Saturday, December 30, 2006
Season's Greetings!
I want to extend best wishes to all of Canada's PAs and to wish you health and happiness for the coming year. I hope you managed to get some down time to re-charge your batteries and to spend some quality time with family and friends.
Sunday, December 17, 2006
Expectations
1. If the anonymous pathologist would like to participate in a dialogue, please identify yourself. We can continue in a less public conversation if you wish. I welcome your comments (and welcome the opportunity to converse on the subject) but the wording of them is intended to induce a response (a dialogue).
2. Clearly, there are unrealistic expectations being put upon PAs (locally). If what is desired is simply to retain, or regain, the status quo (no PAs), negativity will prevail. If fault is sought, it will be found. If the introduction of PAs is viewed as an opportunity and a challenge rather than an impediment, good things may be realized. PAs are here -- to stay, I hope. I'd suggest that the best of this purportedly 'bad' situation be made for the public's, if not for the hospital's, the department's or even the pathologist's sake. A look at the rest of the continent, at medium- and large-scale teaching organizations, may serve to illustrate the type of relationship that exists between pathologists, clinicians and PAs. Rather than attempting to ostracize, criticize and isolate the PA(s) with whom you are forced to work, include them so that they may be aware and informed. I doubt that the relationship that pathologists have with histotechs (with whom they interact many times each day; both as friends and fellow professionals) could be interpreted as "baby sitting." Au contraire, there are many real friendships that have sprung up between pathologists and histotechs. Yet, the PA sits alone in the grossing room awaiting the next critical comment; usually several days after the grossing of the specimen ("Why didn't you take sections of...?!). How about being proactive? A pathologist (the same pathologist who would be responsible for grossing or frozen sections) ought to be responsible for the goings-on in the gross room and ought to visit EACH morning to review the complex specimens with the PAs and to be available throughout the day to field questions from the PAs. If nothing else, the pathologist and the PA will become acquainted. More importantly, this sets up a teaching environment wherein the pathologist can answer questions and give direction to the PA.
Manuals are finally being created for the area. The pathologists will be asked to provide input into the first round of revisions of the policies and procedures. The manual will be used by whomever (PA or pathologist) is performing the gross and this standardization will go a long way towards an overall improvement in the quality of the surgical pathology 'product.' The manual, in and of itself, acts as an instructional document for the PAs as it will also attempt to give insights into why specimens are handled and sectioned in a particular manner. A means by which the pathologists may become proactive is by becoming involved in the discussions surrounding the wording of the procedures. As the Interior migrates toward an educational environment, these manuals will also serve as invaluable resources for pathology residents (who, like PAs, may be reluctant to admit that they have a lot to learn and who would far prefer to consult a manual than, heaven forbid, ask the pathologist and admit that they were overwhelmed by the flood of information when the pathologist explained how to describe and section a specimen the first time -- remember when you were a resident?). Needless to say, manuals are an absolute requirement of any quality-based facility -- something that many of us are becoming more and more deeply involved in -- and for good reason. "Document what you do" (namely, create a manual) and "Do what you document" (namely, abide by the manual).
PAs care as much about the patient (and about their continued employment) as any healthcare professional. Given the right tools and knowledge, they will perform their task with the same level of excellence as the others with whom they work each day.
2. Clearly, there are unrealistic expectations being put upon PAs (locally). If what is desired is simply to retain, or regain, the status quo (no PAs), negativity will prevail. If fault is sought, it will be found. If the introduction of PAs is viewed as an opportunity and a challenge rather than an impediment, good things may be realized. PAs are here -- to stay, I hope. I'd suggest that the best of this purportedly 'bad' situation be made for the public's, if not for the hospital's, the department's or even the pathologist's sake. A look at the rest of the continent, at medium- and large-scale teaching organizations, may serve to illustrate the type of relationship that exists between pathologists, clinicians and PAs. Rather than attempting to ostracize, criticize and isolate the PA(s) with whom you are forced to work, include them so that they may be aware and informed. I doubt that the relationship that pathologists have with histotechs (with whom they interact many times each day; both as friends and fellow professionals) could be interpreted as "baby sitting." Au contraire, there are many real friendships that have sprung up between pathologists and histotechs. Yet, the PA sits alone in the grossing room awaiting the next critical comment; usually several days after the grossing of the specimen ("Why didn't you take sections of...?!). How about being proactive? A pathologist (the same pathologist who would be responsible for grossing or frozen sections) ought to be responsible for the goings-on in the gross room and ought to visit EACH morning to review the complex specimens with the PAs and to be available throughout the day to field questions from the PAs. If nothing else, the pathologist and the PA will become acquainted. More importantly, this sets up a teaching environment wherein the pathologist can answer questions and give direction to the PA.
Manuals are finally being created for the area. The pathologists will be asked to provide input into the first round of revisions of the policies and procedures. The manual will be used by whomever (PA or pathologist) is performing the gross and this standardization will go a long way towards an overall improvement in the quality of the surgical pathology 'product.' The manual, in and of itself, acts as an instructional document for the PAs as it will also attempt to give insights into why specimens are handled and sectioned in a particular manner. A means by which the pathologists may become proactive is by becoming involved in the discussions surrounding the wording of the procedures. As the Interior migrates toward an educational environment, these manuals will also serve as invaluable resources for pathology residents (who, like PAs, may be reluctant to admit that they have a lot to learn and who would far prefer to consult a manual than, heaven forbid, ask the pathologist and admit that they were overwhelmed by the flood of information when the pathologist explained how to describe and section a specimen the first time -- remember when you were a resident?). Needless to say, manuals are an absolute requirement of any quality-based facility -- something that many of us are becoming more and more deeply involved in -- and for good reason. "Document what you do" (namely, create a manual) and "Do what you document" (namely, abide by the manual).
