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International Academy of Physician Associate Educators Newsletter


Board of Directors President

Scott Smalley

Immediate Past President

David Lusale


Lumbani Tshotetsi


Dana Sayre-Stanhope

Director of Communications

Sanele Ngcobo

Director at Large: UK/Europe

Phil Begg

Director at Large: USA/India

Somu Chatterjee

Director at Large: East Africa

Reuben Waswa

Student Board Member

Emily Wright

President’s Corner Welcome to the IAPAE Newsletter. We invite you to learn more about IAPAE, our mission, background, and current efforts to promote the education and training of our important healthcare profession. There are many recent milestones to celebrate and reflect upon in our profession – The United States physician assistant program turned 50 years old last year The Kenya clinical officer training program is turning 90 years old this year as they started training clinical officers in a two-year diploma course in 1929. The India physician assistant program, now 17 years old, is on the cusp of being fully recognized by the Indian government. In Switzerland, there are now 19 physician assistants trained in a new start up clinically focused training course. The United Kingdom has grown from five physician associate programs to 35 programs in 5 years! This is only a small listing of the exciting advancements occurring in our field. To provide background, the International Academy of Physician Associate Educators (IAPAE) is a volunteer-run organisation with a mission to bring together global physician associate educators to develop and share best educational practice respecting regional cultures. The organisation started in 2008 with a vision to be the leading international resource for existing and developing physician associate educational programmes around the world. Educators established IAPAE for educators to promote the teaching and learning of students intending to graduate as healthcare practitioners to deliver healthcare in their respective countries. This healthcare professional has been identified in 46 countries with various names including physician associate, physician assistant, clinical officer, clinical associate, medical licentiate, assistant medical officer, medical assistant, health officer, and feldshers to name a few. In this Newsletter, Professor Phil Begg, a founding member and Trustee of IAPAE, describes the 12-year history of IAPAE through a reflection of our conferences in the Feature Article. Learn more about two training programmes in Uganda and Israel in the Country Focus section. We encourage you to become involved in IAPAE research efforts following reading the Research section. Lastly, we hope you will attend the 12th Annual IAPAE Conference in Winterthur, Switzerland, 16-19 October – read more in the Conference section. Thank you for your interest, involvement, and efforts to promote the teaching and learning of this unique health care profession. We hope you enjoy the Newsletter. Kindly, Scott Smalley IAPAE President of the Board

A long and winding road, a good old country song!

The Beginning 2008

I’ve often said the story of IAPAE sounds like the start of an old country song “It started in a bar in Tucson Arizona”. The truth is it did. In 2007 in the bar of the conference hotel for the annual PAEA conference a small group of friends sat and discussed how exciting the previous years had been with the proliferation of new PA programmes starting up, mainly in the UK, The Netherlands and Canada. Myself, Nick Ross (Birmingham UK), David Fahringer (Kentucky USA), Rachel Detoro (was Catanzaro, Arcadia University USA) and David Kuhns (Maine USA) talked about the need for something akin to PAEA, but covering a global aspect. The longer we talked the more it was clear that if we wanted to do this, we would have to step up. The biggest question was how? The President elect of PAEA was Dana SayreStanhope, and a conversation about the evening before opened the flood gates, Dana knew exactly how we could do this, and soon mobilised the offices of PAEA, with the staff officer Jennifer Jarman soon on the case. Within a very short period, with a huge amount of work, the team had developed the International Forum for Physician Assistant Education (IFPAE), with its inaugural meeting to be hosted at the next PAEA conference in Savannah Georgia in 2008.

Loews Ventana Canyon Resort, Tucson, AZ

The Founding Board of Dana, Nick Ross, David Fahringer and I launched the organisation in an invitation only meeting, bringing together representatives from 14 countries around a table to discuss the challenges of developing a global forum that was inclusive and represented all analogues of the PA role.

We agreed that the organisation needed to be renamed as it was an educators group that would focus on education standards and how they impacted the training of new clinicians and how the standards could be unified across the globe. The proposal was that the organisation be renamed the International Academy for Physician Associate Educators and that we would seek to be an inclusive organisation that brings together educators across the globe under a shared set of values and goals. It was also resolved that work began on developing a set of byelaws and the governance structures be set out before the next conference. We were agreed, we would take our conference to Africa.

Out of Africa 2009

IAPAE was beginning to take shape and we are thankful for all of our colleagues from Ghana, who helped us on this journey. We were going to Bonnie Scotland. In 2009 we were honoured and privileged to hold our 2nd conference in Sunyani, Ghana. To say we received a warm welcome in Ghana would be an understatement; from the very outset our welcome was warm and kind. The regional secretary of health welcomed us and invited us to his home, where we were entertained and made to feel very much at home. The theme was centred on serving rural communities and primary health care. Dr Emanuel Teye Adjase, the Dean of the Kintampo rural health college and champion of the PA analogue in Ghana led the meeting and we set out to start the definition of what the organisation stood for, and what governance would be wrapped around it, deciding on our first set of objectives and an organisational form. We are also grateful for the involvement and presence of Dr Benjamin Aflakpui (Central University Ghana) who helped with this conference and has walked this journey with us. The meeting was joined by not only PA students, but also nursing students from the Sunyani hospital (pictured below) nurse training school. The lively discussions were only surpassed by the drive to agree our plan for the next 5 years, and the structure for setting this out.

