The role of PAs in providing mental health care.

The prevalence of psychiatric and substance use disorders in the United States is rising and of growing concern. Because such behavioral conditions are widespread, one approach is to collaborate with various medical professionals to help offset this demand. To address this issue, the frequency and types of mental health conditions encountered by physician assistants (PAs) were assessed. The National Commission on the Certification of Physician Assistants Practice Analysis was examined for the types of mental health conditions encountered across the spectrum of medical and surgical practices. The findings reveal that, in 2015, at least 62% of PAs saw and evaluated mental health conditions and behavioral disorders at least weekly in their settings. These patient diagnoses were seen with variability based on the specialty of the PA. The highest percentage of cases reported by PAs were in psychiatry, followed by general internal medicine, emergency medicine, family medicine, and hospital medicine. With the profession projected to grow, recruiting, retaining, and integrating more PAs into mental health care is a suggested strategy for addressing national provider shortages.

PA practice analysis: Multidisciplinary tasks, knowledge, and skills.

In conducting its practice analysis, the National Commission on Certification of Physician Assistants incorporated new approaches in 2015. Twelve groups of PAs identified knowledge, tasks, and skills required for practice not only in primary care, but also in 11 practice focus areas (specialties). In addition, a list of diseases and disorders likely to be encountered was identified for each specialty. A representative sample of 15,771 certified PAs completed an online algorithm-driven survey and data were analyzed to determine how practice is the same for all PAs and how it differs depending on the practice focus. Larger differences between PAs in different specialties were seen in the frequency ratings of diseases and disorders encountered than for ratings of task, knowledge, and skill statements. Distinctions between PAs in primary care and those in other specialties were more pronounced, as the specialty was more divergent from primary care.

Measuring clinical decision making: do key features problems measure higher level cognitive processes?

Reliable and objective assessment of clinical decision-making skills has been a long-standing goal in occupational testing in the allied health professions. With this goal in mind, the key features problem (KFP) format was developed which elicits targeted decisions about key features of clinical scenarios. To build on a small body of empirical evidence evaluating their efficacy, this study evaluates whether KFPs successfully assess higher order cognitive processes. Analysis of objective data (item length and difficulty, item performance, and response times) and subjective data (expert ratings of cognitive complexity) supported the proposition that KFPs tend to be more cognitively complex than conventional multiple-choice questions. Not only were they rated as more complex, but this complexity accounted for some of the increase in time spent responding to these items. Results support the use of KFPs in standardized assessments for measuring higher order cognitive processes such as clinical decision making.