Competencies for the Physician Assistant (PA) Profession

HP-3700.4.3 Competencies for the PA Profession [Adopted 2005, amended 2013, reaffirmed 2010, 2018, amended 2021] Competencies for the Physician Assistant (PA) Profession (Adopted 2005, amended 2012, 2021)

Introduction

This document defines the specific knowledge, skills, and attitudes that physician assistants (PA) in all clinical specialties and settings in the United States should be able to demonstrate throughout their careers. This set of competencies is designed to serve as a roadmap for the individual PA, for teams of clinicians, for healthcare systems, and for other organizations committed to promoting the development and maintenance of professional competencies among PAs. While some competencies are acquired during the PA education program, others are developed and mastered as PAs progress through their careers.

The PA professional competencies include seven competency domains that capture the breadth and complexity of modern PA practice. These are (1) knowledge for practice, (2) interpersonal and communication skills, (3) person-centered care, (4) interprofessional collaboration, (5) professionalism and ethics, (6) practice-based learning and quality improvement, and (7) society and population health. The PA competencies reflect the well-documented need for medical practice to focus on surveillance, patient education, prevention, and population health. These revised competencies reflect the growing autonomy of PA decision-making within a team-based framework and the need for additional skills in leadership and advocacy. As PAs develop greater competency throughout their careers, they determine their level of understanding and confidence in addressing patients’ health needs, identify knowledge and skills that they need to develop, and then work to acquire further knowledge and skills in these areas. This is a lifelong process that requires discipline, self-evaluation, and commitment to learning throughout a PA’s professional career.

Background

The PA competencies were originally developed in response to the growing demand for accountability and assessment in clinical practice and reflected similar efforts conducted by other healthcare professions. In 2005, a collaborative effort among four national PA organizations produced the first Competencies for the Physician Assistant Profession. These organizations are the National Commission on Certification of Physician Assistants, the Accreditation Review Commission on Education for the Physician Assistant, the American Academy of PAs, and the Physician Assistant Education Association (PAEA, formerly the Association of Physician Assistant Programs). The same four organizations updated and approved this document in 2012.

Methods

This version of the Competencies for the Physician Assistant Profession was developed by the Cross-Org Competencies Review Task Force, which included two representatives from each of the four national PA organizations. The task force was charged with reviewing the professional competencies as part of a periodic five-year review process, as well as to “ensure alignment with the Core Competencies for New PA Graduates,” which were developed by the Physician Assistant Education Association in 2018 to provide a framework for accredited PA programs to standardize practice readiness for new graduates.

The Cross-Org Competencies Review Task Force began by developing the following set of guiding principles that underpinned this work:

1. PAs should pursue self- and professional development throughout their careers.
2. The competencies must be relevant to all PAs, regardless of specialty or patient care setting.
3. Professional competencies are ultimately about patient care.
4. The body of knowledge produced in the past should be respected while recognizing the changing healthcare environment.
5. The good of the profession must always take precedence over self-interest.

The competencies were drawn from three sources: the previous Competencies for the Physician Assistant Profession, PAEA’s Core Competencies for New PA Graduates, and the Englander et al article Toward a Common Taxonomy of Competency Domains for the Health Professions and Competencies for Physicians which drew from the competencies of several health professions.1 The task force elected not to reference the source of each competency since most of these competencies were foundational to the work of multiple health professions and are in the public domain. The task force acknowledges the work of the many groups that have gone before them in seeking to capture the essential competencies of health professions.

Englander R, Cameron T, Ballard AJ, Dodge J, Bull J, Aschenbrener CA. Toward a common taxonomy of competency domains for the health professions and competencies for physicians. Academic Medicine. 2013 Aug1;88(8):1088-94.

Competencies

1. Knowledge for Practice

Demonstrate knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to patient care. PAs should be able to:

1.1 Demonstrate investigative and critical thinking in clinical situations.

1.2 Access and interpret current and credible sources of medical information.

1.3 Apply principles of epidemiology to identify health problems, risk factors, treatment strategies, resources, and disease prevention/health promotion efforts for individuals and populations.

1.4 Discern among acute, chronic, and emergent disease states.

1.5 Apply principles of clinical sciences to diagnose disease and utilize therapeutic decision-making, clinical problem-solving, and other evidence-based practice skills.

1.6 Adhere to standards of care, and to relevant laws, policies, and regulations that govern the delivery of care in the United States.

1.7 Consider cost-effectiveness when allocating resources for individual patient or population-based care.

1.8 Work effectively and efficiently in various healthcare delivery settings and systems relevant to the PA’s clinical specialty.

1.9 Identify and address social determinants that affect access to care and deliver high-quality care in a value-based system.

1.10 Participate in surveillance of community resources to determine if they are adequate to sustain and improve health.

1.11 Utilize technological advancements that decrease costs, improve quality, and increase access to health care.

2. Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals. PAs should be able to:

2.1 Establish meaningful therapeutic relationships with patients and families to ensure that patients’ values and preferences are addressed and that needs and goals are met to deliver person-centered care.

2.2 Provide effective, equitable, understandable, respectful, quality, and culturally competent care that is responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

2.3 Communicate effectively to elicit and provide information.

2.4 Accurately and adequately document medical information for clinical, legal, quality, and financial purposes.

2.5 Demonstrate sensitivity, honesty, and compassion in all conversations, including challenging discussions about death, end of life, adverse events, bad news, disclosure of errors, and other sensitive topics.