Bonnie Scotland 2010

The grandeur of the mountains, the beauty of the rivers and valleys, welcomed IAPAE to the stunning Mar Hall, in Renfrewshire Scotland. The ancestral home of the Earl of Mar set majestically on the banks of the river Clyde was the idyllic setting for our 3rd conference.

Oh Canada 2011

We were pleased especially to welcome and honour a delegation from Japan, who made an instant impact with their insight into the communities of practice within a similar set of provision problems in their home in Japan. We had keynote speakers from the USA (Professor Bill Stanhope), Scotland (Mr Alberto Gregori) and Ghana (Dr Emanuel Teye Adjase), all of whom challenged our thinking and pushed us to start to consider the place IAPAE would hold in the international community of educators and how we could make a significant difference. We were joined by colleagues from NCCPA the national certifying organisation in the USA, and held a special breakfast forum to discuss ways in which we could work together and develop thinking around certification standards. There was a sense of growing and maturing, but the challenge remained to move at scale we needed to engage further and grow the membership of the organisation

In 2011 the conference followed the PAEA conference in the USA on to Montreal Canada at the beginning of a very cold November, the conference moved to the vibrant city of Montreal Canada, where we were once again inspired by some excellent keynote speakers and the challenge of how we embark on developing reusable learning objects, to shape the development of global standards in healthcare quality, through sound educational learning of our students. Canada, did a wonderful job, in welcoming delegates from many countries and ensured the debate and learning continued to grow.

For IAPAE, Canada was a significant turning point; the first elected Executive board was announced under the Presidency of Dr Emanuel Teye Adjase (Ghana). The Executive board consists of Vice-president Daphne Cohen (Netherlands), Mike Dryer, Treasurer (USA), Nadia Miniclier Secretary (USA) and Karen Mulitalo Director at Large (USA). The Board is supported and challenged by the Founding Board of Trustees, who have the role of ensuring the values, vision and objectives of IAPAE are maintained. The Board of Trustees are Professor Dana Sayre Stanhope, Chair (USA), Professor Philip A Begg, Vice Chair (UK), Professor Nick Ross (UK) and Professor David Fahringer (USA). This was a very exciting meeting and the organisation had now moved towards a new chapter in its history and new governance arrangements, with a Board and responsibility and accountability to the membership.

Our Keynote speakers this year were Karen Mulitalo, who had been one of the pioneers in developing the PA profession in Australia, and was now back in the USA, Nick Ross, who was Associate Professor in Birmingham England who had led the development of the Department of Health’s Competency and Curriculum Framework for PAs, and the final speaker was Mr Ian Jones, who was a leader in PA education in Canada, and had also pioneered the profession in Canada. Josephine Berkvens shared the excellent work she and the team in Utrecht had been doing on EPAs and the way in which this had transformed education into practice.

Johannesburg, South Africa 2012

So onto our next visit to Africa, and to South Africa, Johannesburg. This conference was hosted by the University of Witwatersrand.

The perspective of the conference crossed borders and continents; there were the challenges of the rural healthcare needs of Africa, the contribution to achieving the millennium goals set by the World Health Organisation (WHO) and the development of a specialist PA Midwife role in the Netherlands. The presentations were extraordinary, the conversation inspiring and the commitment to work together greater. South Africa did IAPAE proud; we also have to extend a huge thank you to the American International Health Alliance (AIHA), who supported this conference with travel help and organisational skills. There were exciting opportunities to visit some of the local healthcare providers, local traditional villages, the delights of Johannesburg’s Mandela Square and its wonderful restaurants and the opportunity for Safari.

Birmingham, United Kingdom 2013

The biggest conference yet, with over 70 delegates and speakers from across the globe, including a telecast from Washington DC form Hugh Fitzmullin, who challenged the delegates to develop international accreditation and work together on the development of international standards.

Europe and the UK’s second city Birmingham was the venue of 2013. With more canals than Venice and the city with the greatest number of tree in Europe, Birmingham was pleased to welcome the delegates of IAPAE. The host was the new £750 million Queen Elizabeth Hospital Birmingham. One of the largest hospitals in Europe and the largest solid organ transplant centres in the world. The excellent facilities and the warm welcome set the tone for the conference.

From the serenading on the balcony on the opening reception to the wide ranging conversation over the conference programme, the conference was a great success.

Philly USA 2014 IAPAE has gone a long way towards the development of a truly international family, with shared values and vision, shared belief that the role of the non-physician medical provider makes a significant difference to people at their most venerable in cities, towns, and villages; urban or rural, all over the globe. The conference was a great success with excellent stimulating speakers from the Medical Director of Health Education England Professor Wendy Reid, David Lusale, from Zambia representing the African Network of Associate Clinicians and of course, our dear friend and colleague Professor Nick Ross, who challenged our thinking and was also honoured with a lifetime achievement award and fellowship of IAPAE, our very first recipient. We also saw the setting up of our conference networking groups focussed on Education, Research and collaboration/awareness.