PAs care as much about the patient (and about their continued employment) as any healthcare professional. Given the right tools and knowledge, they will perform their task with the same level of excellence as the others with whom they work each day.
Sunday, December 10, 2006
"Credible"
I received an interesting comment to my previous post, presumably from a Pathologist, which stated that s/he had not yet met a credible pathologist who would endorse a PA (but also considered that the PAs with whom s/he had worked were not worth endorsing).
I wonder if it is a safe assumption that this person has a low opinion of any pathologist who would endorse a PA. More likely, this person is not happy with the 'product' provided by her/his PAs (assuming s/he has PAs).
I recognize that there are many political issues and biases with which a few have had to deal if their experience with PAs is relatively new. It is a challenge for the PAs as well. PAs are not perfect; no one is. A pathologist who views a PA as an extension of her-/himself and teaches and encourages that PA to provide the quality of work that is required, is one who has, in my opinion, the correct attitude. If one is looking for faults, one is certainly going to find them, no matter who one is looking at. PAs are not MDs. Without hands-on support and supervision, they ought not be expected to have the same insights into the subtle nuances (even the not-so-subtle, for that matter) of pathology as pathologists have. This is not to say that they cannot, with the appropriate training, do perfectly adequate Gross Descriptions however. PAs depend upon the active input of pathologists into their day to day practice in order to improve their knowledge base so that they may provide Gross Descriptions which more and more closely approximate those which would be rendered by pathologists. I'd suggest that if the person commenting is dissatisfied with her/his PAs, that s/he: 1. hire individuals with a better background (a BSc will soon be the prerequisite for admission to a PA training course in Canada, as has long been the situation in the USA) and, more importantly, 2. provide on-going support for the PAs by giving regular feedback and instruction.
There is currently no college, in any province, for PAs. Any CME activities are purely optional and self-directed (if not by the employer or pathologist). With minimal encouragement, most PAs will gladly participate in seminars and rounds in order to further their knowledge so that they can improve the quality of their work. They will, in fact, do this even though they cannot claim CME credits (yet). I encourage all pathologists, whether they are just getting to know PAs or whether they have had PAs working for them for years, to continue to work WITH their PAs, rather than apart. Given the chance, PAs can be very good team players.
I wonder if it is a safe assumption that this person has a low opinion of any pathologist who would endorse a PA. More likely, this person is not happy with the 'product' provided by her/his PAs (assuming s/he has PAs).
I recognize that there are many political issues and biases with which a few have had to deal if their experience with PAs is relatively new. It is a challenge for the PAs as well. PAs are not perfect; no one is. A pathologist who views a PA as an extension of her-/himself and teaches and encourages that PA to provide the quality of work that is required, is one who has, in my opinion, the correct attitude. If one is looking for faults, one is certainly going to find them, no matter who one is looking at. PAs are not MDs. Without hands-on support and supervision, they ought not be expected to have the same insights into the subtle nuances (even the not-so-subtle, for that matter) of pathology as pathologists have. This is not to say that they cannot, with the appropriate training, do perfectly adequate Gross Descriptions however. PAs depend upon the active input of pathologists into their day to day practice in order to improve their knowledge base so that they may provide Gross Descriptions which more and more closely approximate those which would be rendered by pathologists. I'd suggest that if the person commenting is dissatisfied with her/his PAs, that s/he: 1. hire individuals with a better background (a BSc will soon be the prerequisite for admission to a PA training course in Canada, as has long been the situation in the USA) and, more importantly, 2. provide on-going support for the PAs by giving regular feedback and instruction.
There is currently no college, in any province, for PAs. Any CME activities are purely optional and self-directed (if not by the employer or pathologist). With minimal encouragement, most PAs will gladly participate in seminars and rounds in order to further their knowledge so that they can improve the quality of their work. They will, in fact, do this even though they cannot claim CME credits (yet). I encourage all pathologists, whether they are just getting to know PAs or whether they have had PAs working for them for years, to continue to work WITH their PAs, rather than apart. Given the chance, PAs can be very good team players.
Monday, November 20, 2006
Anonymous comment?
If you have something to say, it's worth standing behind your words. I can't imagine why you'd not want to put your name to your comments. It sure makes it a whole lot easier to respond if I know to whom I am responding.
I have every reason to believe that the comments concerning MLTs being trained up to be PAs, and the minimum requirement for CAPA membership being a BSc have come from a personal acquaintance of mine from Alberta. This person has expressed concern (justifiably) about the fact that the CAPA will be a small club indeed if MLTs are excluded. I agree (and I have expressed this to the executive committee of the CAPA). As I have told this acquaintance, there will be a grand-mother-/father-ing process wherein those who have been practising PAs for years will be creditted with their valuable years of experience. This will reflect the American experience wherein PAs (many of whom, like many of you, are Histotechs trained up to be PAs) are given credit for their many valuable years of experience and may, with a Pathologist's endorsement, be granted membership to the CAPA.
I don't want it to sound like an eletist group. We want to include as many PAs as possible and we look forward to having a coast-to-coast-to-coast association that has as many Canadian PAs as posisible in the group.
