Fundamentals Exam 1

old PA definition

emphasized practicing medicine with supervision. PAs were qualified by graduation from a "program and/or certification" by the NCCPA

-emphasized relationship with MDs

2014 PA definition

- not spelling out "phyisican assistant" anymore (PA)

- changed "supervision" to "collaborating physician"

-"independent medical decision making"

you have to graduate a PA program to take the PANCE

why should the definition never be "and/or" for graduating a program and/or certification

2015 definition

-simplified a lot

-"PAs are versatile and collaborative"

-took out any reference to a physician

current PA definition

PAs (physician associates/physician assistants) are licensed clinicians who practice medicine in every specialty and setting. Trusted, rigorously educated and trained healthcare professionals, PAs are dedicated to expanding access to care and transforming health and wellness through patient-centered, team-based medical practice

-does not talk about supervision to show our autonomy

Prehistoric Medicine (8000 BC)

medical beliefs were centered on spiritual world and supernatural forces

-"shaman" could contact spiritual world and heal the sick

Egyptian Medicine (2000 BC)

-religious beliefs dominated

-developed the concept of "hemostasis" (applying pressure to wounds)

-mummification taught about anatomy

-concepts of early pharmacy through ointments

Greeks and Romans (450 BC-300 AD)

-beginning to look at world in scientific way

-Hippocrates: Father of Medicine

-the balance of the 4 humors

-Galen: instrumental in art of dissection

-Romans credited with hygiene practices/clean water/baths

4 humors

blood: energy/lively personality

phlegm: lethargy/dull personality

black bile: depression

yellow bile: anger/fiery temperament

The Middle Ages (500-1400AD)

advances in public health were lost, traditional cures viewed as witchcraft and outlawed by the church

bubonic plague struck

Arabic Medicine (700-1500AD)

- islamic scholars saved works of greeks and romans

- examined diet/exercise, prescribed medications, developed hospitals and training programs

-first to use anesthetics

-Ali al-husayn wrote "laws of medicine" with diagnoses, treatments, prescriptions (textbook)

The Renaissance (1400-1700AD)

-vesalius and davinci made detailed anatomic drawings

-william harvey: theory on heart and circulation

-people were hungry for knowledge, lots of grave robbers, dissection on criminals (dead or alive)

18th and 19th centuries (1700-1900)

the microscope, vaccinations (edward jenner- cowpox to create smallpox vax), xrays, antiseptics (Joseph Lister)/hygiene

Louis Pasteur and Robert Koch

Who are the two major contributors to the germ theory of disease (bacteria = infection)

Flourence Nightingale

established early nursing practice and modern hygiene standards in hospitals after seeing patients dying from hospital acquired infections

The 20th Century Medicine (1900-2000)

discovery of penicilin, insulin, mor evaccines, transplantation, IVF, human genome project

21st Century medicine

rapid advancement of technology, advanced pharmaceuticals, use of robotics in surgery, AI

why establish non-physician providers?

need for general healthcare, medical assistance in times of doctor shortages, needed staff to run developing technology

what countries had tried "midlevels" prior to the US?

france (the officier de sante), Russia (feldshers), China (the barefoot doctors)

charles hudson

president of national board of medical examiners, first that suggested the concept of "physician extenders"

Dr. Eugene Stead

father of the PA profession, developed the first PA training program at Duke, envisioned "generalists"

who consisted of the first PA class?

former military corpsmen who had returned from war

Dr. Stead originally tried for nurses but that was shot down

when was the first PA class?

began in 1965, graduated in 1967 (3 members)

Harvey Estes

Dr. that took over Duke PA Program after Dr. Stead retired

changed Steads vision to "purely technical" not involving diagnosis or treatment

Loretta Forn, RN and Henry Silver

started the first "NP-type" program in Colorado, developed to assist in pediatrics

Medex Model

blossom of PA profession in Seattle, another program of training military corpsmen, designed to serve primary healthcare needs in rural and underserved areas

Dr. Richard Smith

Founder of the first MEDEX program (Seattle)

1971 Comprehensive Health Manpower Training Act

-federal support for educational programs for PAs and other non-physicians

Requirements for funding under Comprehensive Health Manpower Training Act

-train for delivery of primary care in ambulatory settings

-place graduates in medically underserved areas

-recruit residents of medically underserved areas, minorities, and women as students

1970 AMA (American Medical Association)

passed bill to make PAs liscensed providers, NC was one of first states

The 4 KEY organizations

AAPA, PAEA (formerly APAP), ARC-PA (formerly JRC-PA), NCCPA

AAPA

American Academy of Physician Associates

-defines and advances profession, advances careers, OUR org!

-changed our name to associate

-ran by PAs and includes students

NCCPA

National Commission on Certification of Physician Assistants

-do our board certification

-design PANCE and PANRE

-define a competent PA by deciding what you need to know to practice

PAEA

Physician Assistant Education Association

-support PA education, resources for PA educators

-make CASPA (recruit PA students)

-serve as a definitive voice for education (will we stay a masters degree or become a doctorate?)

-PACKRAT and EORs

ARC-PA

Accreditation Review Commission on Education for the Physician Assistant

-accrediting body, protects public/students/programs

-holds standards for programs to make GOOD students

APPAP

Association of Post Graduate Physician Assistant Programs

-helps develop residencies and fellowships for PAs

AAPA PAC

political action committee, provides a means for PAs to participate in political process on a national level.