Arcadia University in Philadelphia USA welcomed the Board of IAPAE and the gathered delegates. The Provost said “they were honoured that you have chosen to come to our University for the 7th Annual conference of IAPAE�. Arcadia has a long and strong history of Physician Assistants, both in the USA and as an international ambassador of the profession. They have supported and mentored the development of new programmes across the globe including Sub-Saharan Africa and the United Kingdom.

Dr Mike Dryer, Programme Director at Arcadia in his welcome said, “I have recently had the pleasure of serving on the IAPAE Board as Treasurer and continue to support and promote the work of the organisation, as the international voice of PA Educators”.

Arcadia University is a university set in the historical heartland of the USA, with strong traditions of high quality education for our students; we welcome the 7th Annual Conference of IAPAE and hope that the conference will offer delegates the opportunity to also make history. The organisation honoured Dr Dryer with an award for outstanding contribution to the development of IAPAE.

The beautiful Arcadia University campus.

Pretoria, South Africa 2015

Conference Theme: “The Maturing of the Physician Associate: Educational Training & Faculty Development” Panel Discussion of a Unifying term for the profession: “Accelerated Medically Trained Clinician”, brought a significant range of views and discussion. IAPAE was clearly at the heart of the global development of the family of professions that have emerged over the past 50 years, and was now leading the way in a global discussion about what and how the profession could be utilised.

Keynote speakers for topics of educational programme transition from Diploma to Bachelors to Master’s degree, Faculty development, and District hospital tour with practicing Clinical Associates, Paper Presentations from colleagues around the world, posters presentations and more!

IAPAE reiterated the goals of the organisation and recommitted to these: To represent Physician Associate educators globally; To develop maintain and share a dynamic repository of knowledge and experience relating to international Physician Associate education; To undertake, commission and disseminate research and other scholarly activity concerning international Physician Associate education; To achieve and maintain a heightened awareness and promote recognition of Physician Associate education amongst national governments and international organisations.

We heard from a range of outstanding keynote speakers including Dr Martin Bac, who presented on the role of the Clinical Associate in HIV management and Dr Clemence Marimo in regard to Faculty development.

Our second visit to South Africa was simply a wonderful experience, from the beautiful welcome singing of the students from the Pretoria programme to the excitement of the final day, where the Sub- Committees met with great enthusiasm and hope.

‘B2B’ Back 2 Birmingham again! UK 2016

Despite the immense challenges of a conference where we had, keynote speakers miss flights, fail to get visas to travel and sadly for one, being robbed and unable to travel. We managed to pull together a full programme of events and stimulating speakers, covering some fascinating topics. We saw the committees being re-established and each met for about 45 minutes to talk about how they would continue to work following the conference. There were also some very interesting discussions about how IAPAE could develop into a global accrediting body, which was met with a great deal of enthusiasm. The question remains, about how we manage to develop to this position. As is tradition, at the conclusion of the conference, the Chairman’s cycle of 2 year was rotated, and was passed from Phil Begg to David Fahringer.

And so back to Birmingham England, a quick change of venue from the planned country of the Netherlands, who sadly were unable to host on this occasion. The 9th international gathering was held at the 200 years old Royal Orthopaedic Hospital in Birmingham England. The conference opened with a pleasant late summers evening in the Board room, with a quartet of singers, the Chief Executive Mrs Jo Chambers welcomed delegates to the historic home of the Cadbury family, which is now the Trust headquarters.

The programme was again very busy with keynote speakers Dr Elizabeth Hughes from Health Education England, Professor Jim Parle Chairman of the UK and Ireland Board for Physician Associate Education and Dr Audrey Gibbs the newly appointed Programme Director at the University of East Anglia and outgoing Programme Director at the University of Witwatersrand in South Africa. The conference drew delegates from the UK, USA, Ghana, Zambia, and South Africa. The conference also saw a re-energising of the IAPAE Sub-committee structures, with nominated Chairs to lead them.

The big 10 Lexington Kentucky, USA 2017 “Celebrating the Past Embracing the Future� 10 Years old, what a landmark to reach, and what a journey. We celebrated in the USA, and the beautiful University of Kentucky campus in Lexington, with a wonderful warm Kentucky welcome, and a theme that would set us on course for the next 10 years.

The conference began with a parade of nations and all of the countries present paraded onto the platform carrying their national flag, it was an impressive sight to see the xx countries present. The Dean and Provost welcomed the delegates to Kentucky and to the University.

The conference dinner was held at the lovely Beeches Conference Centre.

The traditional welcome reception and the conference dinner were held in the lovely Boone Center, where we were entertained by the Acoustic Cats, and acapella male voice choir.

