INTRO TO PA EXAM REVIEW

NCCPA

National Commission on Certification of Physician Assistants
only certifying organization for PAs in US
releases a statistical report of PA salaries

AAPA

American Academy of Physician Assistants
serves as central organization
can approve CME

CME

Continuing Medical Education

ARC-PA

Accreditation Review Commission on Education for the Physician Assistant

PAEA

Physician Assistant Education Association

AOR

assembly of representatives

SAAPA

Student Academy of the American Academy of Physician Assistants

HOD

House of Delegates

student government society

involved in community/state/national level activities

Who wrote a letter to duke university proposing the PA program in 1964? (Considered the founder)

Dr. Eugene Stead

Feldshers

european military - 17/18th century
russia had shortage of physicians
feldshers practiced in the military, but when retired practiced in the community
provided most medical care in Alaska in 1800s
schools established in 1900s to start training
feldspars were encouraged to take med school entrance exams
care was "second class" = required more supervision
urban feldspars limited to primary care in ambulances/triage NOT hospitals or clinics

barefoot doctors

1965 - china's healthcare system
chosen from rural production brigades
linked closely w hospitals for training
were encouraged to apply for med school and given priority
1981 - terminated due to abolishment of communes

feldshers and barefoot doctors dwidled because

lack of government support and growth of physcians

PAs are becoming more

Autonomous

overview of development of PA profession

1930s - military corpsmen in prison extend services to prison doctors
1940s - Henry "Buddy" Treadwell is employed as a tech and trains as a "doctor's assistant" under Dr. Johnson
WWII (1942) - fast-track medical curriculum (3 years) is developed by Eugene stead Jr. **curriculum serves as future PA education***
1950s - Eugene trains Thelma Ingles (RN); masters of nursing established but not accredited by National League
1964 - Eugene proposes PA program to Duke Uni.
1965 - 4 military corpsmen are first PA class
1966 - People V Whittaker
1967 - first PA class graduates
1968 - AAPA created at Duke Bill Stanhope first pres.
1969 - JCAHO releases report on PAs
1970 - multiple programs developed
1972 - created PANCE, APAP and JRC-PA
1974 - NCCPA created and *CONSTRUCTION OF TRANS-ALASKA PIPELINE (PAs chosen to provide med services)*
1980s - 42 PA programs
1981 - PANRE created
1984 - Canadian forces begin training
1988 - JRC-PA renamed to ARC-PA
1990-2000 - bachelors transitioned to masters programs
2001 - CASPA, first program in Netherlands
2005 - APAP renamed to PAEA, first UK program
2007 - **ALL 50 STATES ARE ALLOWED TO PRESCRIBE**
2011 - KAREN BASS
2023 - 303 programs, over 168,000 PAs

rankings of PAs with developing programs

Type A, B and C
type A broadly trained 2 year program is the model used today

national PA day

October 6th (also Eugenes bday)

What were 3 groups that inspired the creation of Physician Assistants ("not just based on the American Concept")?

Feldshers in Russia, Barefoot doctors in China, and Military corpsmen in America

Where was the first PA program introduced in 1965?

Duke university

in 2010 why did the immense need for additional manpower, especially in primary care settings start? (this lead to more need for PAs in the field)

Obamacare (Medicare and Medicaid)

Who was the first PA to hold a seat in the US house of representatives?

Karen Bass

Should PAs be adaptable and flexible with patients when working in the field?

absolutely

interpersonal & communication skills

verbal, nonverbal, written and electronic

What should PAs use instead of "medical knowledge" or "knowledge for practice" methods?

patient-centered practice knowledge

patient-centered care

patient and setting-specific assessment and evaluation
management and healthcare that is evidence based, supports patient safety and advances health equity

core competencies for PA profession were created by

NCCPA, ARC-PA, PAEA, AAPA
(2004)

What are the 6 core competencies?

SHHIPP
1. Patient centered practice knowledge
2. Society and Population health
3. Health literacy and Communication
4. Interprofessional collaborative practice and leadership
5. Professional and Legal aspects of Health Care
6. Health Care Finance and Systems

practice-based learning & quality improvement

Demonstrate the ability to learn and implement quality improvement practices by:
critical analyze self, medical literature and other resources
use info for self-eval, lifelong learning, and practice improvement

society and population health

Recognize and understand the influences of pt, family, population, environment and policy on health of population

Population Health Approach

required for improving health outcomes and reducing health disparities

paradigm shifts

values teamwork and emphasizes team-based approach to decision-making and care
focus on health rather than disease
emphasis on "putting it all together"
use of "patient-centered practice knowledge" NOT "medical knowledge"
treat patient and populations, not just patient

cultural humility

state of openness toward understanding and respecting important aspects of other people's cultural identities

what domain is intended to underscore the importance of two key related tenets required for patient-centered care?

health and literacy communication

1. pt's capacity to understand info about their health
2. ability of provider to communicate w pt, making sure they understand

professional and legal aspects of healthcare

1. practice medicine in ethically & appropriate ways
2. new grads need to demonstrate professional maturity & accountability to deliver safe & quality care
3. prioritize patient needs over self
4. new grads must use self-assessment, metacognitive skills, and exercise humility & compassion for patient-centered care

health care finance and systems

essential knowledge and skills needed to successfully navigate health care system
understand micro- and macro-systems of healthcare impact pt outcomes
undersand economic factors that limit access to healthcare (how to deliver high quality care in value-based system)
understand role and productivity limits and the impact on finances and organization

What are PAs governed by? What are nurses governed by?

