated with overall academic achievement for osteopathic medical students [11]. Yet, in 2011, Dixon found that science undergraduate GPA was correlated with COMLEX-USA Level 1 and Level 2-CE (Cognitive Evaluation) scores when looking at multiple cohorts totaling 737 students [12]. In the allopathic realm, the Icahn School of Medicine at Mount Sinai, in 2013, created a FlexMed program targeted toward attracting students to medical school who are from a wide range of backgrounds with majors in areas such as the humanities and social sciences. Traditional prerequisites are waived for these participants with no significant differences in performance on the United States Medical Licensing Examination (USMLE) Step 1 failures, class rank, or honors grades [13].

The Rocky Vista University (RVU) PA Program, established in 2017, initially took a more traditional approach to its prerequisite coursework requirements by requiring a set of science courses commonly needed for entering medical education. During the application process, the program identified that many promising candidates lacked specific science courses, a minimum number of credit hours, or essential lab components, which prevented them from advancing to the interview stage. Consequently, despite their suitability for the program in other respects, these candidates were unable to progress, potentially depriving the program of otherwise well-rounded candidates aligned with its mission. The program consistently required an overall undergraduate GPA as a measure of academic potential, which was maintained, even while specific science prerequisites were reevaluated. The mission of the PA profession is to improve and expand access to healthcare in response to a shortage of primary care physicians; thus, it is critical to select applicants capable of succeeding in rigorous training programs. The RVU PA program aligns with the profession’s mission by emphasizing a curriculum designed to ensure student success on national exams and in their future roles as providers, irrespective of their incoming prerequisites.

Amidst a myriad of opinions within both the PA and MD/DO communities and the challenge the program faced during the interview selection process, a fundamental question persisted: What is the true impact of prerequisite science courses on student outcomes in PA training programs? In response to this question, the RVU PA Program eliminated prerequisite coursework prior to the admissions cycle for their second cohort. This decision was driven by several factors: the limited data in the existing literature supporting the notion that required prerequisites significantly enhance student success; the diverse requirements across different programs that made it challenging to establish a universal standard; and a lack of evidence directly correlating poor student outcomes with cognitive attributes, such as coursework grades. Finally, by adopting a more comprehensive approach, the program aimed to evaluate candidates based on a broader, more holistic range of criteria. This study aims to evaluate the impact of pre-matriculation undergraduate science coursework on student performance in a physician assistant training program, specifically assessing correlations with standardized exam outcomes.