Accreditation Review Commission Research Articles

Blue Sky Thinking: Physician Assistant Accreditation and the Potential Impact on the Programs, Faculty, and the Profession.

Blue sky thinking references the opportunity to brainstorm about a topic without limits… to consider what things might be like if creative thoughts were unconstrained by current philosophies or other boundaries. This article is a call to our fellow educators to consider how blue sky thinking applied to physician assistant (PA) program accreditation might further advance programs, faculty, and the profession. To develop and maintain a PA program, institutions must voluntarily undergo evaluation by the Accreditation Review Commission on Education for the Physician Assistant. Compliance with accreditation encourages sound educational practices, promotes program self-study, stimulates innovation, maintains confidence with the public, and focuses on continuous quality improvement. In addition, accreditation "can hold institutions accountable for desired outcomes and professional standards." Indeed, while the PA profession has promulgated across the globe, the 50+ years of graduating PAs educated with the highest quality education assures that the United States remains a gold standard. As the 5th edition of the standards are implemented and planning for the 6th edition is underway, in the spirit of continuous quality improvement, we encourage stakeholders of the PA profession to contemplate ways in which accreditation might continue to purposefully advance a desired future state for the profession. In this article, we draw on examples from other health professions which might inform a discussion around the future of PA accreditation. Specifically, the topics of a unified profession title and degree, a specific title and position for program leadership, a modification to how PA programs receive medical direction, and efforts to advance scholarship are addressed.

Physician Assistant Program Accreditation Analysis and Survey of Program Directors.

To inform physician assistant program directors through citation analysis after implementation of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) Accreditation Standards, 5th edition. This research used descriptive statistics, Pearson correlation, and the coefficient of determination to analyze the citations reported by ARC-PA during January 2021 to February 2023. Concurrent first-time taker Physician Assistant National Certifying Exam (PANCE) results were used to determine whether a correlation exists between pass rates and citations. In addition, a survey was sent to each institution's current program director to investigate leadership concerns and differences between programs placed on a provisional, continued, or probation status by ARC-PA. Of the 98 program submissions for accreditation, 13 submissions resulted in a probation status outcome. For these 13 programs placed on probation, 46.2% and 30.8% were cited for being noncompliant with leadership Standards A2.09 and A1.02, respectively. Pearson correlation analysis indicates a significant negative correlation between ARC-PA citations and first-time taker PANCE pass rates ( P = .023, 95% confidence interval [CI] = [-0.49 to -0.04]). This is particularly true for programs with continued accreditation ( P = .007, 95% CI = [-0.67 to -0.13]) and programs that performed below the 85% benchmark ( P = .013, 95% CI = [-0.94 to -0.22]) for first-time taker PANCE pass rates. Although a negative correlation is observed between the number of levied citations and PANCE pass rates, the coefficient of determination does not indicate that the number of citations can predict PANCE pass rates ( R2 = 0.0368). Regarding survey data, 42.86% of programs placed on probation cited institutional support as their biggest program weakness or threat. Conversely, 22.22% of programs with provisional status and 12.5% of programs with continued status reported institutional support as their biggest weakness or threat. This research identifies leadership as a deficit of concern associated with programs placed on probation. In addition, a significant negative correlation exists between the number of citations and first-time taker PANCE pass rates-especially for programs with first-time taker PANCE pass rates below 85% or for programs with continued accreditation status.

Physician Assistant Faculty Perceptions Regarding Ongoing Self-assessment and Accreditation.

While the processes of ongoing self-assessment and accreditation provide significant benefits to physician assistant (PA) programs, faculty members are often challenged by the required procedures and standards set by accreditation agencies. This study explored faculty perspectives regarding the processes of ongoing self-assessment and accreditation in PA programs. A qualitative research design centered around semistructured interviews was used. A total of 26 participants were recruited, including PA program directors, associate program directors, directors of assessment and accreditation, past Accreditation Review Commission on Education for the Physician Assistant commissioners, accreditation consultants, deans, and PA Education Association leaders. Semistructured one-on-one interviews were conducted by 8 members of the research team through Zoom video conferencing. Data were collected until saturation was reached. The interview recordings were transcribed and analyzed independently by 3 researchers. The transcripts were imported into NVivo, a qualitative data analysis software, for coding and inductive thematic analysis. Six emergent themes were identified under 2 major categories: facilitators and challenges. Facilitators for conducting continuous programmatic review and analysis include it takes a village, internal and external support, and sustained faculty development, whereas challenges are lack of knowledge and time, unclear expectations, and inflexibility. The study highlights factors associated with facilitating the ongoing self-assessment process. However, a number of challenges were also identified. The study suggests opportunities for intervention at the program, institution, and profession level.