I have every reason to believe that the comments concerning MLTs being trained up to be PAs, and the minimum requirement for CAPA membership being a BSc have come from a personal acquaintance of mine from Alberta. This person has expressed concern (justifiably) about the fact that the CAPA will be a small club indeed if MLTs are excluded. I agree (and I have expressed this to the executive committee of the CAPA). As I have told this acquaintance, there will be a grand-mother-/father-ing process wherein those who have been practising PAs for years will be creditted with their valuable years of experience. This will reflect the American experience wherein PAs (many of whom, like many of you, are Histotechs trained up to be PAs) are given credit for their many valuable years of experience and may, with a Pathologist's endorsement, be granted membership to the CAPA.
I don't want it to sound like an eletist group. We want to include as many PAs as possible and we look forward to having a coast-to-coast-to-coast association that has as many Canadian PAs as posisible in the group.
Sunday, November 05, 2006
CAPA update
To bring readers up to date on developments on the Canadian Association of PAs front, you should know that the organization, truly in its infancy, now has an executive. This was decided upon by those who attended the CAP meeting this year (Newfoundland) and a follow-up meeting at Vancouver Children's Hospital recently (at the time of the AAPA AGM). Lloyd Kennedy (Kingston) and Larry Bluhm (Winnipeg) are co-chairs and Kent Neuert (Vancouver) is the Secretary.
Among abundant amounts of conversation on many topics, the submission of an updated list of key competencies for Canada's PAs will be created (beginning with the CAP's Position Statement); ready for submission to the CAP for ratification by next year's AGM (Toronto). Grandmother-/fathering guidelines is a big topic for discussion. My feeling is that the majority of Canadian PAs are Technologists who (please correct me if you think otherwise) do not hold a baccalaureate and who have been trained on the job. Insofar as the minimum requirement to attain membership will be holding a baccalaureate (plus several years' bench experience), the association is going to be an elite one indeed (or so it would seem to me). There are numerous institutions, especially non-academic centres, at which PAs are involved solely in either surgical, or autopsy, pathology, but not both. The minimum criterion for inclusion will be that the candidate must be able to function in both disciplines. This may further limit the membership.
I understand that just 43 PAs have joined the CAP. These individuals will receive a communique from the CAPA, via the CAP, concerning membership (in the CAPA), and other things -- as soon as possible.
Much progress on the educational front is being made. A number of individuals in Vancouver, Kent among them, are working on the final stages of a curriculum, much of it to be hopefully offered as e-education (aka 'distance ed'). I sincerely hope that they, and anyone else who may hold, or may be working on, a curriculum consult the CMA concerning accreditation of their curriculum.
It is SO very nice to see progress being made. Those who have assisted to date should be given a very big thank-you for their efforts. Thank-you!
Among abundant amounts of conversation on many topics, the submission of an updated list of key competencies for Canada's PAs will be created (beginning with the CAP's Position Statement); ready for submission to the CAP for ratification by next year's AGM (Toronto). Grandmother-/fathering guidelines is a big topic for discussion. My feeling is that the majority of Canadian PAs are Technologists who (please correct me if you think otherwise) do not hold a baccalaureate and who have been trained on the job. Insofar as the minimum requirement to attain membership will be holding a baccalaureate (plus several years' bench experience), the association is going to be an elite one indeed (or so it would seem to me). There are numerous institutions, especially non-academic centres, at which PAs are involved solely in either surgical, or autopsy, pathology, but not both. The minimum criterion for inclusion will be that the candidate must be able to function in both disciplines. This may further limit the membership.
I understand that just 43 PAs have joined the CAP. These individuals will receive a communique from the CAPA, via the CAP, concerning membership (in the CAPA), and other things -- as soon as possible.
Much progress on the educational front is being made. A number of individuals in Vancouver, Kent among them, are working on the final stages of a curriculum, much of it to be hopefully offered as e-education (aka 'distance ed'). I sincerely hope that they, and anyone else who may hold, or may be working on, a curriculum consult the CMA concerning accreditation of their curriculum.
It is SO very nice to see progress being made. Those who have assisted to date should be given a very big thank-you for their efforts. Thank-you!
Monday, October 09, 2006
Thanksgiving
The inaugural meeting of the charter members of the Can Assoc of PAs was held in Vancouver in September, at the Vancouver Children's Hospital, hosted by Kent Neuert, who practises there. In attendance were Larry Bluhm (Winnipeg), Lance Fuczyk, Louise Litsas, Kent and Lloyd Kennedy (Kingston). I could not attend unfortunately. I hope the meeting went well. There was much to discuss. When I learn of any particulars, I will be sure to pass them along to you.
I understand that another PA meeting, hosted by Mount Sinai Hospital (and Alan Wolfe?) is being held in November. Invitations have been forwarded to Ontario PAs. I don't know whether this is a follow-up to the first meeting or not (when I know, I'll let you know).
Happy Thanksgiving everyone. It is time to count our blessings -- of which we indeed have many.
A recent publication of interest: Plasmacytoid Urothelial Carcinoma of the Urinary Bladder, Report of Seven New Cases. Mai, KT et al. Eur Urol, 2006 Jan 18.
Dear alleged colleague,
I'd appreciate it if you would elaborate on the items which you feel require seasoning.
Sunday, October 08, 2006
Anonymous Comments
I appreciate the fact that someone bothers to 1. read a post in my blog and 2. comment.
Dear anonymous colleague,
What comments are they of mine which you say require seasoning?
Dear anonymous colleague,
What comments are they of mine which you say require seasoning?
