PA Professions Exam 1

Name the individuals that served as the first chairman of the PA accrediting organization and the organization's first Executive Secretary, who held that position for two decades.

Malcolm Peterson, MD, and Mr. Lawrence (Mac) Detmer.

Name the Act passed by congress in 1971 that provided direct support for the education of physician assistants.

Comprehensive Health Manpower Training Act of 1971.

Name and define the 3 dimensions (types) of supervision of PAs by physicians.

tense"—although not necessarily side by side—includes consultation while the physician is in attendance. 2) Prospective supervision refers to the established and written practice plans describing the location and content of the practice, as well as daily "patient huddles" to plan for the day's work. 3) Retrospective supervision includes a chart review process as well as "end of the day" presentations and discussions of specific patients.

List the four pillars that are necessary for a newly emerging health profession to succeed.

1) A society of practitioners; 2) an association of educational programs; 3) a nationally recognized body charged with accreditation of the programs; and 4) a process of certification of graduates' competency to protect the public interest.

Name at least two successes that have come from the AAPA working with its State Constituent Chapters to improve laws and regulations that have had a positive impact on PA practice and utilization.

1) Increasing the number of PAs a physician may supervise, in some cases, eliminating ratio requirements altogether, 2) authorizing full prescriptive authority for PAs, and 3) repealing physician-proximity requirements.

State when and where the first organization was formed to represent physician assistant graduates and students.

1968, Duke University, Durham, NC.

List at least 5 ways other than clinical practice that a PA you can help the continued growth and development of the PA Profession

Some Examples: 1) become an officer in local, state or national PA organizations, 2) serve on committees and task groups, 3) serve as an instructor or clinical preceptor of PA and other health related students, 4) become active members of physician specialty organizations or state medical societies, 5) serve on medical regulatory boards and agencies, 6) become a member of PA faculty, 7) conduct research and evaluative studies - publish articles in the PA and medical literature.

After reviewing the videos, list what you believe to be the most important elements that enhance the PA Profession.

Some examples: 1) compassion, 2) awareness of socioeconomic and political issues that impact health care, 3) becoming involved and known in the community, 4) satisfaction of knowing that you have helped someone, 5) excellence in clinical care.

Discuss the importance of the leaders who developed the process of accreditation of PA Programs and explain what is unique about the accreditation of PA Programs compared to other health professions.

Spearheaded by PA Program leaders and the AMA, the development of standards for the education of PAs to work with primary care doctors was a collaborative effort of seven health professional organizations. The work was done through established committees, primarily the Liaison Committee on Medical Education (LCME) of the American Medical Association (AMA) and Association of American Medical Colleges (AAMC) and the AMA's Council on Medical Education. The Essentials were approved by the AMA House of Delegates in December 1971. Soon thereafter, a Joint Review Committee on Educational Programs for Assistants to the Primary Care Physician (JRC-PA) was formed to evaluate compliance with the "Essentials" adopted by the AMA House of Delegates. Malcolm Peterson, MD, (Johns Hopkins) was elected the first Chairman, and Lawrence M. Detmer (AMA) was named Executive Secretary of the JRC-PA.

State at least three provisions in the Affordable Care Act of 2009 that are good news for PAs.

1) It formally recognizes PAs as one of three primary healthcare professions in the U.S., along with physicians and NPs. 2) It provides financial support for the education of PAs who intend to provide primary care services, especially in rural and underserved communities. 3) It provides a five-year, 10 percent Medicare incentive payment for certain primary care. services provided by PAs, as well as other primary care providers, for whom at least 60 percent of services are in primary care. Others 4) It calls for the "Explicit integration of PAs into newly established models of team-based coordinated care, including Patient-Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs). " 5) By acknowledging the critical role of PAs in the healthcare workforce, the ACA sets the stage for reducing barriers to PA practice in state laws and regulations.

Name at least four major private foundations that provided startup funds for PA programs during the 1960s and early 1970s.

1) Josiah Macy, Jr. Foundation, 2) Carnegie Corporation, 3) Rockefeller Foundation, and 4) Commonwealth Fund - and by 1973, the Robert Wood Johnson Foundation.

List at least four ways that federal and foundation funding helped establish the PA profession.

