NCCPA examines change in PANCE

[EMEDPA]

Should NCCPA add a practical exam to PANCE?

a little history here...prior to 1997 PANCE included 3 practical exams and 3 written exams. it was changed to be a computer test more like medical students do. now they have a practical on their certification exam so the logic is that once again we should strive to be like them.

from today's nccpa email blast:

NCCPA is preparing to conduct a pilot study to assess the potential benefits of re-introducing a clinical skills exam to the process of initial certification.

The pilot project will involve the development and administration of standardized patient cases in the form of an Objective Structured Clinical Examination (OSCE). In an OSCE, “patients” are portrayed by people who have been professionally trained to convey specific illnesses or conditions and to participate in evaluation of the student conducting the exam.

Medical students in the U.S. complete an OSCE in the form of USMLE Step 2CS or the COMLEX-USA Level 2 PE exam. Studies of similar exams conducted for Canada’s medical students have shown that performance on the OSCE was a significant predictor of quality-of-care problems(1) and complaints to medical regulatory authorities(2).

“There is much more to being an effective physician assistant than mastery of the knowledge and skills that can be assessed on multiple-choice exams,” says Mark Christiansen, PhD, PA-C, NCCPA chair and director of the University of California – Davis Physician Assistant Program. “NCCPA is conducting this pilot project to inform our discussions about whether a structured clinical skills exam would make a meaningful and responsible addition to our national initial certification process.”

NCCPA is currently accepting proposals from organizations with the facilities and expertise to conduct the pilot with hopes of selecting a partner and beginning work on the project by the end of 2013. The pilot project will take approximately 18 to 24 months to complete, and the decision whether or not to introduce an OSCE for PANCE applicants will be made after its completion.

Additional information on the pilot study is available online at http://www.nccpa.net/NewsArticles/cspilot.

[primadonna22274]

It will be much more expensive and much more cumbersome for sure.

I graduated in 2000 so missed the good ol' PE days. Ironically I'm scheduled to take my COMLEX level 2-PE in January and it's rather intimidating. Very expensive too--$1250 registration fee, ONLY offered in Philadelphia (regardless of where in the US you train) and of course the travel and lodging expenses are considerable as well. Will it make me a better doctor to be evaluated on a high-stakes clinical skills exam by standardized patients? I doubt it but I have to just suck it up and do it.

I think it will be interesting to see how this goes over in the PA community.

[EMEDPA]

when I took pance the skill exam was offered at every pa program along with the written. pance was a week long test then with 3 practicals ( 2 ten min and 1 20 min) and 3 writtens(core knowledge, primary care, surgery), not a 2 hr computer session.

I am all for bringing it back. PANCE today is a joke and curved very low( 54% or so = pass). I think a good paramedic or nurse could pass it without going to pa school at all. it would probably add to the expense but I think would weed out some folks who should not be PAs.

[Guest JMPA]

when I took pance the skill exam was offered at every pa program along with the written. pance was a week long test then with 3 practicals ( 2 ten min and 1 20 min) and 3 writtens(core knowledge, primary care, surgery), not a 2 hr computer session.

I am all for bringing it back. PANCE today is a joke and curved very low( 54% or so = pass). I think a good paramedic or nurse could pass it without going to pa school at all. it would probably add to the expense but I think would weed out some folks who should not be PAs.

 

It should just be required that all new graduates take the USMLE steps prior to any certification to weed out the folks who should not be PAs. Hell lets just go a step further and fade out the profession because nurses and paramedics can out perform a PA.

[UGoLong]

And I used to walk to school uphill both ways... Let's try not to eat our young. There are bigger issues out there these days.

[delco714]

I'm up in the air because my program made us do just that before we graduated

[LT_Oneal_PAC]

I think we never should have gotten rid of it. We did so we could be more like docs? I agree when they raise the bar so should we, but should we lower it with them too?

 

Anyway, it's a good thing to have to confirm minimum competency. That's what certification board are for professions. Establishing if a person is going to be a danger or not. Can we honestly say that about someone who we don't see perform an exam? We are testing book skills and now we need to test the hands on.

 

I love how anytime we think about trying to change this profession internally for the better, someone comes along and says there are bigger issues. In this case, it truly doesn't fly because this isn't the AAPA. It's the certification board with the sole purpose of identifying people who are unsafe to practice. There is no other issue for them. Whether they do a good job of it is up for debate of course.

[KMD16]

Brilliant idea!

[CAAdmission]

If the NCCPA smells some cash in it, they will make it happen.

[Just Steve]

My school runs us through OSCEs. I thought it was an ARC-PA requirement..not the case?

[Armygrunt001]

Not even a question you know its coming...CAQ, Residency programs, etc. Why become a PA?

