Intro to PA BLOCK 1
What are the PA competencies established by AAPA, ARC-PA, PAEA, and the NCCPA
1. medical knowledge/application 2.Interpersonal/communication skills 3.Patient Care (high quality and effective) 4. Professionalism 5. Practice-based learning and improvement 6. Systems-based practice encompasses the societal, organizational, and economic environments in which health care is delivered
How many charts does collaborating physician have to check? how frequently?
20% of patient charts every 30 days In specific categories... they must review every 10 days which include: medically indicated, requested by patient, prescriptions fall out of protocol, when PA prescribes controlled drugs (ALWAYS), when PA has temp license
Alternative PANRE
25 test questions per quarter for two year period multiple choice questions of core medical knowledge gives immediate feedback
ARC- PA
Accreditation Review Commission on Education for the Physician Assistant: approves and revises accreditation standards for PA programs
AAPA
American Academy of Physician Assistants: national voice for PAs and represent the interest of PAs
AR-PA
American Registry of Physician Associates: USED TO encourage training and promote actives of Physician associates
AOR
Assembly of Representatives: student academy of AAPA legislative body
Post Pa School: DEA Number
Assigned to health care providers who prescribe controlled substances$731/3 years
APAP
Association of Physician Assistant Programs: Accreditation, certification, and continued education of PAs.... Now called the PAEA
APPAP
Association of Postgraduate Physician Assistant Programs: post graduate curricula and advice to institutions interested in establishing advanced education of PAs in various disciplines
Who denied Eugene Stead's program at Duke University Hospital to expand the capabilities of nurses?
At Duke University hospital, STEAD wanted to extend the nurses. The national league of nurses turned this down... they were worried about the training model STEAD was insisting on... the medical model. `
Professionalism to other Professionals
Be a team player and work together understand roles of other professionals have clear goals
China's Barefoot Doctors
Brought from RURAL production brigades... went through a 2-3 month training course in regional hospitals due to lack of physicians. they were linked to hospitals with medical supervision. many continued on to med school
COPA
Committee on PAs issues license to PAs in TN adopts rules interpreting the PA practice act, conducts discipline of PA violating rules.
Dr. Amos Johnson
Created a similar role to that proposed by Dr. Hudson for his assistant Buddy treadwell
Class 2 drugs
Used medically but ARE highly ADDICTIVE hydrocodone, cocaine, hydromorphone, oxycodone, adderall, ritalin
Class 4 drugs
Used medically, "Low risk" of dependence and abuse benzos, opiates, soma, tramadol
Class 3 drugs
Used medically, lower risk of dependence/abuse than classes 1 or 2 Codeine, ketamine, testosterone, anabolic steroids
Members of an IPP team
Nurse, NP, PA, Pharmacist, MD, LPN, MA, PT, OT, Psychologist, dietician, social worker
Duke University PA program
October 1965, the first PA program was established. 2 year program for hands on, life long learning. Stead began with a generalist approach and let his first 4 students specialize on the job.
COPA
PA board that adopts rules on PA practice in TN, issues license in TN, conducts disciplinary actions for PAs violating rules. meet in TN 4 times a year
Describe the Physician-PA relationship
PA extends arms/brains of physician PA has a COLLABORATING physician Physician accepts responsibility for care delivered by PA/ maintains delegation with PA-including autonomous medical decision making delegated by physician PA works within scope of practice/seeks guidance as needed is an INTERDEPENDENT practice communication is KEY
Spinal injections and a PA
PA must be directly supervised when doing anything invasive involving the spine
Requirements of Collaborating Physician
PA must have one primary collaborator, who must be an expert in the same area of medicine as the PA, who has an unencumbered license to practice medicine COPA must have the physicians name address and license number
requirements on PA prescriptions
PA name name and strength of drug prescribed quantity of drug instructions for use of drug month and day prescription issued MUST report to COPA that they are allowed to prescribe as well with their name, collaborating physician, protocol of drugs they can prescribe
Abortions and a PA
PA will not prescribe dispense or administer meds for abortion
Controlled Substance Database
Per state... health care practitioners who dispense controlled substances must report it to database. also CHECK the database before prescribing opioids or benzos register with database within 30 days of obtained DEA # PA should always document prescriptions in chart
PAEA
Physician Assistant Education Association: national organization representing PAs educational programs
PAHX
Physician Assistant History Society: preserve history/legacy of PA profession
PANCE
Physician Assistant National Certifying Examination: initial PA-C certification
PANRE
Physician Assistant National Recertification Examination: PA must pass every 10 years to keep valid license.... can take the exam in the 9th or 10th year
What are the 3 types of supervision of the Physician-PA relationship
Prospective: look forward, your scope/what you are anticipated to do Concurrent: ongoing... everyday 1.general: physician is available 2. direct: physician is in building 3. personal: physician is in exam room Retrospective: look back at what you have done/quality of care provided by you
PANRE
Recertification exam that PA will take every 10 years which assesses general medical and surgical knowledge 4 hour exam with 240 multiple choice questions.. 4 blocks of 60 questions 60% of exam is primary care. other 40 is your choice of adult med, surgery, or primary care
Post Pa School: Insurance Credentialing and Privileging
Required by JACHO: Verify your education and competency- to obtain privileges you have to document your training and procedures that you have experience with. Use CAQH to apply for credentialing for all insurance carriers because they are all different- also verifies your education and competency
Professionalism to Society
advocate for patients and the profession serve society work to address health care needs be aware of own limitations
Define PA
an individual who renders services, whether diagnostic or therapeutic, which are acts constituting the practice of medicine. an individual who is authorized to person selected medical services only in collaboration with a licensed Physician
Types of physicians that can directly supervise a PA giving spinal injection
anesthesiologists neurologists orthopedists physical medicine specialists radiologists board-certified pain medicine specialists
The PANCE
application and $500 fee schedule within 180 days after lipscomb releases you 5 hour exam, 300 multiple choice, 5 blocks of 60 questions 45 min for breaks 6 year 6 attempt rule
SAAAPA
Student Academy of the American Academy of Physician Assistants: represents students from each PA program society
Addison Sharp Act
TN rule that states 2 hours of CME MUST BE related to controlled substance prescribing every 2years.... also 2-4 cannot be given for more than 30 days at a time
Post Pa School: Certification
Take the PANCE and become nationally certified by the NCCPA
What are WHOs IPE must have skills?