1) Start up support for individual PA programs; 2) The development of accreditation and certification procedures, including the development of the first national certification examination; 3) Conferences to address legal and workforce issues; and 4) Research and Evaluation Studies focused on the use and effectiveness of physician assistants

List at least four types of regulatory agencies and boards that should have PA representation.

1) State medical licensing boards, 2) Hospital credentialing and privileging committees, 3) ARC-PA - accreditation, 4) NCCPA certification - also the Federation of State Medical Boards and Health Systems Administrative Positions such as "Chief PA."

Describe two major collaborative events that occurred in the 1970's that helped the APAP and the AAPA to promote the use and integration of PAs into the American Health Care System. Who were the leaders who led these developments?

1) The APAP - AAPA joint sponsorship of the first National Conference on New Health Practitioners (designed to be open to PAs and nurse practitioners) held at Sheppard Air Force Base, Wichita Falls, TX and 2) the opening of a national joint office for APAP and AAPA with shared staff in Washington, DC in 1973. 3) The first two Presidents of APAP; Alfred M. Sadler, Jr., MD, and Thomas E. Piemme, MD, provided the key leadership in both of these critical developments.

Name four socioeconomic and political issues that caused civil unrest during the early 1960s.

1) Unpopular war in Vietnam, 2) Segregation of African Americans, particularly in the South, 3) Women's Rights and 4) Farm Workers' Rights.

List three benefits of supervised, Physician/PA team practice that is the hallmark of the PA Profession.

1) an individual PA's scope of practice is determined not by rigid rules and regulations, but by their supervising physician, 2) within a single practice, PAs may have different roles and levels of responsibilities when compared to each other and 3) the partnership with the physician provides opportunities to learn new knowledge and skills, advance negotiated roles and assure seamless, quality of care for patients.

List at least three types of non-physician providers used to provide extended health care services in the USA prior to the formalized education and use of physician assistants.

1) hospital corpsmen, 2) frontier nursing (Appalachia), 3) nurse midwifery and 4) community health aides (Alaska).

After reviewing the videos, list at least three types of targeted underserved communities in which PAs found an opportunity to serve.

1) isolated rural communities, 2) urban health - homeless, street youth at risk, 3) Africa - orphanage for children of AIDs victims

Name three key elements necessary for a Physician/PA team practice to be successful.

1) mutual trust, 2) open and honest communication and 3) shared values, availability, consistency and priorities.

List three advantages gained by PAs with the passage of federal health care laws that were intended to improve access and quality of care to medically disadvantaged communities in the 1970s.

Ability to work in satellite clinics without immediate physician supervision, 2) Ability to prescribe and dispense medications, and 3) Ability to be reimbursed for services rendered.

State the name of the first president of the APAP and the year that the organization was formed.

Alfred M. Sadler, Jr., MD, of Yale University; 1972.

State the current name of the organization that represents graduate physician assistants, and name the person who was elected as the organization's first president.

American Academy of Physician Assistants; William (Bill) Stanhope, MS, PA.

List four factors that fueled the demand for health care services in the 1960s.

An increase in per capita income provided more money to spend on health care, 2) An improvement in hospital standards and the availability of advanced diagnostic and therapeutic technologies improved hospital services and outcomes, 3) An increase in availability of employer prepaid health insurance plans, including hospital insurance, provided greater access to services, and 4) The enactment of Medicare and Medicaid health plans for the elderly, disabled and poor, increased access to services.

Describe how State licensing boards often define the practice of a specific Physician/PA team.

Boards often require that the physician and PA write a practice plan, which broadly describes how the two of them will work together. Ideally this practice plan is updated and revised regularly to reflect changes and additional responsibilities in the PA's role.

Describe what benefits were derived from using former military corpsmen as a primary source of PA students in the 1960s.

Because of the Vietnam War, large numbers of military corpsmen were being trained and released from the military annually with no health care jobs available in the civilian sector. Many physicians had previous experience working with corpsmen in the military. Not using the skills of corpsmen in the civilian sector, after their discharge from the military was a waste of taxpayers' money. The Veterans Administration was interested in creating job opportunities for veterans and needed more clinical support personnel in their own medical facilities. Because of their seasoned and experienced health care backgrounds, corpsmen could adjust quickly to the clinical environment and most were men in a men's environment.

Note the important teams of doctors, lawyers and others who defined how PAs should be introduced into each state's health care system and explain the advantages of the recommendations that they made.

