Physician Assistant


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Physician Assistant

  1. 1. PHYSICIAN ASSISTANT PILOT IN THE NORTHERN REGION DISTRICT HEALTH BOARDS, NEW ZEALAND Governance Document No. 4 POSITION DESCRIPTION Position Title Physician Assistant This position description is prepared specifically for the Physician Assistant Pilot in General Surgery at CMDHB. The nature of the pilot will require flexibility on behalf of the Physician Assistant in terms of the details of the position, its responsibilities and locations, which may change during the course of the pilot. Position Holder's Name: Position Holder's Signature: Primary Supervisor's Name: Primary Supervisor's Signature: Date:
  2. 2. PURPOSE OF THE POSITION The Physician Assistant (PA) role is not currently part of the New Zealand health workforce but is to be piloted for a period of 12 months in general surgery at Counties Manukau District Health Board (CMDHB). A commitment to working in the role for 12 months is required from the PA. The position will require adaptability, flexibility, and the ability to work in a multicultural environment. The pilot will demonstrate how the PA role interacts with Nurses, Junior and Senior Medical Officers and students, and will assist with in assessing whether the PA role can be adapted and developed within the New Zealand Health system particularly in surgery. The PA will be responsible to the primary supervising surgeon for the achievement of agreed objectives and will operate within the confines of CMDHB. The position works with the delegated authority of and under the oversight of the designated vocationally registered supervisor. The role is based at Middlemore Hospital with some specific duties at Manukau Health Park (MHP) (ie, Manukau Surgery Centre and Manukau SuperClinic). VISION AND VALUES ORGANISATIONAL SHARED VISION Our DHB shared Vision is to work in partnership with our communities to improve the health status of all, with particular emphasis on Maori and Pacific peoples and other communities with health disparities. We will do this by leading the development of an improved system of healthcare that is more accessible and better integrated. We will dedicate ourselves to serving our patients and communities by ensuring the delivery of both quality focussed and cost effective healthcare, at the right place, right time and right setting. ORGANISATIONAL VALUES Partnership Working alongside and encouraging others in health and related sectors to ensure a common focus on, and strategies for achieving health gain and independence for our population Care and Respect Treating people with respect and dignity, valuing individual and cultural differences and diversity Professionalism We will act with integrity and embrace the highest ethical standards Teamwork Achieving success by working together and valuing each other’s skills and contributions Innovation Constantly seeking and striving for new ideas and solutions Responsibility Using and developing our capabilities to achieve outstanding results and taking accountability for our individual and collective actions 2
  3. 3. KEY ACCOUNTABILITIES: Clinical • Participates in designated areas of clinical practice as defined and delegated by the primary and secondary supervising surgeons, in accordance with the individual practice plan and scope of practice. • Actively works in partnership with the medical and nursing staff to ensure safe, focussed care for the patient and their family in line with the vision and values of CMDHB. • Maintains professional standards of practice and competence and uses these to support medical and nursing staff in the provision of acute and non acute services, in the inpatient and outpatient settings at CMDHB. • Provides support to clinical staff allowing the most efficient utilisation and deployment of personnel and resources, thereby promoting best practice in providing effective and efficient services to patients. Teamwork • Works collaboratively with the wider multidisciplinary health care team to ensure continuity of care is maintained and to achieve optimal patient access to services and health outcomes Quality • Participates in quality activities. Contributes, supports and encourages improvement clinical service activities through identifying areas for improvement and participating in implementation. Cultural diversity • Demonstrates a commitment to the Treaty of Waitangi and honours cultural diversity. Health and safety • Recognises and accepts individual responsibility for health and safety in the workplace and works within CMDHB’s health and safety policies and procedures. Professional • Participates in service programmes and educational opportunities relevant development to the role. • In conjunction with the primary supervising surgeon, establishes annual goals, objectives, performance targets and strategies to meet these. Pilot • Participates in the evaluation of the pilot of the PA role in the NZ setting. INDIVIDUAL ACCOUTABILITY: • The PA will be responsible for his/her own practice within the boundaries of supervision and his/her defined delegated role, and is accountable to the primary supervising surgeon. • The PA will be primarily responsible to his/her supervisors but will work closely with other members of the multidisciplinary health care team. • The PA undertakes to work only within the defined scope of practice, or as delegated by his/her supervisors, and agrees not to undertake work known to fall outside his/her scope of practice. 3
