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Establishing the Contemporary Practice of the Pathologists' Assistant

Tuesday, September 4, 2018   (0 Comments)
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“Scope of Practice” describes the procedures, actions, and processes that a healthcare practitioner is permitted to undertake in keeping with the terms of their professional certification.

In late 2017, the American Association of Pathologists’ Assistants (AAPA) formed a task force to address revising the current Pathologists’ Assistant Scope of Practice.  This task force included a diverse group of Pathologists’ Assistants and an academic pathologist.  Pathologists’ Assistants on this task force included representatives from academia, clinical instruction, former ASCP BOC examination committee members, community hospitals, laboratory management, and grossing operations management.  This task force was formed in response to concerns expressed by the AAPA membership and the Pathologist’ Assistant Training Program Directors (APATP) that the current scope of practice did not comprehensively reflect the progression of responsibility and contemporary practice of a Pathologists’ Assistant.

Pathologists’ Assistants Scope of Practice Task Force Members: 

Connie Thorpe, PA(ASCP)CM, AAPA Director of Professional Development, Assistant Professor Department of Pathology, Saint Louis University - Representing academia and former ASCP Examination Committee member

Beth Obertino-Norwood, PA(ASCP)CM
AAPA Board of Trustee, Pathologists’ Assistant, Department of Pathology and Immunology, Washington University - Representing the community hospital

Steven Suvalsky,PA(ASCP)CM 
Pathologists’ Assistant, IMMC Histopathology - Representing the community hospital

April Reineke, PA(ASCP)CM, Pathologists’ Assistant, Reading Hospital - Representing academia and former ASCP Examination Committee member

Kelly Kester, PA(ASCP)CM, Laboratory Manager and Instructor, Oregon Health and Science University - Representing management and academia

Krista Szafranski, PA(ASCP)CM, Grossing Operations Manager, CellNetix Pathology, Inc. - Representing management and the private laboratory.

Pathologist Advisor: Carole Vogler, MD
Professor and Chair, Department of Pathology, Saint Louis University.

How did we approach updating the Pathologists’ Assistant Scope of Practice?
This task force carefully evaluated the current Pathologists’ Assistant scope of practice, reviewed the American Society for Clinical Pathology Board of Certification task analysis, and researched trends in the utilization of the Pathologists’ Assistant.  A revised Pathologists’ Assistant scope of practice was then created and was proposed by this task force and submitted to the AAPA Board of Trustees.  This task force and the AAPA Board of Trustees invited the APATP members to provide comment.  The APAPT members provided comment, edits were incorporated, and the AAPA membership was then invited to review this updated scope of practice and provide comment. 

Scope of Practice Background:
The following are excerpts from a paper “Changes in Healthcare Professions’ Scope of Practice: Legislative Considerations” that the task force found helpful and kept in mind while updating the Pathologists’ Assistant Scope of Practice.

Arguments for scope of practice changes should have a foundational basis within four areas:

  1. An established history of the practice scope with the profession
  2. Education and training
  3. Supportive evidence
  4. Appropriate regulatory environment.

Historical Basis:
The historical framework provides the basis for the essentials of the profession, including how it has developed over the years and how it is presently defined.  Changes in scope of practice should fit within the historical, evolutionary and present practice context for the profession.

Questions to be considered include:

  1. Has there been evolution of the profession towards the addition of the new skill or service?
  2. What is the evidence of this evolution?
  3. How does the new skill or service fit within or enhance a current area of expertise?

Education and Training:
Tasks added to a scope of practice are often initially performed by healthcare professionals as advanced skills.  Over time, as these new skills are utilized by a sufficient cohort of professionals, they become entry-level skills and are taught as such in entry-level curricula.  It is not realistic to require a skill or activity to be taught in an entry-level program before it becomes part of a profession’s scope of practice.  However, the entry-level training program and its accompanying accrediting standards should provide the framework, including the basic knowledge and skills needed, to acquire the new skill once the Pathologists’ Assistant is out in the field.  Competence assessment tools should be in place to indicate whether the Pathologists’ Assistant is competent to perform the advanced skill/technique.

Questions to be considered include:

  1. Does current entry-level education prepare Pathologists’ Assistants to perform this skill/technique as their experience increases?
  2. If the change in scope is an advanced skill that would not be tested on the entry-level certification examination, how is competence in the new technique/skill assured?
  3. What competence measures are available and what is the validity of these measures?
  4. Are there training programs within the profession for obtaining the new skill or technique?
  5. Are standards and criteria established for these programs?
  6. Who develops these standards?
  7. How and by whom are these programs evaluated against these standards?

Evidence:
There should be evidence that the new skill or technique will promote quality healthcare.  The base of evidence should include the best available clinical evidence, clinical expertise and research.  Other forms of evidence include evolving concepts in pathology, quality improvement, standards of care, cost-effectiveness analysis, and benchmarking data.

Questions to be considered include:

  1. Is there evidence within the profession related to the techniques and skills involved in the changes in scope?
  2. Is there evidence that the technique or skill is beneficial?

Regulatory Environment:

A consideration in proposing changes in scope of practice is the regulatory environment (ASCP, NAACLS).  Usually, it is the professional association (AAPA, APATP) that promotes and lobbies for scope of practice changes.  The regulatory board should be involved in the process and be prepared to deal with the regulatory issues related to the proposed changes.

Questions to be considered include:

  1. Is the regulatory board authorized to develop rules related to a changed or expanded scope?
  2. Is the board able to determine the assessment mechanisms for determining if an individual professional is competent to perform the task?
  3. Is the board able to determine the standards that training programs should be based on?
  4. Does the board have sufficient authority to discipline any practitioner who performs the task or skill incorrectly or might likely harm a patient?
  5. Have standards of practice been developed for the new technique or skill?
  6. How has the education, training and assessment within the profession expanded to include the knowledge base, skill set, and judgments required to perform the techniques and skills?
  7. What measures will be in place to assure competence?

In conclusion, it is important to remember that a scope of practice is not a job description and is not required to cover every technique and every possible job or task a Pathologists’ Assistant may perform over their professional career and should not attempt to do so.  However, a change or update to the scope of practice should reflect the evolution of abilities of the Pathologists’ Assistant, as reflected in the revised scope of practice.  Factors relevant to scope of practice decision making are those designed to ensure that all certified Pathologists’ Assistants are capable of providing quality patient care.  Most importantly, the strength of the scope of practice lies in broad acceptance by the membership and the desire to ensure the advancement and progression of responsibility for the Pathologists’ Assistant. 

I would like to thank the membership for their detailed comments and suggestions on this modernized Pathologists’ Assistant Scope of Practice.  The AAPA Board of Trustees approved and finalized the revised Pathologists’ Assistant Scope of Practice on July 9, 2018.  With this revision we are surely establishing the contemporary practice of the Pathologists’ Assistant. 


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