We saw the biggest conference to date in the IAPAE history with well over 120 delegates, participating over the 3 days of the conference. The conference was oversubscribed for short papers and we saw the largest number of posters being presented. We were grateful for the support from our commercial partners CME Inc, and Exam Master.

The programme was packed with excellent keynote speakers: Dr Lucy Kibe (USA) working in Kenya. Dr Kibe spoke on “The development of the next generation PA academic community” Professor Yoswa M. Dambisya from Tanzania. Discussed the need for “The global professional term” Dr Lisa Mustone Alexander – President Elect of PAEA (USA). Presented on “Learning from the past, together leading international education into the future”.

This year’s conference saw the first set of parallel workshops being run, which included topics such as: International Resources – sharing and developing core learning Case Based Learning (CBL) – a case study approach to PA learning Developing eye care programs with low resources Teaching clinical skills in entry level PAs The organisation gave a special award for an Outstanding Contribution to Mrs Jennifer Beems Jarmin. Jennifer had been an instrumental part of setting up IAPAE in 2008, without whom the organisation would have most definitely never had been birthed. This recognition was welcomed by all.

One of our founding members and past President and chair, Professor Phil Begg, also received two awards, one for international leadership and the other for continued contribution to IAPAE. Phil has served the organisation in many capacities since its envisaging in 2007 and has attended every conference since.

Zambia 2018

We had made it to 10 years old, and recommitted to the next 10 years, to continue to be the international voice of the PA in all its analogues across the globe and to grow our family, in conjunction with our partners both educationally and commercially. Victoria Falls, Zambia. Lusaka, Zambia was the host city for the 11th international conference and the theme was “Universal Primary Health Care Revisited� and marked our 4th visit to the African continent since the beginning of our journey. The conference opened officially with a wonderful reception at the conference hotel, the Cresta Golf View Hotel. The music was outstanding, and the conversation was a mixture of old friends meeting up and new friendships being formed. The conference concluded with the announcement, we were going back to Africa to Zambia in 2018 for the 11th international gathering of PA academics from across the globe.

Cresta Golf View Hotel, Lusaka.

The keynote speakers this year were preceded by a welcome address from the Permanent Health Secretary Dr Jabbin Longa Mulwanda, who welcomed delegate and the organisation to Zambia. The keynote speakers were: Dr Nathan Bakyaita, WHO Country Director Professor Sekelani Banda, Director HRP&D Ministry of Health Zambia Mr R Shivakumar – President of the Indian Association of PAs (IAPA) The conference was well attended with over 75 delegates on the first day. There were an excellent variety of short papers covering a huge range of topics from Factors that influence implementation of occupational safety and health management systems at public universities in Kenya, to School children and adults as malaria reservoirs in Zomba Malawi, and many others of great interest. The quality has improved and the depth of subjects covered increased every year. There were also a range of workshops offered to those who attended, that covered Problem Based Learning, Curriculum mapping, Lumbar Punctures and using standardized patients. There was a very healthy and in depth discussion about how IAPAE could become the international accreditation body for programmes across the world, more discussion will follow next year at our 12th conference.

We were hugely indebted to SolidardMed and LED Liechtenstein Development Service for their generous and kind support of the entire conference, without which we would never have been able to have such a rich diversity of culture and content at this year’s conference. We were overwhelmed be the extraordinary support and truly hope that this is the beginning of a long-term partnership.

The Future IAPAE has come a very long way since its inception in that bar in Tucson Arizona, we have made lasting friendships, strong partnerships across the globe, we have shared generously, and received with humility. The organisation has grown, and matured. We have made mistakes and suffered growing pains of an adolescent youthful organisation, however in the past 2 or so year we have grown significantly and changed our structures and developed new friends and alliances. As 2018 comes to a close and we start out 12th year of existence, we are a reinvigorated board, with new contributors and a wider scope, refreshed vision. The board is committed to a bright future, an inclusive future with a wider membership that covers more countries. We have seen, in the past 11 years contributions from Ghana, Zambia, South Africa, Ethiopia, Liberia, Malawi, Kenya, Rwanda, Uganda, Mozambique, Japan, Australia, The Netherlands, USA, United Kingdom, Ireland, Canada, Germany, Saudi Arabia, and India. We have met with international bodies such as WHO and AIHA, we have been greeted by Government ministers and national leaders in healthcare, we have developed relationships with key international healthcare NGO’s such as SolidarMed, and we have benefited from the generosity of values based commercial companies such as CME Inc. and Exam Master. All of these are part of our story, and very much part of our IAPAE family.

So, the next chapter is ready to be written, the page in blank, the pen is filled, I hope that whoever is reading this message, has passion and commitment for the PA Profession, and an ethos of giving generously to your fellow mankind. I love this little organisation and all it stands for, we are so much stronger every year, because of the commitment of the IAPAE membership and our developing family, I am proud to serve and humbled by the extraordinary people I have met and had the pleasure of travelling with since 2007, and you inspire me.

