Great Careers in Testing

Noelle Hammerbacher

Noelle Hammerbacher, MS, Managing Editor, National Commission on Certification of Physician Assistants

Noelle Hammerbacher is the Managing Editor for the National Commission on Certification of Physician Assistants (NCCPA), which is based in Johns Creek, Georgia. Noelle manages the production schedules for all seven of NCCPA's examinations, recruits and trains item writers, edits and finalizes examination items, and builds and publishes the examinations. She has over 19 years' experience in the field of medical testing and has edited and published examinations for several other medical specialties, including orthopedics, anesthesiology, and echocardiography. Noelle has an MS in Technical and Science Communication from Drexel University in Philadelphia, Pennsylvania and a BA in English and Secondary Education from King's College in Wilkes-Barre, Pennsylvania. Noelle telecommutes from her home in Havertown, Pennsylvania.

Your Career

Noelle Hammerbacher

You have been in the testing field since 1993, how did you go on this career path?
I fell into the field of medical editing and test publishing quite by accident. I have my BA in English and Secondary Education, so after college, I decided to go right into the field of teaching. After substitute teaching in the public schools, and after teaching kids who were only two years younger than me, I felt like I needed a bit more experience before I could handle the very challenging but rewarding job of teaching our youth. I decided to get a job in the publishing industry and then get back into teaching at a later date. Well, I took the first entry-level job I could get in the industry (as an editorial production assistant at the National Board of Medical Examiners), worked my way up through the ranks, and the rest is history. I still haven't gone back to high school teaching, because I have been quite taken with the testing industry. But I still teach when I train our committee members (and I also teach yoga on the side), so I'm still using that skill set.

What have been the most enjoyable areas of your career?
I really enjoy selecting, training, and working closely with our authors/committee members. NCCPA selects individuals from all over the United States from many different backgrounds and specialties to participate in our process as authors and committee members. These individuals have such great knowledge of the PA profession and the medical field, and I have the editing background as well as the background in the methodologies of item writing. So the combination of our expertise really makes the collaborative process of producing quality examination items a thrilling experience. I learn so much from our committee members, many of whom have become my friends.

What are the keys to success in writing items for an examination?
Know your audience, have a clear blueprint with clear expectations for that audience, and be consistent in how you present your examinations so that every item looks as if it has been written and edited by the same person (even though it took a team of folks to edit, proofread, and publish the examination).

What has been your biggest career challenge and how did you overcome it?
The craft of editing and manipulating language is an art form that is often overlooked and rarely respected. Most editors are silent work horses who have an extreme love for language and an attention to detail that is unrivaled. It has always been a challenge for me to justify to others why my editorial team needs an appropriate amount of time within a production schedule to edit, proofread, fact check, and finalize our items. Many grossly underestimate the time and care it takes to do our work. Over the years, I have earned that respect through perseverance and through consistently providing an end-product that is of the highest quality.

What have you discovered to be the best ways to find and compensate extraordinary item writers and committee members?
At NCCPA, we do a lot of research to determine whether an individual is the correct match for one of our committees. We collect biographical information, sample items, and resumés. I initially choose the candidates based on review of these three documents, and then my fellow editor and the chairperson of the committee reviews the same documents to see if we all agree. Once we select a committee member, we train and mentor them through the first few writing cycles. We also evaluate our committee members at every stage of the process to make sure they are a good match for their specific committee and to make sure they are functioning appropriately. We always provide feedback, whether it is in regard to their writing or their participation during review meetings. To show our appreciation for their time and dedication to this important process, we also offer an honorarium per meeting, give each committee member several small gifts per year, and treat them like VIPs when it comes to facilitating their travel arrangements and making them feel welcome once they're on site.

You presented Getting the Most Bang for Your Item-Development Bucks at the Institute for Credentialing Excellence (ICE), November 2011. What were the key points of your presentation?
I shared NCCPA's entire production process with the attendees of the presentation. I spoke about NCCPA and our examinations, and then I went on to explain how we select, train, and evaluate item writers/committee members, conduct item review meetings, and evaluate the items and the item writing process. The purpose of the presentation was to share our methods for producing our examinations in-house with the highest quality and efficiency in the most cost-effective manner. I believe the presentation was well received and that attendees were definitely interested in our process, which is something of which we are very proud.

What are your favorite technologies and software for the development and management of assessments?
My favorite technology is our own NCCPA item banking system, which the Exam Development department developed in collaboration with our Technology Services department. The database is quite impressive and allows the editors and psychometricians at NCCPA to do everything we need to do with ease.

How have your career efforts improved our world?
I'm really proud to be part of the certification and recertification process for certified PAs. They make a tremendous difference in the lives of patients throughout the US, and NCCPA holds them to very high standards as the only certifying body for the profession. We assess critical competencies throughout PAs' careers, and by achieving and maintaining certification, PAs demonstrate the commitment they have to lifelong learning and improvement. NCCPA certification has played a tremendous role in the acceptance of the PA profession. It's gratifying to know that the exams I help to develop are part of that process.


What is the difference between the PANCE and the PANRE exams?
The PANCE, or Physician Assistant National Certifying Examination, is the initial certification examination that all aspiring physician assistants take after graduating. Since certification is required by all state licensing boards, passing the PANCE is their ticket to beginning their career.

The PANRE, or Physician Assistant National Recertifying Examination, is taken every six years by all PAs who want to maintain certification (and over 90% do).

The content of the two exams is very similar; both cover the full spectrum of general medicine and surgery. The principle difference is their length: PANRE is a little shorter with 240 questions, while the initial certification exam includes 300 questions.

