Intro to PA: What is a PA & How did we get here?; Stress, Burnout & Self-Care

medical professions trained in rigorous postgraduate education programs to evaluate, diagnose, and treat patients

What is a PA?

Europe, Africa, South Asia

What other areas of the world do PAs exist?

Disease centered

medical model; focuses on cause and effect

Person Centered

nursing model; focuses more on the whole person and things that impact a patient overall

Society centered

social model; psychological factors that contribute to care and health outcomes

Military corpsmen

What occupational group has strong historical ties to the beginning of the PA profession?

Mr. Buddy Treadwell

The "first PA" that started as an assistant

Dr. Eugene Stead

Known as the "Father of the PA profession"

Duke University

Where was the first PA program located?

Duke Model

Medex Model

The two types of PA education models

clinical diagnosis, decision making, treatment of medical problems

Dr. Stead's vision for PAs included recognition of certain medical conditions such as heart failure and shock, but they would not be involved with ______, ______, or ______.

Dependent Practice

relying on one practitioner to supervise a single PA, limiting the scope of practice

Independent Practice

PAs and physicians rely on each other to provide high-quality health care to a wide range of pts in all settings

PA education, experience, and preference

Physician delegation

Facility credentialing and privileging

State law and regulations**

PA scope of practice is generally defined by four determinants:

Type of practice

Setting

Acuity of the pts

Physician's needs and preferences

PA's training and experience

Factors in determining PA's individual scope of practice (5):

comprehensively

Central theme of the PA/physician relationship is the recognition that the physician is the more _____ trained member of the team and therefore holds terminal responsibility for ensuring that all members of the team adhere to accepted standards of care.

shared

Originally physicians assumed legal liability and professional responsibility for all of the medical actions of the PA --> now a ____ responsibility.

ethical, legal, medical

The responsibility that the Pa is acting in accordance with the ___, ___ and ___ standards is shared and reciprocal between the PA and physician.

Agency

a fiduciary relationship which manifests from the consent of one person to another that the other shall act on their behalf and subject to their control, and consent by the other so to act

Three factors must be present for an agency relationship to exist between two parties:

Assent: physician consents to the relationship

Benefit: physician accrues some degree of benefits from the acts of the PA

Control: physician has some degree of control

Autonomy

having the right or power to self-govern or to carry on w/o outside control

Delegated Autonomy

based on physician and resident relationships; includes clear lines of accountability and reciprocal responsibilities of seeking and providing supervision and consultation

Autonomy of Practice

the extent to which PAs can determine independently the range of tasks they will perform

optimal-team practice

PAs, physicians, and other health care professionals working together to provide quality care w/o burdensome administrative constraints

National Commission on Certification of Physician Assistants (NCCPA)

the only certifying organization for PAs in the US; PANCE

American Academy of Physician Assistants (AAPA)

national organization supporting and representing PAs and PA students

The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)

the accrediting agency for PA education/programs

Physician Assistant Education Association (PAEA)

national organization representing PA educational programs; PACKRAT and EOR exams

stress

a state of worry or mental tension caused by a difficult situation

short-term stress

can be beneficial; provides motivation to accomplish a task or goal

chronic stress

leads to fatigue, over-reactive emotions and anxiety; can contribute to a plethora of negative physical outcomes

burnout

a consequence of long-term chronic interpersonal stress

emotional exhaustion

low sense of accomplishment

depersonalization and detachment

What are the three aspects of burnout?

emotional exhaustion

generalized fatigue that can be related to devoting excessive time and effort to a task or projects that is not perceived to be beneficial

emotional exhaustion

Emotional exhaustion, low sense of accomplishment or depersonalization and detachment?

May be caused by continuing to care for a pt who has a very poor chance of recovery

low sense of accomplishment

the tendency to negatively evaluate the worth of one's work

low sense of accomplishment

Emotional exhaustion, low sense of accomplishment or depersonalization and detachment?

Feeling insufficient in regard to the ability to perform one's job

depersonalization and detachment

a distant or indifferent attitude toward work; manifests as negative, callous, and cynical behaviors, or interacting w/ colleagues or pts in an impersonal manner

depersonalization and detachment

Emotional exhaustion, low sense of accomplishment or depersonalization and detachment?

May be expressed as unprofessional comments directed toward co-workers, blaming patients for their medical problems, or the inability to express empathy or grief when a patient dies

compassion fatigue

the emotional strain of exposure to working w/ those suffering from the consequences of traumatic events

decreased productivity

decreased job satisfaction

depression

relationship problems

substance abuse

suicide

What are some negative clinician outcomes that can be caused by burnout?

excessive workload

What is the #1 contributor to burnout?

emergency medicine

primary care

oncology

palliative and hospice care

What 4 specialties are at highest risk of burnout?

increased health care costs

higher clinician turnover

reduce pt adherence and satisfaction

poor pt outcomes

4 ways clinician burnout affects the health care system:

clinician wellness that encompasses more than the absence of burnout, but involves true professional fulfillment

What attempt of healthcare improvement was added to Quadriplegic Aim that Triple Aim did not have?

wellness

a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity

resilience

the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress

physical

emotional

professional

intellectual

social

environmental

6 Domains of Wellness

internal factor

External or Internal factor affecting well-being and resilience?

coping skills

internal factor

External or Internal factor affecting well-being and resilience?

teamwork skills

internal factor

External or Internal factor affecting well-being and resilience?

sense of meaning

internal factors

External or Internal factor affecting well-being and resilience?

family dynamics

external factors

External or Internal factor affecting well-being and resilience?

professional relationships

external factors

External or Internal factor affecting well-being and resilience?

pt behaviors and expectations

external factors

External or Internal factor affecting well-being and resilience?

litigation risk

external factors

External or Internal factor affecting well-being and resilience?

clinical responsibilities

physical

Physical, emotional or behavioral sign of burnout:

lowered immunity

physical

Physical, emotional or behavioral sign of burnout:

changes in appetite or sleeping habits

emotional

Physical, emotional or behavioral sign of burnout:

detachment

emotional

Physical, emotional or behavioral sign of burnout:

increasingly negative outlook

behavioral

Physical, emotional or behavioral sign of burnout:

procrastination

behavioral

Physical, emotional or behavioral sign of burnout:

skipping class or work

Stage 1: milder symptoms

Stage 2: longer lasting symptoms

Stage 3: severe symptoms

3 Stages of Burnout

Eat, Sleep, Move your body

3 Daily Must-Do's of Burnout Prevention

increase self-awareness

become more optimistic

increase self-regulation

become more mentally agile

increase connections

increase your strengths of character

6 ways to become more resilient

impaired provider

a provider who is unable to fulfill professional or personal responsibilities due to a variety of different reasons

anesthesiology

emergency medicine

What specialties have the highest rates of impaired providers (2)?

alcohol

What is the most commonly abused substance used by health care providers?

home; work

Problems usually surface at ____ first, as providers make every effort to conceal their symptoms at ____ .

voluntary recovery program

licensee must enter into a consent agreement w/ the licensing board for a period of no less than THREE YEARS (know this!!!); disciplinary action will be deferred so long as the licensee adheres to the terms and conditions of the agreement and maintains satisfactory progress in the program

disciplinary monitoring unit

responds to the needs of licensees who have had formal disciplinary action by the Bureau's licensing boards; ensures that licensees maintain compliance w/ the probationary terms and conditions imposed by the licensing board