Summary
The Pediatrics End of Rotation™ (EOR) exam is one of the PA Education Association’s objective, standardized evaluations and is intended to serve as one measure of the medical knowledge PA students gain during their supervised clinical practice experience. This article outlines the updated PAEA Pediatrics EOR Exam Blueprint, including its content and task areas, and presents the Exam Topic List. The specifications presented here reflect the updated Pediatrics Blueprint and Topic List published by PAEA as of July 2026. Updated Pediatrics exam versions based on these specifications were published July 2026; legacy Pediatrics examinations remain available through July 2027, so students should confirm which version their program is administering. Questions on an examination represent only a sample of the content that may be assessed and may not reflect every topic identified in the Topic List. Exam candidates and clinical coordinators are encouraged to review the original Blueprint, Topic List, and Core Tasks and Objectives through PAEA’s End of Rotation™ Blueprints and Topic Lists resource page at https://paeaonline.org/assessment/end-of-rotation/blueprints-and-topic-lists. [1]
AMBOSS is an independent entity with no affiliation to or endorsement by the PA Education Association (PAEA) or the PAEA End of Rotation™ examinations. The PAEA-derived portions of this article are based on the PAEA Pediatrics End of Rotation™ Exam Blueprint, Topic List, and Core Tasks and Objectives, which are created and owned by PAEA®. The pediatrics-specific "Knowledge of" and "Skill in" descriptions, general study guidance, and organization of certain Professional Practice concepts were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source. AMBOSS does not claim ownership of material originating from PAEA. This article is provided at no cost to the public as an informational resource for PA students, educators, clinicians, and other healthcare professionals. It is not an official PAEA publication and does not contain actual PAEA examination questions. Use or reproduction of PAEA materials is subject to PAEA’s applicable terms and any required permissions. [2]
Overview
Content Categories
| Content Category | Percentage |
|---|---|
| Eyes, Ears, Nose, Oral Cavity, and Throat (EENOT) | 12% |
| Pulmonary | 12% |
| Dermatologic | 10% |
| Gastrointestinal | 10% |
| Growth and Development | 10% |
| Infectious Diseases | 10% |
| Cardiovascular | 8% |
| Neurologic/Psychiatric/Behavioral Health | 8% |
| Endocrine | 5% |
| Hematologic | 5% |
| Renal/Genitourinary | 5% |
| Rheumatologic/Musculoskeletal | 5% |
Task Categories
| Task Category | Percentage |
|---|---|
| History & Physical | 18% |
| Diagnostic Studies | 10% |
| Diagnosis | 20% |
| Health Maintenance | 14% |
| Clinical Intervention | 10% |
| Clinical Therapeutics | 15% |
| Scientific Concepts | 5% |
| Professional Practice | 8% |
Each End of Rotation™ exam contains 120 multiple-choice questions, including 100 scored questions and 20 unscored pretest questions. The Blueprint percentages apply to the 100 scored questions. The updated Pediatrics Blueprint is organized by both content area and task area, and Professional Practice is one of its eight task areas.
General study approach
- Use the Blueprint percentages to set relative study priorities rather than to exclude lower-percentage categories.
- Eyes, ears, nose, oral cavity, and throat; pulmonary; dermatologic; gastrointestinal; growth and development; and infectious diseases together account for 64% of the scored questions; however, every listed category remains testable.
- Diagnosis, History & Physical, Clinical Therapeutics, and Health Maintenance together account for 67% of the scored questions, emphasizing age-specific assessment, diagnostic reasoning, pharmacologic management, preventive care, growth and development, and anticipatory guidance.
- Pediatrics End of Rotation™ questions focus on infants, children, and adolescents and may be set in ambulatory, emergency department, and inpatient care. Preparation should include newborns, infants, children, adolescents, patients with chronic disease or developmental differences, and medically complex pediatric patients.
- End of Rotation™ questions use a one-best-answer clinical-vignette format intended to assess higher-order thinking. Study each condition through its age-specific presentation, growth and developmental context, key distinguishing findings, appropriate diagnostic evaluation, first-line management, weight-based pharmacotherapy when applicable, preventive needs, immunizations, anticipatory guidance, disposition, and follow-up.