2.6 Demonstrate emotional resilience, stability, adaptability, flexibility, and tolerance of ambiguity.

2.7 Understand the emotions, behaviors, and responses of others, which allows for effective interpersonal interactions.

2.8 Recognize communication barriers and provide solutions.

3. Person-centered Care

Provide person-centered care that includes patient- and setting-specific assessment, evaluation, and management and health care that is evidence-based, supports patient safety, and advances health equity. PAs should be able to:

3.1 Gather accurate and essential information about patients through history-taking, physical examination, and diagnostic testing.

3.2 Elicit and acknowledge the story of the individual and apply the context of the individual's life to their care, such as environmental and cultural influences.

3.3 Interpret data based on patient information and preferences, current scientific evidence, and clinical judgment to make informed decisions about diagnostic and therapeutic interventions.

3.4 Develop, implement, and monitor the effectiveness of patient management plans.

3.5 Maintain proficiency to perform safely all medical, diagnostic, and surgical procedures considered essential for the practice specialty.

3.6 Counsel, educate, and empower patients and their families to participate in their care and enable shared decision-making.

3.7 Refer patients appropriately, ensure continuity of care throughout transitions between providers or settings, and follow up on patient progress and outcomes.

3.8 Provide health care services to patients, families, and communities to prevent health problems and maintain health.

4. Interprofessional Collaboration

Demonstrate the ability to engage with a variety of other healthcare professionals in a manner that optimizes safe, effective, patient- and population-centered care. PAs should be able to:

4.1 Work effectively with other health professionals to provide collaborative, patient-centered care while maintaining a climate of mutual respect, dignity, diversity, ethical integrity, and trust.

4.2 Communicate effectively with colleagues and other professionals to establish and enhance interprofessional teams.

4.3 Engage the abilities of available health professionals and associated resources to complement the PA’s professional expertise and develop optimal strategies to enhance patient care.

4.4 Collaborate with other professionals to integrate clinical care and public health interventions.

4.5 Recognize when to refer patients to other disciplines to ensure that patients receive optimal care at the right time and appropriate level.

5. Professionalism and Ethics

Demonstrate a commitment to practicing medicine in ethically and legally appropriate ways and emphasizing professional maturity and accountability for delivering safe and quality care to patients and populations. PAs should be able to:

5.1 Adhere to standards of care in the role of the PA in the health care team.

5.2 Demonstrate compassion, integrity, and respect for others.

5.3 Demonstrate responsiveness to patient needs that supersedes self-interest.

5.4 Show accountability to patients, society, and the PA profession.

5.5 Demonstrate cultural humility and responsiveness to diverse patient populations, including diversity in sex, gender identity, sexual orientation, age, culture, race, ethnicity, socioeconomic status, religion, and abilities.

5.6 Show commitment to ethical principles pertaining to the provision or withholding of care, confidentiality, patient autonomy, informed consent, business practices, and compliance with relevant laws, policies, and regulations.

5.7 Demonstrate commitment to lifelong learning and education of students and other healthcare professionals.

5.8 Demonstrate commitment to personal wellness and self-care that supports the provision of quality patient care.

5.9 Exercise good judgment and fiscal responsibility when utilizing resources.

5.10 Demonstrate flexibility and professional civility when adapting to change.

5.11 Implement leadership practices and principles.

5.12 Demonstrate effective advocacy for the PA profession in the workplace and in policymaking processes.

6. Practice-based Learning and Quality Improvement

Demonstrate the ability to learn and implement quality improvement practices by engaging in critical analysis of one’s own practice experience, the medical literature, and other information resources for the purposes of self-evaluation, lifelong learning, and practice improvement. PAs should be able to:

6.1 Exhibit self-awareness to identify strengths, address deficiencies, and recognize limits in knowledge and expertise.

6.2 Identify, analyze, and adopt new knowledge, guidelines, standards, technologies, products, or services that have been demonstrated to improve outcomes.

6.3 Identify improvement goals and perform learning activities that address gaps in knowledge, skills, and attitudes.

6.4 Use practice performance data and metrics to identify areas for improvement.

6.5 Develop a professional and organizational capacity for ongoing quality improvement.

6.6 Analyze the use and allocation of resources to ensure the practice of cost-effective healthcare while maintaining quality of care.

6.7 Understanding how to practice decisions impacts the finances of their organizations while keeping the patient’s needs foremost.

6.8 Advocate for administrative systems that capture the productivity and value of PA practice.

7. Society and Population Health

Recognize and understand the influences of the ecosystem of person, family, population, environment, and policy on the health of patients and integrate knowledge of these determinants of health into patient care decisions. PAs should be able to:

7.1 Apply principles of social-behavioral sciences by assessing the impact of psychosocial and cultural influences on health, disease, care seeking, and compliance.

7.2 Recognize the influence of genetic, socioeconomic, environmental, and other determinants on the health of the individual and community.

7.3 Improve the health of patient populations

7.4 Demonstrate accountability, responsibility, and leadership for removing barriers to health

 

(Adopted 2005, amended 2012, 2021)