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list 2 professions similar to a PA that were developed in other countries
- Feldshers in Russia
- Barefoot Doctors in China
- started in 17th and 18th century by peter the great
- provided medical care to military and rural russia
- 19th century formal training
- experienced could prescribe diagnose and treat
describe barefoot doctors
- started in 1965 in china
- initially 2-3 months training to indepedent practice
- 1982 more BD that PA, but now opposite
how did pa start in the us?
- 1930s former corpsmans trained for prisons
- wwii coast guard purser mates
- 1961 ama conf discussed
what was the first pa program in the us?
- 1965 duke university 4 corpsmen
- 2 year program emphasized GP, lifelong learning, adapability
why did military corpsman make good pa students?
had skills and experience from war, didn't take away from other fields, allowed transition to civilian life
how were pa programs initiated?
16 pioneer programs for pa/np, medex in NW, CHAP in colorado 1969
what was the first pa graduate degree?
child health associate program colorado 1969, first masters degree
AB pa program?
developed by Hu Myers MD, campus hospital, first four year college to offer a BS degree
Why assistant vs associate?
AMA house of delegates voted to use "assistant"
how many new programs from 1971 to 1973?
31 new pa programs
how many graduates in 1975? (ten years after duke)
1282 pa grads
how many more programs from 1974-1985?
9 more programs
how many practicing pa in 1985?
16,000 estimate by aapa
how many pa programs today vs early 80s?
136 today vs 56 in early 80s
who grants certification to pa?
how do you get certifiied as a pa?
graduated from accedited program then pass the PANCE, then granted from nccpa
how do you recertify as a pa?
- 100 hours CME every 2 years
- retake PANCE every 6 years
what is the PAEA?
PA education association, originally apap changed name in 2004, supports program faculty, online directory and CASPA
What are the three key components of professionalism?
- 1 - commitment to serve
- 2 - specialized body of knowledge
- 3 - ability to self regulate
What are some other components of professionalism?
altruism, accountability, respect, itegrity, ethics, honesty, compassion, lifelong learning, excellence
How does a professional behave toward a patient?
- -put their needs first
- -sensitive and responsive to diversity
- -respect, compassion, integrity
how does a professional behave toward the public?
responsive to needs, commitment to ethics and accountability, and adheres to requirements
how does a professional behave toward themselves?
- -commit to excellence, development
- -know their limitations
- -practice without impairment
- -self reflection and initiative
describe the pioneer period of pa
- mid 1960s through 1970s
- medicare and medicaid
- by end of 1970s 50 programs
what are the factors of compact curriculum?
- mission statements identify the role of graduates, MSU=rural
- breadth and depth offers sufficient background for understanding
- superfluous and redudant content is eliminated
when were the first set of academic standards published for PA education?
- 1971 - diverse approachs with basic standards, from different institutions.
- patient centered education to ensure interpersonal skills
who were the first pa educators?
not pa or clinicians, variety of medicine social work chemistry nursing and biology, all focused on health care
what population are most pa programs dedicated to serving?
any underserved population, rural urban minority etc
what was the maturation period of pa education?
1980s, hmo ppo drg, managed care, pa are cost effective and high quality
what were programs like during 1980s?
became permanent, tenured faculty, adapted to population, focused on primary care
what was the boom or bust time in pa history?
1990s, rapid growth of managed care and influence of insurance, pa in high demand and greater salary
how many programs were there in the 1990s?
started with 51 ended with 120, 10 to 1 applicant ratio
what about pa in the 00s
economic stresses, baby boomers retiring, uninsured
what does the aapa believe about pa degrees
should be masters degrees but no deadline
how many programs are masters degrees as of 2007?
what is the definition of credentialing?
a process that gives a title of credit showing that a person is entitled to or has a right to exercise official power
what is the definition of accreditation?
putting in a reputable category, vouching for the maintainance of standards which allows for credentialing, it is a process of external peer review to determine if standards are being met
who accredits pa programs?
