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NCCPA examines change in PANCE

Should NCCPA add a practical to PANCE?  

103 members have voted

  1. 1. Should NCCPA add a practical to PANCE?

    • Hell yes, we need PAs to demonstrate clinical competence
      33
    • hell no, PA school covers practicals already
      70


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

 

 

HAHA!! bring it junior. I love a challenge. I am not god and no where did I say I was god, you're Napoleon complex sure got kicked into high gear there tho. Hit a nerve? :) Hmm, maybe you see the validity of that argument and are afraid to admit it. What's there to worry about about taking a test to certify a basic level of competency?

Edited by mbalaban

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I think it's an okay idea, I graduated right when they were changing this, so we had to prep for it in school, even though we ended up NOT having to do it.

 

Here's the problem. There is NO graduate...NOT one that is truly competent in physical exams. Medical students aren't either. Heck most residents aren't, and fellows are only starting to be.

 

The truth is one clinical year does not make you completely competent in physical exam techniques. There is too much nuance, too much subtlety. Not too mention interpreting your physical exam results, which is even harder.

 

I think you have to see between 5 and 10 thousand patients before you truly even start to become competent in physical exam techniques and interpretation.

 

I'm not opposed to this move by the NCCPA, but I wonder what the objective actually is.

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I think you have to see between 5 and 10 thousand patients before you truly even start to become competent in physical exam techniques and interpretation.

 

 

That sounds like a reasonable number...I'd say that's probably when I was starting to feel pretty comfortable...particularly with abdominal and neuro exams.

 

E, you and I usually see pretty eye-to-eye on things, but I'm not sure I buy this being absolutely necessary for NCCPA to bring back the practical portion. I took the PANCE well after the original practical portion was dropped, but my "capstone course" (which is what ARC-PA forced programs to do in lieu of dropping the practical part of the PANCE) was very tough and multi-faceted in its approach. I certainly can't speak for other programs, but if the final exam/capstone course is as rough as I had it, then I think that's enough.

Edited by True Anomaly

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If the concern is that PAs coming out of school/clinical rotations are not getting enough PE experience then the issue is there and that's where it should be addressed.

Do they plan on this for PANRE as well?

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Here's the problem. There is NO graduate...NOT one that is truly competent in physical exams. Medical students aren't either. Heck most residents aren't, and fellows are only starting to be.

 

The truth is one clinical year does not make you completely competent in physical exam techniques. There is too much nuance, too much subtlety. Not too mention interpreting your physical exam results, which is even harder.

 

I think you have to see between 5 and 10 thousand patients before you truly even start to become competent in physical exam techniques and interpretation.

 

I have no doubt that is right on. However, this is a test that should be testing the kind of competency achieved with didactic + 1K or so exams. And the kind of competence that could reasonably be tested is pretty easy to achieve by that point. Does anyone think a test like this will be anything other than "choose the right systems/subsystems to examine and order basic labs/imaging?" My guess is it will be just as formulaic as a computer exam with little bearing on real world understanding/practice. I am open to correction on this assumption from people who took the old skills exam of course.

 

 

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

 

EMEDPA: YES

Fair enough. I don't have the experience to comment on this. I will leave that conversation to those of you dealing with new grads.

 

 

 

 

 

 

 

@mbalaban

 

I think you (and it may be my fault for not being specific enough) are confusing what I mean by competent. I am not referring to mastery or anything close to it. I am referring to the ability to choose proper systems to evaluate and understanding of basic tests needed to be ordered to evaluated based on findings This level of competence is ALL a test like this is going to be able to reasonably evaluate unless I am missing something (certainly possible). I don't think anyone doubts more time/practice=better skill.

 

TL : DR= Refering to competence as the level of competence expected after PA school... Not necessarily complete practical competence or anything nearing mastery.

