GUIDELINES FOR
PROFICIENCY REPORT FOR PHYSICIAN ASSISTANTS
A. Guidelines for Rating Individual
Elements
General
Notes:
1.
In these rating
guidelines, “consistently” means no more than 2 instances to the contrary
during the rating period.
2.
Because of variations in
PAs’ practice areas, the guidelines for rating a given component (e.g., “Working Diagnosis”) may not fit a
given PA’s situation precisely. The rating physician should use the guideline
that gives the best approximate fit in such cases. In certain cases a
particularly outstanding or particularly unsatisfactory incident may warrant a
higher or lower rating on a component than the guidelines suggest; the rating
physician should discuss such cases with his or her supervisor before making
the rating.
3.
For certain components,
no description is given for a particular rating level (e.g., high satisfactory). The use of such a rating level would then
be based upon the rating physician’s judgment that the PA’s performance on that
component falls between the two descriptions of the ratings on either side.
4.
In general, the summary
rating for a given element (e.g.,
clinical competence) will be the approximate average for each component under
the element. However, particularly outstanding or particularly unsatisfactory
ratings on one or more components may warrant a summary rating that is higher
or lower than the approximate average of the component ratings.
5.
The “Comments” section
under each element should be used to give specific instances that support the
rating of that element.
6.
All PAs at Grade 13 must
be rated on “Administrative Competence”. PAs at lower grades may be rated on
this element if they have administrative assignments or duties.
Clinical Competence
Data Source: The rating physician should base this rating on (1) a review (by the
rating physician or another qualified physician) of at least 10 records of
patients cared for by the PA during the rating period, (2) routine discussion
with the PA about management of cases during the rating period, (3) observation
of the PA’s actions in routine and emergency clinical care during the rating
period, and (4) relevant results from patient satisfaction surveys and patient
complaints.
Guidelines for Components of Clinical Competence:
History and
Physical Examination
q Not Applicable
q 0 (Unsatisfactory): Has failed to perform 2 or
more assigned examinations. OR 3 or more histories or
examinations show gross inaccuracies, major omissions, or markedly
inappropriate (e.g., inappropriately
judgmental) comments or tone.
q 1 (Low
Satisfactory):
Histories or examinations show 3 or more instances of unfocused content, minor
omissions, or misuse of medical terms that does not reach the level of gross
inaccuracy.
q 2 (Satisfactory): Consistently obtains
accurate histories and consistently identifies major physical findings on
examinations.
q 3 (High
Satisfactory):
Consistently obtains accurate histories with detail above the expected norm,
and elicits all pertinent positive and negative findings on examination.
q 4 (Outstanding): Histories consistently
demonstrate exceptionally insightful and resourceful methods of interviewing
and recording information, and examinations identify subtle findings.
Working
Diagnosis
q Not Applicable
q 0 (Unsatisfactory): Demonstrates on 3 or more
occasions a lack of knowledge in understanding major medical problems. OR
Fails grossly on 3 or more occasions to accurately interpret basic clinical
data to formulate a working diagnosis of patient’s medical problems.
q 1 (Low
Satisfactory):
Understanding of patients’ problems is limited to the most essential findings,
and interpretation of data reveals misconceptions or lack of knowledge about
pathological processes.
q 2 (Satisfactory): Knows basic differential
diagnostic categories and consistently interprets data appropriately to create
adequate working diagnosis.
q 3 (High
Satisfactory):
Frequently offers more than basic, adequate differential diagnosis.
q 4 (Outstanding): Consistently provides
expanded differential diagnosis (when relevant) and demonstrates accurate
knowledge of complex diagnostic issues.
Patient
Management and Treatment
q Not Applicable
q 0 (Unsatisfactory): Demonstrates on 3 or more
occasions poor therapeutic judgment with proposed actions that would likely
affect patient adversely.
q 1 (Low
Satisfactory):
Shows inconsistent prioritizing of clinical issues and problems on 3 or more
occasions. OR Is frequently unable to
establish adequate rapport with patients or families even in routine clinical
situations.
q 2 (Satisfactory): Makes appropriate decisions,
with awareness of own limitations and consultation of supervising physician
when appropriate, and consistently establishes adequate patient rapport in
routine clinical situations.
q 3 (High
Satisfactory):
Shows several instances of creative thinking and above-average skill in
managing and treating routine patient problems, and frequently establishes good
patient rapport in difficult clinical situations.
q 4 (Outstanding): Consistently shows highly
creative thinking or exceptional skill (including therapeutic judgment,
therapeutic application, establishment of rapport, and patient education) in
managing and treating difficult patient problems.
