Competencies
Competency is traditionally defined as an ability to do something, especially measured against a standard. There is a trend in medical education to define specific competencies that professionals should possess in order to practice in the health care field. These competencies address core knowledge but also delve much deeper into practice management and assessing whether the professional understands his or her role in a professional practice. Patient care is the central core principle in determining competencies but this role alone is insufficient in professional practice. There is an emphasis on continued learning and professional behavior on the part of the health care provider.
The Physician Assistant Competencies, developed by the four national PA organizations mirror those developed by various professional health care organizations. The PA Competencies Online Center is hosted by the National Commission on Certification of Physician Assistants on behalf of the PA Competencies Project’s four sponsoring organizations.
The Institute of Medicine's report on the future of health professions education lists five core competencies in which all health care providers should be proficient. The Center for Innovation at the National Board of Medical Examiners is developing a comprehensive list of The Behaviors of Professionalism.
AAPA papers on competence:
- Into the Future: Physician Assistants Look to the 21st Century: A Strategic Plan for the Physician Assistant Profession
- Professional Competence - A Position Paper prepared by the Education Council of the American Academy of Physician Assistants (Adopted 1996)
- AAPA resources on education
Competencies utilized for graduate medical education, in general, are succinctly described by the Accreditation Council for Graduate Medical Education in "An Introduction to Competency-based Residency Education." The Competencies for the Physician Assistant Profession mirror and parallel the six general ACGME competencies. These are described below.
Competency-based education focuses on learner performance (learning outcomes) in reaching specific objectives (goals and objectives of the curriculum). In this setting, learning and teaching are dynamic partners in helping the student to achieve the expected learning outcomes.
Medical knowledge is not just being able
to regurgitate the facts about a disease or to
quote the latest findings from a peer-reviewed
medical journal. The application of learned
medical knowledge includes the ability of the
clinician to properly assess a patient and
his/her physical findings, be able to
appropriately order any necessary tests,
develop a differential diagnosis, and make a
diagnostic judgment and treatment plan. The
ability to apply medical knowledge involves an
analytical approach which takes into account
the lessons learned from the basic and applied
sciences. Being able to list 10 signs and
symptoms of schizophrenia is very
different from recognizing a patient with
schizophrenia and developing an appropriate
treatment approach for that patient.
Book-learned knowledge is not adequate for our
preparation of PA students to become health
care providers in the twenty-first century.
Of all of the competencies listed, a
deficit in medical knowledge is the easiest to
correct. Graduate students do not have to know
all the answers, rather they develop
skills to search for the answers to
puzzling clinical questions. Physician
assistants do need to have a developed core of
medical knowledge in order to pass the national
certification examination, and they need to be
able to maintain and grow this knowledge base
as they provide competent care to patients in
their communities.
Providing patient care is the reason for
the existence of the PA profession. In order to
effectively provide care, PA students need
to gain an appreciation of the essential role
of effective communication with their patients.
This entails giving the patients their full
attention, allowing the patients enough time to
let them know what is wrong with them, and
being nonjudgmental and open to what patients
are saying. Body language communication is as
important as verbal communication.
Ideally, providers will involve patients in the discussion and treatment decisions. Allowing the patients to be partners in their health care decisions is one way of promoting compliance on the part of the patient.
Patient care is more than just knowing what tests or medications to offer to patients. Patient care is ideally done at the bedside with the basic skills of listening, examining, communicating, and educating. This involves patient education that is appropriate to the patient’s literacy and educational and cultural backgrounds.
Sometimes, patient care involves the
performance of medical procedures. Physician
assistants should be able to inform
the patient about the procedures (including the
level of discomfort that is involved with the
procedure), the alternatives (if any) to the
procedure, and the risks and benefits for
having and declining the procedure. Lastly, the
provider should possess the technical
competence to perform the actual procedure in
an efficient manner.
Educators should be aware that PA students enjoy the challenge of diagnosing and treating disease but that as much or more emphasis in their training should be in the area of health promotion and disease prevention. Although less glamorous than discovering a cure for a rare disease, health promotion is the best investment for population groups as a whole. Preventing an illness is more cost effective than treating one. Health promotion is often assigned to the PAs in clinical practice as other health care providers may not see it as valuable to the practice.
Patient-focused care entails being part of the health care delivery team. As part of the team, the PA should gain an appreciation of the specialized knowledge and experience for all members of the team, as well as their training and clinical roles.
Patient-focused care also may include involving the family and supporters of the patient. Appropriate communication with the family is part of the overall care of the patient. Communication and involvement with the family is part of the PA's duty.
Practice-Based Learning and Improvement
PAs practice within health care
organizations and systems, whether in
private physician practices, group practices,
hospital-based practices, or ambulatory centers
or clinics. Community-based practices will
mandate that the PA examine the needs of
the community and set up specialized services
in order to meet the demands within the
community. These specialized services are not
only limited to the practice itself
but may involve other support services
in the community. Determining what patients and
communities need is similar to determining what
PA students need in order to become competent
to practice in their fields.
Analyzing practice experiences is only
one piece of the puzzle. In addition to
assessing the present clinical
setting, PAs also need to properly
interpret the medical literature and clinical
studies to improve their knowledge and skill
sets. Medicine is constantly developing new
theories and treatment modalities and PAs need
to be able to incorporate these into their own
practices. Providers need to become life-long
learners, even beyond the formal requirements
for continuing medical education.
PAs need to be aware of the various types
of medical practice and health care delivery
systems. This awareness will include how costs
are calculated and how resources are allocated.
The ethics of health care delivery systems must
also be part of this understanding. Providers
will need to practice cost-effective,
evidence-based health care so that patient care
is not compromised because of a bottom-line
decision.
PAs are really patient advocates since
they have the training and medical knowledge to
make recommendations to patients who do not
share this same base of knowledge. They
may sometimes need to advocate for patients in
recommending treatment that has better outcomes
but at a higher price. The PA has an
obligation to err on the side of improved
patient outcome rather than making a decision
based upon economic considerations.
Professionalism should be part of the
essence of a person, not something that
magically happens when a person puts on a white
coat. Professionalism is acting in the best
manner possible, following ethical
principles, doing the right thing when no
one is looking. It involves respect
for the dignity of human life along with
compassion for the patient as a fellow human
being. Professionalism also involves an
understanding of the patient’s cultural
background and lifestyle choices. While some of
these choices may not be consistent with the
provider’s own choices, the provider must be
able to respect the person who is making those
choices.
Interpersonal and Communication Skills
Communication with patients involves not only words but the attitude and body language behind those words. Communication is not one person dictating instructions to another but involves sharing information and talking to the patient. Patients need to feel comfortable in discussing intimate details of their lives with their health care providers, and knowing they will be nonjudgmental and discrete in handling this information. The health care provider needs to be cognizant of an appropriate therapeutic relationship and should not share his or her problems with the patient.
Effective communication is not limited to
the provider-patient relationship. As a member
of the health care team, the PA must be
able to effectively communicate treatment plans
to other members of the health care team. This
means that written orders must be legible and
accurate. Verbal communication to these
professionals should be clear and
definitive.
The competencies for PA education and practice are in place to ensure that appropriate care is given in a health care delivery system that provides care that is economically prudent, evidence-based, and compassionate and competent. If the competencies are used as guides, patient care will undoubtedly improve for the patients in our society.