A New Assessment Tool for Orthopaedic PAs and NPs

Cloutier, Dagan, PA-C; Editor, JBJS JOPA

JBJS Journal of Orthopaedics for Physician Assistants: July-September 2018 - Volume 6 - Issue 3 - p e22
doi: 10.2106/JBJS.JOPA.18.00029

When the PA profession began in the mid-1960s, the vision was to address the shortage of primary care physicians in the United States. Since then, the profession has seen tremendous growth and diversification in scope of practice. Today, 73% of PAs practice outside of primary care medicine, and 18.5% practice in surgical subspecialties. In a primary care-based curriculum, PA students receive little exposure to clinical and operative orthopaedics, and much of the knowledge they gain comes through practice experience and orthopaedic-focused CME (continuing medical education). One challenge for orthopaedic surgeons who recruit PAs is finding time to teach the PAs during clinical practice. Another challenge can be determining when PAs are ready to evaluate patients independently, as many PAs desire. To date, there are no assessment tools available for PAs that help to establish the baseline level of knowledge that is required to practice independently. For PAs and NPs, it can be hard to know how their level of knowledge compares to their peers.

The National Commission on Certification of Physician Assistants’ (NCCPA’s) primary care-based recertification requirements are desirable to many PAs because they allow them the flexibility to change specialties throughout their career. However, primary care-based recertification fails to offer orthopaedic PAs a true assessment of our clinical practice like the American Board of Orthopaedic Surgery (ABOS) requires for orthopaedic surgeons. I am personally against required specialty examinations for PAs because this could have many detrimental implications, including challenges with hospital credentialing and insurance reimbursement if they do not become specialty-certified. A required specialty examination also may restrict PAs from changing specialties, which has been a unique asset of the PA profession from the beginning. With that said, I believe that some kind of knowledge assessment tool for orthopaedic PAs is needed to gauge academic progress and to provide motivation to learn continually throughout our careers. The NCCPA took a step in this direction in 2009 when it created specialty examinations to give recognition for PAs who are committed to a specialty. The NCCPA’s Orthopaedic Certificate of Added Qualifications (CAQ) examination is not required to practice in orthopaedic environments. Because it must be taken at a testing center, it has presented barriers to participation. To date, <3% of all orthopaedic PAs haven taken the Orthopaedic CAQ examination.

JBJS JOPA recognizes the need for self-assessment tools that are easily accessible and provide valuable feedback on expected level of knowledge. With this need in mind, JOPA has developed the JBJS JOPA Test Your Knowledge Quiz, a free 60-question general orthopaedic quiz that was written and peer-reviewed by PAs who practice in an orthopaedic setting. The quiz subject matter includes a wide range of musculoskeletal conditions that a general orthopaedic PA or NP would see in clinical practice. The quiz requires decision-making regarding patient care; interpreting imaging such as radiographs, magnetic resonance imaging (MRI), and computed tomography (CT); and a knowledge of basic musculoskeletal anatomy. Because orthopaedic PAs practice in a variety of orthopaedic subspecialties, not all of the questions will be familiar to all who take the quiz. Quiz scores are meant to represent a level of general orthopaedic knowledge, which will vary between providers and practice types. With that said, having foundational knowledge in a wide range of musculoskeletal conditions is an asset that all PAs should strive to achieve.

JOPA is encouraging all PAs and NPs who practice in an orthopaedic setting to take the quiz in order to establish baseline scores. A large number of baseline scores will help us offer PAs and NPs expected scores that are based on practice demographics, such as years of experience, educational background, and orthopaedic subspecialty. I ask that you consider taking the JBJS JOPA Test Your Knowledge Quiz today, and encourage your PA and NP colleagues to do the same. I appreciate your participation. You may access the quiz with the following link: https://www.cme4pac.com/test-your-knowledge-ortho-quiz/

Disclosure: The author indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest form is provided with the online version of the article (http://links.lww.com/JBJSJOPA/A42).

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Suggested Reading

National Commission on Certification of Physician Assistants. 2016 statistical profile of certified physician assistants by specialty. 2017. https://prodcmsstoragesa.blob.core.windows.net/uploads/files/2016StatisticalProfilebySpecialty.pdf. Accessed 2018 May 29.
    Physician Assistant Orthopaedic Surgery. PAOS practice & salary survey report. https://paos.org/news/324119/PAOS-Practice—Salary-Survey-Results-Now-Available.htm. Accessed 2018 May 29.

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