Physician Assistant Practice Quiz PDF

**[Professionalism and Medical Ethics]** - Define Professionalism using AAPA PA competency terminology - The conduct, aims, or qualities that characterize to mark a profession or professional person. - Competencies for the PA profession: 1. Medical knowledge 2. Patient c...

**[Professionalism and Medical Ethics]** - Define Professionalism using AAPA PA competency terminology - The conduct, aims, or qualities that characterize to mark a profession or professional person. - Competencies for the PA profession: 1. Medical knowledge 2. Patient care 3. Interprofessional and communication skills 4. **Professionalism** 5. Practice-based leaning and improvement (CME) 6. Systems based practice - Define emotional intelligence and intellectual honesty and provide examples of each +-----------------------------------+-----------------------------------+ | **Emotional intelligence** | **Intellectual Honesty | | | Intellectual Honesty** | +===================================+===================================+ | Defined by Goleman's 5 domains of | Method of problem solving that is | | emotional intelligence. | [unbiased] with | | | honest attitude. | | 1. Self-awareness | | | | - One's personal beliefs do not | | 2. Self-regulation | interfere with the pursuit of | | | the truth. | | 3. Social skills | | | | - Facts should be presented in | | 4. Empathy | an [unbiased] | | | manner. | | 5. Motivation | | +-----------------------------------+-----------------------------------+ 1. **Altruism**: The practice of disinterested and selfless concern for the well-being of others a. *the essence of professionalism* i. Ex: A PA stays late to comfort a critically ill patient and their family even after their shift ends. 2. **Accountability**: Taking accountability/ responsibility for one's decisions and actions. b. Can be broken down on many levels: ii. Patient: Provider/patient relationship iii. Society: Addressing health needs of the public. iv. Profession: Adhering to ethics of medical practice Ex: PA follows up with a Pt after appt. to ensure pt status, rather than assume pt is doing ok. 3. **Excellence:** The desire to exceeds ordinary expectations in professionalism and the commitment to lifelong learning c. Ex: A PA attends continuing education workshops to stay up to date on the latest treatments. 4. **Duty**: A moral or legal obligation; *a commitment to service*. d. [Duty to Pts]: The ability to have "peace" with the pt & comply with them. v. *"Identify with the pt and not with the disease" -- Dr. Stead* e. [Duty to Profession] is a commitment to service, betting the community and "paying it forward" f. [Duty to Report]: Licensees have a "*... ethical duty to report misconduct".* vi. Ex: If you knew of a provider coming to work intoxicated and *did not* report it, you are *[just]* as guilty as the provider committing the act. 5. **Honor and Integrity**: Fairness and truthfulness in regard to your [word], [commitments], and [straightforwardness]. g. Honor: FIRM adherence to a moral code h. Integrity: Adherence to a code of conduct vii. Ex: A PA refusing to accept a gift card from a pharma company that would've influences their prescribing decisions. 6. **Respect for Others:** A feeling of deep admiration for someone/something elicited by their abilities, qualities, or achievements. i. *Main essence of humanism!* viii. Ex: A PA ensures culturally competent care by considering a Pts religious believes/values before recommending or prescribing treatment options. 1. **Abuse of Power** a. [Interactions with Pts & Colleagues ] i. Ex: Accepting business gifts from Pharma companies b. [Bias ] ii. Ex: Providing different levels of care depending on a Pts SES. c. Sexual harassment iii. Ex: Making assumptions on a Pts pain tolerance based on gender or race (*think 2016 study done on Med students and their interpretation of African American dermis thickness/pain tolerance)* d. Breach in confidentiality 2. **Arrogance:** offensive display of superiority and self-importance; *decrease professionalism* e. Decrease ability to accurately think for oneself f. Lack Pt empathy g. Remove the benefit of having self-doubt 3. **Greed:** Compromising key elements of professionalism in pursuit of money, power, and fame. h. Always remember the best interest of the Pt! 4. **Misrepresentation:** Conscious misrepresentation of material fact with the intent to mislead i. Lying j. Fraud iv. Ex: Erasing or leaving off info from a Pts chart/ Insurance fraud. 