Medical Content Categories
Content Categories
| Content Category | Percentage |
|---|---|
| Eyes, Ears, Nose, Oral Cavity, and Throat (EENOT) | 12% |
| Pulmonary | 12% |
| Dermatologic | 10% |
| Gastrointestinal | 10% |
| Growth and Development | 10% |
| Infectious Diseases | 10% |
| Cardiovascular | 8% |
| Neurologic/Psychiatric/Behavioral Health | 8% |
| Endocrine | 5% |
| Hematologic | 5% |
| Renal/Genitourinary | 5% |
| Rheumatologic/Musculoskeletal | 5% |
Eyes, Ears, Nose, Oral Cavity, and Throat (EENOT) (12%)
Ear disorders
- Cerumen impaction
- Dysfunction of eustachian tube
- Foreign body
- Hearing disorders
- Mastoiditis
- Otitis externa
- Otitis media (with/without effusion)
- Tympanic membrane perforation
Eye disorders
- Conjunctivitis
- Lacrimal disorders
- Optic neuritis
- Orbital/Periorbital cellulitis
- Retinoblastoma
- Strabismus
- Vision abnormalities
Nose/Sinus disorders
Oropharyngeal disorders
- Ankyloglossia
- Congenital palate disorders
- Dental caries
- Dental trauma
- Diphtheria
- Epiglottitis
- Gingivitis
- Herpes simplex virus
- Laryngitis
- Laryngotracheobronchitis (croup)
- Leukoplakia
- Oral candidiasis
- Oral health
- Oral lesions
- Parotitis
- Peritonsillar abscess/Retropharyngeal abscess
- Pharyngitis
- Salivary disorders
- Tonsillar hypertrophy
Pulmonary (12%)
Asthma
Cystic fibrosis
Foreign body aspiration
Infectious disorders
- Acute bronchiolitis
- Acute bronchitis
- Acute epiglottitis
- Influenza
- Laryngotracheobronchitis
- Pertussis
- Pneumonias
- Bacterial
- Viral
Pneumothorax
Respiratory distress
Respiratory distress syndrome in the newborn
Sleep apnea
Dermatologic (10%)
Acne vulgaris
Allergic reactions
- Drug eruptions
- Urticaria
Diseases of hair, nails, or skin
- Acanthosis nigricans
- Alopecia
- Atopic dermatitis
- Erythema multiforme
- Lichen planus
- Pityriasis rosea
- Seborrheic dermatitis
- Stevens-Johnson syndrome
- Tinea versicolor
- Toxic epidermal necrolysis
Infectious disorders
- Bacterial
- Fungal
- Viral
Skin infestations
Skin lesions
Wounds
- Abrasions/Lacerations
- Bites/Stings
- Burns
Gastrointestinal (10%)
Esophageal disorders
Foodborne illness
Foreign body ingestion
Gastric disorders
Gastrointestinal bleeding
Hepatic disorders
Intestinal/Colorectal disorders
- Acute gastroenteritis (viral, bacterial)
- Appendicitis
- Biliary/Duodenal atresia
- Celiac disease
- Fecal impaction/encopresis
- Functional constipation
- Hernias
- Hirschsprung disease
- Inflammatory bowel disease
- Intussusception
- Volvulus
Neonatal hyperbilirubinemia
Toxidromes
- Acetaminophen poisoning
- Ingestion of harmful substances
- Reye syndrome
Growth and Development (10%)
Breast health (pain, mass)
Chromosomal abnormalities (Down syndrome, Turner syndrome, Klinefelter syndrome, Trisomy 13/18)
Developmental milestones
Digital/Technology guidelines
Failure to thrive
Feeding and nutrition
Gender identity
Immunization guidelines
Menarche
Newborn assessment
Physical activity
Physical growth parameters
Physical safety
Puberty
Sexual and reproductive health
Sexual orientation
Social, emotional, and behavioral development
Sudden unexplained infant death