California was the first state to enact regulatory type of legislation. These efforts were led in part by Dr. Malcom Todd who at the time was president of the California Medical Association. North Carolina became the next state to pass this type of legislation. These laws amended the states medical practice act allowing licensed physicians to hire and delegate tasks to trained assistants. The state's Medical Board was responsible for propagating rules and regulations and approving the PA's scope of practice submitted to the Board by the PA's supervising physician. The California and NC laws were based on work accomplished at Duke University in 1969 and 1970, funded by the DEHW to develop model legislation for PAs. The project was coordinated by Martha Ballenger, JD, under the guidance and direction of Dr. E. Harvey Estes, Jr, then chair of Community Health Sciences. Concurrently, DHEW's Assistant Secretary of Health, Dr. Roger O. Egeberg recruited Alfred M. Sadler, Jr., MD, and his brother Blair, a lawyer, working at the National Institutes of Health (NIH), to conduct a review of each state's licensing laws involving all allied health personnel and each state's medical practice act. They and those at Duke concluded that amending each state's medical practice act to enable PAs to practice under physician supervision was the preferred legal choice at that time.

Name the physician who in 1960 called for the education of doctor assistants recruited from the "nonprofessional" ranks using the example of corpsmen, mostly high school graduates, who had been trained to assist doctors in the military.

Charles Hudson MD

Name three major pieces of legislation that were passed by Congress in the 1960s to address civil rights and health care issues.

Civil Rights Act and 2) Equal Opportunity Acts passed in 1964 and 3) Medicare and Medicaid Acts passed in 1965.

List at least three major changes that occurred in medical education as a result of the Flexner Report, released in 1910.

Closure of 50% existing medical schools, 2) increased sciences in curricula, 3) decrease in women and minorities in medicine, and 4) medical schools become attached to academic centers - universities and colleges.

Name the individual who served as the first Executive Director of the APAP and AAPA and the first location of joint National Office.

Donald (Don) Fisher, PhD; Washington, D.C.

Name the Physician who in 1961 called for the training of "assistants to doctors" from a new source of health manpower and used the training and use of corpsmen by the military as an example.

Dr. Charles Hudson's address to the AMA was published in JAMA in 1961.

Name the physician that founded the first PA program to be based in a liberal arts college that admitted individuals directly from high school and awarded a bachelor's degree to graduates.

Dr. Hu Myers established the first degree-granting PA program at Alderson-Broadus College, WV, in 1968.

Describe why Amos Johnson, MD, and Buddy Treadwell are recognized as a prototypical physician/PA practice and the significance of their practice, to the PA concept.

Dr. Johnson trained Treadwell to be his doctor's assistant. By the 1960s, Treadwell was providing medical services under Johnson's supervision, like most PAs are doing today. Since their practice was in NC and served as a clinical training site for Duke University medical students, Eugene A. Stead, Jr., MD, had firsthand knowledge of the practice and used it in formulating his plans to educate PAs at Duke University in 1965.

Explain how students and graduates of divergent educational models were organized at first and what circumstances helped to solidify these various groups into "one voice" for physician assistants.

Each educational program produced graduates that were aligned to that particular model of education. When educators organized into one bargaining unit to address issues of accreditation and certification, the students and graduates in these "associated" programs aligned themselves with the Academy and the organization's membership expanded rapidly. With the AMA and federal government's emphasis on primary care, the specialty-oriented PA programs were stymied. To represent PAs on regulatory bodies, the Academy became more inclusive and thus opened its membership to graduates of MEDEX and other types of PA programs.

Name the physicians and nurses who first attempted to expand the clinical skills of nurses at two different Universities and explain why one attempt failed why the other succeeded.

Eugene A. Stead, Jr, MD, and Thelma Ingles, RN, developed a master's degree, advanced clinical educational program at Duke University for nurses in the late 1950s which was rebuffed by nursing (not accredited) because instructors were mostly physicians, and Ms. Ingles baccalaureate degree was not in nursing, although she was a highly trained RN. Fundamentally, organized nursing was trying to improve its own image and was bent on separating itself from medicine. However, Henry Silver, MD, and Loretta Ford, RN, at the University of Colorado bypassed organized nursing and had their program to educate Pediatric Nurse Practitioners accredited by the American Academy of Pediatrics. The program is seen as the forerunner of the Nurse Practitioner concept.