Team work/trust Role recognition:understand your role/others Communication: effective listening/conflict resolution Learning/reflecting: put IPE into practice.. reflect on your role Patient: best interest at forefront Ethics/attitudes: tolerate differences
TAPA
Tennessee Academy of Physician Assistant: TN laws for PAs
a PAs Protocol
The range of services a PA can provide, jointly developed by PA and collaborating physician
Buman v. Gibson
malpractice case against PA and her physician PA strictly performed wound care, physician spent 5% of time on wound care, Court declares that this is irrelevant, because the point of a PA is to OPEN UP a physicians time for more complex medical tasks. this case determined that Physician must examine PA work if: medically indicated, patient request, prescription outside protocol, controlled drug prescription, PA has temp. license
NCCPA Health Formation
nonprofit supporting the NCCPA
Tolerance
occasional, small reducation in meds for short spells to keep tolerance better controlled in those who are taking addictive meds long term
Professionalism to Oneself
Know what you do and do not know... and know when to get help be aware of conflicts of interest practice without impairment
Dr. Charles Hudson
in 1961, this was the MD who proposed the PA concept at the AMA stating a need for physicians to have an assistant/there was a hole to fill in healthcare.
Henry Silver and Loretta Ford
in 1965 they created a practitioner training program for nurses working in peds (NP concept). at this point, PA profession needed someone to TAKE ownership of the concept
Federal Prison System(corpsmen) and US Coast Guard(purser mates)
in the 1930's-1960's the former corpsmen and purser mates extending Physician care was a predecessor to federal PA training programs... each provided medical services as extension to physician service
IPE
interprofessional education: in school, working with other professionals to learn about their role and how your roles interact
IPP
interprofessional practice: multiple health workers work together with patients/families/communities to deliver high quality care it improves patient outcome, cost efficiency, satisfaction, decrease med error, close gaps in services
Eugene Stead
FATHER of the Profession. first to take ownership of the PA concept. recruited navy corpsman to be apart of his first class of students
JPAE
Journal of Physician Assistant Education: peer reviewed journal of PAEA which acts to help advance PA education
JAAPA
Journal of the American Academy of Physician Assistants: peer reviewed clinical journal of AAPA for the support and advancement of PAs
Post Pa School: Maintaining Certificaiton
1. Take PANRE every 10 years 2. Have 100 hours CME every two years
What conditions in America fostered the PA concept?
1. social awareness of PA role 2. positive ideas around health care 3. concerns about over working physicians 4. awareness of physician extender models 5. availability of the ex-corpsman for training 6. need for more clinical professionals
Parts of the Integrity Code
1. unauthorized collaboration- do not work together if it is not a group project 2. Cheating: do not use unauthorized materials 3. Fabrication: do not alter or falsify data 4. multiple submission: do not use a previously used document 5. false citation: cite things correctly 6. plagiarism: do not use another work/words and claim it as your own 7. Facilitating Academic Dishonestly: do not help someone do something wrong
What happened to PA programs from 1965 (after duke started first PA program) to 1971?
16 more programs emerged using similar model to Duke
Henry Silver/ University of Colorado
1969: Child health associate program... those with no prior health care experience could join program as long as they had 2 years of college experience to get graduate training in Pediatric role.
ERF
Education and Research Foundation: support the education and research needs of the profession... now called the PAF or physician assistant foundation.
HOD
House of Delegates: establishes the policies implemented by the board of directors of the AAPA
Feldshers in Russia
In Russia in the 17th and 18th century during the war, Physicians were in a shortage and military needed more care. Feldshers trained on the job to fill in gaps in care. They worked COMPLEMENTARY to physicians Many continued on to medical school after
who can be a collaborating physician?
