Clinical Practice Competencies
The Wake Forest School of Medicine physician assistant (PA) program guides learners through the acquisition of key learning outcomes, which then become the competencies necessary to practice medicine successfully as PAs as well as realize their full potential for leadership. Our unique training model is relevant to the current practice environment but is continuously being innovated in response to evolving and anticipated future roles for PAs. Our graduates enter clinical practice with a strong foundation and a distinctive ability to continually advance their knowledge and skills.
Our program adopts the Competencies for the Physician Assistant Profession  as a basic framework for the core curriculum. These competencies were developed and adopted through a collaborative initiative by the National Commission on Certification of Physician Assistants (NCCPA), the Accreditation Review Commission for Education of the Physician Assistant (ARC-PA), the Physician Assistant Education Association (PAEA), and the American Academy of Physician Assistants (AAPA). Our program has built upon this framework by enhancing the curriculum with additional attention to leadership, scholarship and intellectual curiosity.
Medical knowledge  includes an understanding of pathophysiology, patient presentation, differential diagnosis, patient management, surgical principles, health promotion, and disease prevention. Our graduates must demonstrate core knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to patient care in their area of practice. Our graduates are expected to demonstrate an investigatory and analytic thinking approach to clinical situations. Graduates of our training program are specifically expected to
- Understand etiologies, risk factors, underlying pathologic processes, and epidemiology for medical conditions
- Identify signs and symptoms of medical conditions
- Select and interpret appropriate diagnostic or lab studies
- Manage general medical and surgical conditions to include understanding the indications, contraindications, side effects, interactions, and adverse reactions of pharmacologic agents and other relevant treatment modalities
- Identify the appropriate site of care for presenting conditions, including identifying emergent cases and those requiring referral or admission
- Identify appropriate interventions for prevention of conditions
- Identify the appropriate methods to detect conditions in an asymptomatic person
- Differentiate between the normal and the abnormal in anatomic, physiological, laboratory, and other diagnostic data
- Appropriately use the history, physical findings, and diagnostic studies to formulate a differential diagnosis
- Provide appropriate care to patients with chronic conditions.
Interpersonal and communication skills  encompass verbal, nonverbal, and written exchange of information. Our graduates must demonstrate interpersonal and communication skills that result in effective information exchange with patients, patients' families, physicians, professional associates, and the health care system. Graduates of our training program are specifically expected to
- Create and sustain a therapeutic and ethically sound relationship with patients
- Use effective listening, nonverbal, explanatory, questioning, and writing skills to elicit and provide information
- Appropriately adapt communication style and messages to the context of the individual patient interaction
- Work effectively with physicians and other health care professionals as a member or leader of a health care team or other professional group
- Apply an understanding of human behavior
- Demonstrate emotional resilience and stability, adaptability, flexibility, and tolerance of ambiguity and anxiety
- Accurately and adequately document and record information regarding the care process for medical, legal, quality, and financial purposes.
Patient care  includes age-appropriate assessment, evaluation, and management. Our graduates must demonstrate care that is effective, patient-centered, timely, efficient, and equitable for the treatment of health problems and the promotion of wellness. Graduates of our training program are specifically expected to
- Work effectively with physicians and other health care professionals to provide patient-centered care
- Demonstrate caring and respectful behaviors when interacting with patients and their families
- Gather essential and accurate information about their patients
- Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
- Develop and carry out patient management plans
- Counsel and educate patients and their families
- Competently perform medical and surgical procedures considered essential for general practice
- Provide health care services and education aimed at preventing health problems or maintaining health.