Tanner staging
Teething
Vitamin/Nutritional deficiencies
Infectious Diseases (10%)
Bacterial infections
- Botulism
- Group A streptococcus
- Group B streptococcus
- Pertussis
- Congenital infections
Fever
- Fever in the infant
- Fever of unknown origin
- Fever without a source
Fungal infections
Multisystem inflammatory syndrome in children (MIS-C)
Parasitic infections
Sepsis
Sexually transmitted infections
Vector-borne infections
Viral infections
Cardiovascular (8%)
Congenital heart disease
- Acyanotic
- Atrial septal defect
- Coarctation of the aorta
- Cyanotic
- Patent ductus arteriosus
- Pulmonary atresia
- Tetralogy of Fallot
- Transposition of the great vessels
- Ventricular septal defect
Hypertensive disorders
Lipid disorders
Shock
- Cardiogenic
Traumatic, infectious, and inflammatory heart conditions
- Acute rheumatic carditis
- Kawasaki disease
Valvular disorders
- Aortic
- Mitral
- Pulmonary
- Rheumatic heart disease
- Tricuspid
Neurologic/Psychiatric/Behavioral Health (8%)
Adverse childhood experiences
Anxiety disorders
Attention-deficit/hyperactivity disorder
Autism spectrum disorder
Child abuse and neglect
Congenital/Genetic disorders
- Cerebral palsy
- Chiari malformation
- Fetal alcohol spectrum disorders
- Huntington disease
- Prader-Willi syndrome
- Spina bifida
- Trisomy 13, 18, 21
- Turner syndrome
Depressive disorders
Disruptive, impulse-control, and conduct disorders
Eating disorders
Febrile seizure
Headache (migraine, tension, idiopathic intracranial hypertension)
Meningitis
Neoplasms of the central nervous system
Seizure disorders
Self-harm
Sleep disorders
Substance use disorders
Suicidality
Syncope, neurogenic
Tic disorders
Traumatic brain injury
Endocrine (5%)
Adrenal disorders
Diabetes mellitus
Diabetic ketoacidosis
Gender diverse care
Gynecomastia
Hypoglycemia
Obesity
Pituitary disorders
Thyroid and parathyroid disorders
Hematologic (5%)
Renal/Genitourinary (5%)
Circumcision
Congenital/Genetic disorders
Cryptorchidism
Enuresis
Hydrocele
Hypospadias
Infectious disorders
Neoplasms
- Benign
- Malignant
- Paraphimosis
- Phimosis
Renal disease
Testicular mass
Testicular torsion
Vesicoureteral reflux
Rheumatologic/Musculoskeletal (5%)
Avascular necrosis
Birth trauma (clavicle fracture, brachial plexus injury, cephalohematoma, subgaleal hematoma)
Developmental dysplasia of the hip
Fractures/Dislocations
Juvenile idiopathic arthritis
Muscular dystrophy
Neoplasia of the musculoskeletal system
Osgood-Schlatter disease
Plagiocephaly
Radial head subluxation
Scoliosis
Slipped capital femoral epiphysis
Sprains/Strains
Talipes equinovarus (Club foot)
Torticollis
Task Categories
Task Categories
| Task Category |
Percentage |
|---|---|
| History & Physical | 18% |
| Diagnostic Studies | 10% |
| Diagnosis | 20% |
| Health Maintenance | 14% |
| Clinical Intervention | 10% |
| Clinical Therapeutics | 15% |
| Scientific Concepts | 5% |
| Professional Practice | 8% |
*AMBOSS editorial study guidance: The following pediatrics-specific "Knowledge of" and "Skill in" descriptions were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source.