Emergency
Skills
q Not Applicable
q 0 (Unsatisfactory): Unwilling to engage (or
engages only reluctantly) in 3 or more emergency situations. OR
shows grossly deficient knowledge or actions during an emergency.
q 1 (Low
Satisfactory):
Has difficulty in recognizing 2 or more emergencies. OR Shows minor
deficiencies in knowledge or actions during an emergency.
q 2 (Satisfactory): Recognizes and responds to
emergencies, and takes appropriate, timely action.
q 3 (High
Satisfactory)
q 4 (Outstanding): Delivers exceptional
emergency care under difficult circumstances. OR Is a recognized leader
in emergency responses in a manner that promotes collaboration of all involved
professionals.
Consultation
Skills
q Not Applicable
q 0 (Unsatisfactory): Is unable to recognize a
clear need for specialty consultation on 3 or more occasions.
q 1 (Low
Satisfactory):
Usually recognizes the need for consultation, but shows inefficient initiation
of the consultation process on 3 or more occasions.
q 2 (Satisfactory): Consistently recognizes the
need for consultation, discusses case with supervising physician, and initiates
consultation process in timely fashion.
q 3 (High
Satisfactory)
q 4 (Outstanding): Consistently recognizes the
need for consultation independently, initiates consultation by most rapid means
available, follows up consultation process closely without need for prompting,
and ensures the most positive outcome available.
Medical
Recordkeeping
q Not Applicable
q 0 (Unsatisfactory): Records show significantly
inaccurate data, major omissions, or major deficiency in timeliness on 3 or
more occasions. OR Records show markedly poor organization requiring 3 or more
corrections.
q 1 (Low
Satisfactory):
Records on 3 or more occasions show moderate disorganization, inconsistency in
quality, lack of supporting detail, minor omissions, or minor failure to meet
timeliness standards.
q 2 (Satisfactory): Records consistently show
timeliness, adequate organization, and sufficient data for accurate monitoring
of current problems.
q 3 (High
Satisfactory)
q 4 (Outstanding): Records consistently show
exceptional thoroughness, clarity, and relevance.
Clinical
Productivity
q Not Applicable
q 0 (Unsatisfactory): Falls below standard of
clinical productivity (set by program director and approved by Service/Care
Line administration) by more than 10%.
q 1 (Low
Satisfactory):
Falls below standard of clinical productivity (set by program director and
approved by Service/Care Line administration), but by no more than 10%.
q 2 (Satisfactory): Meets standard of clinical
productivity (set by program director and approved by Service/Care Line
administration).
q 3 (High
Satisfactory):
Exceeds standard of clinical productivity (set by program director and approved
by Service/Care Line administration) by at least 10%.
q 4 (Outstanding): Exceeds standard of clinical
productivity (set by program director and approved by Service/Care Line
administration) by at least 20%.
Age-Related
Competence
q Not Applicable
q 0 (Unsatisfactory): Clinical knowledge and
skills as rated above show gross deficiencies with patients in one age category
(young adult, middle-aged, or elderly), or moderate deficiencies in two age
categories
q 1 (Low
Satisfactory):
Clinical knowledge and skills as rated above show mild to moderate deficiencies
with patients in one age category (young adult, middle-aged, or elderly)
q 2 (Satisfactory): Clinical knowledge and
skills as rated above are at least satisfactory with all age categories of
patients (young adult, middle-aged, and elderly)
q 3 (High
Satisfactory):
Clinical knowledge and skills as rated above are at least highly satisfactory
with all age categories of patients (young adult, middle-aged, and elderly)
q 4 (Outstanding): Clinical knowledge and
skills as rated above are outstanding with all age categories of patients
(young adult, middle-aged, and elderly)
Summary Rating of Clinical Competence
q 0 (Unsatisfactory)
q 1 (Low Satisfactory)
q 2 (Satisfactory)
q 3 (High Satisfactory)
q 4 (Outstanding)
Comments on Clinical Competence:
Educational Competence
Data Source: The rating physician should base this rating on (1) observations of
the PA’s interactions with trainees during the rating period; (2) informal and
formal feedback elicited from trainees regarding the PA’s educational
activities with them during the rating period, and (3) written feedback
received from training programs regarding the PA’s educational performance
during the rating period.
