Barbara J. Andrew, Ph.D., is a seminal figure in the evolution of certification of physician assistants. In March of 1972, the National Board of Medical Examiners overwhelmingly approved, for the first time, the development of an examination for medically trained persons other than physicians.
Providing medical care under the supervision of physicians, physician assistants were deemed to be an appropriate mission for the Board. To direct the project, John P. Hubbard, MD, President of the NBME, recruited Dr. Andrew from the University of Southern California, where she had obtained her doctorate in testing and measurement.
An advisory committee was appointed that was broadly representative of PA societies, organized medicine, licensing boards, and the Federal government. Under Dr. Andrew’s direction subcommittees were created to address such issues as problem solving, psychomotor skills, interpersonal relations, and eligibility. In spite of the number of programs emphasizing specialty medicine, the examination was to be designed for the assistant to the primary care physician. Skills and tasks appropriate for the PA were defined, yielding an inventory of 600 items from which test committees were appointed to draft the examination.
The first examination for the assistant to the primary care physician was successfully administered in December of 1973 to 880 candidates. The examination was unique in having been derived from “role delineation,” rather than from subject matter content. Test questions required the candidate to have subject matter knowledge, but further required application of that knowledge to problems they would encounter in primary care practice.
Dr. Andrew was a participant in August of 1974 when 14 national organizations, including the NBME, came together to form the National Commission on Certification of Physician Assistants. Although the NCCPA would now assume responsibility for eligibility, standard setting, and the appointment of committees, by contract the National Board of Medical Examiners would continue to develop the examination under Dr. Andrew’s direction.
In 1974, Dr. Andrew was appointed by the NBME to be the Director of a newly formed Division of Research and Development. One of her projects was the development of a fixed “criterion referenced” standard for passing the examination, rather than the traditional “norm referenced” standard that had been used by the Board since its founding. It was first applied to the PA certification examination in 1976, ensuring that the standard would have the same meaning year-over-year. Soon thereafter, she was named Vice President for Institutional Development and Research. Among her achievements in this role was the exploration of the use of computers in testing and measurement. Under her leadership, the NBME pioneered in the development of computer-based patient simulations to test skills of patient management. In 1986, when the Board committed to the administration of examinations by computer, she became President and CEO of CTL Corporation, a wholly owned subsidiary of the National Board of Medical Examiners, established to develop a network of computer-based training and testing centers, and the requisite software to manage the centers.
In 1988, Dr. Andrew shifted career. With Master’s level coursework in business from the Wharton school of the University of Pennsylvania, Dr. Andrew left the NBME to become the President and CEO of Liberty Health System, a company specializing in home health care services and products. Over the ensuing eight years, the company increased its revenues seven-fold to rank 36th in size nationally. She then became President and CEO of Everfilt, a manufacturer of water and wastewater filtration systems. She oversaw its growth from a national to an international corporation, serving a client base that included many Fortune 500 firms.
Living in California, Dr. Andrew recently retired, but continues to provide consulting services to industrial, commercial, and municipal clients for the treatment of water and wastewater.
Acknowledgments: This biography was prepared by Thomas E. Piemme, MD, with the assistance of Dr. Andrew and was submitted to the Society in May 2015. The photographs are courtesy of Dr. Andrew.