Monday, August 07, 2006
Ah summer!
Greetings from the sunny Okanagan. So far, summer 2006 has been just beautiful. I've taken up bicycling; realizing that all of the hills around here make for a great workout, comparable in many ways to running, but better in that bicycling is so low-impact. I really have to get out more so that I can shed some pounds...so that it's not quite so difficult to climb those hills. I have ordered a kayak; I have been meaning to do so for over a year; it's about time! I am very much looking forward to finally getting out on the lake and maybe next year checking out the ocean that everyone says is so wonderful. With a little luck, I'll get a glimpse of some of the old-growth forests before the logging companies turn them into lumber.
Thanks to those who sent comments to my previous post. The PAs who work for the Interior Health Authority in BC are paid at the Lab Technologist III level (equivalent to 'Senior' in other provinces; mid-way between a General Duty Technologist and a Charge Technologist). To my way of thinking, this is an [almost] appropriate level of remuneration; depending upon the PA (not enough for some; too much for others).
Isn't it great that PAs have, for the first [official] time, been formally recognized? The CAP has voted in favour of creating a Pathologist Assistant section. In the era of cutbacks, busy schedules, tight budgets, etc. it is truly nice to have had one of these intangibles thrown our way. It doesn't come without strings however; Canadian PAs will be required to elect an executive, hold meetings, contribute to creating our portion of the CAP constitution, pay dues, attend annual meetings (next year's CAP is in Toronto), etc. Everyone pat yourself on the back; and thank the Pathologists for whom you work. PAs are finally getting a little reward for all of those hard years of work.
Other notable news...
One of our PAs has had a beautiful baby girl and is off until early 2007. To cover the parental leave, we have hired one of the first graduates of the PA training program in Winnipeg and things are working out just great; she's happy and so are we. Good work Larry!
We had the misfortune of having one of the PAs resign; and to do so before even starting work! We were really left in the lurch and as a result, that site has been without PA help for some time as we consider training a Technologist who can function both as a PA and as a Histotechnologist.
One of the four Pathologists in Kelowna has been granted a leave of absence. This position has thankfully been filled (the Pathologists have been very very busy for the last 1 1/2 years).
It may seem strange to those PAs who have practised in larger centres for a long time to learn that we are just beginning to put in place the first procedures for surgical pathology. Numerous factors, not the least of which was steadily increasing workload at the Kelowna site, prevented this very necessary advance. Having survived the first year at Kelowna myself, I realized early on that it needed more than one PA. Over 18,000 surgical pathology cases per annum is more than one person ought to be expected to handle without risking a diminished quality of the reports. It never ceases to amaze me how many Whipple's procedure specimens that we get in Kelowna; far higher proportionate number than at The Ottawa Hospital (whence I came). It would be interesting to learn what factors seem to contribute to what at first blush appears to be a high incidence of pancreatic or bile duct carcinoma in this region (actually the most recent Whipple's that I saw was performed for ascending cholangitis -- which had resulted in a bile duct stricture).
We are (like so many other areas of the hospital) looking for additional space so that we can install an new dissection bay (like the ones used by Calgary Lab Services; made in Calgary). That will give us two spaces; needed so that we can avoid using non-overlapping shifts (once we get another PA or once we begin to accept pathology Residents from UBC -- in a couple of years).
I apologize for the large gaps between posts. I'll try to put up more frequent posts in the future.
Thanks to those who sent comments to my previous post. The PAs who work for the Interior Health Authority in BC are paid at the Lab Technologist III level (equivalent to 'Senior' in other provinces; mid-way between a General Duty Technologist and a Charge Technologist). To my way of thinking, this is an [almost] appropriate level of remuneration; depending upon the PA (not enough for some; too much for others).
Isn't it great that PAs have, for the first [official] time, been formally recognized? The CAP has voted in favour of creating a Pathologist Assistant section. In the era of cutbacks, busy schedules, tight budgets, etc. it is truly nice to have had one of these intangibles thrown our way. It doesn't come without strings however; Canadian PAs will be required to elect an executive, hold meetings, contribute to creating our portion of the CAP constitution, pay dues, attend annual meetings (next year's CAP is in Toronto), etc. Everyone pat yourself on the back; and thank the Pathologists for whom you work. PAs are finally getting a little reward for all of those hard years of work.
Other notable news...
One of our PAs has had a beautiful baby girl and is off until early 2007. To cover the parental leave, we have hired one of the first graduates of the PA training program in Winnipeg and things are working out just great; she's happy and so are we. Good work Larry!
We had the misfortune of having one of the PAs resign; and to do so before even starting work! We were really left in the lurch and as a result, that site has been without PA help for some time as we consider training a Technologist who can function both as a PA and as a Histotechnologist.
One of the four Pathologists in Kelowna has been granted a leave of absence. This position has thankfully been filled (the Pathologists have been very very busy for the last 1 1/2 years).
It may seem strange to those PAs who have practised in larger centres for a long time to learn that we are just beginning to put in place the first procedures for surgical pathology. Numerous factors, not the least of which was steadily increasing workload at the Kelowna site, prevented this very necessary advance. Having survived the first year at Kelowna myself, I realized early on that it needed more than one PA. Over 18,000 surgical pathology cases per annum is more than one person ought to be expected to handle without risking a diminished quality of the reports. It never ceases to amaze me how many Whipple's procedure specimens that we get in Kelowna; far higher proportionate number than at The Ottawa Hospital (whence I came). It would be interesting to learn what factors seem to contribute to what at first blush appears to be a high incidence of pancreatic or bile duct carcinoma in this region (actually the most recent Whipple's that I saw was performed for ascending cholangitis -- which had resulted in a bile duct stricture).