ARC-PA, establishs standards, defines and adminsiters review of programs,
when did ARC-PA start?
what are the ARC PA standards?
institutional responsibilities, admissions, faculty, curriculum, expected competencies, clinical practice, facilities, affiliateions, students, fiscal, publications, record keeping
what is the accreditation process?
apply, submit a self study, undergo a site visit
what does graduation from an accredited school mean?
programs meets standards, student recognition from peers, eligible to certifiy, register and license
what is the paea?
pa education, help faculty in 135 programs, caspa, directory
why is national certification important for pas?
give pa mobility, provides evidence of compentency to employer, and flexiblity to transition
what is the pance?
national certifying exam first admnistered in 1973-74 by NMBE then by NCCPA
what is the NCCPA?
established in early 1970s by AMA, ONLY creditialing org for PA, all states rely on
what does the NCCPA do?
determine elegibility, review applications, adminster exam, determine standards, issue certs, re cerrity, publish pa cert list, serve as resource, conduct research
describe the pance
360 multiple guess, basis medical knowledge, have to graduate from arcpa to take, accredited at time of completion, administered 50 weeks a year by computer, 6 hours, sylvan $425
what is a cme audit?
random audit of cme, must be cert 6 years or 6 attempts at pance, keep labeled certs by two year period for audit
what are your individual responsibilities in the political process?
know issues, provides support for those who work for you, contact elected officials, support pa organizations
who determines practice laws for pa?
STATE govts, must abide by state practice acts, register for license from state
how do you registered with a state?
apply for and renew license 1,2,3 years (WV is 2) supply CME, NCCPA cert, and fee, physician supervision
What is a good state practice law?
one that allows physicians to delegate to PAs any task or responsibility within their scope of practice that the PA is competent to perform
What is the national professional organization for PAs?
- AAPA started in 1968, fulltime staff, lobbying,
- also WVAPA in WV
What is the purpose of the patient record?
to provide the best possible medical care to the patient, should be thorough, accurate and concise
who is the patient record important for?
the patient, anyone involved in care or reimbursment
What are the many purposes of the record in providing the best care?
- real time documentation
- communication tool,
- quality assessment tool,
- reimbursment validation
- risk management
- education and research
what is the best defense against malpractice litigation?
a detailed, concise, and accurate medical record showing person providing care is competent and credible
How is the format and content of the patient record determined?
- organization determines format, laws and agencies determine content
- guidelines found in medicare manual and JNC
what administrative information should be in the patient record?
name address sex race dob nok, who is responsible for payment, signed consent and release of information
what clinical information should be in the inpatient record?
- admitting diagnosis with admission orders
- complete history NLT 24hrs
- chief complaint, current illness
- review of systems
- physical exam
what is a SOAP note?
- Subjective - symptoms
- Objective - signs
- Assessment - working diagnosis
- Plan - course of treatment
What orders can be used for situation where little or no deviation of treatment occurs?
how can orders be given?
written or veberally (if allowed by law and must be signed within 24 hours)
What clinical information should be in a discharge?
- admitting diagnosis
- diagnosis at time of discharge
- reason for admission
- significant findings or tests
- disussion of response to treatment
- follow ups, diet, medication, limitations
What clinical information is pertinent to outpatient visits
- First visit - complete history
- every visit - reason for visit and soap note
what are the rules for documenting information in a record?
- identify patient and facility on every page, each entry with time/date name/credential
- no blank spaces
how do you correct an error when documenting?
draw a single line through information, insert correct information, date and initital correction, if no room make addendum at next open spot and reference error
What are some other rules for documenting information?
- document information ASAP,
- abbreviated sparingly and approved only, be consistent and factual, record all info given to patient before procedure, all telephone contact with patient
what is the purpose of dictating records?
to save time and allow for a more legibile record
what are some rules for dictating?
identify yourself, identify patient, give date and time, idicate what information is being dictated, instructions, spell out anything unusual
what law protects patients right to privacy while keeping care providers informed?
HIPPA, protects identifiable data, apply to all organizaitons and broad formats
what must happen for the release of protected health information?
patient must consent, special consideration made for sensitive info (psych,HIV),
what health information must be reported according to law?
births, deaths, gunshot wounds, communicable disease, evidence of child abuse