Let us go forward with this passion in our hearts and write the next chapter, stronger, better and inclusive, IAPAE is ready. Professor Philip A Begg Founding Trustee, past President and Chair, Director at Large (Europe)

IAPAE Research Sub-Committee Plans for the Future The 11th International Conference of IAPAE in Lusaka, Zambia saw a turning point in the organization’s future with a firm commitment to the re-establishment of the sub-committees. The Research Sub-committee met with a new and revived membership and a drive to plan an achievable schedule of activities under the new chairmanship of Susan Mururi from Kenya, supported by a plethora of wisdom and experience. The committee set out its Terms of Reference and Objective: Terms of Reference: To promote research of global impact and of international standard related to the education and training of PAanalogue healthcare practice 1. To provide a paper for the IAPAE quarterly newsletter as a start point for the development of an IAPAE Journal; 2. To review research abstracts for relevance for conference presentation, in an appropriate time line; 3. To develop a full repository of all relevant peer reviewed articles related to the PA-analogue profession; 4. To explore the potential sources of funding to support research; 5. To set up relevant sub groups; 6. To identify relevant research topics.

The committee will be working on these objectives through a series of research sub- groups, following much discussion the committee agreed to set up an initial three sub-groups, with an active membership and leads. Those sub-groups were agreed around the following priorities: 1. Peer Review Sub-Group – with a focus on research publications through the annual conference. This committee will oversee submitted abstracts to the conference, ensuring a high level of scientific contribution and robustness. This will be chaired by Phil Begg (UK); 2. Grant Support Sub-Group – This sub-group will work across the organisation, exploring grant potential and co-ordinate the submission process and follow up on successful grants with oversight of the completion of the work schedule and timelines. This will be chaired by Lumbani Tshotelsi (South Africa); 3. Research Repository Management – This sits firmly with the organisations main aim to become an international repository of knowledge for countries looking to develop PA-analogue programmes and assist in any way to support these in achieving this objective. The group will also look at how we catalogue the presentations and short papers from the past and present annual conferences to develop a significant body of knowledge for members to view and use. This will be chaired jointly by Claude Mumba (Zambia) and Manase Bocha (Kenya).

The committee agreed that in the period 2018/2020 the following priorities would be undertaken: Systematic review of International Pedagogies, led by Lumbani Tshotelsi from South Africa; Survey of international primary healthcare practices by PAs, led by Rosemary Nganda from Zambia. The Research Subcommittee will report progress through the main Board of IAPAE on a quarterly basis, with the Chair being invited to the appropriate meetings.

COUNTRY FOCUS Uganda Clinical Officers Brief History of the Profession By the 2nd half of the 19th century, Christianity and Western medical care had not reached Uganda. Ugandans were in spiritual “darkness”, and diseases especially, Trypanosomiasis and Syphilis were occurring at epidemic levels in the country. Sir Albert Cook a missionary came to Uganda in 1897 and started a health care unit where he held his first out-patient Clinic under a tree, on Namirembe Hill in Kampala. The first structure he set up was a grass-thatched house built out of mud and wattle with a wooden bed where he saw and operated his patients.

In 1917, Dr. Albert Cook started the first Medical Training School for Dressers and Dispensers to facilitate his Medical work. It was this medical training which gave rise to the establishment of health training institutions for medical practitioners in Uganda. By 1918, under the Ministry of Health, Uganda was training medical practitioners who were called Medical Assistants. In 1946 the Uganda protectorate government identified training in health as one of the avenues to absorb the returnees from the 2nd World War and to care for their health. That year 1946 was when the Ex-service men with good formal education were trained for 2 years to become Medical Assistants. In 1997 the Medical Assistant Curriculum was reviewed, and the education entry requirements became ’A’ level with 2 Principal passes and 1 subsidiary pass in science subjects instead of Good passes at ‘O’ level as was required by the previous curriculum. The new curriculum increased the depth of the required skills, introduced new areas of study like below the Navel in case of women and Primary Health Care (PHC). The title also changed from Medical Assistant to Clinical Officers. Description of Educational Training The Training of Clinical officers takes a minimum of three years. It entails theory and hospital attachment for practice. From 1958 Government established 3 institutions to train Clinical Officers. The training of health professionals was however liberalized in the late 1990s and a number of private Health training institutions have since started to train Clinical Officers and now there are over 22 of them. Description of Educational Training They are middle level health workers who manage all the inter mediate referral package of health that involves examining, diagnosing and prevention of diseases.

Future Direction Academics: The career path is being reviewed, the curriculum for Bachelors in Clinical Medicine is being finalised to be implemented soon. Regulation: Strengthening the Association to streamline regulation Legislation: the educational policies are being revised and will most likely affect the nature of training High Lights and Successes Post basic courses for Clinical Officer Graduates to help them upgrade like Ophthalmic Clinical Officers, Ear Nose and Throat, Psychiatric Clinical Officers Many more private institutions have started to train clinical officers The graduates of Clinical Officer training are highly employable Challenges Association of clinical Officers is not very vibrant Conflict between doctors and COs

A brief history of the Physician Assistant profession in Israel Attempts were made since the early 2000s to create physician assistants in Israel, but initial discussions were met with significant political resistance from physician and nursing groups. A handful of private clinical institutions began piloting a hybrid PA role, but the numbers were small, and they were working in an unregulated environment. The Ministry of Health (MOH) convened a formal committee to explore the possibility of creating a PA role in 2013, and that was the major launching pad for the current PA project. After a few more years of preparation, political navigation, and regulatory updates, the first class of PA students began learning and training in 2016. The PA role was initially piloted only in emergency medicine, but the committee recommended that it could be expanded to other specialties in the future.

