PA to MD alternative

[LT_Oneal_PAC]

Re procedures...

Sorry folks but ""any chimp" cannot be taught to do procedures well.

You can easily teach someone to do something to get it done, but it takes talent and (dare I say) intellect to skillfully perform procedures. They're not all chip shots.

 

Anyone who says otherwise 1) hasn't done enough procedures or 2) hasn't done any challenging ones.

 

I would say that was formerly true, but today with ultrasound, ct, video laryngoscopes, vein finders, it's not as true. Now getting things done the old fashioned way (like a central line without US or a swan without CT) then yes, I agree. However, more and more it's becoming standard to does these things with more tools. Not that I agree with it.

 

I still believe though one is not taught to do these procedures or trusted to do them independently without critically thinking and without being taught how to do them without technological assistance.

[andersenpa]

It would get you written up at my hospital. You could write the order, but you can't make the change. Its a checks and balances system.

 

Let's realize that these hospital policies are often based on institutional experiences and not any global statement on the ability of RTs/PAs/NPs/whoever to competently manage a vent, conscious sedation, etc.

[andersenpa]

It would get you written up at my hospital. You could write the order, but you can't make the change. Its a checks and balances system.

 

Let's realize that these hospital policies are often based on institutional experiences and not any global statement on the ability of RTs/PAs/NPs/whoever to competently manage a vent, conscious sedation, etc.

[andersenpa]

good, although as far as I know it's not a pre-req for pa school but maybe it should be....2000 hrs of hce + viewing the following movies....

 

I thought the way you EM night shifters did it was you go to school and THEN watch all the movies on the slow shifts.

[andersenpa]

good, although as far as I know it's not a pre-req for pa school but maybe it should be....2000 hrs of hce + viewing the following movies....

 

I thought the way you EM night shifters did it was you go to school and THEN watch all the movies on the slow shifts.

[andersenpa]

I never understood people using procedures as evidence of HCE.

 

It seems to me that someone who has done procedures is the DEFINITION of HCE.

If you've done the procedures, you've been exposed to the clinical side of it as well.

 

From a phlebotomist to ortho tech to CNA, they've done the "simian" procedures while they are working in the clinical setting, around PAs/docs/etc....

[andersenpa]

I never understood people using procedures as evidence of HCE.

 

It seems to me that someone who has done procedures is the DEFINITION of HCE.

If you've done the procedures, you've been exposed to the clinical side of it as well.

 

From a phlebotomist to ortho tech to CNA, they've done the "simian" procedures while they are working in the clinical setting, around PAs/docs/etc....

[andersenpa]

I would say that was formerly true, but today with ultrasound, ct, video laryngoscopes, vein finders, it's not as true. Now getting things done the old fashioned way (like a central line without US or a swan without CT) then yes, I agree. However, more and more it's becoming standard to does these things with more tools. Not that I agree with it.

 

I still believe though one is not taught to do these procedures or trusted to do them independently without critically thinking and without being taught how to do them without technological assistance.

 

I am not the kind of person who posts here and "pulls rank" on pre-PAs, but I have to say you sound like you don't know what you're talking about re: procedures, despite whatever your current HCE may be.

Tools and toys don't take as much of the challenge out of interventions as you may think. Knowledge of anatomy, pharmacology, and physiology are critical for performing procedures safely and competently. The devices you mention minimize the risk of complications and stress but the act itself still demands the aforementioned knowledge.

 

And BTW "swan without CT"???? In all my years I've never seen a swan floated with CT guidance. do they do those in the same room as the vein finders????

[andersenpa]

I would say that was formerly true, but today with ultrasound, ct, video laryngoscopes, vein finders, it's not as true. Now getting things done the old fashioned way (like a central line without US or a swan without CT) then yes, I agree. However, more and more it's becoming standard to does these things with more tools. Not that I agree with it.

 

I still believe though one is not taught to do these procedures or trusted to do them independently without critically thinking and without being taught how to do them without technological assistance.