  4. 4. POSITION DUTIES: NB. It is expected that the duties and Scope of Practice will change and develop over time, but may include: • Works with the designated primary and secondary supervising surgeons to develop a practice plan and a scope of practice appropriate for the individual PA’s skills and experience. • Regularly reports to, meets with, and seeks feedback from the supervisors in accordance with the practice plan, and as required by the supervisors. • Integrates into the designated clinical team providing comprehensive care for acute and elective surgical patients in both inpatient and outpatient settings. • Integrates into the routine activities of the clinical team including acute duties, daily team rounds, consultant rounds, clinical meetings, ward meetings, theatre sessions, outpatient clinics, and as designated by the supervisors. • Completes administrative duties associated with team activities including arranging and following-up diagnostic and therapeutic tests, referrals, consultations, completion of discharges, etc. • Documents all relevant aspects of patient care and completes all required paperwork for legal and administrative purposes. • As delegated, provides comprehensive physical assessment of patients encompassing patient interviews, medical histories and physical examination. • Interprets consultation findings, initiates and interprets appropriate diagnostic tests, and assists in developing management options. • Initiates and monitors treatment after consultation with supervisors. • Explains to patients the medical, diagnostic and management options. • Performs specific ward-based procedures, including diagnostic physical exams and treatment procedures, as delegated by the supervisors. • Refers to, and consults with, surgeons and other health professionals, as indicated, in order to manage specific patients, plan and co-ordinate activities, exchange information, and investigate and resolve problems. • Assists with the preparation of patients for theatre, including ensuring all appropriate tests are completed, and patient consented and marked in accordance with CMDHB policies and procedures. • Assists in preadmission clinics ensuring patients are appropriately assessed prior to surgery. • Works to build good working relationships with all members of the multidisciplinary health care team. • Provides advice on the management of patient care to the wider health care team, where appropriate. • Keeps up-to-date on relevant medical research, technology and related issues by attending ongoing education courses and professional meetings, reading journals, etc, to ensure continuing education, training and development is undertaken to meet clinical governance guidelines for continuous professional development (much of this will be available internally at CMDHB). • In exceptional circumstances, provides additional services on an emergency basis under the direction and responsible supervision of a surgeon, as are within the PA's clinical competence and which would not otherwise jeopardise the delivery of care to patients. • Works within the NZ legal framework, the code of consumer rights and the policies and procedures and Clinical Services Capability Framework of the CMDHB. 4
  5. 5. • Takes an active part in the formal pilot evaluation process of the PA role in New Zealand. As determined appropriate, assists in developing a programme for the development and mentoring of “home grown” PAs within New Zealand. OTHER REQUIREMENTS Communication • The PA may be required to communicate about the PA role, both informally and formally. Excellent communication skills are a key requirement. Interpersonal Skills • The PA will work in a professional manner with CMDHB’s multi-cultured client base including compliance with the Treaty of Waitangi and by demonstrating a commitment to partnership. • The PA will be required to develop and maintain effective relationships with a range of CMDHB staff members and external contacts including clinical and administrative staff, managers, patients and their family/whanau. Situations may often call for tact and diplomacy and will require information to be handled in a discreet and sensitive manner. In conflict situations the PA will be required to exercise sound judgement, negotiation and persuasiveness skills, toward facilitating a workable outcome. Strong, well developed interpersonal communication skills are essential. Problem Solving • There will be a requirement to be able to prioritise issues and negotiate time frames, while still providing a quality patient service. The range of problems will be diverse and require solutions customised to meet the circumstances of the patient. Therefore opportunities will arise to provide innovative options to the patient based on proven outcomes. • There will be demands to meet deadlines, maintain accuracy and quality of information. Failure to do so could impact on the organisation in terms of the ability to meet contracted outcomes and provide quality standards. Scope for Action • The PA will be encouraged to use initiative and problem solving skills to put forward innovative approaches to issues. Discretion is required to be exercised in releasing confidential information to the appropriate parties. Statutory Obligations • The PA will be responsible to ensure that procedures involving patients meet statutory requirements and are ethical and clinically appropriate. 5