History & Physical (18%)
-
Knowledge of:
- Components and techniques of comprehensive, focused, and problem-based pediatric histories and physical examinations from birth through adolescence
- Prenatal, birth, neonatal, medical, surgical, medication, allergy, family, developmental, social, environmental, and exposure histories relevant to pediatric care
- Feeding, nutrition, elimination, sleep, immunization, growth, developmental, school, behavioral, and caregiver history
- Age-specific normal vital signs, physical examination findings, growth parameters, and developmental expectations
- Pubertal development, menstrual history, sexual and reproductive health, substance use, mental health, and other components of an age-appropriate adolescent history
- Risk factors and historical features associated with serious illness, congenital disease, developmental delay, abuse, neglect, and preventable injury
- Features distinguishing normal developmental variation from potentially pathologic findings
-
Skill in:
- Obtaining developmentally appropriate histories from children, adolescents, parents, caregivers, medical records, and other available sources
- Conducting pediatric interviews and examinations using age-appropriate, family-centered, and trauma-informed communication
- Performing newborn, infant, child, and adolescent physical examinations appropriate to the presenting problem and developmental stage
- Measuring and interpreting weight, length or height, head circumference, body mass index, vital signs, and growth trends
- Assessing developmental milestones, Tanner stage, feeding, hydration, functional status, behavior, and general clinical appearance
- Obtaining confidential adolescent history when appropriate while explaining the limits of confidentiality
- Recognizing findings suggestive of respiratory distress, dehydration, sepsis, neurologic compromise, shock, abuse or neglect, and other conditions requiring urgent evaluation
- Integrating history, growth, development, and examination findings to distinguish pediatric disorders and determine acuity
Diagnostic Studies (10%)
-
Knowledge of:
- Patient- and family-centered education related to pediatric laboratory and diagnostic studies
- Indications, limitations, risks, contraindications, techniques, and potential complications of commonly used pediatric diagnostic studies
- Age-specific normal ranges and interpretation of routine laboratory and diagnostic findings
- Selection of initial, subsequent, screening, and confirmatory studies based on clinical presentation, age, risk, cost, probable yield, invasiveness, and effect on management
- Indications for newborn screening, bilirubin testing, lead screening, hearing and vision screening, developmental screening, infectious testing, urinalysis, cultures, and other age-appropriate studies
- Indications for radiography, ultrasonography, computed tomography, magnetic resonance imaging, electrocardiography, echocardiography, and other diagnostic modalities
- Pediatric considerations involving radiation exposure, sedation, specimen collection, renal function, contrast administration, and invasive testing
-
Skill in:
- Selecting appropriate initial and subsequent laboratory, diagnostic, and screening studies based on age and clinical presentation
- Collecting blood, urine, respiratory, skin, wound, and other specimens using age-appropriate technique
- Reviewing and interpreting laboratory studies, imaging, electrocardiograms, growth data, and screening results in pediatric clinical context
- Using age-specific reference ranges rather than applying adult normal values to pediatric patients
- Recognizing results that require emergency evaluation, immediate treatment, consultation, referral, repeat testing, or additional diagnostic evaluation
- Determining when testing is unnecessary or when a lower-risk diagnostic approach is appropriate
- Comparing current findings with prior results and monitoring clinically significant trends
- Communicating the purpose, preparation, risks, results, and follow-up implications of diagnostic testing to patients and caregivers
Diagnosis (20%)
-
Knowledge of:
- Significance of age, history, growth, developmental status, physical examination findings, laboratory studies, and diagnostic findings as they relate to the differential diagnosis
- Epidemiology, risk factors, pathophysiology, diagnostic criteria, and typical or atypical presentations of common pediatric conditions
- Age-specific manifestations of illness in newborns, infants, children, and adolescents
- Distinguishing normal growth and developmental variation from disease, developmental delay, or congenital abnormality
- Red-flag findings associated with serious bacterial infection, respiratory compromise, dehydration, neurologic disease, congenital disease, trauma, poisoning, abuse, neglect, and other urgent conditions
- Effects of prematurity, congenital conditions, chronic disease, developmental differences, medications, family history, and social determinants on pediatric presentations
-
Skill in:
- Formulating an appropriately prioritized differential diagnosis based on age, history, physical examination findings, growth and development, and diagnostic data
- Selecting the most likely diagnosis while considering serious or time-sensitive alternative diagnoses