How many of each are taken each year?
In 2011, just under 7,000 PAs took the PANCE, and close to 11,000 took the PANRE.

What is the average number of times PANCE test takers take a test to get a passing score?
The vast majority of PAs -- over 90% -- pass PANCE on their first attempt. PAs are very well prepared for this exam by the time they graduate.

Physician Assistant Careers & Education

What career assessment exams are available to prospective PAs?
Certified PAs practice in primary care and in virtually every medical and surgical specialty and subspecialty out there. The University of Virginia School of Medicine has developed the Medical Specialty Aptitude Test (MSAT), which is designed to help medical students begin to sort out what specialties might be a fit for them; PA students and prospective students might find that helpful, too.

But as far as assessments that could help someone decide whether the PA career path is right for them, I'm not actually aware of any. My best suggestion is to contact a practicing PA and ask to shadow him or her. The PA profession is very generous in that regard, and most PAs would be happy to introduce someone to the profession. The American Academy of PAs has helpful information about the profession, and a new PA graduate started up a Web site last year that looks like it has a wealth of insights for those considering the profession or entering PA school.

How many PAs are there now and what do you expect in 10 years?
Today there are approximately 84,000 certified PAs. It looks like the number of PA educational programs could increase by as much as 30% in the next few years. I am not a workforce researcher, but just some basic calculations suggest that if that happens, we could easily see 150,000 certified PAs 10 years from now -- even more if large numbers delay retirement. And that's really exciting given the physician shortages we already have, which are only projected to worsen for the foreseeable future.

What types of Physician Assistant degrees are offered?
More than 80% of PA programs award Masters degrees, though the specific degree conferred varies pretty widely: Master of Science (MS), Master of PA Studies (MPAS), Master of Science in PA Studies (MSPAS), Master of PA Practice (MPAP), Master of Physician Assistant (MPA), and -- believe it or not -- the list could go on. There are 19 that award Baccalaureate degrees and even a couple that award Associate degrees. All meet the same accreditation standards, though, and the trend is definitely moving in the direction of graduate degrees.

What are some of the most prestigious and effective institutions offering such degrees?
I couldn't identify the most effective institutions offering PA programs, but I can tell you that you would be impressed with the names of some: Yale, Stanford, Duke, Cornell. . . . There is a great range in terms of the size of the university or school housing the programs, and there are both public and private options. If you are interested in PA school, chances are really good there will be one among the 159 accredited programs that fits your needs and preferences. The Physician Assistant Education Association provides Web site visitors the opportunity to search for programs by state.

You use Pearson VUE testing centers -- what are the main reasons you use a 3rd party test administration service and what are the most important elements to consider when choosing one?
We administer computer-based examinations to approximately 18,000 aspiring or current physician assistants per year throughout the US and even in spots around the world. Because our volume of examinees is so large and geographically dispersed, we needed a reputable vendor to help us administer those examinations in secure, comfortable, and standardized testing centers. When choosing a test administration vendor, you should first identify your needs; research companies and identify industry leaders; create a team to assess whether a vendor is a good fit for your company; and be diligent in contract negotiations so that all parties are clear on needs and responsibilities. Good communication is the key to a good vendor relationship.

Medical Certification and Licensure

What health and medical fields of certification and licensure testing are growing in demand?
Almost all fields of medicine need to prove that their practitioners are held to a certain standard and are qualified to provide appropriate and safe care for patients. I don't see this need as decreasing any time soon.

What patents or other intellectual property are most influential in your field of testing?
I'm not aware of patents that are influential, but I would imagine that protecting intellectual property is most important. By intellectual property, I mean the programs that testing companies use to develop items, store and organize items and the associated pictorials or multi-media, and the software that is developed to publish examinations to the field.

If you had the power to change the world of assessment, what would be the first thing you would do?
I would continue to develop items that require the examinee to apply higher-order cognitive skills. Item writing efforts at NCCPA have moved toward this goal over the past few years, and we continue to require this in our item writing efforts. I think it would be great if exams contained exclusively items that present real-life clinical scenarios and require the examinee to use all the knowledge they have obtained through training to discern the most appropriate answer.

When, if ever, do you imagine that high-stakes medical licensing examinations may be delivered online at the home of the test taker vs. at proctored testing centers?
Due to security issues and no real proven way to proctor home-based examinations at this time, I would not expect to see high-stakes medical examinations delivered online anytime in the near future. Even technologies like retinal scanning can't ensure that the person in front of the computer is completing the exam without the help of someone else in the room.

What are some of the most important elements to consider when designing and developing secure high-stakes tests and their supporting administration, scoring, and other systems?
There are so many things to consider! A few of the elements include determining the number of candidates, how much item exposure you want, how many forms to create in order to decrease item exposure, when to test and how to test (i.e., Will you have a one-day window for the exam or will you provide a larger testing window?), how much security is necessary, how much security you can afford, whether to score the exams at the testing site or provide scores to the examinees at a later date, how much money you have and how to stay within budget, and the list goes on and on. . . .

What advice would you give to anyone interested in starting a new certification/licensure examination based on a new field of expertise?
When deciding whether or not to develop a new certification/licensure examination, it is most important to determine if there is a need for the credential. Do the research to find out if spending the time and the money on developing the examination and ultimately creating the credential will be beneficial to the end users. If the data suggests that employers and the general public have a need for such a credential, and if you can prove that there are individuals out there interested in gaining that credential, then you have a market.

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