5. **Impairment:** Drug addiction, alcoholism, mental impairment (psych) k. Provider have a *[moral/legal]* obligation to report! 6. **Lack of Conscientiousness:** "Falling behind"/ Laziness l. Failure to fulfill responsibilities, tardiness, missing meetings, pushing work to someone else. 7. **Conflict of Interest**: utilizing your career to benefit yourself and further your career path. m. Self-referrals, acceptance of gifts, utilizing services, Skewing/compromising research... - Used to inform, guide and shape behaviors/decisions while practicing in the medical field. 1. **Autonomy**: Pt informed consent & Pt understanding a. Pts make their [own] decisions after being presented with elaborate & unbiased Tx options. b. Pts must be respected- regardless with whether you agree with their decisions or not. c. **[Informed consent]**: Should always be *[conversational]* & never authoritative. Must include: i. Nature of Tx or procedure ii. Diagnosis and recommendation iii. Alternative options iv. Credentials & experience of providers on Pt's team v. Sometimes, \~ cost. - Informed consent must be **signed, dated, and timestamped.** vi. [Competency vs. Capacity] 1. **Competency**: the ability to understand consequences and make medical decisions. a. related to age, mental status, disease 2. [Clinical: Delusional capacity vs. Incapacity] b. **Incapacity**: *(think trauma bay)* Pt at baseline is competent, but due to current circumstances, has been deemed incapacitated. i. Capacity may [not] be continuous depending on the situation (Ex: MVA) c. **Delusional Capacity**: (*think psych pts)*- A PTs delusion directly interferes with their medical Tx, they may deemed incapacitated. ii. Again, may not be continuous. 2. **Beneficence**: the best interest of the Pts. 3. **Nonmaleficence**: not [deliberately] causing harm to Pts; do no harm d. [Due care]: Sufficient and appropriate care to avoid causing harm to a Pt. e. [Negligence]: the absence of due care; leads to unintentional but careless risk of harm to Pt. f. **[Rule of Double Effect (RDE)]** Distinction between intended effects and merely forseen effects vii. Nature of the act must be **good** viii. Agent's intention must be **good** ix. Bad effect must not be means to a good effect x. Proportionality: the good effect must outweigh the bad effect! 3. Ex: If Pt dies as an effect to standard care GOOD act / BAD outcome = follows RDE 4. Ex: If a PA administers med to cause harm BAD act/ BAD outcome= doesn't follow RDE 4. **Justice**: Promote fair and equitable Tx to [all] patients. - **Integrity**: allows person to be themselves when values are challenged - **Respect**: Treating human beings, not diseases. - **Courage**: Advocating for yourself and for the good of your patients; sometimes, having to be the whistleblower - **Humility:** Recognizing one's limitations and knowing when to ask for help. - Understanding that there is [always] something to learn from collogues and Pts. - Having the humility to ask for help & asking questions to learn (CME) - Empathy: building rapport with the Pt - Listening and communicating effectively - Understanding others POV in a compassionate manner. - *✨We listen and we don't judge* *✨* - **Benevolence** - **Justice**: The quality of being impartial and fair. - Treating patients fairly - Practice non-discriminately - *When OSU's president gets to bypass everyone at OSUM and get an INP room ready, this is not healthcare justice; it's **partial*** - **Prudence**: the ability to [exercise sound judgment] and caution when making decisions; weighing out risk, benefits, and ethical considerations. 1. **Agent**: POA 2. **Choices**: the moral clock that will help decision making 3. **Consequences**: result/outcome of the decisions- good or bad 4. **Context**: setting that influences the decision **PA Profession History** +-----------------------+-----------------------+-----------------------+ | **PA Predecessors** | **Year/ Role** | **Duties** | +=======================+=======================+=======================+ | **Loblolly's Boys** | **-Est. 1799 in the | **Basically, a | | | US navy** | medical assistant + | | | | day-today tasks** | +-----------------------+-----------------------+-----------------------+ | **Feldshers** | **-2 yrs med | ***Similar to role of | | | education; tuition | US PAs;* diagnose & | | | free** | treat, prescribe | | | | meds, OB care** | | | **-Top 10% attended | | | | med school!