PA Hx and Roles Quizzes

How did the profession come to adopt the title physician’s assistant?

a. There was a strong resistance amongst all PA programs for the title MEDEX, which was suggested by Eugene Stead

b. Those in the profession were initially called syniatrist but that title was abandoned because it was difficult to abbreviate

c. The profession preferred the title physician’s associate but the AMA objected

d. The profession was initially called Medical Care Practitioner but that was abandoned when advanced nurses called themselves Nurse Practitioner

C

• Congress wanted to use it because it indicated a more collegial relationship between the PA and supervising physician and eliminated confusion between the PA and medical assistant, but it was denied.

• Silver had proposed the term syniatrist (from the Greek syn, which means along with or association, and iatric, meaning physician), but it was never used

• Smith proposed the term MEDEX

• The term medical care practitioner was initially considered in England because of the inaccuracy of the word physician, but physician associate was selected to be used there

Which of today’s major PA organizations was founded by students in 1968?

a. AAPA

b. APAP

c. ARC-PA

d. NCCPA

A

Which of today’s major PA organizations was originally called APAP?

a. AAPA

b. American Registry of PAs

c. PA History Society

d. PAEA

D

• APAP (Association of Physician Assistant Programs) was founded by physician faculty from major PA educational programs in 1972. APAP, along with AAPA, led collective efforts in determining policy direction for the profession, such as the establishment of certification processes, developing professional standards, and gaining federal and state funding for PA program development.

Which of today’s major PA organizations stipulates certain standards for PA programs?

a. AAPA

b. APPAP

c. ARC-PA

d. PAEA

C

• ARC-PA became an independent accrediting body in 2000

Which organization it tasked with the protection of the public by ensuring competence of the practicing PA?

a. PAEA

b. NREMT

c. NCCPA

d. PAHx

C

PAs may use the title “physician associate” and when .

a. at their own discretion; the state organization passes legislation

b. when instructed to by their state organization; not in violation of state laws or other policies

c. at their own discretion; not in violation of state laws or other policies

d. when state legislation is passed; their employers authorize use

C

Of the “types” of assistants that evolved, which is the most analogous to today’s PA?

a. Type C

b. Type A

c. Type B

d. PA-C

B

• Type A assistants were able to collect patient history and physical data and they could assist with diagnostics and therapies. They did function under the general supervision and responsibility of the physician but they had a degree of independent clinical judgement

• Type B assistants had technical expertise in a clinical specialty or specific procedure. Because they were so specialized they were less qualified for independent action that extended beyond their specialty

• Type C assistants could perform a limited number of medical care tasks under a more direct supervision. They were similar to Type A assistants but did not have the ability for independent synthesis and judgement

Why did the role of the PA emerge in the mid-1960s?

a. There were military corpsmen returning from Vietnam without jobs to fill

b. Duke had an idea for a unique way to increase the quality of health care in the United States

c. Demands were growing in the United States to make health care more accessible and the healthcare workforce could not keep up with demand

d. A Surgeon Generals report had recommended the formation of a new health profession

C

Before the emergence of the PA profession in the United States, there were examples of non-physician providers assisting physicians. Which of the following pairs (country & named role) is an example cited in the text? 

a. New Zealand - syniatrist

b. Faulkland Islands - assistant medical officer

c. Brazil - associado medico

d. Soviet Union - Feldscher

D

• France used officiers de sante

• Puerto Rico used practicantes

Which of the following factors occurring after the 1900s increased demand for health care service?

a. With advances in diagnostic and therapeutic technologies, medicine was more able to cure patients and health care became something individuals expected to be able to access. 

b. Physician care was getting more expensive so a cheaper alternative was needed

c. The rural areas of the country were growing in population and it was harder for one physician to provide care to such a wide region

d. The Great Depression led to many bankruptcies in physician practices, causing them to close

A

What social and political factors led some to consider health care as a right in 1965? 

a. 75% of the country was covered by private health insurance coverage in 1965, making it affordable to receive services

b. By the late 1960s, civil rights leaders came to view health as a human right and demanded that Congress intervene to correct inequities in healthcare

c. Growing emphasis on free enterprise led to the growth of individually owned physician practices which were able to make services more accessible

d. The growth of the population and its move to rural America resulted in geographic maldistribution of physician services and the farm workers went on strike to get health care for their families

B

Which of the following factors occurring after 1900 decreased the supply of physicians in the United States

a. A growing elderly population in the United States resulted in a shift to delivery systems where physicians were needed as medical directors for nursing homes

b. The 1910 Flexner report identified inferior facilities for training physicians resulting in the temporary or permanent closing of half of the medical schools in the United States. 