We are (like so many other areas of the hospital) looking for additional space so that we can install an new dissection bay (like the ones used by Calgary Lab Services; made in Calgary). That will give us two spaces; needed so that we can avoid using non-overlapping shifts (once we get another PA or once we begin to accept pathology Residents from UBC -- in a couple of years).
I apologize for the large gaps between posts. I'll try to put up more frequent posts in the future.
Sunday, April 23, 2006
What's in a Name?
Among the titles that I have heard for our profession, the most recent -- which I had not heard previously -- was coined at a recent meeting: "Pathologist Assistant." For 30+ years, I have considered myself a Pathologist's (or maybe Pathologists') Assistant. The exact title has been a source of discussion between and among PAs. I must admit that I dismissed the new version when I first heard it but, after giving it some thought I began to believe that this might actually be one of the better titles.
I know that it might seem ludicrous to be considering what we're called when we have practised for so many years. This again illustrates that SO very little has been done for our profession.
"Pathologist's" (singular) Assistant has heretofor been my favourite version. The justification is that at any given moment, I am assisting one, not multiple, pathologists. The title has a more applicable, more immediate context in this form. Further, this version can be used to apply to those PAs who work with just one, or very few, pathologists, as well as those who work with multiple pathologists. Members of the AAPA prefer "Pathologists' " (pl.) Assistant (I have yet to hear a substantive rationale other than the fact that the AAPA uses this version).
I am interested to know what you, Canada's PAs, think. Please cast your vote by posting a comment to this item, anonymously if you prefer.
I know that it might seem ludicrous to be considering what we're called when we have practised for so many years. This again illustrates that SO very little has been done for our profession.
"Pathologist's" (singular) Assistant has heretofor been my favourite version. The justification is that at any given moment, I am assisting one, not multiple, pathologists. The title has a more applicable, more immediate context in this form. Further, this version can be used to apply to those PAs who work with just one, or very few, pathologists, as well as those who work with multiple pathologists. Members of the AAPA prefer "Pathologists' " (pl.) Assistant (I have yet to hear a substantive rationale other than the fact that the AAPA uses this version).
I am interested to know what you, Canada's PAs, think. Please cast your vote by posting a comment to this item, anonymously if you prefer.
Thursday, April 20, 2006
Credentialing, etc.
In response to Norman Poch's comments:
With my move from east to west, I must beg your pardon; I have misplaced your contact information. If you could remind me, I shall add you to my personal contact list.
I repeat that the CSMLS is not the group to take certification of PAs forward; paying your dues to this group DOES NOT impart professional status. We expect to go the route of the CMA Accreditation Office (see http://www.cma.ca/index.cfm/ci_id/19316/la_id/1.htm). I do not discount OJT PAs, I am one myself. Rest assured that all PAs currently practising will be grandmothered/fathered in some way which (thankfully) will not be decided by you or me (I can't imagine how difficult a task that must be).
Please remember that the over-riding reason for establishing minimum credentials; for certifying those individuals who have successfully attained those credentials; for becoming recognised by a college within the province (and paying the tax-deductible dues to that college); for ensuring continuing education; etc. etc. are all for the protection of the public, those who we serve.
I'd suggest that, as professionals, PAs ask our employers to pay the dues for membership to the CAP and to our provincial college (once they recognise PAs).
Please allow me to recount what was, for me, an amusing news item on CBC Radio. The interviewee was aghast at the fact that there were no educational requirements and no standards for house inspectors. I had to chuckle as I drove to work. If the public only knew! Norman, if you have a look at the principles which define any quality management system, you'll see that one of the over-riding principles is that all those who are providing a service (in this case, healthcare) must do as they document (ie. have procedure manuals) and document what they do (ie. produce a consistent, accurate report). To achieve this, among many other things, those who provide the service must have training (and documentation of that training), performance appraisals and continuing education. The member of the public who walks through our healthcare door must be able to do so with the assurance that they will receive the very best, most consistent care that s/he can possibly receive. And if s/he doesn't? What are we here for?
It may not have been long since all MLTs were OJT but they have all been certified since I've been in the business of being a PA. I guess everything's relative.
It doesn't surprise me at all that a number of PAs, including yourself, were missed by the CAP's survey. Please make your (and anybody else who was missed) presence known to them. They will not be surprised either, I'm sure.
With my move from east to west, I must beg your pardon; I have misplaced your contact information. If you could remind me, I shall add you to my personal contact list.
I repeat that the CSMLS is not the group to take certification of PAs forward; paying your dues to this group DOES NOT impart professional status. We expect to go the route of the CMA Accreditation Office (see http://www.cma.ca/index.cfm/ci_id/19316/la_id/1.htm). I do not discount OJT PAs, I am one myself. Rest assured that all PAs currently practising will be grandmothered/fathered in some way which (thankfully) will not be decided by you or me (I can't imagine how difficult a task that must be).
Please remember that the over-riding reason for establishing minimum credentials; for certifying those individuals who have successfully attained those credentials; for becoming recognised by a college within the province (and paying the tax-deductible dues to that college); for ensuring continuing education; etc. etc. are all for the protection of the public, those who we serve.
I'd suggest that, as professionals, PAs ask our employers to pay the dues for membership to the CAP and to our provincial college (once they recognise PAs).