MD, DO, podiatrist
NCCPA
National Commission on Certification of Physician Assistants: credentialing orgnaization of US for PAs to ensure they meet standards of knowledge before practice
Post Pa School: NPI
National provider number is a unique 10 digit identification number issued by CMS
What are Gaps to interprofessional practice
Silos: know only what you were taught Reimbursement: invoice from multiple providers is not cost effective Space: set up for optimal patient flow... no room for IPP Lack of Training: have not worked together before
What are Gaps to interprofessional education
Silos: taught only about your own field Accreditation Standards: differ from field to field.. hard to implement to accommodate what each group needs Scheduling: every one is on a tight schedule! Faculty: resistance to change
Pathway II
a take-home version of the PANRE
TAPA
a volunteer organization who promotes quality, cost-effective and accessible healthcare, to promote the professional and personal development of PAs consists of a board of directors and 7 committees
Richard Smith
at the university of Washington, smith created the MEDEX model, or medical extension model creating a role of someone who were extensions of docs. set up in NW rural areas where the extenders were trained in primary care with docs who would hire them after clinical.
Integrity as a Provider
be forthcoming with information, admit to your errors, use resources appropriately, keep patient info confidential,
Professionalism to Patients
build trust so they open up to you and tell you what is going on sit down view as a whole person open minded, be ethical/do right by patients listen, empathy, be on time, caring respect, compassion, integrity, altruism advocating for patients, being available
PA emeritus
commitment to the professionalism and standards required of PA-C but who are no longer clinically practicing and do not have the need to be certified any longer
Addiction
compulsive drug craving and use, despite adverse consequences as a PA... ALWAYS have resources ready to give a patient in need of help
Narcotic side effects
constipation, somnolence, dizziness, hallucination, RESPIRATORY DEPRESSION/ADDICTION, jitters, insomnia
CME
continued medical education- 100 hours every 2 years 50 hours category 1: pre-approved activities other 50 can be category 1 or 2 ; C1: conferences/lectures/quizzes online or in medical journals/ACLS PALS BLS certifications (keep for 4 years after in case of AUDIT) C2: educational activities related to medicine, PCE, or role of PA like Reading med journal/precepting/prepare for lectures (no audit on C2)
CSMD
controlled substance monitoring database is used every time you prescribe a controlled med in TN. Use it to check up on people/past prescription history
Speciality Certification or CAQ
credential the PA-C can earn in specialities to show commitment to that speciality 4 CORE requirements to obtain CAQ: category 1 speciality CME, 1-2 years experience, Physician attestation, speciality exam
Why do you have to do more research if METH is + on a gas chrom/mass spec?
d-isomer is a street drug with l-isomer is vicks vapor inhaler
Urine analysis
dip sticks SUCK, use Gas Chromatography/mass spectrometry. this shows the breakdown of metabolites and will show exactly which opioid or benzo is in the urine.
Post Pa School: State Licensure
each state has specific rules on obtaining licensure. TN: $335 and it takes 6 weeks to verify COPA (in TN) is state licensure board renew license every 2 years
How frequently does physician have to visit PA at a remote site?
every 30 days
University of Alabama
first to design a program specifically for surgery
Opiate withdrawal
flu-like symptoms -tachycardia, rhinorrhea, and dilated pupils -abdominal pain and diarrhea too can last a week to a month but they WILL NOT DIE
Class 1 drugs
have no medical use, are HIGHLY addictive LSD, Heroin, MDMA, marijuana
Morphine Milligram Equivalent
other meds per mg compared to morphine hydrocodone and morphine = 1 oxycodone = 1.5 oxymorphone = 3 hydromorphone = 4 etc.
Who should you form professional relationships with as a PA
patient/patient families other health care professionals/health care system society yourself
PA foundation
philanthropic arm of the AAPA
PA-C
physician assistant certified
Hu Myers- WV
program for nonmilitary and those w/o medical experience.developed Alderson-Broaddus program which recruited people from small Appalachian communities to become "PA"- used a campus hospital to train students with no prior med experience
Opiods
substances that act on opioid receptors that are typically used medically for anesthesia, pain relief, and suppress cough
Professionalism
the skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well RESPECT, COMPASSION, INTEGRITY
PI-CME and self assessment CME
there are two types of CME category 1. PI and Self assessment- no longer required self assessment cme used to get awarded an additional 50%... so cme =10 hours the NCCPA used to convert it to 15 hours the first 20 hours of PI-CME also used to be doubled
Alturism
unselfish regard for the welfare of others be available... help and speak up for patients
Class 5 drugs
used medically, mainly for cough or diarrhea, very low risk of dependence and abuse lomotil, lyrica, low dose codeine cough meds
Temporary license
valid for 15 months while waiting to pass PANCE, and can be renewed for 12 more months if they fail PANCE on first attempt AKA maximum duration = 27 months