PAs --> board of medicine
NPs --> board of nursing

what is an interdisciplinary team?

everyone you work with (physician, PA, RN, PT, OT, cardiologist, neurologist, etc)
patient-centered care
all collaborate for 1 pt

qualities of interdisciplinary team

1. leadership and management
2. communication
3. personal rewards, training, development
4. appropriate resources/procedure
5. appropriate skill mix
6. climate
7. individual characteristics
8. clarity of vision
9. quality and outcomes of care
10. respect/understand roles

leadership and management =

need clear leader who acts and listens, democratic and shares power

communication =

leader needs good communication skills and ensures there is system in place to communicate

personal rewards, training, development =

incorporate individual rewards/opportunity; continued training

appropriate resources/procedure =

good structure, set meetings, ensure procedures are in place to uphold goal for pt

appropriate skill mix =

need different ppl with different skills

climate =

culture of trust btw team, value contributions

individual characteristics =

know strengths/weaknesses of team; work towards same goal

clarity of vision =

portray uniform image, clear set values

quality and outcomes of care =

patient-centered; encourage feedback for self-assessment

respect/understand roles =

share power, joint working, autonomy

What are some top concerns of Physicians?

Supervision roles = don't want to check someone else's work
Prescribing = what does Dr feel comfortable having PA prescribe (ex: DEA license)
3rd party reimbursements = might not get paid as much w a PA (gov't reimburses 85% of PA care)
Malpractice coverage = coverage might go up
How do I hire? - acquire CV and interview

who has a remarkably lower rate of malpractice liability?

PAs

T/F more than 1/3 of PAs report being hired from their clinical preceptor

TRUE

why hire a PA

• broad base of knowledge/experience

• scope of practice defined by physician

• range of diagnostic and therapeutic procedures

• enhance coordination of care and pt satisfaction

benefits of hiring a PA

easing physician workload = improve flow, efficiency and access to care
cost effective = every $1 generated, PA gets paid 0.30
boost pt satisfaction = 86-96% satisfaction; good interpersonal care, confidence in care and understanding of problem; easier access to appts

Physician-PA relationship

supervision (prospective, concurrent and retrospective)
delegation
consultation

prospective vs concurrent vs retrospective supervision

prospective = agreement made at time of employment delegating duties, responsibilities and scope of practice of both parties
concurrent = oversight/availability of physician; general (available at all times), direct (onsite), personal (in room)
retrospective = evaluation of performance, peer reviews, cosigning charts

Is the supervising physician considered always the employer?

no

Who determines what tasks/patients the PA gets? (scope of practice)

the supervising physician

can be on site or offsite

Should the PA have a written agreement that states any care they provide is ultimately the physician's responsibility?

yes

What should Physician-PA delegation not be confused with?

Protocols (too tedious, not flexible, frowned upon)

Should the physician be available to PAs at all times?

YES!

physician should be available either on site, via telecom, or have physician see pt same time as PA

practice settings for PAs

primary = internal med, family med, peds
specialty = GI, ENT, surgery, OBGYN, etc

difference between NCCPA and AAPA

AAPA = all PAs, students and pre-PAs
NCCPA = only CERTIFIED PAs

US DOL predicts PA occupation to grow

30% from 2014 to 2024

faster than average for all occupations

growth of PA profession is due to

expanding health care industry and aging boomer population

in early years of PA profession, it was considered to be

predominantly in-practice profession and determined by 2 training programs (duke vs medex)

recent shift from in-patient to out-patient but is now shifting back to in-patient due to hospitalists

What training is considered a "duke" model approach?

Hospital based training

What training is considered a "Medex" model approach?

Out-patient training

T/F : any specialty available to physician is available to PA

true

what are the exceptions to specialties available to PAs?

ophthalmology, and highly specialized care

residencies available for PAs

primarily surgery
derm, EM, critical care med

STARPAHC

space technology applied to rural Papago advanced health care

- partnership between NASA and Indian health services
- funded remote med services to Native Americans in Papago reservation and astronauts in space

What is telehealth?

a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies.

What are some examples of telehealth?

Mobile app that alerts the public with a disease outbreak,
Video conference platform for medical education

What is telemedicine?

