- Practice Management
- Professional Development
- About SEMPA
- Career Center
These standards were originally developed by the SEMPA Postgraduate Education Committee and approved by the SEMPA Board of Directors on October 26, 2014.
In 2021, the committee updated the original SEMPA Postgraduate Education Program Standards with revisions made in alignment with the 2020 Accreditation Council for Graduate Medical Education (ACGME) guidelines and Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) Clinical Postgraduate Standards, 3rd Edition.
SEMPA thanks the members of the Postgraduate Education Committee for their time, efforts, insight, and collaboration in the development of these standards. The volunteer participation in such an important initiative is commended.
2014 SEMPA Postgraduate Education Committee
Chair Lynn Scherer, PA-C
Postgraduate Committee Members
Matthew Boutte, PA-C
Bartholomew Cambria, PA-C
Scott Fillman, PA-C
John Graykoski, PA-C
Jonathan Lerner, PA-C
Adam Lloyd, PA-C
Mary Masterson, PA-C
Douglas McGee, DO, FACOEP, FACEP
Gregory Raines, PA-C
Dennis Tankersley, PA-C
Ann Verhoeven, PA-C
Mary Jo Wagner, MD, FACEP
Fred Wu, PA-C
2021 SEMPA Postgraduate Education Committee
Chair Ann Verhoeven, PA-C
Workgroup Committee Members
Jeff Callard, PA-C
Lynn Scherer, PA-C
Nathaniel Shekem, PA-C
Fred Wu, PA-C
Postgraduate Committee Members
Sara DeSanctis, PA-C
Tara Igneri, PA-C
Jennine McAuley, PA-C
Paul Mochmer, PA-C
Jennifer Spisak, PA-C
Kevin Wyne, PA-C
The following is the summary of standards developed by SEMPA for postgraduate training programs in emergency medicine for physician assistants. Portions of this document have been adapted from the applicable and relevant published standards for graduate medical education by the ACGME. A list of references can be found at the end of this document.
The education of physician assistants to practice the specialty of emergency medicine is experiential and necessarily occurs within the context of the health care delivery system. Developing the skills, knowledge, and attitudes leading to proficiency in all the domains of clinical competency requires the physician assistant to assume personal responsibility for the care of individual patients in an educational setting. For the physician assistant resident/fellow, the essential learning activity is interaction with patients under the guidance and supervision of faculty members who give value, context, and meaning to those interactions. As emergency medicine physician assistant (EMPA) residents/fellows gain experience and demonstrate growth in their ability to care for patients, they assume roles that permit them to exercise those skills with greater autonomy. This concept-graded and progressive responsibility is one of the core tenets of the American graduate medical education. Supervision in the setting of graduate medical education has the goals of: assuring the provision of safe and effective care to the individual patient; assuring each resident’s/fellow’s development of the skills, knowledge, and attitudes required to practice medicine proficiently; and establishing a foundation for continued professional growth.
Postgraduate medical training in emergency medicine prepares physician assistants for the practice of emergency medicine. These EMPA postgraduate programs must teach the fundamental skills, knowledge, and humanistic qualities that constitute the foundations of emergency medicine practice. The EMPA postgraduate programs provide progressive responsibility and experience in these areas to enable effective management of clinical problems. EMPA residents/fellows must have the opportunity, under the guidance and supervision of a qualified faculty member, to develop a satisfactory level of clinical maturity, judgment, and technical skill. On completion of the EMPA postgraduate program, EMPA residents/fellows should be capable of practicing emergency medicine, able to incorporate new skills and knowledge during their careers, and able to monitor their own physical and mental well-being.
Based on institutional preference, the term residency, fellowship, or postgraduate program is appropriate to describe physician assistant clinical postgraduate medical education. The programs should clearly identify themselves as emergency medicine physician assistant postgraduate education programs.
EMPA postgraduate programs in emergency medicine are typically configured in a 12-month to 18-month format. The lengthier programs are commonly those that have additional off-service rotation opportunities.
Completion of an EMPA postgraduate education training program in emergency medicine should prepare the candidate to sit for the Certificate of Added Qualifications in Emergency Medicine (CAQ-EM) granted through the National Commission on Certification of Physician Assistants (NCCPA). Additionally, there is significant value in developing a universal internal metric for postgraduate programs to utilize annually in evaluating their program’s performance relative to all other EMPA postgraduate programs throughout the country. SEMPA will continue to evaluate and make recommendations regarding the use and development of a universal internal metric.