Guidelines for Components of Educational Competence:
Teaching and
Monitoring
q Not Applicable
q 0 (Unsatisfactory): Provides little or no
instruction or feedback to trainees. OR
Demonstrates poor mentoring techniques or attitudes.
q 1 (Low
Satisfactory):
Provides limited or somewhat reluctant instruction and feedback to trainees. OR Shows minor deficiencies in mentoring
techniques or attitudes.
q 2 (Satisfactory): Provides basic instruction
and feedback to trainees, and is readily available to teach.
q 3 (High
Satisfactory):
Meets basic educational needs of trainees, seeks further opportunities to
provide instruction, and serves as good role model.
q 4 (Outstanding): Instructs trainees
thoroughly and effectively, continually finds ways to provide additional
teaching without prompting, uses creative teaching methods, and serves as a
superior mentor.
Coordination
of Educational Activities
q Not Applicable
q 0 (Unsatisfactory): Fails to adequately assess
or provide for trainees’ educational needs. OR
Shows gross deficiencies in coordinating educational activities (e.g., fails to meet required deadlines).
q 1 (Low
Satisfactory):
Frequently lacks educational preparedness, makes basic but incomplete use of
available educational resources, and shows inconsistency or mild deficiencies
in coordinating educational activities.
q 2 (Satisfactory): Meets basic educational
needs of trainees, uses basic resources effectively, and shows generally
effective efforts in coordinating education.
q 3 (High
Satisfactory):
Develops and implements educational resources, exceeds basic needs of trainees
by providing valuable additional training, and shows generally effective
coordination of education with minimal disruption of student time.
q 4 (Outstanding): Thoroughly anticipates
trainees’ educational needs, develops and implements outstandingly effective
programs, uses resourceful and innovative approaches, and provides educational
experience consistently rated as superior by trainees, either at VA Medical
Center or at affiliated institutions.
Summary Rating of Educational Competence
q 0 (Unsatisfactory)
q 1 (Low Satisfactory)
q 2 (Satisfactory)
q 3 (High Satisfactory)
q 4 (Outstanding)
Comments on Educational Competence:
Research and Development
Data Source: The rating physician should base this rating on (1) observations of
the PA’s activities in research protocols during the rating period, and (2)
information from other investigators whose protocols the PA has supported or
worked with during the rating period.
Guidelines for Components of Research and Development:
Research
Protocol Participation and Coordination
q Not Applicable
q 0 (Unsatisfactory): Is reluctant to identify or
recruit patients for research protocols. OR
Is unwilling to participate in research protocol. OR Participation in research protocol shows major deficiencies.
q 1 (Low
Satisfactory):
Participation in research protocols is reluctant or inconsistent.
q 2 (Satisfactory): Participates in recruitment
of research protocol participants and supports all research protocols.
q 3 (High
Satisfactory):
Is actively and effectively engaged in a research protocol as a primary or
backup coordinator.
q 4 (Outstanding): Is actively and effectively
engaged in 2 or more research protocols. OR
Actively participates in development of research protocols. OR Initiates and implements own approved
research protocol.
Scholarly
Activity
q Not Applicable
q 0 (Unsatisfactory): Is unwilling to assist
research or scholarly activity of others.
q 1 (Low
Satisfactory):
Is reluctant to assist research or scholarly activity of others.
q 2 (Satisfactory): Gathers data to assist
research or scholarly activity of others.
q 3 (High
Satisfactory):
Has authored or co-authored an article published in a peer-reviewed
professional journal, or a presentation at a national meeting.
q 4 (Outstanding): Has authored or co-authored
2 or more articles published in a peer-reviewed professional journal, or 2 or
more presentations at national meetings, or 1 article and 1 presentation.
Summary Rating of Research and Development
q 0 (Unsatisfactory)
q 1 (Low Satisfactory)
q 2 (Satisfactory)
q 3 (High Satisfactory)
q 4 (Outstanding)
Comments on Research and Development:
Administrative Competence
Data Source: The rating physician should base this rating on (1) observations of
the PA’s administrative activities during the rating period, and (2)
information from Service/Care Line administration about the PA’s administrative
activities during the rating period.
Guidelines for Components of Administrative
Competence:
Supervisory
Ability
q Not Applicable
q 0 (Unsatisfactory): Markedly ineffective in
ensuring that supervised staff perform satisfactorily. OR Engages in grossly inappropriate supervisory behavior (e.g., sexual harassment, unlawful
discrimination).
q 1 (Low
Satisfactory):
Somewhat ineffective in ensuring that supervised staff perform satisfactorily.
q 2 (Satisfactory): Generally effective in
ensuring that supervised staff perform satisfactorily.
q 3 (High
Satisfactory):
Elicits above-average performance and cooperation from supervised staff.
q 4 (Outstanding): Elicits outstanding
performance and cooperation from supervised staff, and demonstrates in‑depth
knowledge of using resources to further the mission and goals of the service.