Please allow me to recount what was, for me, an amusing news item on CBC Radio. The interviewee was aghast at the fact that there were no educational requirements and no standards for house inspectors. I had to chuckle as I drove to work. If the public only knew! Norman, if you have a look at the principles which define any quality management system, you'll see that one of the over-riding principles is that all those who are providing a service (in this case, healthcare) must do as they document (ie. have procedure manuals) and document what they do (ie. produce a consistent, accurate report). To achieve this, among many other things, those who provide the service must have training (and documentation of that training), performance appraisals and continuing education. The member of the public who walks through our healthcare door must be able to do so with the assurance that they will receive the very best, most consistent care that s/he can possibly receive. And if s/he doesn't? What are we here for?
It may not have been long since all MLTs were OJT but they have all been certified since I've been in the business of being a PA. I guess everything's relative.
I agree with you that credential-creep seems to be all pervasive. Please see my comment in the preceeding post. I feel that an MSc is more than what's needed; especially if the BSc is earned in Canada. The bottom line...no matter what degree you have, you know next to nothing until you actually start doing hands-on bench work. Get the foundation; start building, and the sooner the better. The longer people stay in school, the more (and justifiably) they will expect in salary (the less likely hospitals will want to hire them).
Thank-you for your comments. Please stay in touch.
PA Forum, Vancouver, April 12, 2006
I was encouraged and pleasantly surprised by the attendance and interest taken by all attendees (stakeholders) at the one-day forum in Vancouver held on April 12, 2006. The event was hosted, and well organized, by the Provincial Laboratory Coordinating Office (PLCO http://www.plco.ca ), the British Columbia educational authority and the CAP. I had the considerable pleasure of meeting Dr. D. Banerjee at the meeting.
The distribution of PAs throughout the country and throughout the continent was presented. Kent Neuert, BSc, PA(ASCP), Vancouver Children’s Hospital presented his personal experience. It was great to finally meet face to face with someone with whom I have exchanged a number of emails over the last year or so. I am sorry that we didn’t actually have time to talk; maybe at the AAPA meeting…I hope!
The group broke up into smaller groups to discuss the definition of a PA (as given in the CAP’s position statement...at http://www.cap.medical.org/position_statement_assistants.htm ) and the educational requirements were also considered. The consensus was that a Masters degree should be required. Personally, I feel that a BSc (earned in Canada) is sufficient, with the qualification that a number of specific courses (eg. anatomy) be required (eg. replace organic chemistry with anatomy…now that would be a welcome relief!) and that a practicum (~1 yr) be added afterwards.
It is very encouraging to know that the CAP recognises PAs and is willing to accept us in their group. They will not (nor should they) take on any of the responsibilities for the organization of our group; we will have to do that. I am hoping that they may at least help to direct our efforts (eg. how do we go about electing an executive?). We’re all pretty new at this and can use any and all help offered.
I am very appreciative of the PLCO’s efforts in organizing this ground-breaking meeting. In fact, I’m sure that I won’t truly understand the importance of this until a few years from now. I have been a PA for so long and it has been so long that nothing has been done. Little did I know that coming to BC would open this door. Thank-you Barbara and thank-you Roy.
The distribution of PAs throughout the country and throughout the continent was presented. Kent Neuert, BSc, PA(ASCP), Vancouver Children’s Hospital presented his personal experience. It was great to finally meet face to face with someone with whom I have exchanged a number of emails over the last year or so. I am sorry that we didn’t actually have time to talk; maybe at the AAPA meeting…I hope!
The group broke up into smaller groups to discuss the definition of a PA (as given in the CAP’s position statement...at http://www.cap.medical.org/position_statement_assistants.htm ) and the educational requirements were also considered. The consensus was that a Masters degree should be required. Personally, I feel that a BSc (earned in Canada) is sufficient, with the qualification that a number of specific courses (eg. anatomy) be required (eg. replace organic chemistry with anatomy…now that would be a welcome relief!) and that a practicum (~1 yr) be added afterwards.
It is very encouraging to know that the CAP recognises PAs and is willing to accept us in their group. They will not (nor should they) take on any of the responsibilities for the organization of our group; we will have to do that. I am hoping that they may at least help to direct our efforts (eg. how do we go about electing an executive?). We’re all pretty new at this and can use any and all help offered.
I am very appreciative of the PLCO’s efforts in organizing this ground-breaking meeting. In fact, I’m sure that I won’t truly understand the importance of this until a few years from now. I have been a PA for so long and it has been so long that nothing has been done. Little did I know that coming to BC would open this door. Thank-you Barbara and thank-you Roy.
Other business: please be aware that the British Columbia Interior Health Authority has an opportunity for a full-time PA in Penticton and a 21-week maternity leave for a PA (posted on the CAP website http://www.cap.medical.org/ad_pathologist_assistant_interior_health_bc.htm as well as on the AAPA website).
Monday, April 10, 2006
SPREADING THE WORD
Last week, I was delighted to make the acquaintance of a PA in deepest, darkest Edmonton; one of several in that city that had been missed by the CAP’s PA search last year. Thank-you for volunteering to contact the others so that they too might make their presence known. If there are others elsewhere in the country who were missed, I encourage you to make your presence known to the CAP so that they can have as complete a list of Canadian PAs as possible.
I’m off to Vancouver on Wednesday at the invitation of the CAP, the PLCO (BC’s Provincial Laboratory Coordinating Office) and BC’s educational authority to attend a one-day stakeholders’ forum on the subject of education, distribution and regulation of PAs in this province. I’m really hoping that something substantive can come of this meeting. I’ll let you know what I learn at the meeting soon.