 

I am not the kind of person who posts here and "pulls rank" on pre-PAs, but I have to say you sound like you don't know what you're talking about re: procedures, despite whatever your current HCE may be.

Tools and toys don't take as much of the challenge out of interventions as you may think. Knowledge of anatomy, pharmacology, and physiology are critical for performing procedures safely and competently. The devices you mention minimize the risk of complications and stress but the act itself still demands the aforementioned knowledge.

 

And BTW "swan without CT"???? In all my years I've never seen a swan floated with CT guidance. do they do those in the same room as the vein finders????

[LT_Oneal_PAC]

I am not the kind of person who posts here and "pulls rank" on pre-PAs, but I have to say you sound like you don't know what you're talking about re: procedures, despite whatever your current HCE may be.

Tools and toys don't take as much of the challenge out of interventions as you may think. Knowledge of anatomy, pharmacology, and physiology are critical for performing procedures safely and competently. The devices you mention minimize the risk of complications and stress but the act itself still demands the aforementioned knowledge.

 

And BTW "swan without CT"???? In all my years I've never seen a swan floated with CT guidance. do they do those in the same room as the vein finders????

 

Everything you said is in also (though summarized) in my quote. You are not taught procedures without learning everything about it.

 

Hehe, I agree it's ridiculous and I've never done it, but in my old critical care unit it was not allowed to place one without portable CT. In the OR, however, it's regularly done without and it does take more skill to understand why/where it's not advancing, not to mention placing them from places other than the right IJ and having to turn more corners.

[LT_Oneal_PAC]

I am not the kind of person who posts here and "pulls rank" on pre-PAs, but I have to say you sound like you don't know what you're talking about re: procedures, despite whatever your current HCE may be.

Tools and toys don't take as much of the challenge out of interventions as you may think. Knowledge of anatomy, pharmacology, and physiology are critical for performing procedures safely and competently. The devices you mention minimize the risk of complications and stress but the act itself still demands the aforementioned knowledge.

 

And BTW "swan without CT"???? In all my years I've never seen a swan floated with CT guidance. do they do those in the same room as the vein finders????

 

Everything you said is in also (though summarized) in my quote. You are not taught procedures without learning everything about it.

 

Hehe, I agree it's ridiculous and I've never done it, but in my old critical care unit it was not allowed to place one without portable CT. In the OR, however, it's regularly done without and it does take more skill to understand why/where it's not advancing, not to mention placing them from places other than the right IJ and having to turn more corners.

[physasst]

It seems to me that someone who has done procedures is the DEFINITION of HCE.

If you've done the procedures, you've been exposed to the clinical side of it as well.

 

From a phlebotomist to ortho tech to CNA, they've done the "simian" procedures while they are working in the clinical setting, around PAs/docs/etc....

 

Not necessarily...It's an easy thing to quantify, which is why people ask for it, but that doesn't mean they know what the hell they are doing. I was first assist in both Neurosurgery and Ortho before going to EM...I've done a lot of procedures...I find them occasionally difficult from a manual perspective (86 year old with degenerative spine who needs an LP), but not from a mental perspective. Never did. It's repetition....boring....

 

I've met too many students who talk about their HCE, but when you ask them why they are doing this....cannot formulate a really good answer. Now, take the same 86 year old, put them on Coumadin, or LMWH, and then ask, do you need to do this? What about their clinical situation gives you that answer? What if their status changes? Can it wait? Why? Why not? What do you need to worry about? etc.etc.etc.

 

THAT's the knowledge that matters.

 

To be honest, I don't even care to do procedures anymore...except cardioversions.....which I still enjoy, but otherwise, I let the residents or students do them. I'd rather see people or catch up on charting (so I can be out the door as soon as the shift is over, as the fewest number of minutes that I can spend there, the better).....YMMV

[physasst]

It seems to me that someone who has done procedures is the DEFINITION of HCE.