Planning
Ability
q Not Applicable
q 0 (Unsatisfactory): Fails to establish logical
plan for completion of assigned task.
q 1 (Low
Satisfactory):
Planning ability is limited to rote following of already defined basic
protocols or formulas.
q 2 (Satisfactory): Shows ability for
independent planning, but plans frequently require some revision.
q 3 (High
Satisfactory):
Independently develops clear, concise plans that can be implemented with
minimal significant revision.
q 4 (Outstanding): Develops detailed,
coordinated, and innovative plans that require no significant revision for
implementation.
Decision
Making
q Not Applicable
q 0 (Unsatisfactory): Frequently unable to make a
decision despite reasonable availability of data and time.
q 1 (Low
Satisfactory):
Frequently vacillates before making a decision. OR Decisions are often impulsive or last‑minute.
q 2 (Satisfactory): Arrives at reasonable
decisions when data and time are adequate.
q 3 (High
Satisfactory):
Demonstrates ability to reach reasonable decisions on less than favorable data,
but is hesitant to implement fully until data become more ideal.
q 4 (Outstanding): Consistently makes and
implements sound and reasonable decisions under unfavorable conditions of data
or time.
Correspondence,
Reporting, and Other Administrative Products
q Not Applicable
q 0 (Unsatisfactory): Fails to complete 3 or more
required reports, correspondence, or other administrative products. OR 3 or more required reports,
correspondence, or administrative products show major inaccuracies, major
omissions, or major deficiencies in timeliness.
q 1 (Low
Satisfactory):
Required reports, correspondence, or other administrative products on 3 or more
occasions show minor inaccuracies, minor omissions, or minor failure to meet
timeliness standards.
q 2 (Satisfactory): Required reports,
correspondence, and other administrative products are consistently accurate,
complete with regard to information requested, and timely.
q 3 (High
Satisfactory):
Required reports, correspondence, and other administrative products are
consistently accurate, complete with regard to information requested, and
submitted significantly earlier than required deadline.
q 4 (Outstanding): Required reports,
correspondence, and other administrative products consistently show exemplary
attention to accuracy and detail, contain significant relevant content beyond
that requested, and are submitted significantly earlier than required deadline.
Summary Rating of Administrative Competence
q 0 (Unsatisfactory)
q 1 (Low Satisfactory)
q 2 (Satisfactory)
q 3 (High Satisfactory)
q 4 (Outstanding)
Comments on Administrative Competence:
Personal Qualities
Data Source: The rating physician should base this rating on (1) observations of
the PA’s behavior during the rating period, and (2) information from other
staff and from patients about the PA’s behavior during the rating period.
Guidelines for Components of Personal Qualities:
Relationship
with Staff and Others
q 0 (Unsatisfactory): Is uncooperative, disruptive,
or otherwise markedly problematic in working with a team.
q 1 (Low
Satisfactory):
Usually has mild to moderate problems in establishing useful team
relationships. OR Is mostly a passive
team member.
q 2 (Satisfactory): Is consistently a
cooperative, active, and satisfactorily productive team member.
q 3 (High
Satisfactory):
q 4 (Outstanding): Shows consistent skill in
establishing and maintaining relationships of mutual respect and dignity and in
gaining other team members’ cooperation to accomplish tasks and resolve
problems; is highly valued as a team member.
Dependability
q 0 (Unsatisfactory): Markedly unreliable in
timeliness or content of performance. OR
3 or more absences without leave or adequate reason.
q 1 (Low
Satisfactory):
Mildly unreliable in fulfilling responsibilities. OR Clearly lacks enthusiasm in fulfilling responsibilities.
q 2 (Satisfactory): Consistently fulfills
assigned responsibilities, meets required deadlines, and keeps appointments.
q 3 (High
Satisfactory):
Consistently fulfills all assigned responsibilities, and frequently shows
initiative as well.
q 4 (Outstanding): Shows exceptional dedication
and enthusiasm, consistently completes assignments well before deadlines, seeks
to appropriately expand scope of responsibility, and monitors others to ensure
their dependability as well.
Ability to
Handle Groups
q Not Applicable
q 0 (Unsatisfactory): Avoids group situations.
q 1 (Low
Satisfactory):
Participates minimally or passively in meetings and other group situations.
q 2 (Satisfactory): Effectively leads group
discussions.
q 3 (High
Satisfactory):
Effectively leads group discussions and seeks opportunities to enhance group
leadership skills.
q 4 (Outstanding): Is recognized as an exceptionally strong g