[taotaox1]

Ooo Ooo! Lets add this to the PANRE as well!

 

No? I thought not.

 

I will end up seeing over 1000 patients by the time I graduate and I have multiple MUST PASS standardized patient exams throughout the clinical year. I see no value in paying more money and adding more stress to my life for something I have already paid a lot of money to be tested on. If schools are graduating students that cannot perform a physical exam then that is a problem with the ARC-PA not doing it's job. I am all for high standards, but in my mind having people cough up money (likely 1k+) to be retested on this will be low yield; not likely to improve graduating PA skill or garner us any more respect as a profession.

[Joelseff]

Ooo Ooo! Lets add this to the PANRE as well! No? I thought not.

 

Lol

 

Sent from my myTouch_4G_Slide using Tapatalk 2

[EMEDPA]

When it was part of the exam before it was not expensive. the cost did not go down when they went from 6 exams to 1.

let's talk about this on it's merits, not whether or not it will cost more.

[EMEDPA]

Not even a question you know its coming...CAQ, Residency programs, etc. Why become a PA?

the answer used to be "to avoid ochem". in 2013 I don't know how to answer that question for anyone under 35 except to say "seriously consider medschool if you can".

[taotaox1]

When it was part of the exam before it was not expensive . the cost did not go down when they went from 6 exams to 1.

let's talk about this on it's merits, not whether or not it will cost more.

 

I have no doubt, however, that the cost will go UP when they add in a second test (not to mention travel costs). The cost factor of something like this IS a factor and should be considered in the evaluation of its merits.

 

That said, considering the fact that this kind of testing is an integral part of any PA program anyway, what do you feel is gained by making graduates re-test in this fashion? I just don't see the value in it. I am a student, so I am obviously not dealing with new grads in the workplace... But I can't imagine performing basic physical exams are where they are deficient. Heck, we had to be proficient at that by the end of the first semester.

[EMEDPA]

The value is that it is a standardized exam. not every program teaches practicals the same way and not every student masters clinical exams in school. this would force students to really know their stuff before they enter practice. back in the day folks would attend a board review course which covered both didactic and practical components. as it is set up now you can almost guess your way through pance and pass. 54% . think about it.

[rev ronin]

54% correct is passing? Sounds about right for the type of questions I saw on my PANCE. I wouldn't mind if they had a sub-exam of straightforward, clinically meaningful questions without trick answers that every PA should be able to answer immediately even if awoken from a coma, on which test-takers would have to get a 95% (gotta allow for a few typos and misreading of questions) to pass... but the PANCE as it stands is the kind of test where a 54% really isn't that bad of a score.

[taotaox1]

EMEDPA,

 

The question I have is this: Is there a problem with current new grad PAs being unable to perform reasonable physical exams? If there is, then maybe this is warranted. If not, it seems like a solution looking for a problem to me.

[EMEDPA]

EMEDPA,

 

The question I have is this: Is there a problem with current new grad PAs being unable to perform reasonable physical exams? .

YES. probably 30% of new PAs I see would not have passed the old version of pance.

some of this has to do with a decline in the quality of clinical rotations at some places. I have heard students say they completed entire rotations and just watched doctors work. not acceptable. clinical rotations should not = shadowing a doctor for 4-6 wseeks but actually doing the work themselves with supervision.

[mbalaban]

I will end up seeing over 1000 patients by the time I graduate and I have multiple MUST PASS standardized patient exams throughout the clinical year. I see no value in paying more money and adding more stress to my life for something I have already paid a lot of money to be tested on. If schools are graduating students that cannot perform a physical exam then that is a problem with the ARC-PA not doing it's job. I am all for high standards, but in my mind having people cough up money (likely 1k+) to be retested on this will be low yield; not likely to improve graduating PA skill or garner us any more respect as a profession.

 

#1, 1000 patients and you are competent? Was that in each specialty or overall? Overall? So 1000 patients in 8 (?) rotations? So let's be even, 1000/8=125. So after 125 patient encounters you are a master at that specialty? Seriously? You haven't even touched the surface of the procedures you can do. I've been an EMT/medic and flight medic since 1996 (medic since 1999) for a number of years during my career, I averaged 20 calls in a 24 hr shift. I practically doubled that magical 125 number in one month. But in my nearly 15 years, even on the helicopter, I have done exactly 1 trach, I've seen, I'm guessing in the 10's of thousands of patients, and have done just 1 trach. So this whole 1000 patients thing, meaningless. In my experience as an FTO and teaching EMT's and medics, 125 patients is barely enough to get you comfortable in your own skin let alone proficient.

 

#2, your exams you've been passing during your clinical year are just school exams. Schools are free to test however they desire. Some test better than others. Some curve different than others etc. That's why there is a certification exam. I'm sure you took more exams during the didactic year than clinical. By your argument, you shouldn't even have to take the PANCE. See the flaw in that argument?