- Recognizing age-specific and atypical presentations of common pediatric diseases
- Distinguishing infectious, congenital, developmental, neurologic, behavioral, metabolic, traumatic, toxicologic, and other causes of similar presentations
- Identifying concurrent diagnoses, complications, developmental concerns, and chronic disease comorbidities
- Recognizing the ill-appearing child and conditions requiring emergency stabilization, hospitalization, specialty consultation, or urgent referral
- Revising the differential diagnosis when symptoms persist, treatment fails, developmental concerns emerge, or new findings become available
- Managing diagnostic uncertainty through appropriate reassessment, follow-up, caregiver education, and return precautions
Health Maintenance (14%)
-
Knowledge of:
- Recommended well-child care, preventive services, screening, and anticipatory guidance from the newborn period through adolescence
- Routine childhood and adolescent immunization schedules, catch-up immunization principles, contraindications, precautions, risks, and benefits
- Normal physical growth, developmental milestones, social-emotional development, pubertal development, and Tanner staging
- Developmental, behavioral, vision, hearing, oral-health, nutrition, anemia, lead, lipid, mental-health, substance-use, and other age-appropriate screening principles
- Infant feeding, childhood and adolescent nutrition, physical activity, sleep, and healthy weight promotion
- Age-specific injury prevention, physical safety, safe sleep, sudden unexplained infant death risk reduction, child passenger safety, water safety, firearm safety, and poisoning prevention
- Adolescent confidentiality, sexual and reproductive health, sexual orientation, gender identity, contraception, and sexually transmitted infection prevention
- Risk factors and signs of child abuse, neglect, exploitation, bullying, intimate partner violence, self-harm, suicidality, and substance use
- Effects of family roles, caregiver health, housing, food access, transportation, finances, health literacy, environmental exposures, and other social determinants on child health
-
Skill in:
- Performing age-appropriate preventive histories and physical examinations during well-child visits
- Assessing and documenting growth, developmental milestones, behavior, school performance, pubertal development, nutrition, physical activity, and sleep
- Identifying preventive services and screening studies that are due based on age and individual risk factors
- Developing routine and catch-up immunization plans and counseling caregivers regarding vaccine benefits, risks, and common concerns
- Providing developmentally appropriate anticipatory guidance to children, adolescents, parents, and caregivers
- Counseling families regarding feeding, nutrition, oral health, safe sleep, injury prevention, physical activity, digital technology, and other healthy behaviors
- Providing confidential and developmentally appropriate adolescent counseling regarding mental health, substance use, sexual and reproductive health, and safety
- Recognizing barriers to preventive care and coordinating appropriate medical, developmental, educational, behavioral, and community resources
- Identifying suspected abuse or neglect and initiating appropriate protective intervention, referral, and mandated reporting
Clinical Intervention (10%)
-
Knowledge of:
- Indications, contraindications, risks, benefits, complications, techniques, and aftercare for common pediatric clinical interventions and procedures
- Principles of immediate stabilization of airway, breathing, circulation, neurologic function, hydration, and temperature in acutely ill children
- Oral and intravenous fluid management for dehydration and other common pediatric conditions
- Principles of wound care, irrigation, closure, dressing, foreign-body management, splinting, immobilization, and other common pediatric interventions
- Nonpharmacologic management of respiratory, gastrointestinal, dermatologic, musculoskeletal, behavioral, developmental, and chronic pediatric conditions
- Criteria for emergency evaluation, specialty consultation, hospital admission, transfer, or referral
- Roles of developmental services, physical therapy, occupational therapy, speech therapy, behavioral health, nutrition services, social work, schools, and other community resources
- Postprocedural monitoring, discharge planning, caregiver education, and pediatric follow-up
-
Skill in:
- Prioritizing interventions based on age, severity of illness, physiologic stability, and risk of deterioration
- Initiating age-appropriate stabilization for respiratory distress, shock, dehydration, seizure, anaphylaxis, severe infection, trauma, and other urgent conditions
- Selecting appropriate oral or intravenous fluid therapy and monitoring response
- Performing or assisting with appropriate pediatric procedures within the PA’s training and assigned role
- Selecting age-appropriate nonpharmacologic treatments and supportive care
- Determining when outpatient management is appropriate and when emergency evaluation, admission, consultation, or transfer is required
- Evaluating response to intervention through repeat examination, vital signs, hydration status, respiratory status, pain, function, and other relevant findings
