This year in JAAPA, you will notice a change in the way the competencies for the physician assistant profession are addressed. In 2005, all four national physician assistant organizations developed and endorsed a set of competencies for the profession. These competencies were closely modeled after those developed by the Accreditation Council for Graduate Medical Education, carefully adapted for physician assistant practice, and designed to apply to PAs in all specialties and settings.

There are six domains. Medical knowledge competencies entail an understanding of pathophysiology and the diagnosis and management of disease. Patient care competencies describe the skills and abilities needed todeliver effective, patient-centered care. Interpersonal and communications kills competencies focus on the verbal and nonverbal exchange of information,not just between PAs and patients but also between PAs and the other providers in the health care system. Professionalism competencies describe the values andideals we embrace as a helping profession. The practice-based learning and improvement domain lists the important skills and abilities needed to evaluate and improve our patient care practices. The final domain, system-based practice describes the competencies needed to deliver the highest quality care ofoptimal value within the complex systems in which we practice.

JAAPA took a leadership role in promoting the competencies by integrating a “competencies thermometer” into each issue. The purpose of thethermometer was to inform readers which of the six domains of competency were addressed in each of the feature articles. The new design is now incorporatedinto the table of contents. On the first page of contents, you will see a boxlisting the six competency areas, along with the starting page numbers ofarticles in which each competency is addressed. While the original competencies thermometer served to increase PAs' awareness of the competencies, it did not make it clear that the competencies are addressed throughout each issue ofJAAPA, not just in the feature articles. The feature articles do an excellent job of addressing the medical knowledge, patient care, and practice-based learning competencies. Yet they often do not explicitly or fully address some ofthe other less tangible competencies, such as professionalism, interpersonal & communication skills, or system-based practice.

We are rapidly realizing that proficiency in these other competencies is essential to delivering the highest quality care. Through the work of organizations like the Institute of Medicine and the Agency for Healthcare Research and Quality, we are discovering that competence in medical knowledge and patient care is necessary but not sufficient to the delivery of high quality care. Currently, the care delivered in the United States is fraught with overuse, underuse, and inappropriate use of health care services.Dangerous medical errors continue to occur, despite nearly 10 years ofawareness and focus on patient safety. Health disparities between racial, ethnic, and socioeconomic groups persist and resist improvements, despite a Healthy People 2010 goal to eliminate disparities. The costs of health care continue to spiral upward, with growing evidence that we as a nation get little health value for the dollars we spend.

PAs alone cannot solve all the problems of the health care system, but we do believe that PAs can be an important part of the solution. Ina 2008 AAPA survey of educational needs, we learned that PAs still want educational programs that focus primarily on medical knowledge and patientcare; however, PAs also recognize the need to learn more about system-based practice and practice-based learning and improvement. In response to that need, the Education Council is developing tools and information to help PAs taketheir clinical practice to the next level. We believe it is only through rigorous, ongoing self-evaluation that we can really know whether or not we aredelivering optimal care. In the future, you will see more focus on continuous professional development and not just continuing medical education.

JAAPA continues to take an active role in promoting the physician assistant competencies with the revised competencies thermometer. Although PAs have become much more aware of the competencies and have beenintegrating them into practice, we have still more opportunities to use the competencies to take our practices to the next level. The revised competencies thermometer, which includes every feature article and department in the Journal, serves as a reminder of the relevance and significance of all of the competencies. By placing this revised and more inclusive thermometer in eachissue's table of contents, we hope to give the competencies a place of prominence in your mind as you open the Journal each month. We hope you will discover new ways to address the competencies and to think about them in your daily practice and in your reflections on patient encounters.

For the full version of the Competencies for the Physician Assistant Profession, please see http://www.aapa.org/component/content/article/26--general-/695-professional-competence-policy-paper. NCCPA has a self-evaluationtool for the competencies available at www.nccpa.net/pdfs/competencies%20Self%20Evaluation%20Tool.pdf JAAPA