Edited by taotaox1

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I don't think it is necessarily a bad idea. Have a list of must haves for a basic exam (abdominal, neuro complaint) and have the students/soon to be PAs practice this. I would guess similar to what the NREMT practical exam is. It isn't a perfect assessment (nothing really is), but I think it gives students a good base to start from and once in regular practice, they can mold this basic approach to what works best for them. I've been an FTO and trainer throughout most of my jobs, and my philosophy always was to teach the 'right' way to do things. If you teach your trainees/students at the highest possible level, when they inevitably change their approach to fit their way of working, they will still be able to do a very good job and get all of the necessary things covered.

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Very few medical students fail the Clinical Skills examination. I imagine the NCCPA will make ours a bit tougher, and I am sure that it will raise the price of the over-all certification process to 2K or greater. Standardized patients, central locations, travel expenses, etc.

 

And, the NPs, as usual will have no required uniform certification process or centralized educational approval body. . We are building up our qualifications immensely (and have over the past decade) to match MD/DO tit for tat, but still get no respect or good press (just look at the Wall Street Journal and Washington Post this week) as compared to the NPs. I do not know who is doing their marketing but they put “Mad Men” to shame!!!!!

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Being that were getting rid of certificate programs will the MCAT now be a pre-req in the application process? I'm noticing a trend of no HCE in students being accepted to PA programs much like Med School. In the future will a step 1, 2, and 3 process be introduced?

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

 

It is an ARC-PA requirement. My program does multiple OSCE's throughout CMS and "final" OSCE's during the second year.

 

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".

 

?? Been reading this forum for quite some time and I generally agree with what you have to say....but really? Why not just advocate scrapping the profession as a whole?

 

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.

 

Is there a program out there that doesn't use/follow The Bates Guide to Physical Examination for practical/physical exams? This is the most standard part of any curriculum, the programs need only to follow the chapters...and they do. I would expect this to be true for any program....any current or recent students please chime in if I am wrong.

 

 

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.

 

Very "eat your young" attitude....how very nursing. :O_O: The good ole days syndrome at its finest.

 

Anecdotal.

 

 

What is with all the doom an gloom on this board. It's one of the reasons I stopped posting. Seriously, if you don't like your job.....quit it and find another. I will enjoy being a PA and I will take the good with the bad (I know there is some bad). Lighten up folks.

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Being that were getting rid of certificate programs will the MCAT now be a pre-req in the application process? I'm noticing a trend of no HCE in students being accepted to PA programs much like Med School. In the future will a step 1, 2, and 3 process be introduced?

 

I wonder if this is the reasoning behind NCCPA'S push for this...

 

Oh and Yes! The sky is falling!

 

(had to meet the quota)

 

Sent from my myTouch_4G_Slide using Tapatalk 2

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TA- I know you and I know about the standards of your program. I will be politically correct here and only say that not all programs are as stringent as yours in providing a good experience to their students.

back in the day everyone knew they would be tested against a standard model for physical exams in order to be licensed so they took it a bit more seriously than " I just need to pass this class".

sure, everyone learns physical exams in PA school year 1. at the end of year 2 how many of them can still do them properly? how many of them actually continue to practice them after they are signed off in class?

part of the exam is judgement as well as "do a heart exam". you need to demonstrate that you know what to do, not just how to do it. one of my practical exams for the boards was this : "your pt is a 35 yr old male who was just diagnosed with HIV infection. you are his pcp and he is coming to you for his first exam. you have 20 minutes, go".

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I'd have no problem with proving a baseline competency. My issue with this process is that obviously a student will be held accountable for poor PE skills, but what about the program? If this proposed test is used to place defienect programs on probationary status if x% of their students do not pass, I'm all for it.

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I have a couple of points for you to consider:

 

1. The PANCE certifies a new PA to start practicing; it does not mean he or she has anything close to mastery. The same was true of my university training in engineering and probably for many other disciplines as well.

 

2. No test can test everything. Before something significant is added (or added back) to the PANCE, someone needs to prove that it's really needed. Kind of like proving that there is a lot of voter fraud before you make a couple of hundred million people get ID cards before they can vote.

 

3. The NCCPA, however well-intentioned, is a business, and one that would otherwise be losing 40% of its income when the PANRE cycle goes to 10 years. The specialty exams -- and possibly increasing the complexity and duration of the PANCE -- represent potential new revenue streams for them. I'm not sure leaving it up to them to decide if additional testing requirements are needed is necessarily the way for the profession to go.