c. Because of the failure of legislation in 1910 that would have created a Medicare-like system, financial funding for medical education ended

d. The nurse practitioner role had been created at Duke resulting in a lower cost alternative so hospitals employed NPs resulting in physician unemployment

B

What was the name of the then President of the National Board of Medical Examiners who called on the AMA to support creation of a PA-like individual?

a. E. Harvey Estes

b. Richard “Dick” Smith

c. Charles Hudson

d. Eugene Stead

C

• E. Harvey Estes chaired the Department of Community Health Sciences, which was where the first PA program at Duke was transferred to

• Eugene Stead established the first formalized PA program at Duke University

Which of the following correctly describes a “local circumstance” that existed at Duke that made it an ideal place for the start of the PA profession?

a. Duke had a source of funding from the National Heart Institute that could be shifted to allow monies for PA program startup

b. Duke experienced a more acute personnel shortage than other institutions

c. Duke was looking to increase the length of its medical school and many wanted them to start a PA program shorter in length

d. Duke had a relationship with the Public Health Service which provided the instructors for the new PA program

A

• Mission of Duke was to help the health of the people in North Carolina

• Duke was looking at shortening the medical curriculum before the creation of the PA profession

Which of the following correctly identifies an experience from the early career of Dr. Eugene Stead that provided him with confidence that someone trained in a shorter time could provide "superb medical care" in the role of assistants to physicians?

a. Dr. Stead was a medical missionary with Albert Schweitzer and he saw individuals serving in a PA-like role of Officer de Sante in West Africa

b. Dr. Stead led a student run clinic in rural North Carolina and he used military corpsmen to successfully mentor the first and second year medical students

c. During WW II, Stead relied on a fast-track model to train physicians at Emory Hospital when he was left with only first and second year medical students to care for patients when all the attendings and upper class medical students were drafted to serve in the military

d. Dr. Stead was involved with the Office of the Surgeon General where many discussions were being held on innovative ways to use non-physicians in the deliver of care

C

Dr. Dick Smith is considered by many as one of the key pioneers of the PA profession. He embraced the concept of the PA from his time working as part of the US Surgeon General's team to desegregate hospitals in the South. He spent time in North Carolina and was introduced to a physician known also to Dr. Stead. That physician employed an assistant that was an informally trained PA. What is the name of that physician

a. Prentiss Harrison

b. Joyce Nichols

c. Amos Johnson

d. Loretta Ford

C

One of the early prototype PA programs was launched at the University of Colorado by Henry Silver, MD. The model was unique in a number of ways. Which of the following correctly describes one or more unique features? 

a. It was the country's first surgeon assistant training program and it was housed in a liberal arts college

b. Students would work closely with pediatricians on their way to becoming child health associates. Those students were the first PAs to earn master's degrees

c. Students in the PA program would spend only 3 months in the classroom and then would spend 12 months in community-based clinical practice

d. PAs trained at the PA program would become officers in the US Public Health Service

B

Which of the following is the name of the type of program that is the main West Coast model, described as the “collaborative” model and is focused on primary care in medically underserved areas?

a. Oregon Health Sciences University model

b. MEDEX PA program

c. University of Colorado externship model

d. Alderson-Broaddus medical center model

B

• MEDEX: developed by Richard Smith

• University of Colorado: emphasizes collaborative, hands-on, and family centered care

• Alderson-Broaddus: first baccalaureate program at a liberal arts school (established by Hu Crim Myers)

What is the term for the philosophical approach PA education which bases one’s education on demonstration of expected levels of knowledge and skills rather than on the achievement of a particular academic agree?

a. Competency based

b. Educationally efficient

c. Generalist

d. Biomedical

A

What is the appropriate term that is used to describe the approach used by PA programs to provide a broad educational foundation that allows PAs to move from specialty to specialty over their careers?

a. Collaborative

b. Primary care

c. Generalist

d. Intensive

C

Which of the following correctly reflects the reason that PA programs moved toward having a strong focus on primary care education and which caused many of the specialty programs to close?

a. Action by AMA to direct its accrediting body to close specialty programs

b. Accreditation standards adopted that allowed degrees to be granted only by primary care PA programs

c. Medicare classification system adopted that reimbursed only PAs graduating from Type A programs

d. Federal funding initiative which awarded money to programs that trained graduates for primary care practice

D

Which of the following correctly represents how accreditation for PA education programs has evolved?