If you've done the procedures, you've been exposed to the clinical side of it as well.

 

From a phlebotomist to ortho tech to CNA, they've done the "simian" procedures while they are working in the clinical setting, around PAs/docs/etc....

 

Not necessarily...It's an easy thing to quantify, which is why people ask for it, but that doesn't mean they know what the hell they are doing. I was first assist in both Neurosurgery and Ortho before going to EM...I've done a lot of procedures...I find them occasionally difficult from a manual perspective (86 year old with degenerative spine who needs an LP), but not from a mental perspective. Never did. It's repetition....boring....

 

I've met too many students who talk about their HCE, but when you ask them why they are doing this....cannot formulate a really good answer. Now, take the same 86 year old, put them on Coumadin, or LMWH, and then ask, do you need to do this? What about their clinical situation gives you that answer? What if their status changes? Can it wait? Why? Why not? What do you need to worry about? etc.etc.etc.

 

THAT's the knowledge that matters.

 

To be honest, I don't even care to do procedures anymore...except cardioversions.....which I still enjoy, but otherwise, I let the residents or students do them. I'd rather see people or catch up on charting (so I can be out the door as soon as the shift is over, as the fewest number of minutes that I can spend there, the better).....YMMV

[andersenpa]

Everything you said is in also (though summarized) in my quote. You are not taught procedures without learning everything about it.

 

Hehe, I agree it's ridiculous and I've never done it, but in my old critical care unit it was not allowed to place one without portable CT. In the OR, however, it's regularly done without and it does take more skill to understand why/where it's not advancing, not to mention placing them from places other than the right IJ and having to turn more corners.

 

I'm guessing you mean fluoro (Xray) not CT.

[andersenpa]

Everything you said is in also (though summarized) in my quote. You are not taught procedures without learning everything about it.

 

Hehe, I agree it's ridiculous and I've never done it, but in my old critical care unit it was not allowed to place one without portable CT. In the OR, however, it's regularly done without and it does take more skill to understand why/where it's not advancing, not to mention placing them from places other than the right IJ and having to turn more corners.

 

I'm guessing you mean fluoro (Xray) not CT.

[LT_Oneal_PAC]

I'm guessing you mean fluoro (Xray) not CT.

 

Lol yes, forgive me. Don't k ow what I was thinking.

[LT_Oneal_PAC]

I'm guessing you mean fluoro (Xray) not CT.

 

Lol yes, forgive me. Don't k ow what I was thinking.

[Contrarian]

^^^ Now that ^^^ was freeeekin hilarious... and classic.

[Contrarian]

^^^ Now that ^^^ was freeeekin hilarious... and classic.

[whimsygirl]

Let's realize that these hospital policies are often based on institutional experiences and not any global statement on the ability of RTs/PAs/NPs/whoever to competently manage a vent, conscious sedation, etc.

 

Absolutely agree.

[whimsygirl]

Let's realize that these hospital policies are often based on institutional experiences and not any global statement on the ability of RTs/PAs/NPs/whoever to competently manage a vent, conscious sedation, etc.

 

Absolutely agree.

[acozadd]

After reading all that, nope I pegged it right the first time.

 

LOL'd hard, was thinking this while I read that as well.

[acozadd]

After reading all that, nope I pegged it right the first time.

 

LOL'd hard, was thinking this while I read that as well.

[jdtpac]

This thread started on as asking about bridge programs and on the difference between PAs and NPs oversight, and has now completely veered of the subject and onto respiratory and other procedures. If you don't mind I would like to attempt to address Veritas86’s first question. There is a bridge program at The Lake Erie College of Medicine (LECOM) which only recently began its first class in 2011. LECOM is an osteopathic medical, DO medical schools traditionally accept a larger percentage of PAs than M.D. programs. This is why LECOM decided to establish their Accelerated Physician Assistant Pathway (APAP) program. They reserve 12 openings for PAs in their APAP program and PAs must commit to doing a residency in primary care. The only advantage of this program to the traditional meds school pathway is that reduces that time from 4 years to 3 years which in turn decreases the cost by about one quarter. The other advantage is that because of being a PA with clinical experience a minimum GPA requirement is only 2.7 whereas most traditional programs require a 3.0 or higher GPA.