 

4. I've worked with PAs from several programs and precepted some. I don't see a big problem with their entering skills. They have much to learn, but so did -- and do -- I. This is a profession that requires lifelong learning. Openly complaining about the relative inexperience of new PAs does not help us attract or train them. Their training did not end when they were certified and our responsibility to help new PAs honors the contributions made by those who helped us when we were new to the profession.

 

5. Our profession doesn't compete with physicians as much as it does with NPs. NPs are well-meaning people who, in my experience, do a great job. Like us, they come to their training with a variety of past experience: some have more and some have less. Within their NP training programs, they get maybe 25% of the clinical hours that we do, much less in the way of the range of required clinical experience, and a one-time certification program. Still, they are ahead of us in clinical privileges in some parts of the country. I don't think that adding to the complexity of our own certification process is going to help us here.

 

I don't belittle any of the opinions -- agreeing or disagreeing with my position -- that have been posted. I only ask that you step back and think about the objectives and methods that would help our profession.

 

I, for one, did take that year of organic chemistry + lab (which, in the end, I didn't need to get in) and became a PA because it gave me the chance to make a difference at a time in my life when becoming a physician would not have been an option. Having worked with a dedicated SP for the past 7 years, I can honestly say that I admire him, his knowledge, and scope of practice. I would not, however, want to live his life.

Edited by UGoLong

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Being that were getting rid of certificate programs will the MCAT now be a pre-req in the application process? I'm noticing a trend of no HCE in students being accepted to PA programs much like Med School. In the future will a step 1, 2, and 3 process be introduced?

I think the future is longer programs to make up for less experience( The USC model), followed by required postgrad training and specialty board certification.

at some point all pa programs will probably be MS level with a handful of entry level doctorate programs.

the docs go to school, do a residency, then take a test. the same will be required of us at some point. it will still be shorter than the medschool route.

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Why not just advocate scrapping the profession as a whole?

 

Because scrapping the PA profession would shut the door of advancing the career of many health care professionals who currently work in advanced technician levels such as military medics, corpsmen, paramedics, RTs, RNs, etc. I am one of those guys who went to the Navy right out of high school and started learning medicine. There are thousands of people just like me. While in the service or working as a paramedic et al they get married, have kids, continue with their adult life. When they finally decide that it's time to take their experience to the next level, they may not be willing to dedicate 12 years to get through med school (four years undergrad, four years med, three years residency). They are seeking a balance of doing better medicine while still getting a chance to experience their kids growing up.

 

going the med school route out of high school (starting with undergrad), puts a medical school graduate/doctor/DO on target to be well trained and employed in a six figure/yr job at the peak of child rearing years. They can live a very comfortable lifestyle while having the families they always dreamed of. For me, at age 40, with no degree, with three kids less than 10 years of age, PA was my ticket. Please don't advocate for doing away with this profession. I would encourage instead an aggressive recruiting of students just like me. Go the military bases and EMS companies. Put recruiters in hospitals talking up the advanced techs. Fill this profession with applicants who have already seen 10,000 patients. (literally) Then we wouldn't be seeing the call for CAQs, residencies, and increasing the testing module for PANCE.

 

Now though, we have forced the mandatory masters degree....so my peers...my fellow paramedics, are further discouraged as they could swing a couple of years but 4-6 years of salary loss and stress on their already existing family is more than they want to risk. It's a disservice to the profession.

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I'm all for the older applicant with experience going to pa school.

I would encourage younger folks to seriously consider medical school if they don't have prior experience in the medical field.

many here will disagree with me but I don't think PA should be an entry level career. that was not the intention of the founders of the profession.

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I remember my undergrad days when everyone who had a Low GPA/MCAT scores would say Im going to PA school rather than do a Post Bach program. Sadly some of them became PA. In the future will the patient be asking themselves are they a PA because they had low grades, and MCAT scores because the training, and certification process is almost as long?