Methodology Applied by a Physician Assistant Program to Evaluate the New ARC-PA 5 th Edition Diversity and Inclusion Standard.

Diversity and inclusion in higher education are a top priority for institutions. In 2020, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), in its 5 th edition of the Accreditation Standards for Physician Assistant Education, implemented a standard specifically designed to require programs to demonstrate their commitment to diversity and inclusion. Through a protocol-driven methodology, consistent with the ARC-PA's 4 key elements of analysis, one PA program demonstrates and explains how it examines ongoing compliance with diversity and inclusion within their program.

The PA profession in the 1990s.

History is rarely linear, and nowhere is this more evident than the US physician assistant/associate (PA) movement (1965-2021). The 1990s stand out as pivotal years for the PA profession, marked by advances that shaped the profession, experiments in primary care delivery, sex equity, the Balanced Budget Act, and national policy errors in predicting a physician surplus. Rapid growth followed program expansion, doubling from 57 in 1993 to 120 by 1999. By the end of the decade, all states had advanced PA-enabling legislation with broad-based prescribing. During this era, PA-focused research moved from descriptive to predictive, an official journal emerged in 1988, the Accreditation Review Commission on Education for the Physician Assistant became independent, and the American Academy of Physician Associates helped shape federal health policy. Also during this period, the profile of PAs shifted from older males to younger females with important sociological implications in leadership and career development. Notable milestones included national recognition of PAs as Medicare-eligible providers, direct commissioning in the military, and employment surges in the Veterans Health Administration and US Public Health Service. Not least of all this was a time of role shifts toward specialized medicine and surgery.

Utilization of pharmacists in physician assistant didactic curricula in the United States

IntroductionThe primary objective was to describe the percentage of physician assistant (PA) programs who utilize pharmacists to lecture on pharmacology/pharmacotherapeutics content. Secondary objectives were to describe the percentage of pharmacology/pharmacotherapeutics lectures pharmacists deliver, the percentage of programs who employ a full-time pharmacist to coordinate the Pharmacology/Pharmacotherapeutics courses, and the inclusion of pharmacists in other courses in the curricula. MethodsThis was a prospective, cross-sectional, cohort survey. All PA programs listed on the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) website with an available email address for the Director of Pre-Clinical Education/Didactic Education, Academic Coordinator, or Chair/Director were recruited for the study. A link to an online survey was distributed to each program. The survey collected data on program characteristics as well as utilization of pharmacists in the curriculum. Descriptive statistics were used for all analyses. ResultsOf the 187 programs receiving the survey, 66 completed the survey (35%). Eighty-three percent of programs reported that pharmacists were utilized to deliver pharmacology/pharmacotherapeutics content. For those programs who utilize pharmacists, 80% reported pharmacists teach more than 75% of the lectures. Twenty-three (35%) programs reported having a full-time pharmacist on faculty to coordinate these courses. Almost half of respondents also commented that pharmacists were involved in other courses in the curriculum. ConclusionsMore than 80% of programs responding to the survey utilize pharmacists to deliver pharmacology/pharmacotherapeutics content. Studying the utilization of pharmacists and their impact in other health sciences curricula is warranted.

Does Education in Oral Health Competencies in Physician Assistant Education Programs Translate to Delivery of Oral Health Services in Clinical Practice?

