Moving From Comprehensive to Core: Methods for Redefining Your Construct

• In Event: Maintaining Certification: Issues, Challenges, and Potential Solutions

Abstract

Physician assistants (PA) are healthcare professionals who are trained in the medical model as general practitioners. Before being licensed to practice medicine in any U.S. state and territory, a PA student must graduate from an accredited PA education program and pass a national certification examination (PANCE). Also every ten years, a PA must pass a recertification examination (PANRE). Historically, both exams broadly cover the domain of medical knowledge.
One of the major issues; however, is that PAs do not practice “general medicine.” In fact, PAs are increasingly working in specialty areas. Furthermore, due to their generalist training PAs can switch specialties during their career. This portability is a hallmark of the profession, and nearly 50% of PAs take advantage of this capability at least once during their career. The coupling of PAs working in specialty areas and the need to maintain the ability to change practice areas is a significant challenge in creating a maintenance of certification (MOC) process that is relevant to PAs and provide reasonable assurance of competency. In 2015, an initiative was undertaken to modify the recertification exam. The key feature of this modification is to restrict the domain of knowledge covered on the exam to only the medical knowledge that is needed for safe and effective practice regardless of specialty—or core medical knowledge. In doing this, PAs would maintain the flexibility that they desire, but also test content that is more limited in scope than the current recertification exam.
A series of meetings, using both qualitative and quantitative methods, were planned to determine what content should be considered core. In the first meeting, Individuals from both primary care and specialty disciplines were brought in to discuss what content was core through two quantitative methods. First, using a Q-sort approach, PAs created an ordered list of disease and disorders, where content at the top of the list was “most core.” From there, PAs employed a “bookmark” procedure to draw a line in this ordered list to separate out topics that are core from those that are not. As a result, approximately one-third of disease and disorders were deemed “not core,” and removed from further consideration.
After eliminating entire topics from the definition of core medical knowledge, a further distillation of what aspects of each remaining topic met the definition of core was considered. For example, cauda-equina is a life-threatening condition which PAs ranked as core; however, as PAs would not treat this disorder detailed questions about treatment would not be considered core. Focus groups were convened to help parse out aspects of each topic into three different performance level (basic, intermediate, and advanced). The results of these focus groups were used to create a survey, which was administered to all PAs to determine what level of each topic best meets the definition of core. This study will summarize the methods and findings at each stage of the process and present the final content outline from the core proceedings.

Authors

• Joshua T. Goodman, National Commission on Certification of Physician Assistants

• Andrew D Dallas, National Commission on Certification of Physician Assistants

• Grady Colson Barnhill, Comm. on Dietetic Registration

• Sheila Mauldin, National Commission on Certification of Physician Assistants