Name two physicians who used former military corpsmen, as their first recruits to be educated as physician assistants and explain the differences in their approach.

Eugene Stead, MD developed a 2-yr academic based program at Duke University in 1965, 2). Richard Smith, MD developed a joint academic/community-based program at the University of Washington in 1968. Stead called his students physician's assistants and Smith called his MEDEX; both used a generalist model of education. A collaborative (with physicians), rapid deployment model was also a feature of Smith's approach to educating PAs.

After reading the following definition of strategic behavior, list and describe four behaviors that you can have that will nurture relationships with others who share the common goal of increasing access to health care across all populations. "The term strategic behavior usually refers to decision-making that takes into account the actions and reactions of other health care professional organizations or their agents. Its essential feature is the recognition of the direct interdependence between one's behavior and that of others."

Example behaviors might include: Respect. As a PA I should be able to promote my perspectives without offending other health professionals, especially with my colleagues at work. I need to develop self-control and a genuine respect for the opinions and feelings of others. Listening. I understand that responding to opinions without taking the time to understand the feelings and perspectives behind them will undermine honest and open communications. Mutual Intent. I need to share my professional goals for health care, understand those of the organization for whom I work, and join with others on the health care team to develop a mutual intent to accomplish these goals. Self-Discipline. I need to recognize when my emotions are getting out of control and how to disengage until I can proceed with a meaningful, constructive attitude. Reconciliation. I need to recognize when I have hurt a team member and make things right. Grudges and other hard feelings stifle open and honest communications and the achievement of mutual goals.

Explain how federal funding shaped the demographics of the PA profession during its first decade of existence.

Federal funding mandated programs to provide equal opportunities for women and under-represented ethnic groups and to educate students and place graduates into primary care specialties, especially in rural and inner-city communities.

Explain how private foundation support was used to solidify the mission and goals of PA educators and graduate PAs in the early 1970s.

Foundation funds helped establish a National Office in Washington, D.C., to serve both the staffing needs of the American Academy of Physician Assistants and the Association of Physician Assistant Programs (now PAEA) and to collect annual demographic information from PA graduates and students.

Explain why in 1976 the name of the accrediting organization dropped primary care from its title.

In 1976, the organizations responsible for accrediting PAs for primary care physicians and for accrediting PAs for surgeons merged into one organization - to accredit Programs for Physician Assistants.

Name two individuals in the videos who are considered community activists and describe briefly their impact on the health and well-being of individuals in their communities

Joyce Nichols became involved in tenants' rights in low rent housing projects, became a member of the housing authority, developed a scholarship program for poor kids and used her education as a PA to serve a predominately medically underserved community. Karen Bass helped organize and manage a community-based social justice group and later became a member of the California legislature and then a member of the US House of Representatives.

State an aspiration of the PA History Society in developing this learning module.

It will inspire all PAs to actively promote the PA profession as a strategy for access to excellent care for everyone!

Explain why Medicare and Medicaid national health insurance plans became necessary in the 1960s

Many Americans received third-party health insurance as a benefit of employment. Without employment, older Americans, the disabled and the poor could not afford third-party insurance - so the federal government intervened, to assure they received access to health care services.

Name the outcome of a grant awarded by the Department of Health, Education and Welfare (DHEW) to the Department of Community Health Sciences, Duke University, in 1970.

Model State Legislation for Physician Assistants - This was coordinated with the work of Alfred M. Sadler, Jr., MD, and Blair L. Sadler, JD, who completed a similar project at the National Institutes of Health in 1969-1970. Both teams collaborated on the proposed solution to licensure for the PA; namely a simple amendment to each State's Medical Practice Act that permitted a licensed physician to delegate appropriate functions to a specially trained assistant (the PA).

Explain how the organizations established to accredit PA educational programs and to certify graduates of these programs, differ from the organizations that oversee other health professionals.

Most accrediting and certifying agencies do not have outside representation on their boards. This is not true for physician assistants. The accrediting body (ARC-PA) includes seven sponsoring health professional organizations and the certifying body (NCCPA) includes thirteen (originally fourteen) sponsoring health professional organizations.