Description of Educational Training The PA role was designed for seasoned paramedics, in possession of a bachelor’s degree at minimum, to receive an up-training in emergency medicine that would allow them to take on an advanced clinical role in the emergency department. The course was designed and run by the MOH and classroom time takes place in the government hospital of Sheba Medical Center in Tel Hashomer. It is a learn-while-you-work education model with PAs working four days per week in their employment ED and one full day per week in the classroom for one year of education. PA students must be hired by a hospital before registering for the course, and they receive a full salary during their education. The PA students receive a certificate of training and a PA registration number with the MOH upon successful conclusion of the course and passing of the summative exam. Role of Clinical Practice The PA role was designed to take on specific physician tasks in the ED that would free up the doctors to see more patients, reduce overcrowding, and improve patient satisfaction. The PAs spend most of their time doing a new patient workup, history, and physical exam, ordering labs and tests, presenting patients to the doctor to discuss a management plan, monitoring and escorting critical patients and responding to cardiorespiratory codes within the hospital. The PAs are not allowed to order medications in their name unless it is part of an ACLS protocol.

Future Direction

Highlights, Successes & Challenges

Most of the stakeholders in Israel would like to see the PA role expanded to all medical specialties, both inpatient and outpatient. They would also like to see PA education moved to academic institutions with a general medical education and a graduate degree conferred. In the future, there will need to be clearer regulations and formalization of the PA profession with state licensure.

Early survey studies have shown that satisfaction is high among PAs and ED doctors and that the general population is very open to the idea of receiving care from PAs. PAs remain frustrated, though, by resistance from nursing groups and the obstacles in clinical practice that have resulted from this. Political fighting has been the major reason for stalling PA progression. Physician groups have become more open to the idea of PAs over time, but there is still significant resistance from nursing groups who view the PAs as competition for their plans to develop nurse practitioners. Both PAs and NPs are currently being developed simultaneously in different specialties. The MOH has commissioned several committees this year to explore the future directions of PAs in Israel.

Oren Berkowitz, Ph.D., PA-C Senior Lecturer Department of Health Systems Management Ariel University, Ariel, Israel

2018 IAPAE CONFERENCE REPORT Eleventh (11TH) Annual IAPAE Conference Held at Chainama College of Health Sciences, Lusaka, Zambia











3 – 6th October, 2018 Theme:


Conference delegates with guest of honor middle second role standing Prof E Choma, PS (Training)

New IAPAE President S, Smalley & L Tshotetsi, Secretary 2018

Supported by:

Republic of Zambia Ministry of Health

1.0 ACKNOWLEDGEMENT Thanks to the Ministry of Health of Zambia and Chainama College Hospital Management for hosting the IAPAE 2018 Conference, along with the Chainama College of Health Sciences in Lusaka, Zambia. Thanks to SolidarMed who supported delegates with transportation, conference accommodation and catering for the conference event.

Thanks to the conference organizing committee for the time invested in planning for the conference; Ms E Muleya, Dep Director (MoH), Ms E Tembo Dep Registrar (CCHS), Ms E Chirwa, Head Skills Lab, (CCHS), D Mubanga HoD (CCHS), R Chulu, Acct (Higher Educ Authority), D Kopakopa, Presid (ZMLPA), and D Lusale Chair/IAPAE Presid. Prof P Grange TA ML Prog (Solidarmed) and Dr H. Barigye, ML Prog (CCHS). Not the least, we appreciate all the delegates and students in attendance. We especially appreciate the Keynote speakers, short paper presenters and poster presenters for the sound scientific papers presented and the wonderful hospitality received from Cresta Golfview hotel.



Prof E Chomba Guest of Honor Middle & Dr N. Bakyaita WHO Lt

The 11th International Academy of Physician Associate Educators (IAPAE) Annual Conference The conference started on 4th October and continued through 6th October 2018. It was officially graced by Prof E Chomba, Permanent Secretary (Training), Ministry of Health on behalf of the Minister of Health. The conference program included; welcome of the guest of honour and delegates to IAPAE 2018 conference by David Lusale, IAPAE President. He acknowledged 11 countries were represented at the conference including Kenya, Uganda, Malawi, South Africa, Tanzania, Zambia, Zimbabwe, India, Japan, UK and USA. The first day had 86 participants, 76 participants on day two and 56 delegates on the third day. During the third day, a general meeting and four subcommittee meetings were held; Advocacy & Education, Faculty & Membership, Communication & Repository and Research subcommittees. The subcommittees appointed Chairs and drafted their Terms of Reference, developed aims, objectives and work plans for the next 12 months. The IAPAE Board meeting was also held with planning for IAPAE incorporation, developing the conference venue for 2019 conference, planning for a second 5 year – strategic plan and expanding the Board with regional Directors at Large with consideration for East Africa, West Africa, India, Europe, UK, and Canada.