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Because scrapping the PA profession would shut the door of advancing the career of many health care professionals who currently work in advanced technician levels such as military medics, corpsmen, paramedics, RTs, RNs, etc. I am one of those guys who went to the Navy right out of high school and started learning medicine. There are thousands of people just like me. While in the service or working as a paramedic et al they get married, have kids, continue with their adult life. When they finally decide that it's time to take their experience to the next level, they may not be willing to dedicate 12 years to get through med school (four years undergrad, four years med, three years residency). They are seeking a balance of doing better medicine while still getting a chance to experience their kids growing up.

 

going the med school route out of high school (starting with undergrad), puts a medical school graduate/doctor/DO on target to be well trained and employed in a six figure/yr job at the peak of child rearing years. They can live a very comfortable lifestyle while having the families they always dreamed of. For me, at age 40, with no degree, with three kids less than 10 years of age, PA was my ticket. Please don't advocate for doing away with this profession. I would encourage instead an aggressive recruiting of students just like me. Go the military bases and EMS companies. Put recruiters in hospitals talking up the advanced techs. Fill this profession with applicants who have already seen 10,000 patients. (literally) Then we wouldn't be seeing the call for CAQs, residencies, and increasing the testing module for PANCE.

 

Now though, we have forced the mandatory masters degree....so my peers...my fellow paramedics, are further discouraged as they could swing a couple of years but 4-6 years of salary loss and stress on their already existing family is more than they want to risk. It's a disservice to the profession.

 

You're preaching to the choir, our backgrounds are very similar. I hope the PA profession continues to grow considering I will finally be one....as soon as I get this silly PA school stuff out of the way.

 

My only point is, the good ole days weren't all that great. Some folks are looking back with rosy colored glasses. The continual bashing of current students and elitist attitude of "I went to school here vs here..." is getting old. It reeks of the nursing culture.

 

Take a look at the past HCE and GPA stats on the PAED site and you will see that the disparity of HCE back in the day vs today isn't as great as some would have you believe. There is a difference...yes, but it isn't that much.

 

Folks are advocating for longer schools, CAQ's, and residencies. That's great for the young fresh-faced undergrad with no HCE and little life experience out of academia . Unfortunately, that would squeeze out many of the older/experienced folks. There is no way I could realistically do all that with a family of four. I wouldn't be unique in that. It's why I choose to be a PA.

 

There are folks who are advocating the self eating snake. More school, more currencies, more HCE.....it will squeeze out the very folks they want to apply. Might as well advocate scrapping the profession.

 

As far as the original topic....if the NCCPA wants to bring it back they will. I have zero expectations that it will somehow make folks better clinicians. It is nothing more than a money generator. That's my life/medical experience speaking.....albeit not a PA.

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My only point is, the good ole days weren't all that great. Some folks are looking back with rosy colored glasses. The continual bashing of current students and elitist attitude of "I went to school here vs here..." is getting old. It reeks of the nursing culture.

 

Take a look at the past HCE and GPA stats on the PAED site and you will see that the disparity of HCE back in the day vs today isn't as great as some would have you believe. There is a difference...yes, but it isn't that much.

 

I find that hard to believe seeing as the profession started with corpsmen and such that were getting out of the service (4 or more years of service) and giving them a chance to continue their career, so you are looking at 8k hours vs current 250 hrs.

 

Folks are advocating for longer schools, CAQ's, and residencies. That's great for the young fresh-faced undergrad with no HCE and little life experience out of academia . Unfortunately, that would squeeze out many of the older/experienced folks. There is no way I could realistically do all that with a family of four. I wouldn't be unique in that. It's why I choose to be a PA.

 

There are folks who are advocating the self eating snake. More school, more currencies, more HCE.....it will squeeze out the very folks they want to apply. Might as well advocate scrapping the profession.

 

As far as the original topic....if the NCCPA wants to bring it back they will. I have zero expectations that it will somehow make folks better clinicians. It is nothing more than a money generator. That's my life/medical experience speaking.....albeit not a PA.

 

I think the advocacy for longer programs and residencies etc is due to the lack of experience coming out of school. How would the NCCPA benefit financially from you having to do residency? They wouldn't.