Name the health professional organization that was primarily responsible for developing a national certifying examination for physician assistants and state the year the first certifying examination was administered.

National Board of Medical Examiners, 1973 - This was the first time that the NBME had ever tested anyone other than physicians.

Name the organization that was established to certify physician assistants in 1974, the individuals who served as the organization's first president and as its first executive director, and the location of its first national office, which opened in 1975.

National Commission on Certification of Physician Assistants (NCCPA), Thomas (Tom) Piemme, MD; David Glazer, Atlanta, GA.

Explain why efforts to pass national health care insurance failed in the 1940s and 1950s.

National Health Insurance was viewed by the American Medical Association and by right-wing conservative politicians as "socialized medicine", and was viewed even as being "communistic" during a time of cold war fears; national health insurance was viewed by some as being un-American with a threatened loss of freedom of choice.

Name the federal National Institutes of Health agency that provided a grant to Duke University that helped Eugene A. Stead, Jr., MD, start the first formal educational program for physician assistants in 1965.

National Heart Institute - Dr. Stead was a member of the NHI Advisory Board and had discussed his plans to start a program to educate PAs with other members of the Board prior to the grant being submitted.

Explain why initial federal funding did not mandate that PA and MEDEX programs offer baccalaureate degrees to graduates.

Obtaining liberal arts requirements for degrees would prolong length and cost of PA education. At the time local clinical needs far outweighed academic considerations. The requirement that entering students would need 2 years of college credits would impede the enrollment of highly experienced corpsmen and non-degree nurses, which at the time were the mainstay of the applicant pool. The PA and MEDEX curricula were "competency based" rather than "degree based."

Name the important event that took place on the day that fourteen health professional organizations met and signed papers to establish a national commission to certify physician assistants (NCCPA).

On August 8, 1974, Richard Nixon stated that he would resign as President the following day.

Explain why physician assistants can say that they are "partners in health care" and really mean it.

Our professional history and legacy has always been one of collaboration with physicians which, although often talked about by other professions, such as nursing, is not honored in their certification or accreditation processes.

State the major benefit that the Balanced Budget Act of 1997 had on PAs (and NPs).

PAs and NPs were recognized in this Act as Medicare covered providers in all settings at a uniform rate of payment (85% of physician level). These federal rates were subsequently accepted by other 3rd party payers and paved the way for expanded acceptance and utilization of both groups.

Explain why it is important for current PAs to see themselves in pioneering roles, as PAs who graduated in the 1960s and early 1970s did.

PAs are still a small workforce compared to medicine and nursing. As access to health care improves, many patients are having their first encounter with a PA - educating patients to the role of the PA remains important; As PAs are given more responsibility for patient care, even patients who have been seen by PAs, may see them more often in other settings - providing quality, patient centered care will be important across all fields of medicine and surgery.

Name two leaders mentioned in this module that played key roles in securing federal funding for PA education programs and administration of these funds including grant management.

Paul Rogers, a lawyer and long-term Congressman from Florida, championed the PA profession in its early years. As the powerful chair of the House Subcommittee on Health and the Environment, he was an avid supporter of Title VII legislation that provided funds for PA Programs. Rogers collaborated with Dr. David Sundwall, staff director of the US Senate Labor and Human Resources Committee, to assure continued funding throughout the 1970s. Rogers and Sundwall worked closely with Hilmon Castle MD and Bill Wilson from the University of Utah MEDEX PA Program. Sundwall was a primary care physician from Utah.

After reading the biography of one of the pioneering researchers who studied physician assistants (see biographies at http://www.pahx.org/bio.html) write a brief description of his or her contribution to the field.

Richard M. Scheffler, PhD was one of the first economists and health care policy fellows to study the potential impact of using physician assistants (PAs) in the delivery of health care in the United States. He performed his first national study on PAs in 1972, describing the role and practice characteristics of a sample of 150 PAs. Eugene Schneller's book titled Physician's Assistants: Innovation in the Medical Division of Labor was published in 1978. He was the first sociologist to analyze the newly emerging PA profession, which he felt, at the time, was a significant innovation in the medical division of labor. He coined the term, "performance autonomy," to describe how PAs assumed more responsibility over time, negotiating their roles within a given clinical setting. Dr. Jane Cassels Record, another economist, released her book, Staffing Primary Care in 1990: New Health Practitioners, Cost Savings and Policy Issues in 1981. The book was based on a decade of studies of physician assistants and nurse practitioners working in the Kaiser Permanente Health Plan, Portland, OR. In 1979, Dr. Henry Perry, a general surgeon, surveyed 552 chairmen of departments of surgery with hospital beds greater than 400 and found that 67% of the chairman felt that the addition of PAs to their staffs had improved patient care and to a little lesser extent, improved the training of surgical residents. Based on the survey, Perry predicted that a greater number of PAs would be employed in surgery, reducing the number going into primary care and medicine.

