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  1. 1. CERTIFICATION STANDARD T H E V A L U E O F T H E P A - C® The PA-C Credential: Who, What & Why PAs are licensed health care professionals who practice ers and third-party payers are also increasingly requiring medicine with the supervision of a physician. The team PAs to maintain their NCCPA certification in addition to approach to medicine that develops out of the physician- their state-issued license. Maintenance of the PA-C® PA relationship establishes a foundation for the shared credential represents a commitment to lifelong learning and responsibilities of patient care. PAs bring a comprehensive evaluation of knowledge and skills applied across a broad skill set to patient care and can conduct physical exams, spectrum of medical and surgical areas. diagnose and treat illnesses, order and interpret tests, counsel on preventative health care, assist in surgery and -- NCCPA’s mission is to assure that certified physician in almost all states -- write prescriptions. assistants meet professional standards of knowledge and skills. The easiest way to check the certification status of a Conferred by the National Commission on Certification of PA is to use the Verify PA-C function at NCCPA Connect Physician Assistants (NCCPA), the Physician Assistant- (www.nccpa.net). By entering the PA’s last name and state, Certified® (PA-C®) credential is required in all 50 states for you can find the current status and expiration date for any initial licensure and in 19 states for licensure renewal. PA’s certification. If more information is needed, a simple NCCPA offers the only nationally recognized certification form on the same screen allows you to request the addi- program for PAs in the United States. Physicians, employ- tional information. PA Education & Initial Certification PAs are educated in intensive didactic and clinical pro- grams accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). To facilitate the close working relationship PAs have with their supervising physician, the profession trains students in the medical model, mirroring the training most medical students receive. Often PAs and medical students even attend classes together. The average PA curriculum runs 26 months. Education focuses on classroom and laboratory instruction in the PANCE is a computer-based exam that assesses a PA’s medical and behavioral sciences (such as anatomy, pharma- general medical and surgical knowledge with 360 multiple- cology, pathophysiology, clinical medicine and physical choice questions. The exam is administered 50 weeks a diagnosis), followed by rotations in internal medicine, year at Prometric testing centers around the U.S. family medicine, surgery, pediatrics, obstetrics and gynecol- ogy, emergency medicine and geriatric medicine. More than 60,000 PAs have passed the initial certification exam since it was first administered in the mid-1970s. Once PAs graduate from their PA program, they become Today, more than 50,000 certified PAs practice in almost eligible for NCCPA’s initial certification exam, called the every setting and medical and surgical specialty (see Physician Assistant National Certifying Exam (PANCE). Table 2, inside). The PA population continues to grow New graduates must pass PANCE within six attempts and steadily as each year around 5,000 new PAs graduate and within six years of graduation. take PANCE.
  2. 2. Commitment to Lifelong Learning & Assessment To maintain NCCPA certification, PAs must complete a nance -- a take-at-home exam called the Pathway II. Both two-pronged process that requires both ongoing education exams include 300 multiple-choice questions designed to and evaluation. Every two years PAs are required to assess PAs medical and surgical knowledge. log 100 hours of continuing medical education (CME), including at least 50 Category I hours. Despite the relatively rigorous certification maintenance and recertification requirements, the vast majority of the The American Academy of Physician Assistants (AAPA) members of this conscientious profession maintains approves both live presentations and enduring material certification throughout their careers. In 2003, for ex- programs for Category I CME credit. AAPA also stipulates ample, 98% of PAs met the requirements to maintain the following as Category I (pre-approved) CME credit for continuous certification. physician assistants: programs that are approved by the American Osteopathic Association Council on Continuing Medical Education for Category I credit, Prescribed Credit How Do PAs Earn CME? by the American Academy of Family Physicians, or Ameri- can Medical Association Category I CME for the Self-Directed Study 44% Physician’s Recognition Award from organizations accred- ited by the Accreditation Council for Continuing Medical Lecture/Learner Programs 38% Education. Certificate Courses 14% In addition to earning CME, PAs are also required to pass a recertification exam once during every six-year Interactive (Hands On) Training 4% certification maintenance cycle. NCCPA offers the 100% computer-based Physician Assistant National Recertifying Exam (PANRE) and -- for PAs who can document suffi- Table 1: PAs earn CME through a variety of formats as cient additional continuing education, research or other reported by certified PAs who logged their CME online at training above the requirements for certification mainte- NCCPA’s Web site, 2003-2004. Certified PAs Practice in Every Medical Specialty 8,000 7,000 39.1% Specialities as reported 6,000 by respondents to a 2003- 2004 NCCPA survey. 5,000 4,000 18.2% 3,000 15.5% 2,000 10.4% 1,000 4.0% 3.8% 3.2% 3.0% 2.7% 0 Family Medicine Surgery Emergency Medical Pediatrics Obstetrics/ Occupational Surgical Practice Medicine Subspecialties Gynecology medicine Subspecialties Table 2