  6. 6. TEAM AND REPORTING RELATIONSHIPS • The PA will work as a member of the surgical team and will therefore be expected to work closely with medical, nursing and allied health staff. The PA will be expected to communicate openly and build good working relationships with all members of the wider multidisciplinary health care team to ensure safe and effective patient care. • The PA will be able to formulate and implement various aspects of management whilst ultimately reporting directly to the supervising surgeons. PERSON SPECIFICATION SKILLS/KNOWLEDGE/BEHAVIOUR For the purposes of selecting USA trained PAs for the pilot, the required professional competencies for PAs are drawn from the American Academy of PAs (AAPA) - “Competencies of the PA Profession” (adopted in 2005) – refer Attachment. Professional competencies for PAs include: • the effective and appropriate application of medical knowledge • interpersonal and communication skills • patient care • professionalism • practice-based learning and improvement • systems-based practice Plus an unwavering commitment to continual learning and professional growth, and the supervising medical practitioner–PA team, for the benefit of patients and the larger community being served. Physician Assistants are not currently a part of the New Zealand health workforce. This pilot will be the first time PAs will be employed within the New Zealand health system. As the pilot progresses the role is likely to change and develop as the opportunities PAs provide are further identified. Consequently, PAs in the pilot will need to demonstrate: • ability to integrate in to a new team • ability to adapt as the role develops. This will include initially working within a more limited scope of practice than is currently practiced in the USA • ability to identify how PAs can add value to the current team • willingness to learn new skills • willingness to take on the challenge of developing a new role in the New Zealand health care setting QUALIFICATIONS & EXPERIENCE Essential Education, Training and Experience • Current membership of USA-based National Commission on Certification of PAs (NCCPA) and the eligibility to maintain membership for the duration of the employment contract. (Membership of NCCPA will provide evidence that a practitioner holds a qualification from an accredited training programme and has passed the PA National Certifying Exam (PANCE) that assesses basic medical and surgical knowledge. To maintain NCCPA membership PAs must show evidence of continuing medical education (CME) and complete a recertification exam in the fifth or sixth year of a six- 6
  7. 7. year certification maintenance cycle.) • Hold a current licence to practice in the USA state he/she is coming from • Minimum of three years recent (current) practice in a PA role in the USA in surgery • Demonstrate evidence of continuing medical education (CME) 7
  8. 8. Attachment to Physician Assistant Position Description USA Professional Competencies for Physician Assistants in New Zealand Pilot For the purposes of selecting USA trained Physician Assistants (PAs) for the Northern Region pilot, the required professional competencies for PAs will be drawn from the American Academy of PAs (AAPA) - “Competencies of the PA Profession” (adopted in 2005). Professional competencies for PAs include the effective and appropriate application of medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement, systems-based practice, as well as an unwavering commitment to continual learning and professional growth, and the supervising Medical Practitioner – PA team, for the benefit of patients and the larger community being served. These competencies are demonstrated within the scope of practice, whether medical or surgical, for each individual PA as that scope is defined by the supervising medical practitioner and appropriate to the setting. The PA profession defines the specific knowledge, skills, and attitudes required and provides educational experiences as needed in order for PAs to acquire and demonstrate these competencies. In addition to these skills and attributes, PAs are expected to uphold the values and practices described in the profession’s Guidelines for Ethical Conduct. Medical knowledge Medical knowledge includes an understanding of pathophysiology, patient presentation, differential diagnosis, patient management, surgical principles, health promotion, and disease prevention. PAs must demonstrate core knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to patient care in their area of practice. In addition, PAs are expected to demonstrate an investigatory and analytic thinking approach to clinical situations. PAs are expected to: • Understand aetiologies, risk factors, underlying pathologic process, and epidemiology for medical conditions • Identify signs and symptoms of medical conditions • Select and interpret appropriate diagnostic or lab studies • Manage general medical and surgical conditions to include understanding the indications, contraindications, side effects, interactions, and adverse reactions of pharmacologic agents and other relevant treatment modalities • Identify the appropriate site of care for presenting conditions, including identifying emergent cases and those requiring referral or admission • Identify appropriate interventions for prevention of conditions • Identify the appropriate methods to detect conditions in an asymptomatic individual • Differentiate between the normal and the abnormal in anatomy, physiology, laboratory findings, and other diagnostic data • Appropriately use history and physical findings and diagnostic studies to formulate a differential diagnosis • Provide appropriate care to patients with chronic conditions. Interpersonal & communication skills Interpersonal and communication skills encompass verbal, nonverbal, and written exchange of information. PAs must demonstrate interpersonal and communication skills that result in 8
