Recertification: toward the development of standards for assuring continued competence.

NCCPA, in collaboration with NBME, has begun an investigation that may lead to the development of standards for measuring continued competence. In 1981, the 1980 Primary Care Physician's Assistants Certification Examination was administered as a recertification examination to 1,166 PAs who were originally certified in 1975. The scores were standardized by using the standardization constants for the 1980 Certification Examination reference group. There was a difference between the performance of the certification examinees and the performance of the recertification examinees, with recertification examinees doing less well on all sections than the certification examinees. Correlations calculated between recertificants' performance on their original certification examination and their performance on the recertification examination showed a positive relationship between the two examinations. Their performance on a variety of biographical variables was also analyzed, and the only variable that significantly changed their performance was their current employment status. The validity of the test for making judgments about the competence of experienced practitioners was not addressed by the current study and is a crucial question in evaluating the test as a recertification instrument.

Recognition of common childhood malignancies.

Although cancer has an annual incidence of only about 150 new cases per 1 million U.S. children, it is the second leading cause of childhood deaths. Early detection and prompt therapy have the potential to reduce mortality. Leukemias, lymphomas and central nervous system tumors account for more than one half of new cancer cases in children. Early in the disease, leukemia may cause nonspecific symptoms similar to those of a viral infection. Leukemia should be suspected if persistent vague symptoms are accompanied by evidence of abnormal bleeding, bone pain, lymphadenopathy or hepatosplenomegaly. The presenting symptoms of a brain tumor may include elevated intracranial pressure, nerve abnormalities and seizures. A spinal tumor often presents with signs and symptoms of spinal cord compression. In children, lymphoma may present as one or more painless masses, often in the neck, accompanied by signs and symptoms resulting from local compression, as well as signs and symptoms of systemic disturbances, such as fever and weight loss. A neuroblastoma may arise from sympathetic nervous tissue anywhere in the body, but this tumor most often develops in the abdomen. The presentation depends on the local effects of the solid tumor and any metastases. An abdominal mass in a child may also be due to Wilms' tumor. This neoplasm may present with renal signs and symptoms, such as hypertension, hematuria and abdominal pain. A tumor of the musculoskeletal system is often first detected when trauma appears to cause pain and dysfunction out of proportion to the injury. Primary care physicians should be alert for possible presenting signs and symptoms of childhood malignancy, particularly in patients with Down syndrome or other congenital and familial conditions associated with an increased risk of cancer.