PA foundation

Philanthropic arm of the PA profession, focused on service

NCAPA

North Carolina Academy of Physician Assistants,

North Carolina's chapter, first to have PA serve on medical board, first to have PA representation in medical society

profession started here!

To take the PANCE you have to

graduate from ARC-PA accredited program

You can schedule your PANCE ___ days prior to graduation

180

You can take your PANCE ___ days after program completion

7

how many attempts do you have to take the PANCE in 6 years?

6 attempts

you need PANCE certification maintenance every ___ years and recertification every ___ years

maintenance: 2 years,

recertification: 10 years

how long is the PANCE (questions/time)?

5 hours, 300 MCQs

what is the percentage of content on the PANCE?

95% medical content

5% professional practice

(up to 20% may be general surgical topics)

PANRE vs PANRE-LA

PANRE: completed in one 5-hour session, personvue

PANRE-LA extended time, administered 12 quarters over a 3 year-period

What is a CAQ

certificate of added qualifications, independent of regular NCCPA certification

TRUE OR FALSE: employers can limit scope of practice

True

TRUE OR FALSE: MDs have to sign off on inpatient PA notes

FALSE

TRUE OR FALSE: PAs have to meet with supervising physician monthly for the 1st 6 months and then every 6 months after

TRUE

TRUE OR FALSE: in NC, the supervising MD is responsible for PA medical acts

TRUE

TRUE OR FALSE: PAs in NC have to have a back-up supervising physician

FALSE

TRUE OR FALSE: in NC, MDs have a limit on the number of PAs to supervise

FALSE

TRUE OR FALSE: the NCMB specifies what medical tasks a PA may perform

TRUE, but employer/supervising MD can limit change

TRUE OR FALSE: PAs can prescribe schedule II controlled substances

TRUE

who grants our liscensure

the state medical board; protects regulated personnel AND the public from unqualified/unethical practitioners

North Carolina Medical Board requirements

have to pass PANCE, does not require recertification (most employers require), require annual renewal

direct supervision

on site (same facility/room), immediately available if need arises

indirect supervision

supervisor is available for consultation, but may not be on site

NCB meeting requirements with supervising physician

once a month for the first 6 months, and then every 6 months after

delegation of functions

governed by the prevailing custom and practice

also based upon court decisions, attorney general decisions, or legislative enactment

what drug schedules can PAs prescribe

schedule 2-5 drugs

schedule I drugs

not currently accepted medical use in the US, high potential for abuse (heroin, LSD, cannabis)

schedule II/IIN

substances with high potenital for abuse that may lead to dependence

II: hydrocodone, cocaine, methadone, oxycodone, fentanyl

IIN: amphetamine, methanphetamine

schedule III

substances with moderate to low potential for abuse

ex. Tylenol with codeine, ketamine, anabolic steroids

schedule IV drug examples

tramadol, valium, xanax

non clinical PA roles

legal, education, medical system admin, pharmaceuticals, politics, insurance

top reasons PAs get sued

1. errors in diagnosis

2. errors in treatment

3. medication errors

4. surgical errors

four elements of negligence

duty, breach of duty, causation, injury/damages

duty

patient/provider relationship must exist, provider must owe this to the patient; must identify a standard of care

breach of duty

lack of reasonable care under the circumstances; act of omission and act of commission (did not meet standard of care)

causation

the breach of duty by the provider CAUSED the bad outcome experienced by the patient

malpractice insurance

typically provided by employers

main types of malpractice insurance

claims made and occurrence based

claims made insurance

malpractice insurance that covers you for incidents that OCCUR and are REPORTED DURING the coverage period

stops when you leave the job

occurence malpractice insurance

covers you for incidents that occur during the coverage period REGARDLESS of when they are reported

why does academic and intellectual honesty matter?

academic: relates to competence, degree is meaningless without it

intellectual: disservice to public and profession without it

science misconduct

misrepresentation, misappropriation, interference or practices that seriously deviate from those that are commonly accepted within the scientific community

interference

a person's research is seriously compromised by intentional and unauthorized taking, sequestering, or damaging of property (someone is intentionally interfering with someone elses stuff)

misrepresentation

fabrication, falsification and/or omission of facts as part of deliberate attempts to deceive

falsification

changing data, results, or facts

ex. displaying all of your results but blatantly changing the data to support your hypothesis

omission

act of not presenting certain information that results in a distortion of the truth

ex. only displaying the results that support your hypothesis

misappropriation

unauthorized use of ideas or unique methods obtained by a priviledged communication or in research, the unlawful presentation of another person's result, idea, plan, observation, or data as one's own research

ex. reviewing anothers article/manuscript/grant application and proceeding with the idea like its yours

plagiarism

utilizing someone elses work without giving appropriate credit

4 types: direct, mosaic, paraphrase, insufficient acknowledgement

direct plagiarism

verbatim use of passages without using quotation marks and crediting the author

mosaic plagiarism

borrowing ideas/opinions from a source, using a few verbatim works/phrases without crediting author

paraphrase plagarism

restating a phrase or passage, providing the same meaning but in a different form without attribution to the original author

insufficient acknowledgement

noting original source of only part of what is borrowed, or failing to cite the source material in such a way that a reader will know what is original and what is borrowed

professionalism values

responsiblity, maturity, communication skills, respect

burnout

unmanaged stress can lead to this, occurs when there is a mismatch within a key aspect of your life (situation does not support your values, amount of work unequal to the reward)

symptoms of stress vs symptoms of burnout

stress: heightened emotional response

burnout: hopelessness/helplessness