** | | +-----------------------+-----------------------+-----------------------+ | **Barefoot doctors** | **-China; Farmers | **Basic hygiene, | | | Village aides** | preventive | | | | healthcare, family | | | **-(6 months OTJ | planning, common | | | training)** | illness.** | +-----------------------+-----------------------+-----------------------+ | **Frontier Nursing | **-Est. 1925 by Mary | **-1925: Maternal & | | Services** | Breckridge; Maternal | child health; used | | | & child health.** | midwives from Great | | **(*Mary | | Britian** | | Brackenridge)*** | **-In 1939- Frontier | | | | Grad school of | **-1936: Grad school | | | midwifery** | of midwifery still | | | | operate today** | | | **-1960- 1^st^ NP** | | | | | **-1960- 1^st^ | | | | certificate for | | | | family NPs** | +-----------------------+-----------------------+-----------------------+ | **Vivien Thomas** | **1930- surgical lab | **-Trained by Dr. | | | assistant & | Blalock** | | | researcher** | | | | | **-Taught at John | | | | Hopkins (mid 70's)** | | | | | | | | **-Developed surgical | | | | techniques & | | | | equipment.** | +-----------------------+-----------------------+-----------------------+ +-----------------------------------+-----------------------------------+ | Dr. Charles Hudson (1961) | **1^st^ physician to suggest | | | non-physician provider** | | | | | | - Obviously, homeboy got | | | shutdown by the AMA House of | | | Delegates | | | | | | - Published an article in JAMA | | | about corpsman | | | | | | - 2-3yrs of college that | | | paralleled medical school | | | | | | - Develop technical skills | | | | | | - OAPA award named after him! | | | | | | - Practiced in Cle, OH. | +===================================+===================================+ | Dr. Eugene Stead (1964) | ***[Founder of the PA profession! | | | ]*** | | | | | | - Wanted to develop Ad Clin Rn, | | | was rejected due to too much | | | physician involvement. | | | | | | - *Announced he would create a | | | course of study for corpsman | | | to become physician | | | assistants.* | | | | | | - First graduating class: | | | **Oct. 1966 -- Oct 1967** | | | | | | - 4 ex-navy corpsmen | | | | | | - 2 Yr program | | | | | | - 9 months (basic med | | | sciences) & 15 months | | | rotations. | +-----------------------------------+-----------------------------------+ | Dr. Amos Johnson/Henry Treadwell | ***Prototype for the PA program | | | at DUKE*** | | | | | | - Dr. A Johnson GP in rural NC | | | | | | - Henry Treadwell Trained to | | | diagnose & treat by Dr. | | | Johnson. | | | | | | ***MD/non-MD duo*** | +-----------------------------------+-----------------------------------+ | Dr. Harvey Estes (1968) | Took over Duke PA after Stead. | | | | | | - Expanded the PA concept | | | across the US | | | | | | - 1968: **Established AAPA** | | | with the Duke grads! | +-----------------------------------+-----------------------------------+ | Dr. Richard Smith | MEDEX Medicine Extension. | | | | | | Dr. Smith confirmed the need to | | | train non-physician providers. | | | | | | - Developed the concept of | | | "deployment of students" | +-----------------------------------+-----------------------------------+ | Dr. Henry Silver (1975) | - Professor of pediatrics; | | | developed to address | | | healthcare needs for | | | children. | | | | | | - Child Health | | | Associate/PA: 2 yrs of | | | college + NO med | | | experience | | | | | | - 1975: **First PA Program to | | | offer PA Master's Degree** | | | | | | - **ONLY** PA program to | | | focus on children. | +-----------------------------------+-----------------------------------+ | Dr. Hu Myers | Developed a training program | | | designed to recruit high school | | | students native to the area of | | | rural WV. | +-----------------------------------+-----------------------------------+ +-------------+-------------+-------------+-------------+-------------+ | | **Year | **Type of | **Location* | **Founder** | | | started** | Program** | * | | +=============+=============+=============+=============+=============+ | **Duke | Oct 6. 