Professionalism  is the expression of positive values and ideals as care is delivered. Foremost, it involves prioritizing the interests of those being served above one's own. Our graduates must know their professional and personal limitations. Professionalism also requires that PAs practice without impairment from substance abuse, cognitive deficiency, or mental illness. Our graduates must demonstrate a high level of responsibility, ethical practice, sensitivity to a diverse patient population, and adherence to legal and regulatory requirements. Graduates of our training program are specifically expected to demonstrate
- Understanding of legal and regulatory requirements, as well as the appropriate role of the PA
- Professional relationships with physician supervisors and other health care providers
- Respect, compassion, and integrity
- Responsiveness to the needs of patients and society
- Accountability to patients, society, and the profession
- Commitment to excellence and on-going professional development
- Commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices
- Sensitivity and responsiveness to patients' culture, age, gender, and disabilities
- Self-reflection, critical curiosity, and initiative.
Practice-based learning and improvement  includes the processes through which clinicians engage in critical analysis of their own practice experience, medical literature, and other information resources for the purpose of self-improvement. Our graduates must be able to assess, evaluate, and improve their patient care practices. Graduates of our training program are specifically expected to
- Analyze practice experience and perform practice-based improvement activities using a systematic methodology in concert with other members of the health care delivery team
- Locate, appraise, and integrate evidence from scientific studies related to their patients' health problems
- Obtain and apply information about their own population of patients and the larger population from which their patients are drawn
- Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
- Apply information technology to manage information, access online medical information, and support their own education
- Facilitate the learning of students and/or other health care professionals
- Recognize and appropriately address gender, cultural, cognitive, emotional, and other biases; gaps in medical knowledge; and physical limitations in themselves and others.
Systems-based practice  encompasses the societal, organizational, and economic environments in which health care is delivered. Our graduates must demonstrate an awareness of and responsiveness to the larger system of health care to provide patient care that is of optimal value. Our graduates should work to improve the larger health care system of which their practices are a part. Graduates of our training program are specifically expected to
- Use information technology to support patient care decisions and patient education
- Effectively interact with different types of medical practice and delivery systems
- Understand the funding sources and payment systems that provide coverage for patient care
- Practice cost-effective health care and resource allocation that does not compromise quality of care
- Advocate for quality patient care and assist patients in dealing with system complexities
- Partner with supervising physicians, health care managers, and other health care providers to assess, coordinate, and improve the delivery of health care and patient outcomes
- Accept responsibility for promoting a safe environment for patient care and recognizing and correcting systems-based factors that negatively impact patient care
- Apply medical information and clinical data systems to provide more effective, efficient patient care
- Use the systems responsible for the appropriate payment of services.
Leadership is a process through which a person influences others to achieve a common goal. The PA profession has the ability to create lasting, transformational change in the way we engage, treat, and support America's patients and their families. The PA profession is rich in talent and filled with the kinds of individuals that patients really want involved in their lives. In this era of team-based care, no one knows better than PAs how to coordinate successful care.  PAs must be able to advocate for patients, communities, and the advancement of the profession for improved access to high quality health care. Graduates of our training program will be able to support positive change through the application of transformational leadership by applying the following skills: [3,4]
- Assist others in forming a vision for improved care
- Communicate the values of the PA profession to others
- Support a culture of teamwork and change
- Communicate openly and transparently with others
- Acknowledge the value and contributions of others
- Seek continually opportunities for leadership development
- Lead with courage, integrity, selflessness, empathy, collaboration, and reflection. 
1. Competencies for the Physician Assistant Profession. Available at http://www.nccpa.net/PAC/Competencies_home.aspx.
2. Bushardt RL. A new era-for JAAPA, the health care system, and the PA profession. JAAPA. 2011;24(7):13.
3. Calhoun GS, Griffith JR, Pattullo A, Sinioris ME. The Foundation of Leadership. In: Baldrige Winning Organizations. Bulletin of the National Center for Healthcare Leadership. December 2007.
4. Collins J. Good to Great and the Social Sector. HarperCollins; 2005.
5. On Leadership (2011). Leadership character: A six-part series by West Point's Col. Eric Kail. Washington PostOnline. Available at http://www.washingtonpost.com/leadership.