Each EMPA resident/fellow must meet all the requirements set forth for the didactic, clinical, and procedural guidelines. Additionally, each EMPA resident/fellow must meet the requirements of professional and ethical behavior as outlined in this document. Each postgraduate program must provide honest, objective data, and feedback to EMPA residents/fellows and provide accurate references to future employers upon completion of the postgraduate program.
SEMPA advises that if an EMPA postgraduate education program exists in an institution that has a physician emergency medicine residency, that it operates in parallel with the physician emergency medicine residency to promote team-based clinical care in the practice of emergency medicine. Additionally, EMPA program directors should work in conjunction with emergency medicine physician program directors to ensure the best possible didactic, clinical, and procedural experiences for all learners. It is important to establish whether there are sufficient training opportunities for both programs to meet their experiential needs prior to initiating an EMPA postgraduate education program at a site with an existing physician emergency medicine residency.
The goal of each EMPA postgraduate program should be to meet the Standards as outlined in this document and follow the process that SEMPA delineates. In addition, EMPA postgraduate programs may consider obtaining accreditation through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA).
SEMPA encourages established EMPA postgraduate education programs to work collaboratively with SEMPA and other EMPA postgraduate programs to share resources and curricula with other entities that are providing or developing postgraduate specialty training programs in emergency medicine and commit to assisting new EMPA postgraduate programs.
Critical illness or injury that acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient's condition.
Critical Care services are defined as the direct delivery of medical care for a critically ill or critically injured patient. It involves decision making of high complexity to assess, manipulate, and support vital organ system failure and/or to prevent further life-threatening deterioration of the patient's condition. Examples of vital organ system failure include but are not limited to central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic and/or respiratory failure.
Instructional faculty include those who regularly educate, supervise, and evaluate the residents/fellows.
The primary clinical site is the medical institution in which the EMPA postgraduate program is based, and the majority of the clinical rotations and didactic education are done. Office space for the EMPA postgraduate program personnel shall be provided there.
One sponsoring institution must assume ultimate responsibility for the EMPA postgraduate program, as described in the Institutional Requirements, and this responsibility extends to EMPA resident/fellow assignments at all participating sites.
The sponsoring institution should provide a minimum of 3,000 clinical hours or 18 months of training for each individual EMPA resident/fellow.
The primary clinical site in which EMPA residents/fellows rotate must have at least 30,000 emergency department visits annually to ensure that there are a sufficient number of patient encounters for all learners.
The sponsoring institution and the EMPA postgraduate program must ensure that the EMPA program director has sufficient protected time and financial support for his or her educational and administrative responsibilities to the program.
The sponsoring institution and participating sites must provide salary support and/or protected time for:
There must be a Program Letter of Agreement (PLA) between the EMPA postgraduate program and each participating site providing an assignment/rotation. The PLA must be renewed at least every five (5) years.
The PLA should:
The EMPA postgraduate program should be based at the primary clinical site.
EMPA postgraduate programs using multiple participating sites must ensure the provision of a unified educational experience for the EMPA residents/fellows.
Each participating site must offer significant educational opportunities to the overall EMPA postgraduate program.
The majority of assigned rotations should be situated at the primary clinical site. The program should ensure that residents are not unduly burdened by required rotations at geographically distant sites.
There must be a single EMPA program director or co-directors with authority and accountability for the operation of the EMPA postgraduate program.
The EMPA program director should continue in his or her position for a length of time adequate to maintain continuity of leadership and program stability.
Qualifications of the EMPA program director must include:
The EMPA program director must oversee and ensure the quality of didactic and clinical education in all sites that participate in the EMPA postgraduate program.
The program director must design and conduct the program in a fashion consistent with the needs of the community, the missions of the Sponsoring Institution and the missions of the program.
The EMPA program director must be clinically active in emergency medicine.
The EMPA program director should not work more than 30 hours per week clinically, on average, or 1,560 clinical hours per year and no less than 12 hours per week clinically, on average, or 624 hours per year.
The EMPA program director must:
and, to that end, must:
The medical director must:
At each participating site, there must be a sufficient number of instructional faculty with documented qualifications to instruct and supervise all EMPA residents/fellows at that location.
The faculty must:
The Sponsoring Institution must provide the opportunity for continuing professional development of the program faculty by supporting the development of the clinical, teaching, scholarly and administrative skills/abilities required for their role in the program.
Professional development involves remaining current with clinical and academic skills and developing new skills needed for position responsibilities. The types of opportunities supported by institutions vary and may include funding to attend continuing education conferences, non-vacation time to attend professional organizational meetings, funding to attend professional organizational meetings, time for research/scholarly activities, time to pursue advanced degree and/or tuition remission for an advanced degree, payment of dues and fees related to certification maintenance and/or time needed for review and study.