- Coordinating specialty, developmental, behavioral, rehabilitation, educational, and social-service referrals
- Providing caregivers with clear aftercare instructions, warning signs, return precautions, and follow-up plans
Clinical Therapeutics (15%)
-
Knowledge of:
- Indications for use
- Contraindications and precautions
- Mechanisms of action
- Dosing and routes of administration
- Pharmacokinetics and pharmacodynamics
- Weight-based and age-specific dosing principles, maximum doses, medication formulations, and administration considerations
- First-line and alternative pharmacologic treatment of common acute and chronic pediatric conditions
- Appropriate antimicrobial selection, dosing, duration, and principles of antimicrobial stewardship
- Pharmacologic management of asthma, allergic disease, pain, fever, infectious disease, endocrine disease, neurologic conditions, behavioral health conditions, and other common pediatric disorders
- Age-specific contraindications, precautions, adverse effects, drug interactions, and medication toxicities
- Medication considerations related to prematurity, renal or hepatic impairment, chronic disease, puberty, pregnancy, and lactation in adolescent patients
- Medication adherence, safe storage, accidental ingestion prevention, caregiver administration, and other pediatric medication-safety principles
-
Skill in:
- Selecting appropriate pharmacologic therapy based on age, weight, diagnosis, severity, allergies, comorbidities, organ function, prior treatment, and patient or caregiver preferences
- Calculating accurate weight-based medication doses, maximum doses, concentrations, and administration volumes
- Writing complete and accurate pediatric prescriptions with appropriate formulation, dose, route, frequency, duration, quantity, and instructions
- Selecting appropriate empiric and targeted antimicrobial therapy
- Monitoring therapeutic response through symptoms, physical examination findings, laboratory studies, growth parameters, and other clinically relevant measures
- Recognizing and managing adverse effects, allergic reactions, drug interactions, medication toxicity, and treatment failure
- Adjusting, tapering, discontinuing, or changing pharmacologic regimens when appropriate
- Reconciling medications and identifying dosing errors, duplication, interactions, inappropriate formulations, and adherence barriers
- Counseling children, adolescents, parents, and caregivers regarding medication purpose, administration, expected benefits, adverse effects, precautions, storage, and adherence
Scientific Concepts (5%)
-
Knowledge of:
- Associations among pediatric conditions and complications identified through the application of scientific concepts
- Genetics, embryology, congenital disease, and inheritance patterns relevant to pediatric conditions
- Normal fetal-to-neonatal transition and physiologic adaptations of the newborn
- Normal physical growth, neurologic development, cognitive development, puberty, and maturation across childhood and adolescence
- Age-related cardiovascular, respiratory, renal, fluid, electrolyte, metabolic, hematologic, immune, and endocrine physiology
- Pathophysiology of common congenital, infectious, inflammatory, metabolic, developmental, neurologic, and chronic pediatric diseases
- Microbiology and immune-system development relevant to pediatric infection, immunization, and infectious-disease susceptibility
- Nutrition, energy requirements, vitamin and mineral physiology, and mechanisms of growth failure or nutritional deficiency
- Age-related pharmacokinetic and pharmacodynamic differences relevant to pediatric medication selection and dosing
- Public-health principles related to immunization, injury prevention, child development, infectious disease, environmental exposures, and pediatric health disparities
-
Skill in:
- Applying pediatric anatomy, physiology, growth, and developmental principles to diagnosis and management
- Relating congenital and genetic mechanisms to clinical presentations and associated complications
- Applying age-specific cardiovascular, respiratory, renal, metabolic, and neurologic physiology to assessment and treatment
- Applying microbiologic and immunologic principles to infection prevention, vaccination, diagnosis, and treatment
- Applying nutritional and metabolic principles to growth, feeding, deficiency states, and chronic disease
- Relating developmental neurobiology and behavioral development to pediatric assessment
- Applying pharmacokinetic and pharmacodynamic principles to pediatric medication selection, weight-based dosing, monitoring, and toxicity
- Incorporating evidence-based medicine and current pediatric guidance into clinical decision-making
Professional Practice (8%)
Legal/medical ethics
-
Knowledge of:
- Parental or guardian permission, pediatric assent, informed consent, and refusal for examinations, medications, procedures, and other interventions
- Decision-making authority, guardianship, custody, surrogate decision-making, and evolving adolescent autonomy
- Confidentiality and privacy considerations involving adolescents, sexual and reproductive health, substance use, mental health, family involvement, and electronic communication
- Legal and ethical responsibilities related to suspected child abuse, neglect, exploitation, trafficking, and mandated reporting