Please be aware that there is a 1.0 FTE PA position (paid at MLT III level) in Penticton available at present. The job is listed on the Interior Health website (http://www.roomtogrowbc.ca/showcaseopps.asp), the AAPA site (www.pathologistsassistants.org) and will soon be on the CAP site as well (www.cap.medical.org).
I’m off to Vancouver on Wednesday at the invitation of the CAP, the PLCO (BC’s Provincial Laboratory Coordinating Office) and BC’s educational authority to attend a one-day stakeholders’ forum on the subject of education, distribution and regulation of PAs in this province. I’m really hoping that something substantive can come of this meeting. I’ll let you know what I learn at the meeting soon.
Please be aware that there is a 1.0 FTE PA position (paid at MLT III level) in Penticton available at present. The job is listed on the Interior Health website (http://www.roomtogrowbc.ca/showcaseopps.asp), the AAPA site (www.pathologistsassistants.org) and will soon be on the CAP site as well (www.cap.medical.org).
Sunday, February 12, 2006
Addresses SVP
I tried to send a letter to all Canadian PAs for whom I have email addresses. Judging by all of the Undeliverable receipts that I received, it would appear that I have quite a large number of incorrect addresses. Would everyone please be so kind as to contact me with their correct email address? Of course, if you got the letter, don't bother. Thanks.
Sunday, January 29, 2006
CSMLS?
Anyone who has received an invitation from the CSMLS to attend an ad hoc meeting concerning registration of PAs should think twice before accepting. The CSMLS certifies (‘registers,’ if you prefer) technologists. The loosely-formed committee (of which I am a part) which has been formed within the last few months and has been looking at improving the lot of Canada's PAs, has agreed that eventually, all fully-qualified Canadian PAs will hold an MSc. We do not see the CMSLS being involved in the standardization of credentials or training or certification or regulation of Canadian PAs. If you are invited, my advice to you is that you not attend. Your absence will make the statement for you (and will greatly simplify matters).
Sunday, January 15, 2006
ASSOCIATE (v.)
I must apologise for the long time between posts. The pace of the work in Kelowna was certainly hectic in November and December. I barely had a chance to come up for air. The volume of work in January seems to be somewhat more manageable…so far. I thought you might like to know just how busy it is here. The 3 sites produce about 45,000 cases annually. Three PAs do all of the gross descriptions for those cases. 7 pathologists sign-out those cases. The Ottawa Hospital produces only slightly more cases per year. Twelve PAs and 28 pathologists work at TOH.
To bring you up to date on life in the Interior of BC from my perspective...we will be interviewing candidates for the PA position in Kelowna within the next 1 ½ weeks. This person will assume the position that I have held since May, 2005. I’ll become the PA Quality Coordinator for the three sites within the Interior (Vernon, Kelowna and Penticton). In that role, I will enjoy interacting with the PAs, the Clinical Director (when we get one), the pathologists and the regional manager to introduce a common manual for surgical pathology and gross description templates.
Other news – there will be a 21-week PA locum in Vernon beginning in July (a maternity leave). Also, we will be looking at hiring a casual PA to fill in during vacations and other leaves of the three PAs. It was very nice that Alan Wolff decided to do a 2-week locum in Vernon during Danielle Lee's vacation in January.
Now to the subject of this post: several PAs across Canada and myself have been corresponding recently; trying to firm-up arrangements with the Canadian Association of Pathologists (CAP) so that Canada’s PAs can form an association (The Canadian Association of Pathologist’s Assistants (CAPA)) as a branch of the CAP. It was very nice of the CAP to offer this to us. It means that we will not have to expend huge amounts of time (and money) in drawing-up our own constitution. Cytotechnologists have already associated with the CAP. I envisage the PA arrangement to be similar. The problem (well, one of the problems) is that Canadian PAs are not yet certified. How does one define a PA? Our credentials and our responsibilities are all over the map. We are lucky that our American colleagues have shown the way, partly. The difference is that they already have an accredited training course in place so the definition is significantly less cloudy than in Canada. They have gotten around this problem as well though in that they have allowed for differing levels of membership. You can still belong to the association, but in an ‘associate’ capacity (presumably without voting privileges…but you still get invited to the AGM!) if you, for instance, do not hold a degree. With the CAP’s assistance and direction, we hope to define the criteria for membership in the CAPA.
I think that until the CMA accredits a PA training program, we cannot expect to associate to the same degree as the Cytotechnologists however. The inaugural executive committee can hopefully come up with some criteria for that which defines a Canadian PA and that will go a long way to firming up the definition when drawing up a list of key responsibilities for PAs.
There are a number of contentious issues that we’ll need to grapple with. Among these, perhaps the most difficult will be deciding whether or not to admit non-degree holding PAs into the association. If we agree that we will do this (and I think we should), we then need to decide how many years of bench experience will be required before they are admitted. Certainly those who already hold AAPA memberships or fellowships will be admitted. Foreign-trained medical doctors practising as PAs will likely be admitted but, like all other PAs, will require an assessment from an impartial pathologist (hopefully using a format provided by the CAP); this is in keeping with the wishes of the CAP (see the Position Statement on the CAP website http://www.cap.medical.org/position_statement_assistants.htm). There are already many MLTs who have evolved into PAs. In fact, most Canadian PAs are MLTs. The contribution that they provide to the provision of excellent healthcare should not go unrecognized. They deserve to be allowed to associate along with the [minority] of degree-holders. We can set the bar high for the future (ie. when there are PAs being trained in Canada using an accredited curriculum) but should grandmother/father those who are currently practising.