The institution and the EMPA postgraduate program must jointly ensure the availability of all necessary professional, technical, and clerical personnel for the effective administration of the program.
The institution and the EMPA postgraduate program must jointly ensure the availability of adequate resources for EMPA postgraduate education, as defined in the emergency medicine EMPA postgraduate program requirements.
At every site in which the emergency department provides EMPA postgraduate education, the following must be provided:
Clinical support services must include nursing, clerical, intravenous, electrocardiogram (EKG), respiratory therapy, messenger/transporter, and phlebotomy, and must be available on a 24- hour basis.
Office space for program coordinators and additional support personnel must be provided at the primary clinical site.
Each clinical site must provide timely consultation from services based on a patient’s acuity.
If any clinical services are not available for consultation or admission, each clinical site must have a written protocol for provision of these services elsewhere.
Each clinical site must ensure timely consultation decisions by a provider from admitting and consulting services with decision-making authority.
The patient population must include patients of all ages and genders as well as patients with a wide variety of clinical problems.
The primary clinical site to which EMPA residents/fellows rotate must have at least 30,000 emergency department visits annually.
The primary clinical site should have a significant number of critically ill or critically injured patients constituting at least three percent or 1,200 (whichever is greater) of the emergency department patients per year.
EMPA residents/fellows must be provided with prompt, reliable systems for communication and interaction with supervisory physicians.
The program, in partnership with its Sponsoring Institution, must ensure healthy and safe learning and working environments that promote resident well-being and provide for:
The program’s educational and clinical resources must be adequate to support the number of residents/fellows appointed to the program.
EMPA residents/fellows must have ready access to specialty-specific and other appropriate reference material in print or electronic format. Electronic medical literature databases with search capabilities should be available.
An applicant must meet the following qualifications to be eligible for appointment to EMPA postgraduate education program:
The following must be defined, published, and readily available to prospective and enrolled EMPA residents/fellows:
The following must be defined, published, and readily available to enrolled EMPA residents/fellows:
Grievance and due process policies and procedures must address:
Policies and procedures for processing resident/fellow grievances must be defined, published, and readily available to program faculty.
Residents/fellows must not be required or expected to perform non-patient related clerical or administrative work for the program that is not a component of the curriculum.
The EMPA postgraduate program’s educational resources must be adequate to support the number of EMPA residents/fellows appointed to the program.
The curriculum must contain the following educational components:
The EMPA postgraduate program must integrate the following ACGME competencies into the curriculum:
EMPA residents/fellows must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. EMPA residents/fellows must demonstrate proficiency in:
Additionally, EMPA residents/fellows must be able to competently perform all medical, diagnostic and surgical procedures considered essential for the area of practice. EMPA residents/fellows must demonstrate proficiency in:
EMPA residents/fellows must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to patient care.
EMPA residents/fellows must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life-long learning.
EMPA residents/fellows are expected to develop skills and habits to be able to meet the following goals:
EMPA residents/fellows must demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals.
EMPA residents/fellows are expected to:
EMPA residents/fellows must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.
EMPA residents/fellows are expected to demonstrate:
EMPA residents/fellows must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.
EMPA residents/fellows are expected to:
The curriculum must include:
EMPA residents/fellows should treat a significant number of critically ill or critically injured patients at participating sites.
The curriculum must advance EMPA residents/fellows’ knowledge of the basic principles of research, including how research is conducted, evaluated, explained to patients, and applied to patient care.
EMPA residents/fellows should have the opportunity to participate in scholarly activity.
Postgraduate training programs should consider establishing a Clinical Competency Committee4 to systematically evaluate EMPA resident/fellow performance and progression. The EMPA program director may appoint the members of a Clinical Competency Committee and must be included in the committee or advised of the results of their evaluations. At a minimum the Clinical Competency Committee must be composed of three members of the program or institutional faculty. Others eligible for appointment to the committee include non-physician members of the health care team. There must be a written description of the responsibilities of the Clinical Competency Committee.
The Clinical Competency Committee or the EMPA program director should:
The faculty must evaluate EMPA resident/fellow performance in a timely manner during each rotation or similar educational assignment and document this evaluation at completion of the assignment.
The EMPA postgraduate program must:
The EMPA program director must verify each EMPA resident’s/fellow’s records of major resuscitations and procedures as part of the semiannual evaluation.
The evaluations of EMPA resident/fellow performance must be accessible for review by the resident/fellow, in accordance with institutional policy.
At least semi-annually, each EMPA resident’s/fellow’s competency in procedures and resuscitations must be formally evaluated by the EMPA program director.
A plan to remedy deficiencies must be in writing and on file.