The purpose of this study was to determine the extent to which physician assistants (PAs) are educated in oral health competencies and the relationship of education to providing oral health services to patients. The study was conducted in 2016 by administering an Internet-based survey to a nationwide sample of 2014 graduates of programs accredited by the Accreditation Review Commission on Education for the Physician Assistant. The survey response rate was 12.7% (N = 304). More than half of the PAs who received education in oral health in their professional education programs indicated that oral health curricula were either integrated into one or several topical areas in the base curriculum or delivered in stand-alone lectures. The majority of PA respondents rated their educational preparation as good or excellent in helping them provide oral health education to their patients (54.8%), make appropriate referrals to oral health providers (53.7%), and provide preventive oral health services (51.2%), while more than 40% rated their preparation as good or excellent in helping them identify oral diseases, conditions, and intervention strategies. More than one-third (35.7%) of all PA respondents reported that they provided oral health services in their clinical practices. PAs who received instruction in oral health competencies through the PA education curriculum or from other sources were 2.82 times more likely to provide oral health assessment and screening services to their patients (95% confidence interval, 1.19-6.67). The PA respondents' provision of oral health services was also significantly associated with working in primary medicine or urgent care practice specialties but not with the work setting. PAs educated in oral health competencies are more likely to provide such services to patients, especially in primary medicine or urgent care settings.

Accreditation 101: Develop, Assess, and Report Program Goals.

The aim of this article is to highlight the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) accreditation requirements for PA program goals, describe methods for writing effective goals, provide examples and analysis of hypothetical goals, and encourage the use of effective reporting strategies. Programs are encouraged to use one of 3 mnemonic conventions with each providing a useful framework for identifying key elements of goals: FAST, SMART, and Objectives and Key Results. These 3 acronyms are easy to remember and will yield goals that are consistent with the requirements of ARC-PA.

Physician Assistant Program Goals: A Thematic Analysis.

The purpose of this study was to provide a descriptive analysis of the goals of the accredited physician assistant (PA) programs across the country in order to obtain a baseline understanding of their themes. Initial review of the goals resulted in the identification of recurring themes. The goals were evaluated relative to meeting the requirements specified in Standard A3.14 of the Accreditation Review Commission on Education for the Physician Assistant, including listing the goal with the defined benchmark expected and the program's progress in reaching the goal. Accreditation status was compared. Of the 238 accredited PA programs at the time of the study, 157 (66%) had Accreditation-Continued status, 56 (24%) were Accreditation-Provisional, and 25 (11%) had Accreditation-Probation status. The median number of 5 goals per program did not vary dependent on accreditation status. Only 43 of 238 PA programs (18%) provided goals with required benchmarks and supporting outcomes on their webpages. Almost all programs included at least one goal (and often more than one) with the theme of student acquisition of knowledge, skills, and attitudes needed to be a PA. Other commonly included themes in programmatic goals included the "capacity" of students to graduate from the PA program and become employed, valuing diversity and cultural differences, a comprehensive and strong curriculum, as well as alumni who are self-directed, lifelong learners. Program goals should be reviewed to ensure they include benchmarks that define success and report progress or outcomes in achieving those goals. Thematic analysis provides a powerful summary that then can be used to make conclusions across a large set of program data.

Is prescribing by PAs and NPs comparable to physician prescribing?

PAs and NPs have broad prescribing authority in the United States, yet little is known about how the quality of their prescribing practices compares with that of physicians. The quality of prescribing practices of physicians, PAs, and NPs was investigated through a serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Ambulatory care services in physician offices, hospital EDs, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, PAs, and NPs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use. The study sampled 701,499 patient visits during the study period, representing about 8.3 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; PAs and NPs each accounted for 1.6% of these visits. The proportion of eligible visits in which quality standards were met ranged from 34.1% (angiotensin-converting enzyme inhibitor use for patients with heart failure) to 89.5% (avoidance of inappropriate medications in older adults). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between PAs, NPs, and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by PAs and NPs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures. Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by PAs, NPs, and physicians was generally comparable.1.

Citation and Characteristic Analysis of Physician Assistant Programs Placed on Accreditation-Probation, 2015-2017.

