German Medical Association defines scope of activity for physician assistants

Berlin. The German Medical Association (BÄK) published a new position paper on the physician assistant profession on Friday. It not only calls for standardizing study content and examinations nationwide, but also provides an overview of the skills physician assistants (PAs) are expected to use to relieve the burden on physicians in practices and clinics.

Eight years after its initial publication, the position paper on physician assistance was revised with the cooperation of the German Society of Physician Assistants (DGPA). Back then, in 2017, the title still referred to it as a new profession in the healthcare sector. Now, it refers to an "established professional profile."

Framework for activities

Accordingly, the BÄK press release states: " Physician assistants have become an integral part of healthcare in Germany in recent years." Against this backdrop, it is becoming increasingly important to clearly define the areas of responsibility between physicians "and this relatively young professional group within the interprofessional team." This position paper is intended to contribute to this.

Among other things, the German Medical Association (BÄK) and the German Society of General Practitioners (DGPA) have considered the PA competencies that define the scope of practice for hospitals and practices. The basic and advanced competencies should be taught by universities as part of the bachelor's program. They should also verify that graduates have mastered these competencies.

The position paper lists, for example, the following as practice-relevant basic (GK) and advanced competencies (EK) :

• As part of the collaboration in the preparation of the diagnosis and treatment plan: The general responsibilities include, for example, taking and documenting anamnesis, a general physical examination, and assessments; recognizing important clinical pictures in internal medicine, surgery, orthopedics and trauma surgery, gynecology, urology, neurology, oncology, and endocrinology; classifying and evaluating laboratory findings; aligning one's own approach with basic leading symptoms, treatment pathways, SOPs, etc., as well as legal regulations; classifying pathophysiological and microbiological relationships; establishing a suspected/working diagnosis, including initiating differential diagnostic measures. The following are defined as EK in this area: preliminary sonographic examinations of various organ systems and the preparation of a preliminary treatment plan.
• As part of the implementation of a treatment plan: as general medical services , the placement of peripheral vascular access, a transurethral indwelling catheter; the performance of peripheral injections (IC, SC, IM, IVIO), as well as the establishment of infusions and the administration of medications. The following are listed as EC : implementation of analgesic measures; wound management, dressing changes including documentation of findings; management of drains and stomas in various organ systems; the application of immobilizing and functional dressings, as well as aids/ortheses.
• Communication and information dissemination tailored to the recipients: Structured dissemination (handover) of information within the team as well as to co-treatment and follow-up practitioners; presentation of patients, findings and disease progression; support and implementation of visits and medical consultations; intra- and interprofessional communication; communication with patients and relatives appropriate to the subject and situation; support in explaining diagnoses, treatment plans and medical measures; compliance management.
• Process management and team coordination: including structuring admission documents; completing records/findings; ensuring the implementation of ordered examinations and medical measures; managing consultations. As an extended competency : participation in clinical studies.
• Documentation support: Documentation of examinations and findings; documentation of clinical courses; coding with classification systems. EC includes, among others: documentation of discharge summaries, doctor's letters, transfer reports, etc.; documentation of MDK responses, preparatory issuance of certificates, rehabilitation applications, etc.; coding in quality assurance; quality and risk management.
• when participating in complex examinations and carrying out medical-technical activities, insofar as these are not reserved for specific professional groups: Within the scope of expanded competencies , the evaluation of laboratory tests; the interpretation of histological and microbiological samples including blood cultures; the preparation for carrying out imaging procedures (X-ray requirements) and the evaluation of the images; the evaluation of long-term blood pressure measurements, resting and stress ECGs and findings; cooperation in consultation examinations.

In addition to basic and advanced skills, PAs should also be able to acquire specialized skills through continuing education after graduation. This should then enable physician assistants to evaluate functional diagnostics or long-term ECGs, for example. (juk)