Progress and improvement must be monitored at a minimum of every month if a EMPA resident/fellow has been identified as needing a remediation plan.
The EMPA postgraduate milestones must be used as one of the tools to ensure EMPA residents/fellows are able to practice core professional activities upon completion of the EMPA postgraduate program.
The EMPA program director must provide a summative evaluation for each EMPA resident/fellow upon completion of the program.
This evaluation must:
At least annually, the EMPA postgraduate program must evaluate program and instructional faculty performance as it relates to the educational program.
These evaluations should include a review of the faculty’s clinical teaching abilities, commitment to the educational program, clinical knowledge, professionalism, and scholarly activities.
Faculty member evaluations must also include administrative and interpersonal skills, quality of feedback and mentoring for EMPA residents/fellows, and participation in and contributions to EMPA resident/fellow conferences.
This evaluation must include at least annual written confidential evaluations by the EMPA residents/fellows.
Faculty members must receive feedback on their evaluations at least annually.
Results of the faculty educational evaluations should be incorporated into program-wide faculty development plans.
The program must define and maintain consistent and effective processes for the initial and ongoing evaluation of all sites and preceptors used for PA trainees’ clinical practice experiences.
The program should establish criteria by which to initially evaluate new sites and preceptors as well as those that have an ongoing relationship with the program.
The program must assure and document that each clinical site provides the PA trainees access to the physical facilities, patient populations, and clinical supervision necessary to fulfill the program’s learning outcomes.
The EMPA program director should consider the appointment of the Program Evaluation Committee (PEC).
The Program Evaluation Committee:
The EMPA postgraduate program must document formal, systematic evaluation of the curriculum at least annually, and is responsible for rendering a written and Annual Program Evaluation (APE).
EMPA residents/fellows and faculty must have the opportunity to evaluate the EMPA
postgraduate program confidentially and in writing at least annually.
The EMPA postgraduate program must use the results of EMPA residents’/fellows’ and faculty members’ assessments of the program together with other program evaluation results to improve the program.
The EMPA postgraduate program must prepare a written plan of action to document initiatives to improve performance in one or more of the areas listed in section, as well as delineate how they will be measured and monitored.
The program must apply the results of its on-going self-assessment to the curriculum and other dimensions of the program including:
EMPA postgraduate programs and sponsoring institutions must educate EMPA residents/fellows and faculty members concerning the professional responsibilities of physician assistants to appear for duty appropriately rested and fit to provide the services required by their patients.
The EMPA postgraduate program must be committed to and responsible for promoting patient safety and EMPA resident/fellow well-being in a supportive educational environment.
The EMPA program director must ensure that EMPA residents/fellows are integrated and actively participate in interdisciplinary clinical quality improvement and patient safety programs.
The learning objectives of the EMPA postgraduate program must:
The EMPA program director and institution must ensure a culture of professionalism that supports patient safety and personal responsibility.
EMPA residents/fellows and faculty members must demonstrate an understanding and acceptance of their personal role in the following:
All EMPA residents/fellows and faculty members must demonstrate responsiveness to patient needs that supersedes self-interest. They must recognize that under certain circumstances, the
best interests of the patient may be served by transitioning that patient’s care to another qualified and rested provider.
Programs must design clinical assignments to optimize transitions in patient care, including their safety, frequency, and structure.
Programs in partnership with their Sponsoring Institutions, must ensure and monitor effective, structured hand-over processes to facility both continuity of care and patient safety.
Programs must ensure that EMPA residents/fellows are competent in communicating with team members in hand-over process.
Programs and clinical sites must maintain and communicate schedules of attending physicians and residents/fellows currently responsible for care.
The EMPA postgraduate program must:
Each EMPA postgraduate program must have a process to ensure continuity of patient care in the event that a EMPA resident/fellow may be unable to perform his/her patient care duties.
The sponsoring institution must provide adequate sleep facilities and/or safe transportation options for EMPA residents/fellows who may be too fatigued to safely return home.
The responsibility of the program, in partnership with the Sponsoring Institution, to address well-being must include:
In the clinical learning environment, each patient must have an identifiable, appropriately credentialed and privileged attending physician (or licensed independent practitioner as approved by each Review Committee) who is ultimately responsible for that patient’s care.
This information should be available to EMPA residents/fellows, faculty members, and
patients. EMPA residents/fellows and faculty members should inform patients of their respective roles in each patient’s care.
The EMPA postgraduate program must demonstrate that the appropriate level of supervision is in place for all EMPA residents/fellows who care for patients.