a. Under its umbrella, AAPA formed the accrediting body ARC-PA, which then took the steps of establishing the Accreditation Standards for PA education

b. AMA took the lead by establishing an independent body called the Commission on Accreditation of Allied Health Education Programs

c. ARC-PA was established by AMA as an independent organization which later fell under the umbrella of the Commission on Allied Health Education Programs (CAAHEP)

d. Under its umbrella, AMA initially had one of its committees (CAHEA) develop the Essentials which led to a Joint Review Committee for Educational Programs for the Assistant to the Primary Care Physician (JRC-PA)

D

What is the name of the physician who started the flagship program for model of PA education predominant on the West coast?

a. Henry K. Silver

b. Richard “Dick” Smith

c. Hu C. Myers

d. Harvey Estes

B

What key argument has been used historically to describe the reasons that PAs believed that the physician-PA clinical relationship is fundamental?

a. The agency relationship is essential for assuring that PAs have the authority to act

b. The relationship is key to allowing businesses to employ PAs

c. The relationship assures the delivery of high quality care

d. The relationship is a requirement for Medicare reimbursement

C

• Relationship was first described by Stead. Originally proposed that PAs would not be involved in the clinical diagnosis, decision making, or treatment of medical problems, but this has progressed as health care as a whole has progressed.

What term is used in the AAFP-AAPA joint policy statement to describe the situation where PAs are allowed to practice medicine as trained and able to make health care decisions within their delegated scope of practice and without the need for physician input on these decisions unless the PA determines the input is necessary?

a. Agency relationship

b. Delegated autonomy

c. Interdependent

d. Collaboration

B

• Agency relationship:

  • Agency is a fundamental legal concept: consent by one person to another that the other shall act on his behalf and subject to his control, and consent by the others so to act

  • Three factors: physician consent to the relationship, physician accrues some degree of benefits from the acts of the PAs, the physician has some degree of control of, or right to control the PA

The Medicare definition of supervision contemplates three levels of physician availability to provide guidance to PAs (for example, when a complex patient is encountered and the path forward is unclear). Which of the following terms correctly reflects Medicare’s language for the most common form of physician availability in which the physician is available at all times through electronic communication?

a. General supervision

b. Personal supervision

c. Direct supervision

d. Retrospective supervision

A

• General supervision: the physician must be available to the PA at all times

• Direct supervision: the physician must be physically present in the building

• Personal supervision: most restrictive form, requires the physician to be present in the room where the PA provides care

• Retrospective:

  • Not a type of concurrent collaboration and supervision

  • The process of evaluating the performance, clinical activities, and quality of care provided by the PA

Three general categories exist in the Framework of Supervision that has historically guided PA practice. Which of the following terms used in that Framework would describe the establishment of a PAs scope of practice?

a. Retrospective supervision

b. Concurrent supervision

c. Direct supervision

d. Prospective supervision

D

Framework types of supervision and collaboration

• Prospective: delineates the duties and responsibilities (scope of practice) of both the physician and PA

• Concurrent: the oversight and availability of the physician

• Retrospective: review of care after it has been provided

The most successful clinical teams are those:

a. That ensure the physician exerts an appropriate amount of direct supervision over the PA

b. That utilizes the physician’s abilities most fully to ensure that the PA acts within their scope of practice

c. That utilizes the skills and abilities of each team member most fully

d. That brings in subject matter experts to compensate for knowledge deficits of a team member

C

The Optimal Team Practice policy currently being advanced by the AAPA includes four components. Two of the components of the OTP relate to the physician-PA relationship. Which of the following statements correctly reflects the OTP goal for changes in the parameters of the physician-PA relationship?

a. Replace obsolete supervisory agreement laws with practice-level decision making about collaboration

b. Authorize PAs to be sole owners or majority partners of medical PA practices

c. Physicians will continue to assume responsibility and liability for PA actions

c. OTP is intended to allow PAs to practice independently so as to compete effectively with nurse practitioners

A

• Dated state laws include many burdensome administrative activities that prevent PAs from being fully utilized → these have led to the impression that other health professionals are easier to hire and manage

• “The degree of collaboration between the physician and the practicing PA should be determined at the practice level in accordance with the practice type and the experience and competencies of the practicing PA” → physicians will not be required to assume responsibility and liability for PA actions unless directly involved in the care of a patient

• Another aspect focuses on the determination in scope of practice: OTP presumes that processes will be put in place for PAs to establish their own personal scope of practice and that PAs will limit their own scope of practice to those activities and procedures for which they are adequately prepared through training and experience