APAP Responds to Proposed Revisions of the ARC-PA Accreditation Standards

By Dawn Morton-Rias, PD, PA-C
President Elect, APAP

As one of the sponsoring organizations of the Accreditation Review Commission on Education for the Physician Assistant, Inc., (ARC-PA), APAP had the opportunity to offer commentary to the proposed revisions of the Accreditation Standards. All APAP faculty members were invited to forward their concerns and recommendations to an APAP Web link to ensure that the board’s commentary represented the views and opinions of the membership. Member program faculty were also encouraged to submit individual comments directly to the ARC-PA. Sixteen responses were received from individual PA programs. Each response was summarized according to the accreditation standard, frequency of responses, and issues raised with the proposed change. The summary findings were presented for discussion to the board of directors, which met by conference call to consider each issue and formulate a unified response to the ARC-PA before its December 1 deadline.

Member programs shared their views regarding several of the proposed changes to the Standards. In its response to the ARC-PA, APAP recommended that the Commission clarify the language contained in the introduction and the definitions sections; consider using the term “health care” when appropriate, as opposed to “medical care”; and cite the physician assistant’s role and responsibilities not only in treatment and management, but also in health promotion and disease prevention.

Some respondents expressed support for Standard A1.5b, that accredited PA programs must be established in senior colleges and universities affiliated with appropriate clinical teaching facilities, stating that this standard affirms the fact that PA education has moved towards the graduate level. Other respondents expressed concern that the standard delivers a message of limitation and exclusion to member programs housed in community colleges. In its response to the ARC-PA, the board acknowledged that the 1999-2000 APAP Degree Task Force recognized that PA training is at the graduate level but also affirmed that the report did not recommend that non-graduate programs be eliminated. Recognizing the unique role that all member programs play in educating the next generation of physician assistants, the APAP Board of Directors asked whether there was data to support the change to the standard. APAP strongly recommended that the standard be revised to include language that encourages and assists programs to move to a graduate degree or document relationships with appropriate academic institutions to offer graduate degree options as an alternative to the exclusion of member programs.

The issue of current national certification for the program director raised concerns among respondents. Two expressed support for the revised Standard A2.6b, which requires that the program director hold national certification. Those who responded in the affirmative shared that, at a minimum, program directors should hold the same clinical credentials as those held by teaching and administrative faculty. Other colleagues, based on a number of concerns, argued that current national certification should not be required for program directors. In APAP’s response to the ARC-PA, the APAP Board of Directors stated that this requirement exceeds the vast majority of state licensing requirements. The board also maintained that since the current NCCPA recertification process is not a competency examination, holding current certification does not ensure clinical competence. This position is supported by the fact that the current NCCPA recertification process does not assure that PA program directors possess adequate knowledge and skills in leadership, teaching, management, and program evaluation-the key responsibilities of most PA program directors today. The board noted that, unlike residency program directors, the majority of a PA program director’s time is occupied by the aforementioned functions. Further, the board said that many institutions do not provide a mechanism by which program directors can practice in their parent institutions; nor do they require clinical practice as part of the PA program director’s job description. Finally, the board asserted that at a time when PA programs are struggling to fill faculty positions and the ARC-PA and APAP are attempting to study and address the problem of faculty turnover, it would not seem prudent to institute a new standard that could exacerbate the problem. The board recommended study of faculty turnover trends and also suggested that if the decision is made to require PA program directors to be clinically active and currently certified, that the ARC-PA provide advance notice for implementation of this modification. The APAP Board of Directors recommended that this change be considered carefully before implementation and respectfully requested clarification of the rationale for the new standard and any evidence to substantiate the change from “should” to “must” in this requirement.

Additional recommendations regarding sponsorship included a suggestion that the program director shall be assigned to the institution on a full time basis, as opposed to assignment to the PA program. Respondents asserted that the proposed standard might inhibit experienced PA program directors from participating in additional leadership opportunities within their institutions.

Several respondents expressed concern with regard to Standard B7.5, a program must document that every student has clinical experiences to include a) medical care across the life span to include pregnancy, infant, children, adolescents, adults and the elderly; b) general surgery; c) gynecology; d) emergency medicine; and e) psychiatry/behavioral medicine. The APAP Board of Directors expressed concern that the wording of this standard and its components reflects movement toward discipline-specific experiences. It asserted that physician assistant programs rely on a variety of clinician preceptors and settings to ensure that students acquire the essential knowledge and skills for entry into the profession. The board recommended alternative language that would facilitate greater program flexibility in the context of the communities that programs aim to serve. Specifically, the APAP Board of Directors recommended revision of Standard B7.5, as follows: “The program must document that every student has clinical experiences to include a) medical care across the life span to include pregnancy, infant, children, adolescents, adults and the elderly; b) surgery; c) women’s health; d) emergency medicine; and e) psychiatry/behavioral medicine.”

Finally Standard B7.6, that programs should provide specific supervised clinical experiences with physicians and/or PAs in family medicine, general internal medicine, obstetrics and gynecology, general surgery, psychiatry, pediatrics, and emergency medicine raised significant concern among program respondents. As proposed, the standard requires that programs either provide specific experiences in each discipline or document a compelling reason for failure to comply with the standard. The APAP Board of Directors stated that revision of this standard (from its predecessor B6.2) moves clinical education of physician assistant students from a cross-discipline, competency-based, clinical training model that is inherent in the PA profession to a strictly medical, discipline-based structure. The board maintained that this represents a major change in the clinical education of PA students and may challenge programs to secure additional, alternative clinical sites. The APAP Board of Directors recommended that Standard B6.2 be retained in place of the newly proposed B7.6.

The APAP Board of Directors conducted a comprehensive review of the feedback provided by the respondents and worked diligently to represent all APAP member programs in this important endeavor. The board looks forward to a continuation of the dialogue with the ARC-PA.

The APAP Board of Directors and staff wish each of you the very best for the holiday season and the New Year.

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