Supervision may be exercised through a variety of methods. Some activities require the physical presence of the supervising faculty member. Portions of care provided by the EMPA resident/fellow can be adequately supervised by the immediate availability of the supervising faculty member or resident physician, either in the institution, or by means of telephonic and/or electronic modalities. In some circumstances, supervision may include post-hoc review of EMPA resident/fellow-delivered care with feedback as to the appropriateness of that care.
To ensure oversight of EMPA resident/fellow supervision and graded authority and responsibility, the EMPA postgraduate program must use the following classification of supervision:
Direct Supervision – the supervising physician is physically present with the EMPA resident/fellow and patient.
Oversight – the supervising physician is available to provide review of procedures/encounters with feedback provided after care is delivered.
The EMPA program director and faculty members must assign the privilege of progressive authority and responsibility, conditional independence, and a supervisory role in patient care delegated to each EMPA resident/fellow.
The EMPA program director must evaluate each EMPA resident’s/fellow’s abilities based on specific criteria. When available, evaluation should be guided by specific national standards- based criteria.
Faculty members functioning as supervising physicians should delegate portions of care to EMPA residents/fellows, based on the needs of the patient and the skills of the EMPA residents/fellows.
EMPA postgraduate programs must set guidelines for circumstances and events in which EMPA residents/fellows must communicate with appropriate supervising faculty members.
Each resident/fellow must know the limits of their scope of authority, and the circumstances under which the resident/fellow is permitted to act with conditional independence.
Faculty supervision assignments should be of sufficient duration to assess the knowledge and skills of each EMPA resident/fellow and delegate to him/her the appropriate level of patient care authority and responsibility.
The clinical responsibilities for each EMPA resident/fellow must be based on level of training, patient safety, EMPA resident/fellow education, severity and complexity of patient illness/condition and available support services.
When EMPA residents/fellows are on emergency medicine rotations, the following standards apply:
EMPA residents/fellows must care for patients in an environment that maximizes effective communication. This must include the opportunity to work as a member of effective interprofessional teams that are appropriate to the delivery of care in the specialty and larger health system.
Interprofessional teams must be used to ensure effective and efficient communication for appropriate patient care for emergency medicine department admissions, transfers, and discharges.
Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities, clinical work done from home and all moonlighting.
Moonlighting must not interfere with the ability of the EMPA resident/fellow to achieve the goals and objectives of the educational program and must not interfere with the residents’/fellows’ fitness for work nor compromise patient safety.
EMPA residents/fellows should have 10 hours, but must have eight hours, free of duty between scheduled duty periods.
EMPA residents/fellows must have at least 14 hours free of clinical work and education after 24 hours of in-house call.
EMPA residents/fellows must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks). At-home call cannot be assigned on these free days.
Clinical and educational work periods for residents/fellows must not exceed 24 hours of continuous scheduled clinical assignments.
It is essential for patient safety and EMPA resident/fellow education that effective transitions in care occur. EMPA residents/fellows may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours.
Additional patient care responsibilities must not be assigned to a resident/fellow during this time.
In unusual circumstances, EMPA residents/fellows, on their own initiative, may remain beyond their scheduled period of duty to continue to provide care to a single patient. Justifications for such extensions of duty are limited to reasons of required continuity for a severely ill or unstable patient, academic importance of the events transpiring, or humanistic attention to the needs of a patient or family.
Additional patient care responsibilities must not be assigned to a resident/fellow during this time.
Night float must occur within the context of the 80-hour and one-day-off-in-seven requirements.
EMPA residents/fellows must be scheduled for in-house call no more frequently than every- third night (when averaged over a four-week period).
Time spent on patient care activities by EMPA residents/fellows on at-home call must count towards the 80-hour maximum weekly hour limit. The frequency of at-home call is not subject to the every-third night limitation but must satisfy the requirement for one-day-in-seven free of duty, when averaged over four weeks.
At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time for each EMPA resident/fellow.
Residents are permitted to return to the hospital while on at-home call to provide direct care for new or established patients. These hours of inpatient care must be included in the 80-hour maximum weekly limit.
Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine. 2021. Accessed: 7/22/2021
Accreditation Review Commission on Education for the Physician Assistant, Inc. Accreditation Standards for Clinical Postgraduate PA Programs. 2019. Accessed: 7/22/2021
Counselman FL, Babu K, Edens MA, et al. The 2016 Model of the Clinical Practice of Emergency Medicine. J Emerg Med. 2017;52(6):846-849.
Ekpenyong A, Padmore JS, Hauer KE. The Purpose, Structure, and Process of Clinical Competency Committees: Guidance for Members and Program Directors. J Grad Med Educ. 2021;13(2 Suppl):45-50.