After reviewing the videos about Ruth Ballweg and Admiral Mike Milner, describe how they responded to opportunities that led them into varied and interesting careers as PAs.

Ruth Ballweg, a MEDEX graduate, practiced clinically, then became involved in education, helped save the Northwest MEDEX/PA program, secured millions of dollars in grants to improve health care in the northwest and has become involved in the movement to establish PA-type programs internationally. Mike Milner a former Air Force corpsmen, graduated from the Oklahoma PA Program and joined the Public Health Service, became the Chief of PAs working in the Indian Health Service, later helped plan strategies to combat influenza outbreaks and bioterrorism and then worked to improve health in the federal bureau of prisons. He obtained the rank of Admiral in the US Public Health Uniformed Services.

After reading the biography of one of the non-PA pioneering educators featured in this module (see biographies at http://www.pahx.org/bio.html) write a brief description of his or her contribution to the field

Suzanne Greenberg (Northeastern University), the first women director of a physician assistant program, served as APAP's first secretary and treasurer. Her background was in social work. Jesse Edwards, a cofounder of the Nebraska University PA Program, helped develop the first computerized test item bank used by APAP programs to evaluate and compare student's academic progress. He developed a joint university and military service program and later, a distant learning curriculum to provide early PA graduates, master degrees. He was a retired major from the US Air Force with an administrative background. Denis Oliver served as director of the Iowa University Program for nearly 20 years. From 1984 until 1995 he conducted and published the APAP's Annual Report on Physician Assistant Programs. Oliver held a Ph.D. in Biochemistry. William (Bill) Wilson was a co-founder and first director of the Utah University MEDEX PA Program. He worked behind the scenes to establish federal funding for emerging PA programs, from the Bureau of Health Manpower, DHEW. Greenberg, Edwards and Oliver, also served as presidents of the APAP (now PAEA).

Name two pioneering leaders of private foundations mentioned in this module and describe their contributions to the development of the PA profession.

Terrance Keenan was a trailblazer in health philanthropy serving first at the Commonwealth Fund of New York in the 1960s and later at the Robert Wood Johnson Foundation for decades. He was one of the first private foundation leaders to recognize and support the education and use of PAs and NPs to assist primary care physicians. As a leading philanthropist in the Carnegie Corporation, the Robert Wood Johnson Foundation and finally as President of the Commonwealth Fund, Margaret Mahoney played a vital role in the use of PAs and NPs in primary care. She served as a member of the NBME's Goals and Priorities Committee that recommended the NBME develop a national certifying examination for physician assistants in the early 1970s.

Explain how the American Academy of Physician Assistants (AAPA) is organized and how policies are considered and made by the Organization.

The AAPA is a confederation of PA State Chapters and PA Specialty Interest Groups. The House of Delegates (HOD) is the Academy's policymaking body. The AAPA provides continuing medical education opportunities for PAs through its annual conference, and advocates for effective legislation and reimbursement for PA services.

Discuss the steps taken to develop a process of national certification of Pas; identify two or more leaders who were instrumental in making this happen and explain what is unique about the certification of PAs compared to other health professionals.

The AMA and the National Board of Medical Examiners (NBME) joined forces in April 1972 to develop a national certifying examination for the assistant to the primary care physician. At the time,. John Hubbard MD, a renowned pediatrician, was the President of the NBME. He chose Barbara J. Andrew, Ph.D., to direct the project. The Advisory Committee formed to develop the examination and its supporting subcommittees included a diverse array of professionals: physicians, physician assistants, MEDEX, nurses, and lawyers representing educational programs, professional organizations and private foundations. The first certifying examination for PAs was administered in December, 1973. In 1974, fourteen national health organizations came together to form the National Commission on Certification of Physician's Assistants (NCCPA) to provide oversight regarding eligibility and standards for the NBME examination, and to assure state medical boards, employers and the public of the competency of PAs. Thomas E. Piemme, MD, was elected the first president and David L. Glazer was selected as the first Executive Director. An office was opened in December in Atlanta, GA. Again, having other health professions involved in the certification process for PAs is unique compared to other health professions.