The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) is responsible for accrediting the current 236 entry-level physician assistant (PA) programs in the United States. This study analyzes citations levied against PA programs by the ARC-PA and how those citations relate to the commission's ultimate accreditation decisions; in addition, this study compares PA program characteristics and assesses those characteristics as they relate to recent accreditation outcomes. This study used citations for specific violations of ARC-PA Standards to analyze the ARC-PA's accreditation decisions from September 2015 through September 2017. The institutional characteristics of programs that received an accreditation-probation decision were compared with those that received an accreditation-continued or accreditation-provisional decision. Where possible, outcome decisions were benchmarked using national data obtained from publications distributed by the Physician Assistant Education Association. On average, programs that were placed on accreditation-probation during the time frame of this study had received their initial accreditation 16 years before being placed on probation. Altogether, 393 citations were levied against those programs (range: 2-60 citations; median: 13.5 citations). Physician assistant programs that were awarded provisional or continued accreditation were cited for slightly different Standards violations than PA programs that were placed on probation. The average 5-year pass rate for students taking the Physician Assistant National Certifying Examination for the first time was not very different for students from PA programs that were placed on probation and all other programs. Faculty members, institutions, and entities that support PA program development can use this information to compare PA programs. The results of this study can help PA programs identify areas of frequent noncompliance with the ARC-PA's Standards; provide context that PA programs can use to assess their performance against other programs in the accreditation process; and help PA programs identify areas in need of priority attention nationwide.

State of Evidence-Based Practice in Physician Assistant Education.

Evidence-based practice (EBP) involves using the best evidence available to guide patient care. The use of EBP improves patient outcomes and the quality of care delivered. Studies have investigated how EBP is taught in other health professions but not in physician assistant (PA) programs. The purpose of this study was to explore how PA programs teach this subject matter. After permission was obtained, a survey was adapted from a similar study completed in medical schools. Requests were emailed to 186 accredited PA programs with available contact information. These data were analyzed using descriptive statistics. The text responses were reviewed and summarized to describe how EBP was taught in the programs surveyed. Eighty-four responses were received from the 186 PA programs contacted with the survey request, giving a 45.2% return. Approximately 95% of respondents reported having formal EBP training in their curriculum. Respondents reported formal EBP training through a variety of educational activities, with time spent on these activities ranging from 4 hours to 550 hours. Barriers to implementation of an EBP curriculum were reported by 27% of respondents, with the most common barrier being lack of time. Most PA programs that responded have formal EBP training in the curriculum. There is little standardization regarding the methods used and time spent in these activities. The Accreditation Review Commission on Education for the Physician Assistant may be able to assist in overcoming the reported barriers and improving standardization by implementing a specific EBP accreditation standard.

Quantifying Cadaver Use in Physician Assistant Anatomy Education.

To quantify the number of cadavers used in physician assistant (PA) anatomy education and to ascertain the origins of those cadavers. An electronic survey was generated and distributed to all schools that had been accredited by the Accreditation Review Commission on Education for the Physician Assistant. Responses were reported using descriptive statistics. The survey had a 49% response rate. Among the responding programs, 79% reported working with 655 cadavers, with an average of one cadaver per 5.72 students. Programs reported that 21% receive cadavers from multiple sources. Of all programs using cadavers, 62% receive cadavers from medical schools, 23% from in-house anatomical gift programs, 19% from state anatomy boards, 9% from private organizations, and 8% from other sources. Anatomy educators reported that 55% know the origins of the cadavers in their programs, 18% do not, and 27% are uncertain. In categorizing cadavers at their programs, 56% were reported as registered donors, 4% as next-of-kin donations, 1% as unclaimed dead, 17% as uncertain origin, and 22% as unaccounted for by respondents. Among educators who teach anatomy to PA students, 45% do not know or are uncertain of the origins of the cadavers in their programs. Of the reported 655 cadavers used in PA education, 289 were not categorized as registered donors. Facing the expansion of PA programs, educators need to be aware of cadavers' origins to ensure that all aspects of PA education are consistent with the ethics that the students are being taught. Those ethics include the need for informed consent for all cadavers involved in PA education.