 

When I was on the AAPA BOD in 2008 LECOM approach the Academy and the Physician Assistant Education Association (PAEA) seeking an endorsement of the concept of bridge programs while at the same time they were submitting their proposal to The American Osteopathic Association's Commission on Osteopathic College Accreditation. After much discussion in 2009 and 2010 by the Academy's Education Council and PAEA both groups expressed concerns about creating pathways out of the profession, especially at a time when the demand PAs was at its highest. In 2009 the AAPA’s Annual Censes indicated less than 1% of PAs actually went on to pursue training as a physician. However, because this was an issue being discussed amongst the profession, in 2011 the Academy's Education Council presented a draft policy statement and position paper to the House of Delegates in Las Vegas that basically stated:

"The American Academy of Physician Assistants can neither support nor endorse the development of bridge programs. PAs who are interested in pursuing training leading to the MD or DO degree should examine closely and compare them to traditional medical educational programs".

The House of Delegates did not pass these proposals but referred them back to the Education Council for further study citing the same original concerns of the Council and PAEA.

 

For the purposes of this discussion I do not think you are going to see a large number of bridge programs opening in the near future. Not just because of what I just mentioned above, but also because I do not believe there is an overwhelming desire by either the PA or nursing professions of wanting to push the issue. And because I do not think the majority of medical schools see any advantage for them.

[jdtpac]

This thread started on as asking about bridge programs and on the difference between PAs and NPs oversight, and has now completely veered of the subject and onto respiratory and other procedures. If you don't mind I would like to attempt to address Veritas86’s first question. There is a bridge program at The Lake Erie College of Medicine (LECOM) which only recently began its first class in 2011. LECOM is an osteopathic medical, DO medical schools traditionally accept a larger percentage of PAs than M.D. programs. This is why LECOM decided to establish their Accelerated Physician Assistant Pathway (APAP) program. They reserve 12 openings for PAs in their APAP program and PAs must commit to doing a residency in primary care. The only advantage of this program to the traditional meds school pathway is that reduces that time from 4 years to 3 years which in turn decreases the cost by about one quarter. The other advantage is that because of being a PA with clinical experience a minimum GPA requirement is only 2.7 whereas most traditional programs require a 3.0 or higher GPA.

 

When I was on the AAPA BOD in 2008 LECOM approach the Academy and the Physician Assistant Education Association (PAEA) seeking an endorsement of the concept of bridge programs while at the same time they were submitting their proposal to The American Osteopathic Association's Commission on Osteopathic College Accreditation. After much discussion in 2009 and 2010 by the Academy's Education Council and PAEA both groups expressed concerns about creating pathways out of the profession, especially at a time when the demand PAs was at its highest. In 2009 the AAPA’s Annual Censes indicated less than 1% of PAs actually went on to pursue training as a physician. However, because this was an issue being discussed amongst the profession, in 2011 the Academy's Education Council presented a draft policy statement and position paper to the House of Delegates in Las Vegas that basically stated:

"The American Academy of Physician Assistants can neither support nor endorse the development of bridge programs. PAs who are interested in pursuing training leading to the MD or DO degree should examine closely and compare them to traditional medical educational programs".

The House of Delegates did not pass these proposals but referred them back to the Education Council for further study citing the same original concerns of the Council and PAEA.

 

For the purposes of this discussion I do not think you are going to see a large number of bridge programs opening in the near future. Not just because of what I just mentioned above, but also because I do not believe there is an overwhelming desire by either the PA or nursing professions of wanting to push the issue. And because I do not think the majority of medical schools see any advantage for them.