Prof Sekelani Banda, Director HRD&P, MoH, Zambia: Emphasised standard setting as a catalyst for quality Improvements in health professions’ education. Generated rethinking about generalized standard pass mark as opposed to specific exam tailored taking into account level such as easy/ difficult.


Mr. R Shivakumar: Metamorphosis of Physician Assistant workforce in India – Discussed the cadre of PAs in India (about 1000), who are not yet regulated and going through recognition status by stakeholders.

The conference had three keynote speakers, two from Africa and one from India, 12 short papers were presented, many posters and four parallel training workshops were conducted as summarized below. We were fortunate to have a film shown about physician assistants and similar health cadres during the conference titled: “As Good As You Can, As Professionally As You Can. The Physician Assistant Concept around the world”. The film displays the physician assistant model of the mid-level healthcare worker around the world, featuring PA health care professionals in the United States, United Kingdom, Netherlands, Israel, South Africa, Liberia, India, Laos and Australia made by Adam Halbur, filmmaker. This version was made especially for the 11th Annual Conference of the International Academy of Physician Associates. Keynote speakers and short paper presenters: 1.

Dr Nathan Bakyaita, WHO Country Director, Zambia: “Universal Primary Health Care” – He stressed the need for practitioners to approach universal health care holistically without leaving any person behind.


Short papers presented – Day 1, 2 & 3

The conference had three keynote speakers, two from Africa and one from India, 12 short papers were presented, many posters and four parallel training workshops were conducted as summarized below. We were fortunate to have a film shown about physician assistants and similar health cadres during the conference titled: “As Good As You Can, As Professionally As You Can. The Physician Assistant Concept around the world”. The film displays the physician assistant model of the mid-level healthcare worker around the world, featuring PA health care professionals in the United States, United Kingdom, Netherlands, Israel, South Africa, Liberia, India, Laos and Australia made by Adam Halbur, filmmaker. This version was made especially for the 11th Annual Conference of the International Academy of Physician Associates. 1.

Factors that Influence Implementation of Occupational Safety and Health Management System at Public Universities In Kenya-A Case Study Of Egerton University, by David K. Njeru, Egerton University. Kenya.


MLP Training: Monitoring and Evaluation Report by Dr Henry Barigye. Zambia


IAPAE act as an International Accreditation Body by Professor Dana Sayre-Stanhope (via video) and Scott Smalley. USA and South Africa.


Disaster risk reduction for safety of students, teachers and support staff in secondary schools in Kiambu County, Kenya. By Susan Mururi – Mount Kenya University, Nairobi, Kenya.


School children and adults as Malaria reservoirs in Zomba, Malawi: using Malaria rapid Diagnostic tests for case detection, Lambani Tshotetsi. Malawi/ South Africa


Social Adjustment: Factors affecting it and it’s correlation with academic performance of first year university students, by Dr Yasmin SultanaMuchindu, Zambia


Solidarmed Organization (NGO) supporting education, health care, Medical Licentiate training in Zambia, professional association and Africa Network of Clinical Practitioners – presented by Prof Phillipe Grange, Zambia


Kenya Clinical Officers Union – established to advocate for clinical officers welfare in Kenya presented by Peterson Wangirwa, Union Chairman. Kenya


Factors influencing nutritional practices in Chongwe district by Priscilla Funduluka. Zambia


Kenya Clinical Officers Association “Success of the Association” presented by Albert Taiti, Chairman. Kenya


Survey of Physician Assistant Programs from around the world presented by David Fahringer, Kentucky USA


Film: PAs Around the Globe: As good as you can, as professionally as you can, presented by filmmaker Adam Halbur, USA


Posters presentations (About 6)


Workshops Held (4 Parallel sessions) - Day 2 1.

Spinal anaesthesia in low setting health facilities by John Chama, Chainama College of Health sciences, Lusaka, Zambia - Zambia


Case Based Learning (CBL), A case study approach to PA learning, a practical session. By Professor Phil Begg, University of Birmingham England.


Skills development with involvement of simulating patients by Professor David Fahringer, University of Kentucky. USA


Curriculum Mapping; from Learning objectives to outcomes and everything in between by Scott Smalley, University of Witwatersrand, Johannesburg, South Africa



Academic Awards 1.

The best short paper award was given to Dr Yasmin S Muchindu.


The best poster award was presented to Ms Rosemary Ngandu.

3.6 Besides the interesting and engaging presentations and chairing of sessions, the conference had 2 evenings on 3rd and 5th of gala dinner celebrating the conference of IAPAE. The Zambian cultural ensemble “Nomanjani� entertained the delegates with the rich Zambian and African heritage and history through Music. They formed part of the memorable time of 2018 conference for the delegates.