 

The testing is not to make a better clinician. The testing is to ensure a baseline standard for those finishing school. Just like NREMT has practical stations. How many times have you backboarded a patient in EMT or paramedic school? How many times were you checked off on it in school and ride alongs? But yet you still have to do it for the NREMT. I am shocked that people are so scared of having to show competency.

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Guest Paula
I think the future is longer programs to make up for less experience( The USC model), followed by required postgrad training and specialty board certification.

at some point all pa programs will probably be MS level with a handful of entry level doctorate programs.

the docs go to school, do a residency, then take a test. the same will be required of us at some point. it will still be shorter than the medschool route.

 

The Carolinas Health System is offering post-grad fellowships to PAs and NPs in the areas of Hospitalist, Surgical, Urgent Care, Cardiology, Pulmonology, Critical Care starting October 2013. They are in the process of developing a Primary Care Fellowship. There is a stipend and then an offer of employment might be made at the end of the training with a 2 year commitment to the Carolinas system. It is perfect for PA/NP and I think is the wave of the future. If all teaching health systems offered these to new grads/experienced PAs then there would be no reason for organized medicine to cry foul when PA/NPs want to work at the "top of their license".

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Where do I start.:;;D:

 

I find that hard to believe seeing as the profession started with corpsmen and such that were getting out of the service (4 or more years of service) and giving them a chance to continue their career, so you are looking at 8k hours vs current 250 hrs.

 

Search this site and you will see that someone posted the stats. It was about this time last year....or you can join PAEA and look it up for yourself. The profession started with corpsmen...yes, but that was only the first class. It was mixed with various levels of HCE types shortly there after. Fact of the matter is, folks have been gaining acceptance into with various levels of experience almost since the start. The trend is now lower...but not that lower if you look at the averages.

 

BTW, I am all for HCE. The strength of my application was built on 20 years of HCE.

 

 

 

I think the advocacy for longer programs and residencies etc is due to the lack of experience coming out of school. How would the NCCPA benefit financially from you having to do residency? They wouldn't.

Re-read what I wrote. I was referring to the original topic of bringing back the physical evaluations portion of the PANCE.

 

The testing is not to make a better clinician. The testing is to ensure a baseline standard for those finishing school. Just like NREMT has practical stations. How many times have you backboarded a patient in EMT or paramedic school? How many times were you checked off on it in school and ride alongs? But yet you still have to do it for the NREMT. I am shocked that people are so scared of having to show competency.

I am well aware of baseline testing and standards are used for, I used to develop these very types of things in my former profession. I was referring to another poster stating how the physical exam portion somehow made the students of their era "better", to which I say...nonsense.

 

Believe me, I have no issues showing competency. I lived in a bubble of constant assessment for almost 15 years. I have zero fear of this. If they bring it back, fine...I don't care. A couple assessments of clinical evaluation on fake patients will accomplish nothing but generate money for the NCCPA.

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I am shocked that people are so scared of having to show competency.

 

 

That is quite the assumption you are making about the people in this thread's motivation. You realized that none of the people involved in this conversation will be subject to this requirement right? Not even the incoming first year's are going to be subject to this as the study does not end for 18-24 months [+ time to implement] and it only applies to the PANCE . Pretty sure no one is "scared" of it. We are debating the merits based on cost/benefit/value, not making personal attacks.

 

 

 

 

Also, your point about having to do skills for the NREMT does not really apply. EMT/Para Programs are no where near as homogenous or carefully regulated as PA programs are. It is not that I don't think showing and being evaluated on competency is important or necessary, it is that I believe the structure of PA school and its oversight allows for this outside of an expensive "all or nothing" test. If there is a problem with PA exam skills, it can be taken care of via ARC-PA instead of the NCCPA. The advantage of fixing issues via program oversight is that is fixes the problem BEFORE it develops (aka in training) instead of at the end, when the damage has already been done.

Edited by taotaox1

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All PAs school have rigorous didactic education and testing. The whole PANCE is a not necessary as those who are weak will be properly weeded out by programs due to high ARCPA standards.

Edited by Oneal

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