- Ethical considerations involving vaccination, treatment refusal, disagreement between caregivers and clinicians, serious illness, medical futility, and end-of-life care
- Advance directives, code status, including do-not-resuscitate and do-not-intubate orders, organ donation, and goals-of-care decisions when applicable to pediatric patients
- Patient and family rights, cultural and religious beliefs, health disparities, and legal or policy issues affecting pediatric patients and families
-
Skill in:
- Obtaining appropriate parental or guardian permission and age-appropriate pediatric assent
- Supporting developmentally appropriate participation by children and adolescents in health care decisions
- Maintaining adolescent confidentiality while explaining its limits and recognizing situations requiring disclosure or protective intervention
- Recognizing and responding appropriately to suspected abuse, neglect, exploitation, or unsafe living conditions
- Communicating with guardians, legally authorized representatives, and multidisciplinary child-protection teams when appropriate
- Recognizing and escalating complex ethical or legal concerns to the supervising physician, ethics service, risk management, legal counsel, or other appropriate resource
Medical informatics
-
Knowledge of:
- Accurate and complete documentation of pediatric history, examination, growth, development, immunizations, assessment, treatment, counseling, and follow-up
- Documentation requirements related to preventive care, developmental screening, immunizations, medication dosing, procedures, abuse or neglect, and transitions of care
- Electronic health records, immunization registries, growth charts, clinical decision-support systems, patient portals, telemedicine, and evidence-based pediatric resources
- Privacy considerations involving parent or guardian portal access and confidential adolescent information
-
Skill in:
- Documenting growth, development, clinical reasoning, treatment decisions, counseling, and follow-up accurately and promptly
- Using electronic systems to review immunization history, growth trends, medication history, prior testing, and preventive-care needs
- Tracking diagnostic studies, referrals, abnormal screening results, and developmental concerns through appropriate follow-up
- Protecting confidential pediatric and adolescent information when using electronic health information systems and communication tools
Patient care and communication (individual patients)
-
Knowledge of:
- Affordable, effective, age-appropriate, and patient-specific pediatric care
- Family-centered communication and the roles of children, adolescents, parents, guardians, and caregivers in health care decisions
- Developmentally appropriate, trauma-informed, culturally responsive, and disability-inclusive communication principles
- Effects of health literacy, language, disability, culture, family structure, finances, housing, transportation, food access, education, and social support on child health
- Communication strategies appropriate to different developmental stages and to children with developmental, behavioral, cognitive, sensory, or communication differences
-
Skill in:
- Establishing rapport with children and adolescents while also building effective partnerships with parents and caregivers
- Communicating with empathy, cultural humility, and developmentally appropriate language
- Using qualified interpreters and accessible communication methods when appropriate
- Explaining diagnoses, procedures, medications, preventive recommendations, and follow-up plans to children and caregivers in understandable language
- Confirming caregiver understanding through teach-back and demonstration when appropriate
- Engaging adolescents in confidential and age-appropriate discussions regarding mental health, substance use, sexual health, safety, and other sensitive topics
- Identifying barriers to adherence and coordinating realistic medical, developmental, educational, behavioral, and community resources
PA role in professional practice
-
Knowledge of:
- Professional and clinical limitations, scope of practice, credentialing, privileging, supervision, and collaboration requirements
- Responsibilities of the PA in well-child care, acute pediatric care, chronic disease management, developmental assessment, procedures, emergency evaluation, and transitions of care
- Roles and responsibilities of pediatricians, family physicians, nurses, pharmacists, therapists, behavioral health clinicians, social workers, developmental specialists, educators, and other members of the interprofessional team
- Professional boundaries, conflicts of interest, clinician impairment, ethical conduct, and effects of implicit bias on pediatric assessment and treatment
-
Skill in:
- Recognizing personal limitations and seeking supervision, consultation, referral, or transfer of care appropriately
- Communicating effectively during pediatric consultations, referrals, handoffs, multidisciplinary discussions, and transitions of care
- Collaborating with medical, developmental, behavioral, educational, rehabilitation, and social-service professionals
- Maintaining professional behavior and appropriate boundaries with children, adolescents, families, caregivers, and colleagues