 

#3 You can't test a persons ability to interact and interview a patient on a computer. You can't use a computer to test how to best get information out of a difficult patient. You can't use a computer to test compassion when telling family a loved one is dead. You can't use a computer to test how to calm and handle a psych patient. With so many schools getting away from the intent of the profession, I think it is VERY IMPORTANT to the health of this profession to make sure the kids that are being whipped out of these schools can do what they are supposed to be able to do. What is the #1 thing a PA does? talk to patients, interact with patients (whichever way you want to say it). You think with your 125 OB patient encounters you are proficient and comfortable asking a woman what her G,P,A, and why any A's? I will place money on having a new grad PA that has say 250hrs of HCE prior to school and one with say 5000 hrs, doing the same tasks and I guarantee the patient's encounter will be a lot smoother with the seasoned person.

 

 

Oh, and @primadonna, Testing isn't designed to teach you anything, it's designed to assess your abilities. Will it make you a better MD? No, not supposed to. Will it ensure a certain level of competency? That's what it is supposed to do.

[Guest JMPA]

I think we never should have gotten rid of it. We did so we could be more like docs? I agree when they raise the bar so should we, but should we lower it with them too?

 

Anyway, it's a good thing to have to confirm minimum competency. That's what certification board are for professions. Establishing if a person is going to be a danger or not. Can we honestly say that about someone who we don't see perform an exam? We are testing book skills and now we need to test the hands on.

 

I love how anytime we think about trying to change this profession internally for the better, someone comes along and says there are bigger issues. In this case, it truly doesn't fly because this isn't the AAPA. It's the certification board with the sole purpose of identifying people who are unsafe to practice. There is no other issue for them. Whether they do a good job of it is up for debate of course.

This statement is wrong and misleading.

"the sole purpose of identifying people who are unsafe to practice." really? no. their purpose is to certify those whom are competent. there is a significant difference. do they fingerprint, do backround checks, perform drug screenings, chart reviews, ect, ect ect........ Maybe they sould strictly for you. sure lets have the nazi SS, ahem i mean the nccpa decide whom will practice and whom will not.

[Guest JMPA]

where did this assumption that ARCPA programs are not meeting standards and graduating students capable of performing physical exams? and as far as polls, whom is voting on this poll? is it strictly PAs, or do we have other non pa members voting?

[Guest JMPA]

#1, 1000 patients and you are competent? Was that in each specialty or overall? Overall? So 1000 patients in 8 (?) rotations? So let's be even, 1000/8=125. So after 125 patient encounters you are a master at that specialty? Seriously? You haven't even touched the surface of the procedures you can do. I've been an EMT/medic and flight medic since 1996 (medic since 1999) for a number of years during my career, I averaged 20 calls in a 24 hr shift. I practically doubled that magical 125 number in one month. But in my nearly 15 years, even on the helicopter, I have done exactly 1 trach, I've seen, I'm guessing in the 10's of thousands of patients, and have done just 1 trach. So this whole 1000 patients thing, meaningless. In my experience as an FTO and teaching EMT's and medics, 125 patients is barely enough to get you comfortable in your own skin let alone proficient.

 

#2, your exams you've been passing during your clinical year are just school exams. Schools are free to test however they desire. Some test better than others. Some curve different than others etc. That's why there is a certification exam. I'm sure you took more exams during the didactic year than clinical. By your argument, you shouldn't even have to take the PANCE. See the flaw in that argument?

 

#3 You can't test a persons ability to interact and interview a patient on a computer. You can't use a computer to test how to best get information out of a difficult patient. You can't use a computer to test compassion when telling family a loved one is dead. You can't use a computer to test how to calm and handle a psych patient. With so many schools getting away from the intent of the profession, I think it is VERY IMPORTANT to the health of this profession to make sure the kids that are being whipped out of these schools can do what they are supposed to be able to do. What is the #1 thing a PA does? talk to patients, interact with patients (whichever way you want to say it). You think with your 125 OB patient encounters you are proficient and comfortable asking a woman what her G,P,A, and why any A's? I will place money on having a new grad PA that has say 250hrs of HCE prior to school and one with say 5000 hrs, doing the same tasks and I guarantee the patient's encounter will be a lot smoother with the seasoned person.

 

 

Oh, and @primadonna, Testing isn't designed to teach you anything, it's designed to assess your abilities. Will it make you a better MD? No, not supposed to. Will it ensure a certain level of competency? That's what it is supposed to do.

just another medic thinking he is GOD, i eat medics for breakfeast, love to rip them apart in the ER

[mbalaban]

I voted yes and I'm not even in school yet. I'm not afraid to take an exam to verify and show my basic level of competency.