A specific kind of telehealth that involves a clinician providing some kind of medical services.

use of med info unchanged from one site to another via electronic communication in order for provider to address pt concerns

can include 2-way video, email, smart phones, robotic surgery

What are some examples of telemedicine?

Mobile app that lets physicians to treat their patients via video chat
software that allows PCP send pt photos of rash/mole to derm for quick diagnosis

types of telemedicine available

1. store-and forward (asynchronous) = share pt info with provider at diff location, consultation with specialist, pt and PCP don't need to happen at same time
2. remote patient monitoring (RPM) = tracking health data from distance; AKA telemonitoring/home telehealth
3. real-time telemedicine (synchronous) = live interaction btw provider & pt via video-chat (teladoc or doctorondemand)

benefits of telemedicine

1. more convenient/accessible
2. saves on cost
3. increase pt engangement
4. extend access to specialist consults
5. better quality pt care

cons of telemedicine

1. requires training and equipment
2. some models may reduce care continuity
3. reduce in-person interactions
4. reimbursement is tricky

top specialties for telemedicine

derm
radiology
psyciatry
ophthalmology
nephrology
obstetrics
oncology
pathology
rehab

telehealth etiquette

appearance, no distractors, privacy, nonverbal/verbal communication, empathy

how many telehealth resource centers in US

14
all funded by HRSA

optimal team practice

all healthcare professionals work together to provide quality care without burdensome admin constraints
allows PAs to practice to full extent
brings healthcare access to pts who need it

how do states allow PAs to practice to their full extent?

eliminate specific physician-PA relationship
rate separate majority-PA board to regulate PAs
add PAs to medical/healing art boards
authorize PAs to be eligible for direct payment

ARC-PA timeline

1971 - "essentials" developed with AMA
1997 - essentials became standards
2001- ARC-PA separated from Commission on Accreditation of Allied Health Education Programs
2019 - 5th edition of standards released

how to get accreditation from ARC-PA

do not need to know dates, just focus on overview and when you get accreditation

provisional accreditation process:
- does institution meets eligibility requirements?
- submit a formal written request for entry
- site visit
- program obtains app packet from ARC-PA
- submit ARC-PA FS (due 6 months before site visit)
- FS feedback given form ARC-PA
- provide formal response with app to any issues that arose
- submit completed app (due 3 months before site visit)
- provisional process = 3 site visits (a permanent director must be in place)
visit 1 = 6-12 prior to matriculation; eligible for accreditation-provisional
visit 2 = within 6 mo of graduation of first class; continue as accreditation-provisional
visit 3 = 18-24 mos after 2nd visit

all visits passed = accreditation-continued!

breakdown of the 5th edition standards

section A = admin (A1-3)
section B = curriculum & instruction (B1-4)
section C = evaluation (C1-2)

Section A of standards

sponsorship, institution responsibilities/resources, program personnel, operations, policies, faculty/staff records

section B of standards

curriculum, didactic instruction, clinical, assessment of student learning

section C of standards

program self-assessment, clinical site eval

mission of PAEA

Leadership, innovation, and excellence in PA education

basically what helps programs run their faculty and what needs to be included in lectures

PANCE

Physician Assistant National Certifying Examination
can be taken 6 times over 6 year period (only 3 times a year)
300 MC questions (60 Q/min)
5 hr exam

PANRE

recertification required every 10 years
process can begin in 9th year
have 2 attempts
option to do focused PANRE (60% general, 40% focused)

PANCE / PANRE Blueprint

cardio - 13%
GI - 9%
pulm - 10%

professional practice Qs is most recent section added (ethical questions)

CME requirements

100 hrs every 2yrs
50 cat 1 = articles w tests, attending lectures, CPR/ACLS/PALS

50 cat 2 = reading journals, hour by hour, UpToDate

category 1 PI vs SA

must have 20/50 hrs for first 2 years (1 cycle), over 4 cycles must have 40 total of each category
PI = performance improvement (comparing to national standards); credits logged during every 2 yr cycle is doubled
SA = self-assessment (review own skill set); given 50 additional credit (ex: 10 credits is covered to 15 by NCCPA)

requirements for PA license in FL

- must be 18 y/o
- graduated from PA program
- sworn statement for any prior felonies
- sworn statement for any previous license revocation
- 2 LOR
- 2 credit hrs of medical error CME, 1 domestic violence, 1 HIV/AIDS, 2 prescribing controlled substances

what do you not need to provide to obtain license in FL

transcript/course content in pharm if they want to prescribe

how often do you renew PA license

every 2 years
eligible once you finish 100 CME hrs

CAQ

Certificate of Added Qualifications

4 requirements: pass exam, 1-2 yrs in field of specialty, physician attestation, Cat specialty CME

what must you complete if you are a prescribing PA

10 hrs CME in specialty
medical errors every 2 years
dom violence every 3rd renewal
prescribing controlled substances