  3. 3. Exam Developed to Meet Rigorous Expectations The test development process employed for the PA certification and recertification exams adheres to strict Examination Content guidelines designed to ensure the validity and reliability Blueprint of the exams. NCCPA’s certification and recertification exams are Organ Systems & Practice Areas constructed based on an examination content blueprint (at left) that specifies the organ systems and practice % of areas and knowledge, skills, and abilities that are tested Exam Diseases, Disorders & Medical Assessments of the: on the exam. The content blueprint is validated every Content five to seven years by a practice analysis, an intensive 16 Cardiovascular System three-step research process through which the day-to-day activities of PAs and the knowledge and skills needed to 12 Pulmonary System execute those activities are identified and classified by 10 Gastrointestinal System/Nutrition their degree of importance. Based on the outcome of that analysis, the content blueprint is revised to reflect the 10 Musculoskeletal System evolution of medicine, surgery and PA practice, thereby 9 Eyes, Ears, Nose & Throat ensuring that PAs are always being tested on what they need to know to fulfill their role in the health care 8 Reproductive System delivery team. 6 Endocrine System Test committees made up of PAs and physicians write the 6 Neurologic System test questions for NCCPA’s exams under the direction of Psychiatry/Behavioral Science experts at the 6 National Board of 6 Genitourinary System Medical Examiners If you are interested in Dermatologic System (NBME). Each 5 serving as a physician question is edited 3 Hematologic System for style and clarity member of an NCCPA test by NBME’s test- writing committee, 3 Infectious Diseases contact NCCPA at writing experts, 100% reviewed by the test 678.417.8100. writing committee and then pre-tested Knowledge, Skills & Abilities on an actual NCCPA examination. During the pre- testing, statistical analyses are conducted to determine % of the validity and difficulty of each new question. The Exam Knowledge & Skill Areas question becomes a scored item only after it proves to be Content both valid and relevant. 16 History Taking & Performing Physical Exams Items are continually reviewed, and outdated or overex- 14 Using Lab & Diagnostic Studies posed questions are removed from the examinations. 18 Formulating Most Likely Diagnosis 14 Clinical Intervention 18 Clinical Therapeutics 10 Health Maintenance 10 Applying Scientific Concepts 100% Table 3
  4. 4. Setting the Standard for PA Practice Maintaining certification represents both a commitment to lifelong learning and – since the PA-C® is the only professional designation for physician assistants – a commitment to enhancing the integrity of the credential and the PA profession. To that end, great clinicians are more than knowledgeable, skilled health care providers; they’re also professional, ethical people who incorporate those values into the work that they do every day. In addition to CME and recertification requirements, here are a few other ways NCCPA holds certified PAs to appropriate professional standards: CME audits: To ensure the accuracy of CME logging submis- sions, NCCPA randomly selects PAs for auditing, requiring them to provide supporting documentation for all of their Category I CME hours. For the 2001-2003 cycle, 95% of audited PAs successfully provided all required documentation to substantiate their Category I CME submissions. Rigorous exam security: NCCPA’s computer-based exami- nations are administered through Prometric testing centers where PAs take their examinations in a tightly controlled environment. Also, NCCPA reviews examination results for indications that irregular behavior may have occurred. Review of disciplinary issues: Another way that NCCPA holds certifying and certified PAs to high standards of Our Mission professional and ethical conduct is through a disciplinary policy that provides consequences for cheating on exams, NCCPA assures that certified physician falsifying certification records, revocation or suspension of a assistants meet professional standards of medical license, felony convictions, mental incompetence knowledge and skills. and documented gross or unethical conduct. In response to reports questioning the quality of available medical Our Board of Directors care and growing interest in competence assessment within the medical and surgical professions, NCCPA and other PA constituent NCCPA’s Board of Directors includes public and organizations – AAPA, ARC-PA and the Association of Physician PA directors at large, as well as appointees from Assistant Programs (APAP) – have undertaken a cooperative effort these participating organizations: to establish a shared, profession-wide definition of PA competen- cies. This project takes a holistic view of PA practice and recog- · American Academy of Family Physicians nizes the breadth of competencies associated with medical practice. · American Academy of Pediatrics As this project evolves, NCCPA and the PA profession are drawing · American Academy of Physician Assistants largely on the guidelines for professionalism and assessment · American College of Emergency Physicians developed for physician organizations. The ultimate goal is to · American College of Physicians identify and enact new ways to develop PA competencies, assess · American College of Surgeons those competencies and offer remediation to PAs who don’t meet · American Hospital Association established standards. · American Medical Association · American Osteopathic Association · Association of American Medical Colleges · Association of Physician Assistant Programs For more information on certified physician assistants, contact · Federation of State Medical Boards NCCPA at: 12000 Findley Road, Suite 200 Duluth, GA 30097 · U.S. Department of Defense Phone: 678.417.8100 Fax: 678.417.8135 · U.S. Department of Veterans Affairs Web: www.nccpa.net E-mail: www.nccpa.net