State the name of the present organization that accredits PA educational programs, its current status as an accrediting agency and the location of its national office.

The organization changed its name to the Accreditation Review Committee on Education for the Physician Assistant (ARC-PA) in 1981, became a freestanding accrediting agency in 2001, and is located in Johns Creek, GA - north of Atlanta. It is now called the Accreditation Review Commission on Education for the Physician Assistant, Inc.

Explain why it was important for PA educators and graduates to develop accreditation standards and a national certification process using the American Medical Association's and the National Board of Medical Examiner's organizational infrastructure and affiliations, rather than doing this on their own.

The AMA had tradition of working with "allied health professions", an experienced staff, resources and the ability to obtain federal and private foundation funding to develop accreditation and the NBME had the experience and expertise concerning certification processes for a newly emerging profession; (especially for the PA - who was to help physicians meet the demand for health care services). The AMA's working relationship with the AAMC and NBME allowed task groups to be formed quickly, that included representation from many key health professional organizations. Having organized medicine involved, assured the public, policy-makers and funding agencies, that PAs were well educated and highly qualified to practice medicine in partnership with physicians.

State the name of the current organization that represents PA educational programs throughout the United States.

The APAP changed its name to the Physician Assistant Education Association (PAEA) in 2005.

Describe the health professional organization that was responsible for developing and approving the education essentials for physician assistants, the year the essentials were adopted and the name of the organization established to accredit programs that met the standards.

The American Medical Association (AMA) was responsible for drafting the essentials, with input from other health professional organizations; the AMA House Of Delegates (HOD) adopted the essentials in December 1971 and the Joint Review Committee for Educational Programs for the Assistant to Primary Care Physician (JRC-PA) was established in 1972 to accredit PA programs.

Describe the current status of the NCCPA

The NCCPA serves the public through exemplary programs that evaluate critical PA competencies and require the pursuit of life-long learning and improvement. It establishes eligibility requirements, develops, administers and evaluates both entry-level and recertification examinations and logs continuing medical education hours, necessary to maintain certification. The board is composed of 13 supporting health organizations; the national office is located in Johns Creek, GA - north of Atlanta.

Describe the function of the American Registry of Physicians' Associates and its role in meeting the needs of PA Educators and the profession.

The Registry was formed to keep track of PAs who graduated from 2-yr based academic programs and to assure employers and the public that they met a common core of competencies. The Registry did not have the resources for educators to address issues of accreditation, certification, and enactment of state enabling legislation, funding and faculty development. The Association of Physician Assistant Programs (APAP) was formed for these and other purposes.

Describe the final outcome of a 'White Paper on the Physician's Assistant' written by Alfred M. Sadler, Jr., MD, Blair L. Sadler, JD, and Ann A. Bliss, RN, MCSW, of the Yale University School of Medicine, in 1971, and funded by the Aid to Crippled Children Foundation, the Carnegie Corporation, the Commonwealth Fund, the Macy Foundation and the Rockefeller Foundation.

The following year, the paper was expanded into the first book written about PAs in the U.S., entitled The Physician's Assistant: Today and Tomorrow, which was published by Yale University Press (256 pages) and distributed widely without charge, by the five Foundations.

Describe what medicine and the delivery of health care services looked like in the first half of the 20th century.

The medical profession was mostly white and male dominated, there were more generalists than specialists, most physicians worked in private office-based practices, fee-for-service was the primary method of payment (out-of-pocket), and hospital cost per capita was low.

Describe the basic commitment that a physician makes when he or she agrees to supervise a physician assistant.

The supervising physician agrees to be available to the PA at all times to review patient findings and to recommend and discuss treatment options.

Describe the current status and relationship of the PAEA (former APAP) and the AAPA.