Professional development
-
Knowledge of:
- Continuing medical education resources relevant to pediatric preventive care, acute illness, chronic disease, growth and development, and behavioral health
- Evidence-based pediatric guidelines, immunization recommendations, quality standards, developmental screening tools, and evolving pediatric practices
- Principles of lifelong learning, self-assessment, feedback, clinician well-being, and maintenance of pediatric clinical competence
-
Skill in:
- Critically evaluating pediatric literature and applying evidence-based recommendations appropriately
- Identifying and interpreting information from reliable pediatric and preventive-care resources
- Recognizing personal knowledge or skill gaps and pursuing appropriate education, supervision, simulation, feedback, or additional training
- Participating in quality-improvement, morbidity review, patient-safety, and preventive-care initiatives
Public health (population/society)
-
Knowledge of:
- Population-level principles of childhood immunization, communicable-disease control, injury prevention, nutrition, developmental health, and health promotion
- Health disparities and barriers affecting pediatric access to preventive, medical, developmental, behavioral, dental, and specialty care
- Environmental and occupational exposures affecting children, including lead, tobacco smoke, unsafe housing, toxins, and other hazards
- Community resources addressing food insecurity, housing instability, developmental services, school needs, behavioral health, substance use, violence, and family support
- Public-health and mandated-reporting requirements involving communicable disease, abuse, neglect, and other threats to child safety
-
Skill in:
- Recognizing reportable diseases and following applicable public-health and mandated-reporting requirements
- Counseling families regarding immunization, injury prevention, healthy development, environmental safety, and risk reduction
- Identifying children and families affected by health disparities or barriers to care
- Connecting patients and caregivers with medical, developmental, educational, nutritional, behavioral, dental, and community services
- Recognizing population-level patterns of infectious disease, environmental exposure, injury, abuse, and other pediatric health concerns
Risk management
-
Knowledge of:
- Accountability, standards of care, and appropriate resource utilization in pediatric practice
- Common causes of preventable harm involving weight-based medication dosing, diagnostic delay, communication failure, missed abnormal results, inadequate follow-up, and unsafe transitions of care
- Patient-safety measures involving accurate patient identification, weight verification, allergy review, medication reconciliation, infection prevention, procedural safety, and the Universal Protocol when applicable
- Importance of safeguarding children and recognizing discrepancies between history, developmental ability, and injury patterns
- Requirements for reporting adverse events, near misses, equipment failures, occupational exposures, and other safety concerns
-
Skill in:
- Verifying patient identity, current weight, allergies, medication concentrations, and calculated doses before medication administration or prescribing
- Using age-appropriate safety measures during procedures, medication administration, sedation, immobilization, and other interventions
- Providing explicit return precautions and safety-net instructions when managing uncertain or evolving pediatric conditions
- Tracking referrals, diagnostic studies, abnormal results, developmental concerns, and overdue follow-up to prevent loss to care
- Providing safe handoffs that communicate age, weight, active problems, treatments, medication doses, completed and pending studies, safety concerns, and follow-up needs
- Recognizing, documenting, reporting, and responding appropriately to adverse events and near misses
- Escalating concerns when patient safety, suspected abuse or neglect, clinician impairment, staffing, equipment function, or standards of care are compromised
Disclaimer
AMBOSS is an independent entity with no affiliation to or endorsement by the PA Education Association (PAEA) or the PAEA End of Rotation™ examinations. The PAEA-derived portions of this article are based on the publicly available PAEA Pediatrics End of Rotation™ Exam Blueprint, Topic List, and Core Tasks and Objectives, which are solely created and owned by PAEA®. The pediatrics-specific "Knowledge of" and "Skill in" descriptions, general study guidance, and organization of certain Professional Practice concepts were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source. AMBOSS does not claim ownership of material originating from PAEA. This article is provided at no cost to the public as an informational resource for PA students, educators, clinicians, and other healthcare professionals. It is not an official PAEA publication and does not contain actual PAEA examination questions. Questions on an examination represent only a sample of the content that may be assessed, and the Topic List is not a comprehensive list of all possible examination topics. Use or reproduction of PAEA materials is subject to PAEA’s applicable terms and any required permissions. [2]