An Analysis of Physician Assistant LibGuides: A Tool for Collection Development

ABSTRACTThe Physician Assistant (PA) specialty encompasses many subject areas and requires many types of library resources. An analysis of PA LibGuides was performed to determine most frequently recommended resources. A sample of LibGuides from U.S. institutions accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) was included in this study. Resources presented on guides were tabulated and organized by resource type. Databases and point-of-care tools were the types of resources listed by the most LibGuides. There were over 1,000 books listed on the 45 guides, including over 600 unique books listed. There were fewer journals listed, only 163. Overall, while the 45 LibGuides evaluated list many unique resources in each category, a librarian can create an accepted list of the most frequently listed resources from the data gathered.

Investigational Overview of Supervised Clinical Practice Experiences.

While the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) provides standards, there is variation allowed in design and implementation of supervised clinical practice experiences (SCPEs). Limited research has assessed for a correlation between SCPE design and program outcomes, including PANCE "First-Time Taker Pass Rate." The objective of this research is to evaluate for trends and best practices in clinical education design, as well as any correlation to PANCE pass rate. Data were gathered through an online survey with 14 multiple-choice questions referring to "core" clinical rotations and then anonymously tabulated. Participants were identified by ARC-PA's listing of PA programs as of May 2014, excluding those programs with "Accreditation-Provisional" or "Accreditation-Probation" statuses. Contact was initiated with one faculty member at each program. A post hoc analysis was performed to evaluate for correlations between SCPE design and PANCE pass rates. Our research quantifies variation in many aspects of the administration and design of the clinical education curriculum. During post hoc analysis, the groups were divided into "above average" and "average or below" in relation to PANCE pass rates compared with the national average, with several significant differences identified. These differences include the average length of rotation, programs that require a minimum end-of-rotation passing score, and programs that require a minimum score on the preceptor evaluation. This research demonstrated many viable options and approaches to various components of clinical education, as well as some correlations between supervised clinical practice experience (SCPE) design and PANCE first-time taker pass rates.

A Spatial Analysis of Physician Assistant Programs.

The Accreditation Review Commission on Education for the Physician Assistant projects a total of 273 accredited programs by the summer of 2020. Over the past 10 years, the number of Central Application Service for Physician Assistants (CASPA) applicants per seat has increased by 53%. However, no studies have addressed the current geographic relationship of applicants to programs and program growth. The purpose of this study was to describe the geospatial patterns and relationships of physician assistant (PA) programs and CASPA applicants. Program directory information for established (n = 159), satellite (n = 18), and new PA programs (n = 95) was mapped using ArcGIS software. Permanent US ZIP codes for PA applicants (n = 22,603) from the 2014 to 2015 CASPA admissions cycle were also mapped. Point data were used to calculate the nearest neighbor by program type. Correlation was used to measure the association between PA applicants, program class size, and state population metrics. Most of the 95 new PA programs were geographically close to established programs. The median distance of new programs to the nearest neighboring established program was 25.6 miles (mean 39, standard deviation 38). Both established and new PA programs were found to be highly clustered (Moran's I z score < 2.58, p = .01). The geographic distribution of the CASPA applicant pool was related to distribution of the US population, certified PAs, and practicing physicians. PA program growth has exceeded projections. The close proximity of new programs to established programs will likely result in continued competition for quality applicants, PA faculty members, and clinical training sites.

Is Professionalism Important in Physician Assistant Education?

Purpose: This study was designed to demonstrate the importance of a formal professionalism curriculum in physician assistant (PA) education. The PA concept arose from the medical profession, and PA education was designed to follow the medical model of education. Courses have been mandated by the Accreditation Council for Graduate Medical Education (ACGME) to include professionalism. Just as in the curriculum in medical schools, PA educators have been allowed to create their own professionalism curricula. The American Academy of Physician Assistants (AAPA) and the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) have mandated that professionalism and ethics must be included in PA education. To address this need, a professionalism curriculum for first year PA students was created that combined standards of professionalism that are taught in medical school with those from the PA profession. Method: Sixty-four students enrolled in their first year of a master’s degree PA program were asked to voluntarily participate in a two-part survey to assess their knowledge of professionalism. The initial survey was administered prior to any formal education in professionalism. The same survey was repeated following the completion of the professionalism curriculum. The design of the survey was cross sectional and consisted of close ended questions. A Likert scale was utilized for responses, allowing for statistical analysis and comparison. Results: Sixty-three of 64 students completed both surveys. Results did not demonstrate a statistically significant improvement in knowledge of professionalism. Student evaluations were overwhelmingly positive, as was their participation in group discussions. Conclusions: Professionalism did not significantly improve. The lack of statistical significance may have referred to the lack of reliability in the findings but did not indicate the curriculum was effective or ineffective. It may have been wiser to continue professionalism education throughout the didactic year, incorporating case studies and simulation exercises.