We should also stipulate that the degree holders hold an appropriate degree (eg. BSc in Biology; MSc; MD).
What do we do about those who never perform autopsies? What about those who perform only autopsies?
I would be interested to hear any input that you might have to this subject. I am sure that many of you have lots of things to add and have many questions; I’d be glad to hear from you. We had hoped to have a 2006 meeting of Canadian PAs but it’s looking like this might have been a little optimistic.
An update re PA workload units: the CIHI will be looking at this in the fall and the following spring (2007). The wheels of bureaucracy certainly do turn slowly. The good news is that they are turning.
Also, I was pleased to sit with the British Columbia laboratory accreditors (DAP) in November. It amazes me that PAs have flown under the radar of the accreditors in all other provinces. It took the BC pathologists to give the accreditors the heads-up about the existence of PAs and the significant change in practice that had occurred recently. Their written report will be available soon and it will contain recommendations (in keeping with the CAP’s stated wishes concerning CME activities, for example) which apply specifically to PAs. I think that all of Canada’s PAs should make their provincial lab accrediting bodies aware of their existence and should also insist that there be specific wording in the accrediting agreement stipulating that there be proper, safe working conditions for PAs, adequate space, CME activities, safety awareness training, etc. I’ll bring you all up to speed on what I learn from the written statement from the DAP once I get the chance to read it.
Other news – there will be a 21-week PA locum in Vernon beginning in July (a maternity leave). Also, we will be looking at hiring a casual PA to fill in during vacations and other leaves of the three PAs. It was very nice that Alan Wolff decided to do a 2-week locum in Vernon during Danielle Lee's vacation in January.
Now to the subject of this post: several PAs across Canada and myself have been corresponding recently; trying to firm-up arrangements with the Canadian Association of Pathologists (CAP) so that Canada’s PAs can form an association (The Canadian Association of Pathologist’s Assistants (CAPA)) as a branch of the CAP. It was very nice of the CAP to offer this to us. It means that we will not have to expend huge amounts of time (and money) in drawing-up our own constitution. Cytotechnologists have already associated with the CAP. I envisage the PA arrangement to be similar. The problem (well, one of the problems) is that Canadian PAs are not yet certified. How does one define a PA? Our credentials and our responsibilities are all over the map. We are lucky that our American colleagues have shown the way, partly. The difference is that they already have an accredited training course in place so the definition is significantly less cloudy than in Canada. They have gotten around this problem as well though in that they have allowed for differing levels of membership. You can still belong to the association, but in an ‘associate’ capacity (presumably without voting privileges…but you still get invited to the AGM!) if you, for instance, do not hold a degree. With the CAP’s assistance and direction, we hope to define the criteria for membership in the CAPA.
I think that until the CMA accredits a PA training program, we cannot expect to associate to the same degree as the Cytotechnologists however. The inaugural executive committee can hopefully come up with some criteria for that which defines a Canadian PA and that will go a long way to firming up the definition when drawing up a list of key responsibilities for PAs.
There are a number of contentious issues that we’ll need to grapple with. Among these, perhaps the most difficult will be deciding whether or not to admit non-degree holding PAs into the association. If we agree that we will do this (and I think we should), we then need to decide how many years of bench experience will be required before they are admitted. Certainly those who already hold AAPA memberships or fellowships will be admitted. Foreign-trained medical doctors practising as PAs will likely be admitted but, like all other PAs, will require an assessment from an impartial pathologist (hopefully using a format provided by the CAP); this is in keeping with the wishes of the CAP (see the Position Statement on the CAP website http://www.cap.medical.org/position_statement_assistants.htm). There are already many MLTs who have evolved into PAs. In fact, most Canadian PAs are MLTs. The contribution that they provide to the provision of excellent healthcare should not go unrecognized. They deserve to be allowed to associate along with the [minority] of degree-holders. We can set the bar high for the future (ie. when there are PAs being trained in Canada using an accredited curriculum) but should grandmother/father those who are currently practising.
We should also stipulate that the degree holders hold an appropriate degree (eg. BSc in Biology; MSc; MD).
What do we do about those who never perform autopsies? What about those who perform only autopsies?
I would be interested to hear any input that you might have to this subject. I am sure that many of you have lots of things to add and have many questions; I’d be glad to hear from you. We had hoped to have a 2006 meeting of Canadian PAs but it’s looking like this might have been a little optimistic.
An update re PA workload units: the CIHI will be looking at this in the fall and the following spring (2007). The wheels of bureaucracy certainly do turn slowly. The good news is that they are turning.
Also, I was pleased to sit with the British Columbia laboratory accreditors (DAP) in November. It amazes me that PAs have flown under the radar of the accreditors in all other provinces. It took the BC pathologists to give the accreditors the heads-up about the existence of PAs and the significant change in practice that had occurred recently. Their written report will be available soon and it will contain recommendations (in keeping with the CAP’s stated wishes concerning CME activities, for example) which apply specifically to PAs. I think that all of Canada’s PAs should make their provincial lab accrediting bodies aware of their existence and should also insist that there be specific wording in the accrediting agreement stipulating that there be proper, safe working conditions for PAs, adequate space, CME activities, safety awareness training, etc. I’ll bring you all up to speed on what I learn from the written statement from the DAP once I get the chance to read it.
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