¹Carl Remigius Medical School, Physician Assistants, München, Germany
²Institut für Kommunikations- und Prüfungsforschung gGmbH, Heidelberg, Germany
³Fliedner Fachhochschule, Physician Assistants, Düsseldorf, Germany

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Background and objectives: Physician assistants have been around in Germany for twenty years. In contrast to the USA, there is no educational accreditation or licensing of PAs in Germany [1]. While PAs in the USA are accredited by the “Commission on Education for the Physician Assistant (ARCPA)” and regular tests are required to maintain board certification and state licensing, there is no official certification for PAs in Germany. Even though the German PA curriculum and its scope were outlined by the German Medical Association in 2019, most PAs perform delegable tasks at the discretion of their practising physician.

Methods: There are many differences in the training of PAs at German universities and these differences can lead to graduates having different knowledge and skills, which in turn can lead to unequal treatment of patients. The physician assistant exam was developed in co-operation with the German University Association of Physician Assistants (DHPA) and the Umbrella Consortium for Assessment Networks (UCAN [2]. UCAN’s examination software was used to ensure that the examination is of a uniformly high standard across all universities. The UCAN network consists of a total of 77 faculties, medical associations and the Institute for Medical and Pharmaceutical Examination Questions (IMPP) has been a UCAN partner since 2017. The PA exam questions were compiled from UCAN’s Item Management System (IMS) which is a question database with which exams are collaboratively written, managed and released for the examination pool in a quality-assured manner with the help of adaptable review checklists. Questions from competence levels two to three (A and B) were selected based on the competence catalogue of the German medical association and the National Competence-Based Catalogue of Learning Objectives in Medicine (NKLM). The PA exam was analysed using the automated analysis of the UCAN system and the test statistics analysis software Examinator for quality assurance of examinations [3].

Results: In 2023 and 2024, the PA exam was held in eleven different faculties with 141 and 82 participants respectively. This corresponds to 22% of all physician assistants working in Germany. Both exams comprised 120 questions with a total of 120 points possible. 17% of the questions were categorised as easy and 15% as difficult. This means that 68% are of medium difficulty and were easy for the physician assistants to answer. The average score obtained was 82.84 points (69.03%), with a maximum score of 111 points (92.50%). The reliability of both examinations, indicated by Cronbach’s alpha, was with 0.93 (2023) und 0.94 (2024) high.

Diskussion: Overall, both examinations demonstrated high levels of success among candidates and strong internal consistency, reflecting the effectiveness of the assessment tools in measuring the knowledge and competencies required for future physician assistants in Germany.

Literatur

[1] Lang T, Berkowitz O, Heistermann P. A Comparison of German and United States Physician Assistant Curricula. J Physician Assist Educ. 2022;33(1):66-71. DOI: 10.1097/JPA.0000000000000406
[2] Hagl C, Lubik K, Heistermann P. Erstes bundesweites Physician Assistant Examen mit großem Erfolg durchgeführt. Physician Ass. 2024;5(1):1-3.
[3] Thamburaj AJ, Brass K, Herrmann M, Jünger J. 8th meeting of the medical assessment consortium UCAN: “Collaborative Perspectives for Competency-based and Quality-assured Medical Assessment”. GMS Z Med Ausbild. 2015;32(4):Doc37. DOI: 10.3205/zma000979