PA Profession Competencies

Between 2003-2004, the National Commission on Certification of Physician Assistants (NCCPA) led an effort with three other national PA organizations [Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), American Academy of Physician Assistants (AAPA), and Physician Assistant Education Association (PAEA) — formerly Association of Physician Assistant programs (APAP)] to define PA competencies in response to similar efforts conducted within other health care professions and the growing demand for accountability and assessment in clinical practice. The resultant document, Competencies for the Physician Assistant Profession, provided a foundation from which physician assistant organizations and individual physician assistants could chart a course for advancing the competencies of the PA profession.

This document was updated in 2012 and then approved in its current form by the same four organizations.

This document serves as a map for the individual PA, the physician-PA team, and organizations committed to promoting the development and maintenance of professional competencies among physician assistants. While some competencies will be acquired during formal PA education, others will be developed and mastered as physician assistants progress through their careers. The PA profession defines the specific knowledge, skills, attitudes, and educational experiences requisite for physician assistants to acquire and demonstrate these competencies.

The clinical role of PAs includes primary and specialty care in medical and surgical practice settings. Professional competencies for physician assistants include the effective and appropriate application of medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement, and systems-based practice. Patient-centered, physician assistant practice reflects a number of overarching themes.

These include an unwavering commitment to patient safety, cultural competence, quality health care, lifelong learning, and professional growth. Furthermore, the profession’s dedication to the physician-physician assistant team benefits patients and the larger community.

Medical knowledge includes the synthesis of pathophysiology, patient presentation, differential diagnosis, patient management, surgical principles, health promotion, and disease prevention. Physician assistants 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, physician assistants are expected to demonstrate an investigative and analytic thinking approach to clinical situations. Physician assistants are expected to understand, evaluate, and apply the following to clinical scenarios:

• evidence-based medicine
• scientific principles related to patient care
• citologies, risk factors, underlying pathologic process, and epidemiology for medical conditions
• signs and symptoms of medical and surgical conditions
• appropriate diagnostic studies
• management of general medical and surgical conditions to include pharmacologic and other treatment modalities
• interventions for prevention of disease and health promotion/maintenance
• screening methods to detect conditions in an asymptomatic individual
• history and physical findings and diagnostic studies to formulate differential diagnoses

Interpersonal and communication skills encompass the verbal, nonverbal, written, and electronic exchange of information. Physician assistants must demonstrate interpersonal and communication skills that result in effective information exchange with patients, patients’ families, physicians, professional associates, and other individuals within the health care system. Physician assistants are expected to:

• create and sustain a therapeutic and ethically sound relationship with patients
• use effective communication skills to elicit and provide information
• adapt communication style and messages to the context of the interaction
• work effectively with physicians and other health care professionals as a member or leader of a health care team or other professional group
• demonstrate emotional resilience and stability, adaptability, flexibility, and tolerance of ambiguity and anxiety
• accurately and adequately document information regarding care for medical, legal, quality, and financial purposes

Patient care includes patient- and setting-specific assessment, evaluation, and management. Physician assistants must demonstrate care that is effective, safe, high quality, and equitable.

Physician assistants are expected to:

• work effectively with physicians and other health care professionals to provide patient-centered care
• demonstrate compassionate and respectful behaviors when interacting with patients and their families
• obtain essential and accurate information about their patients
• make decisions about diagnostic and therapeutic interventions based on patient information and preferences, current scientific evidence, and informed clinical judgment
• develop and implement patient management plans
• counsel and educate patients and their families
• perform medical and surgical procedures essential to their area of practice
• provide health care services and education aimed at disease prevention and health maintenance
• use information technology to support patient care decisions and patient education

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. Physician assistants must acknowledge their professional and personal limitations. Professionalism also requires that PAs practice without impairment from substance abuse, cognitive deficiency, or mental illness. Physician assistants must demonstrate a high level of responsibility, ethical practice, sensitivity to a diverse patient population, and adherence to legal and regulatory requirements.

Physician assistants are expected to demonstrate:

• understanding of legal and regulatory requirements, as well as the appropriate role of the physician assistant
• professional relationships with physician supervisors and other health care providers
• respect, compassion, and integrity
• accountability to patients, society, and the profession
• commitment to excellence and on-going 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 abilities
• self-reflection, critical curiosity, and initiative
• healthy behaviors and life balance
• commitment to the education of students and other health care professionals

Practice-based learning and improvement includes the processes through which physician assistants engage in critical analysis of their own practice experience, the medical literature, and other information resources for the purposes of self- and practice- improvement. Physician assistants must be able to assess, evaluate, and improve their patient care practices.

Physician assistants 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
• apply knowledge of study designs and statistical methods to the appraisal of clinical literature and other information on diagnostic and therapeutic effectiveness
• utilize information technology to manage information, access medical information, and support their own education
• recognize and appropriately address personal biases, gaps in medical knowledge, and physical limitations in themselves and others

Systems-based practice encompasses the societal, organizational, and economic environments in which health care is delivered. Physician assistants must demonstrate an awareness of and responsiveness to the larger system of health care to provide patient care that balances quality and cost, while maintaining the primacy of the individual patient. PAs should work to improve the health care system of which their practices are a part.

Physician assistants are expected to:

• effectively interact with different types of medical practice and delivery system
• understand the funding sources and payment systems that provide coverage for patient care and use the systems effectively
• 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 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
• recognize and appropriately address system biases that contribute to health care disparities
• apply the concepts of population health to patient care