1965 | Primary | Durham, NC | Dr. E Stead | | University* | | Care focus | | | | * | | | | | +-------------+-------------+-------------+-------------+-------------+ | **MedEx** | 1969 | Primary | Washington | Dr. R Smith | | | | Care in | (1º), | | | | | rural areas | Wyoming, | | | | | | Alaska, | | | | | | Montana, | | | | | | Idaho, | | | | | | Hawaii | | +-------------+-------------+-------------+-------------+-------------+ | **Alderson- | 1968 | 4-yr | John Creek, | Dr. Hu | | Broaddus** | | bachelor's | GA | Myers *.* | | | | degree: | | | | | | Liberal | | | | | | Arts | | | | | | Sciences | | | | | | | | | | | | Direct | | | | | | entry from | | | | | | high school | | | | | | | | | | | | Became | | | | | | model for | | | | | | smaller | | | | | | colleges. | | | +-------------+-------------+-------------+-------------+-------------+ 1. **PA History Society** a. To share the Hx of the development of PA profession and illustrates how PAs continue to make a difference in our society. i. Sit within NCCPA! 2. **AAPA** b. National professional society for PAs c. Advocates and educates on behalf of the profession and patients PA serve ii. ***Mission**: Empower PAs, advance the PA career, and enhance patient health.* iii. **Value**: Leadership, unity, accountability/transparency, excellence, equity. d. ***Every state is represented with AAPA as a constituent organization**!* 3. **NCCPA** e. Certifying organization for PAs in the U.S. (1974) f. Provides certification that reflects standards for clinical knowledge, clinical reasoning, and medical skills required upon entry into practice. iv. Certifying Exam = **PANCE** (\$550) / Certifying body = NCCPA 1. 180 days to complete test post initial completion date! 4. **ARC-PA** g. **Only** agency that establishes standards and accredits PA programs h. Foster excellence in PA education through the development of [uniform national standards] for educational effectiveness. 5. **PAEA** i. National Org representing PA educational programs j. CASPA k. All accredited programs are a member of the PAEA and serve as a voice for entry-level PA education globally. v. **Mission**: Encourage/assist/SUPPORT programs to educate competent & compassionate PAs 6. **OAPA** l. Provided a foundation for the PA profession for the state of Ohio m. Advances profession through legislation, advocacy, CME opportunities, and promoting career to the general public. **PA Education, Certification and Licensure** - Commonality for [all] programs but allows for creativity and innovation; how PA programs msut structure themselves to meet accreditation requirements. - **A- Administration** - Institution responsibilities, program personnel, admissions, program policies. - **B- Curriculum and instruction** - Outlines didactic and clinical curriculum requirements. - **C- Evaluation** - Ongoing program self-assessment, self-study report, clinical site evaluation. - **D- Provisional Accreditation** - Provisional accreditation requirements - **E- Accreditation Maintenance** - Program and sponsoring institution responsibilities. +-----------------------------------+-----------------------------------+ | **Provisional** Accreditation | 1^st^ review standards, Must meet | | | eligibility requirements. | | | | | | ***Initial provisional*** | | | (validates/verifies/clarifies) | | | ***Provisional monitoring*** | | | (within 6 months of 1^st^ | | | graduating class) ***Final | | | provisional*** (review | | | self-study) ***Accreditation | | | continued.