  9. 9. effective information exchange with patients, their patients' families, Medical Officers, professional associates, and the health care system. PAs are expected to: • Create and sustain a therapeutic and ethically sound relationship with patients • Use effective listening, nonverbal, explanatory, questioning, and writing skills to elicit and provide information • Appropriately adapt communication style and messages to the context of the individual patient interaction • Work effectively with medical staff and other health care professionals as a member or leader of a health care team. • Apply an understanding of human behaviour • Demonstrate emotional resilience and stability, adaptability, flexibility, and tolerance of ambiguity and anxiety • Accurately and adequately document and record information regarding the care process for medical, legal, quality, and financial purposes. Patient care Patient care includes age appropriate assessment, evaluation, and management. PAs must demonstrate care that is effective, patient-centred, timely, efficient, and equitable for the treatment of health problems and the promotion of wellness. PAs are expected to: • Work effectively with medical staff and other health care professionals to provide patient- centred care • Demonstrate caring and respectful behaviours when interacting with patients and their families • Gather essential and accurate information about their patients • Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment • Develop and carry out patient management plans • Counsel and educate patients and their families • Competently perform medical and surgical procedures considered essential in the area of practice • Provide health care services and education aimed at preventing health problems or maintaining health. Professionalism Professionalism is the expression of positive values and ideals as care is delivered. Foremost, it involves prioritizing the interests of those being served above one's own. PAs must know their professional and personal limitations. Professionalism also requires that PAs practice without impairment from substance abuse, cognitive deficiency, or mental illness. PAs must demonstrate a high level of responsibility, ethical practice, sensitivity to a diverse patient population, and adherence to legal and regulatory requirements. PAs are expected to demonstrate: • Understanding of legal and regulatory requirements, as well as the appropriate role of the PA • Professional relationships with medical supervisors and other health care providers • Respect, compassion, and integrity • Responsiveness to the needs of patients and society • Accountability to patients, society, and the profession • Commitment to excellence and ongoing professional development • Commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices • Sensitivity and responsiveness to patients' culture, age, gender, and disabilities • Self-reflection, critical curiosity, and initiative. Practice-based learning and improvement 9
  10. 10. Practice-based learning and improvement includes the processes through which clinicians engage in critical analysis of their own practice experience, medical literature, and other information resources for the purpose of self-improvement. PAs must be able to assess, evaluate, and improve their patient care practices. PAs are expected to: • Analyze practice experience and perform practice-based improvement activities using a systematic methodology in concert with other members of the health care delivery team • Locate, appraise and integrate evidence from scientific studies related to their patients' health problems • Obtain and apply information about their own population of patients and the larger population from which their patients are drawn • Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness • Apply information technology to manage information, access online medical information, and support their own education • Facilitate the learning of students and/or other health care professionals • Recognize and appropriately address gender, cultural, cognitive, emotional, and other biases; gaps in medical knowledge; and physical limitations in themselves and others. Systems-based practice Systems-based practice encompasses the societal, organizational and economic environments in which health care is delivered. PAs must demonstrate an awareness of and responsiveness to the larger system of health care to provide patient care that is of optimal value. PAs should work to improve the larger health care system of which their practices are a part. PAs are expected to: • Use information technology to support patient care decisions and patient education • Effectively interact with different types of medical practice and delivery systems • Understand the funding sources and payment systems that provide coverage for patient care • Practice cost-effective health care and resource allocation that does not compromise quality of care • Advocate for quality patient care and assist patients in dealing with system complexities • Partner with supervising physicians, health care managers, and other health care providers to assess, coordinate, and improve the delivery of health care and patient outcomes • Accept responsibility for promoting a safe environment for patient care and recognizing and correcting systems-based factors that negatively impact patient care • Use information technology to support patient care decisions and patient education • Apply medical information and clinical data systems to provide more effective, efficient patient care • Utilize the systems responsible for the appropriate payment of services (not required in New Zealand) 10