Overview and introduction
Congratulations on choosing to be a physician assistant (PA) as we move beyond the 50th year celebration of the PA profession! As educators who have also enjoyed clinical practice as part of our professional roles, we welcome you to our career and challenge you to explore it fully during your PA education. As many senior PAs say with great enthusiasm, “I had no idea where the PA career would take me or the many options and opportunities that would come along. Who knew?”
Our goal for this seventh edition of Physician Assistant: A Guide to Clinical Practice is to be both a textbook and your lifelong “go-to” resource on PAs and the profession; we want it to be a guide that will remain on your bookshelf throughout your career. In the early days of the PA profession, there were no textbooks or resources specifically for PAs. We relied on resources for physicians and medical students, and faculty members photocopied handouts that they had developed individually or borrowed from their colleagues in other programs. Fortunately, the W.B. Saunders Publishing Company saw the potential for a PA textbook, and in 1994, the first edition of this book was released. The editors were pleased to receive numerous communications from PA students expressing enthusiasm, pride, and even relief that there was “finally a book for PAs” sitting on the shelves of their college bookstores and libraries.
The early editions of the book were only available in hard copy. We’re delighted that it’s now available in both a hard copy and a downloadable version. This eliminates the need for you to carry around the heavy printed version of the book and allows you to have just what you need available on your computer screen for use in the classroom, study sessions, and clinical rotations. You’ll always have it with you! Be sure to check out the book’s additional features in the online version.
This edition includes additional primers on how to best use many of the unique and latest teaching and learning approaches that are features of a constantly evolving PA educational methodology.
In addition to the skilled faculty members in your program whom you know well, you’ll also benefit from experiences from other faculty members and health care leaders beyond your own program. We’ve purposely recruited a wide range of experts from the United States and several other countries. You can expect to see even more international involvement in future editions as PA utilization, education, and regulation expand outside the United States.
A lot of the stress of PA education comes from not knowing what PAs really do. This book will help with that! Our goal as editors is to show you a bigger world of what PAs have been, are currently, and can become. Some of the chapters are about cutting-edge topics you didn’t know you’d need. You’ll probably have a different view about the relevance of these issues by the time you graduate and start your first job.
You’ll find that you need the book’s various sections at different times in your education and PA career. Section I features an overview of the career. You may find these topics assigned early in your PA program as your faculty introduce you to PA history. Although we’ve come a long way in 50 years, there is still work to be done in the further development and regulation of PAs in new roles. Section I will provide you with background about how we got to where we are. We hope it will inspire you to consider PA and community leadership roles throughout your career. You’ll learn the principles behind PA education and why it’s different from medical school. You’ll find out how to be safe in clinical settings. You’ll discover the complexities of how PAs are allowed to work because of PA program accreditation, national certification by the National Commission on Certification of Physician Assistants (NCCPA), licensure at the state level, and privileges at the institutional level. You’ll develop a greater understanding of physician–PA supervisory relationships, and you’ll gain an appreciation for the long-term challenges that we faced and continue to face for appropriate recognition and payment for our services. Finally, you’ll learn about the importance of being part of an interprofessional team. These first chapters may be especially helpful to share with your family and friends who may not yet understand as much as they would like about the PA profession.
Section II focuses on medical knowledge. This section is not intended to substitute for the many outstanding medical textbooks available to all types of clinical students. Some chapters in Section II are examples of how this book serves as a resource for topics and skills you didn’t know you’d need. As PA educators, we’re proud of our responsibility to design the PAs of the future. New health care systems will need PAs who understand evidence-based medicine and research methodology. Keeping people healthy becomes increasingly important as more and more people have access to health care, and we need to think about the unique health care needs of specific populations. Common clinical procedures are included to give some examples of the broad procedural skill sets of PAs. The description of PA prescriptive practice has a similar role.
Genetics will continue to play a greater role in medicine, and our genetics chapter provides updated information that you can integrate into your practice. Other marketable skill areas this text will enhance include chapters on chronic care, alternative and complimentary medicine, end-of-life issues, and the changing health care environment.
PAs are known for their outstanding communication and people skills. Section III is designed to reinforce the communication experiences that PA students receive throughout their education and practice. This section provides an important background about the appropriate use and value of electronic medical records. Tools such as patient education, cultural sensitivity, and cultural competence are also available in this section.
Section IV focuses on clinical rotations. These chapters are not intended as a substitute for other textbooks on these medical and surgical specialties nor are they there to supplant your program’s rotation manuals. For the seventh edition, we’ve asked our authors to rewrite these chapters to focus specifically on what a student needs to know for each of these rotations. We’ve included the rotations that are required by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) as well as examples of the most common electives. We believe that this section will be especially popular.
Professionalism is the subject of Section V. Professionalism is a hot topic in all clinical education programs and is often an area that students may not have previously considered.
We’ve focused on professionalism as it applies to PAs specifically. Similarly, this section considers ethics and malpractice relative to PA practice. Finally, this section reviews the issue and range of postgraduate programs.
Section VII on systems-based practices has several functions. The initial chapter on health care delivery systems is designed to provide students with information about changes in the health care delivery system, primarily in response to the regulations concerning the provision and access to health care as defined by the Affordable Care Act and the discussion of the possibility of “Medicare For All” or other alternatives that provide universal access. This is a rapidly evolving topic with a range of regional differences. Recognizing the underlying principles of these changes will help students and practicing PAs to make employment decisions about the type of setting in which they’d be the best fit.
Other chapters in this section have been written to allow readers to explore settings and populations where PAs are employed and practice. In addition to providing a background for job choices, this section is also written to encourage PAs to understand and appreciate the wide range of employment opportunities and challenges that are available to PAs.
Finally, Section VIII will help new graduates as they move into clinical practice. New PAs describe several years of transition as they move from being students into the world of clinical practice. It’s reasonable to expect that this transition will take 2 to 3 years. Even in the early stages of a PA career, there are opportunities to move into leadership and professional service. This is the time to think about the potential for involvement in PA education, either as a preceptor or as a part- or full-time faculty member. The last chapter explores our future. As authors and teachers, we are excited that you will be a part of it.
We would like to offer some general pieces of advice that we hope will further maximize your experience as a PA student and as a PA:
In class and in clinic: go early, stay late.
Get to know your faculty members—be transparent.
Get to know each of your classmates—schedule a time with each of them one on one at least once in the first quarter or semester of school.
Stay caught up—pay attention to objectives in your courses. They’re designed to guide you in what you need to know and in how to spend your precious time.
Meet as many PAs as you can. They will be role models and mentors.
Most importantly, learn from your patients.
Again, welcome to this wonderful career!