The two organizations have their own separate offices and staff located in Washington, DC and Alexandria, VA; sponsor separate annual conferences; and have their own professional publications. The two organizations continue to share volunteer leadership and remain in close communication on policy matters that effect the PA profession. (In 2015, the PAEA office moved into the newly constructed AAMC building in Washington, DC)

State at least three factors at the time, which led nursing leadership to reject an excellent and pioneering program to provide advanced clinical skills to nurses.

There was a shortage of nurses, 2: Steps were being taken to improve the image of nursing by requiring RNs to have baccalaureate degrees, 3) The Duke program's instructors were primarily physicians not nurses and Ms. Ingles did not have a degree in nursing although she was a highly trained and skilled RN, 4) Nursing leadership was involved in the feminist movement; (most physicians were men and most nurses were women) and 5) Role identification - nursing leadership could not envision a hybrid nurse-physician practitioner or nurses working under the supervision of a physician. Nursing saw its role and knowledge base to be separate and distinct from the practice of medicine.

Obj. 3: Describe the impact of WWII and its aftermath on medicine, and the delivery of health care services in the 1950s and 1960s.

There was an increase in number of specialists compared to generalists, there was a shift from office to hospital care, there was an increase in availability of third party health insurance, there was an increase in diagnostic and therapeutic procedures that could be offered to the public, and there was an increase in the nation's gross domestic product, with associated increase in family incomes, that increased the demand for health care services.

Explain what additional steps must be taken by a nationally certified PA, who decides to work in a hospital, health care system or to be reimbursed by some third-party insurers.

They must be further "credentialed" and "privileged" by the system's credentialing and privileging committee based on education, certification, licensure and experience.

Describe the events and name the people and university where the first attempt was made to provide nurses advanced clinical skills in the 1950s.

To address shortage in clinical support personnel, Eugene A. Stead, Jr. MD and Thelma Ingles RN, a prominent nurse educator, developed an advanced clinical nurse specialist program at Duke University that was rebuffed (not accredited) by organized nursing leadership (the National League for Nursing).

Explain how the issues of accreditation and certification helped unify the PA profession

To improve communications and decision making, the AMA wanted to deal with only one organization representing the interest of graduate physician assistants. This was necessary for PAs to have representation on the accrediting Board. In order to be that organization, the Academy (AAPA) had to become inclusive, accepting MEDEX and specialty trained PAs as members. PA educators were already collaborating on accreditation and certification issues and when formed in 1972, the Association (APAP) opened membership to any PA program that met the AMA standards for educating primary care PAs. The AAPA and APAP (now PAEA) leadership worked closely to assure that each organization's goals were met and that each had fair representation on the accrediting and certifying agencies.

State two benefits of offering a degree to PA graduates.

Within professional ranks, degrees are important and can help improve acceptance by physicians, nurses and the public, 2) Being in a degree-granting program made students eligible for scholarships, student loans and Public Health Service forgiveness loans.

Choose one of the physicians who founded a model PA Program and describe the program's characteristics and purpose.

curriculum was divided into a didactic and clinical phase. His first students were all former military corpsmen. Students were educated as generalists but could use clinical electives to obtain more experience in a specialty area of medicine or surgery. In 1968, Richard Smith established a receptive framework to win support at the local, state and national level for his MEDEX approach of educating and deploying students into the communities, where they were trained by local physicians and would remain after graduation. The program was based at the University of Washington and was intended to meet the needs of northwestern states. Like Stead, he used former military corpsmen, building on their previous knowledge and skill. Hu Myers believed that degrees would motivate people to become "doctor assistants" and make them more readily accepted by doctors, nurses and patients. He launched his 4-year, degree granting program at Alderson-Broaddus College in 1967. This liberal arts college was not affiliated with a medical school. Applicants were not required to have previous health care experience and were accepted directly from high school. In 1967 at the University of Alabama in Birmingham, John Kirklin decided that surgeons could benefit from having assistants as members of their surgical teams. He was concerned about an oversupply of surgeons and believed highly educated assistants could substitute for surgical house staff, thereby, reducing the number of residents needed in surgery. This led him to establish the country's first Surgeon Assistant (SA) Training Program, eventually gaining the approval and support of the American College of Surgeons. In 1968 Henry Silver launched the Child Health Associate Program at the University of Colorado Medical Center. Individuals with 2-3 years of college education enrolled in the 3-year training program to become physician assistants to provide primary health care services to children. The Child Health Associate program was the first PA program to offer its graduates a master's degree.