Attitudes Toward Academic Dishonesty in Physician Assistant Students.

The purpose of this study was to assess physician assistant (PA) students' attitudes and experiences toward academic dishonesty during training and to determine whether PA students self-report cheating during PA school. An anonymous, quantitative, exploratory, descriptive survey was sent to clinical-year PA students enrolled in PA programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). A sample of 493 self-selected PA students in their clinical year of training responded to the survey. Only 3% of clinical-year PA students self-reported cheating during PA school. Males self-reported significantly higher rates of cheating in PA school than females. The most common cheating behavior that clinical-year PA students reported either observing or hearing about in PA school was receiving information about an exam prior to its administration (70.9%). The attitudinal statement that respondents most strongly agreed with was that "cheaters in PA school just end up hurting themselves in the long run." The strongest predictor for cheating in PA school was a history of cheating as an undergraduate. This study confirmed previous research indicating that academic dishonesty exists in PA education. It also determined that clinical-year PA student attitudes toward and experiences with academic dishonesty vary.

Student mental health implications for physician assistant education.

This report examines student mental health and learning disabilities along the continuum from childhood to college by examining diagnosing and prescribing patterns and potential implications for physician assistant (PA) faculty based on the Standards of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5, Section 2, Specific Learning Disorders). We reviewed existing data to compare decades of national patterns in diagnosing and prescribing for conditions that have known comorbidities with learning disabilities. By including quantitative and qualitative data from children, adolescents, undergraduate college students, and veterans, we illustrate the potential impact these patterns could have on some current and future applicants to PA educational programs and the requirements for PA faculty to address these needs. Multiple national data sources revealed increasing numbers of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), psychoactive prescriptions written for those under age 18, and self-reported increases in multiple psychological disorders among college students. More recent evidence shows a twofold increase in military veterans returning to college with posttraumatic stress disorder, traumatic brain injury, and depression. The growing numbers of students with conditions described in this report requires academic faculty to be aware of requirements to recognize and address their mental health service needs. PA educators could benefit from supplemental faculty development activities to help prepare them to recognize the pipeline patterns of a growing percentage of postsecondary students with mental health conditions and learning disabilities.

Postgraduate Clinical Education of Physician Assistants

Physician assistant (PA) postgraduate clinical training programs have existed since 1971. There are anecdotal reports of increasing numbers of programs available in the United States, although a reliable means of identifying and tracking such programs has not been available. The purpose of this study was to describe the current state of postgraduate, clinical educational programs for PAs based on defined criteria for study inclusion and to propose the use of these criteria for use by future investigators to determine trends in program development. All programs potentially meeting the study criteria for postgraduate PA clinical programs, including programs actively enrolling PAs and that provide didactic and clinical instruction of 6 or more months duration, were contacted to participate in an online survey. A total of 49 programs (42 nonmilitary) programs were included with 22 nonmilitary programs opening for enrollment in or after 2008. Most programs enrolled one or two PAs annually. All respondents of nonmilitary programs indicated that a certificate of completion was provided and no academic credit or degree was offered. A variety of didactic and clinical instructional methods were used. Most sites also provided clinical rotations for PA students, and many required PA residents to participate in student teaching. Although few programs have been accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), most programs are pursuing, or plan to apply for, accreditation. The results of this survey provide an up-to-date report on the status of PA postgraduate clinical training programs. The investigators recommend future studies use the same criteria for inclusion to establish future trends in program development.