Physician associate education programs - clinical officers, medical licentiates, clinical associates, physician associates, assistant physician were marketed


There was capacity building that took place in medical education presentations and research paper presentations and posters


Delegates had platform to network, shared experiences and possible solutions to specific challenges unique to individual countries


IAPAE expanded membership to subcommittees that are set to work during 2018-2019 and report to the Board quarterly. Demonstrated by Terms of Reference, Objectives and Work plans that were written and submitted


IAPAE gained partnership with organization like SolidarMed (Zambia)


Karibu pharmaceutical (Zambia) marketed drug products and gave out some of the samples to delegates


Zambian students had an opportunity to attend the IAPAE conference and appreciated the physician associate career


The Ministry of Health and World Health Organization appreciated IAPAE conference and enlightened them more about physician associate education globally to have a platform of meeting together North - South, East – West collaboration. This may help with future support to IAPAE, members and country physician associate programs.



To achieve and maintain a heightened awareness and promote recognition of Physician Associate education amongst national governments and international organisations.

The turnout was large numbers each day with robust discussions and development of friendships and educational partnerships. The humanity of Africa was on display each day during this conference. The Zambian conference was a success and support received from SolidarMed was remarkable.


The conference offered a broader global perspective of what IAPAE stands for and is able to contribute to the training of Physician Associates internationally. The organization mission is to be the leading international resource for existing and developing Physician Associate Educational programmes. Together, we continue to offer education support for PAs, Research, Repository, Advocacy and Communication. The 11th annual IAPAE Conference continued the aims of the organisation; 1.

To represent Physician Associate educators globally;


To develop maintain and share a dynamic repository of knowledge and experience relating to international Physician Associate education;


To undertake, commission and disseminate research and other scholarly activity concerning international Physician Associate education;

Light Moment of delegates– Zambians and Kenyans at the Venue.

IAPAE in Session

Join us for the 12th Annual IAPAE Conference to be held at the Zurich University of Applied Sciences in Winterthur, Switzerland from 16 – 19 October 2019 This year’s Theme is “Task Sharing, a sustainable solution to global healthcare needs” CONFERENCE PROGRAMME OVERVIEW: 16 October, Wednesday, 18:30 Meet and Greet; Opening Ceremony of IAPAE Conference Welcome to new conference delegates and familiar friends as we begin the 12th Annual IAPAE Conference with the theme of “Task Sharing, a sustainable solution to global healthcare needs”. Join us for an evening reception. Light fare and drinks included. Venue: Kantonsspital (Hospital), Brauerstrasse 15, Winterthur Conference Day 1: 17 October, Thursday 08:30 Conference Registration 09:00 Conference Opening Join us for a full day of Keynote speakers, Short Paper presentations and poster presentations. Tea, Coffee, Snack breaks and Lunch included. Venue: ZHAW Gesundheit, Zurich University of Applied Sciences, Technikumstrasse 71, Winterthur Conference Day 2: 18 October, Friday 09:00 am start time The second day continues with Keynote speakers, Short Paper presentations from colleagues around the world and posters presentations. The afternoon session is for PA education development in Switzerland. Tea, Coffee, Snack breaks and Lunch included.

Venue: ZHAW Gesundheit, Zurich University of Applied Sciences, Technikumstrasse 71, Winterthur 18:30 Gala Dinner Evening Conference Celebration Dinner is planned for time with friends, networking with new colleagues and awards for short papers and posters. Join us for an evening dinner. Dinner meal included. Venue: Kantonsspital (Hospital), Brauerstrasse 15, Winterthur Conference Day 3: 19 October, Saturday 09:00 am start time The third day starts with parallel workshops and Short Papers with the IAPAE General Meeting with elections for open positions on the Executive Board and Subcommittees. 3rd Day continues with break-out sessions for the five Subcommittee planning meetings: Advocacy & Education Subcommittee, Faculty & Membership Subcommittee, Research Subcommittee, and Communication & Repository Subcommittee. Conference concludes with closing ceremony. Tea, Coffee, Snack breaks and Lunch included. Venue: ZHAW Gesundheit, Zurich University of Applied Sciences, Technikumstrasse 71, Winterthur

Conference Registration Rate Options: Option 1 – Standard Package 3-day Conference Rate, $375.00 Option 2 – Special Nations Standard Package 3-day Conference Rate, $125.00 Option 3 – Standard 1-Day Conference rate, $150.00 Option 4 – Special Nations 1-Day Conference rate, $50.00 Option 5 – Student Package 3-day Conference Rate, $90.00 Option 6 – Student 1-Day Conference Rate, $35.00 Option 7 – Meet and Greet Reception only, $20.00 Option 8 – Gala Dinner only, $40.00 Option 9 – Vendor/Exhibitor rate, $500.00 Please visit to learn more about the conference, to register, to make payment and access the hotel booking website for reduced hotel rates.

We look forward to seeing you at the Conference to take part in Keynote speakers, short papers and discussions for incorporating best practices and evidence based research for the education and training of this important healthcare profession.

We are grateful for the support from our sponsor, including:

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