*** | +===================================+===================================+ | **Continued** Accreditation | ARC-PA confirms validation visit | | | date Program submits SSR | | | validation visit occurs Program | | | receives written report. | +-----------------------------------+-----------------------------------+ | **Probation** Accreditation | Not meeting the needs of student | | | education | +-----------------------------------+-----------------------------------+ | **Administrative** Accreditation | Not paying fees/submitting | | | reports | +-----------------------------------+-----------------------------------+ | **Withdrawn** Accreditation | No longer in compliance with the | | | standards | +-----------------------------------+-----------------------------------+ - Medical Knowledge - Clinical and technical skills - Professional behaviors - Interpersonal skills - Clinical reasoning - Problem-solving abilities required for PA practice - Voluntary - Category I in specialty CME (75 credits) - 2K-4K hours of experience in the field of practice (within 6 yrs) - Procedure/patient care case log specific to the specialty - Specialty exam for CAQ The 10-year certification maintenance process includes five two-year cycles during which all certified PAs must log 100 CME credits online and submit a \$180 certification maintenance fee - Category I: Min 50hrs (each 2 yr cycle) - Performance improvement - Self-assessment - Category II: No minimum (hour by hour basis) - Medically related activity that enhances the role of a PA - Reading - Non-category I courses, etc. 1. **Licensure** - A **mandatory** process required by the **state** to legally practice a profession. - Ensures that professionals meet minimum competency standards. - Example: Physician Assistants (PAs) must be licensed by the state medical board. 2. **Registration** - A **record-keeping** process where professionals are listed in a registry. - Often required for tracking purposes but does not necessarily indicate competency. - Example: Some healthcare workers may need to register with a state database. 3. **Certification** - A **voluntary** process that demonstrates a professional has met higher standards than licensure requires. - Typically awarded by a **national or professional organization**. - Example: PAs get certified by passing the **PANCE** exam from the **NCCPA**. **Importance of Each** - **Licensure** ensures legal authority to practice. - **Registration** helps regulate and monitor professionals. - **Certification** adds credibility and may be required for employment in certain settings. +-----------------------------------+-----------------------------------+ | **Statutes** | **Rules** | +===================================+===================================+ | Laws passed by the **state | Detailed guidelines created | | legislature**. | by **state agencies or medical | | | boards** to enforce statutes. | | Broad legal framework governing | | | healthcare practice. | More specific and can be updated | | | more frequently than statutes. | | Example: Ohio's **PA practice | | | laws** dictate scope of practice. | Example: State medical boards | | | defining **PA supervision | | | requirements**. | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | **Credentialing** | **Privileging** | +===================================+===================================+ | Verification of education, | Grants **specific** permissions | | training, licensure, | for clinical procedures within a | | certification, and professional | hospital. | | history. | | | | Based on training and | | Ensures healthcare providers | demonstrated competency. | | meet the hospital's standards. | | | | Example: A PA may be privileged | | ***Credentialing** = \"Are you | to **perform sutures** but | | qualified?\"* | not **intubations**. | | | | | | ***Privileging** = \"What can | | | you do in this hospital?\"* | +-----------------------------------+-----------------------------------+ **Vulnerable Populations/Cultural Awareness** **Common Disparities** **Solutions** ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Access to healthcare, quality of care, socioeconomic factors, language barriers, and cultural misunderstandings. Increasing healthcare access, providing culturally competent care, improving education and outreach to vulnerable groups, offering interpreter services, and addressing systemic inequalities. - **Healthcare Disparities**: Differences in health outcomes and access to care based on factors such as race, ethnicity, socioeconomic status, geography, and disability. - **Barriers**: Financial constraints, lack of insurance, geographic isolation, lack of culturally competent care, and systemic racism. - **Impact on Healthcare Delivery**: Disparities lead to unequal health outcomes, delays in care, and preventable health conditions, disproportionately affecting [marginalized groups].