Physician Assistant Curriculum Research Articles

Creative Solutions for a Condensed Anatomy Course.

There are many variations of anatomy courses taught in accredited physician assistant (PA) programs in the United States. Course directors and program leadership must choose how to effectively deliver content within their program constraints. Our anatomy course has faced challenges related to instructional time for didactic and laboratory sessions, course length, curricular placement and alignment, assessments, and faculty availability. These challenges are not specific to anatomy courses in PA curricula but exist in anatomy courses in various health care programs. In this article, we present major solutions to challenges in didactic delivery, laboratory sessions, course content, and assessments over a 5-year period. Through modifications and problem-solving, we identified the following 4 lessons learned during this process: course alignment to clinical relevance, intentional content delivery for different pedagogical approaches, structured laboratory sessions with appropriate staffing, and an appropriate weighting for assessments. These lessons and solutions will be useful to other anatomy and disciplines-based course directors facing similar challenges.

Teaching Future Physician Assistants to Provide ADEPT-CARE to Disabled Patients: A Novel Application of Disability Curriculum.

Physician assistant (PA) students will be certain to provide care to patients with disabilities in their future careers. However, there is a dearth of literature on disability-related education in PA training. This curriculum sought to fill this need. The specific aims of this study were to (1) evaluate the implementation of a 3-part disability-focused education curriculum in PA education, (2) assess changes in PA students' self-perceived confidence and attitudes toward patients with disabilities, and (3) assess students' attitudes toward ADEPT-CARE. A 3-part disability curriculum was implemented into the first-year PA curriculum at a single Mid-Atlantic institution. Students could voluntarily complete pre and post-surveys which assessed their self-perceived confidence and attitudes toward people with disabilities, perception of the curriculum, and attitudes toward ADEPT-CARE and disability health. Thirty students participated in the study, with a 100% survey response rate. Nearly all participants agreed or strongly agreed that this curriculum enhanced their medical education (n = 28, 96.6%, frequency missing n = 1). After curriculum completion, there was a statistically significant improvement in participants' confidence in their ability to assess patients with disability (46.7%-93.3%, P < 0.001), ability to provide the same quality of care to patients with disability as those without disability (80.0%-96.7%, P = 0.025), and perception of quality of life of persons with disabilities ( P = 0.030). This curriculum was well received by PA students and improved their attitudes toward patients with disabilities, thereby fulfilling a critical need for PA educators.

Social Media in Physician Assistance and Medical Education

Objective: To assess physician assistant (PA) students’ experiences with social media (SM) as a part of their medical education. Place and duration of study: Study was conducted at Fazaia Medical College, Islamabad, Pakistan from July 2019 to July 2020 in one year duration. Methodology: This study was completed in two different phases. In phase 1 a cross sectional survey was conducted to measure student opinions and experience with social media. This survey was conducted on all 1st and 2nd year PA students. Phase 2 was a longitudinal observational survey to incorporate two 1st year PA classes regarding social media in medical education resources. First year and second year students from medical school were enrolled. Results: The mean support of social media inclusion in physician assistant, enhancing existing curriculum, and the anticipation of formal inclusion in the future was 2.42±0.58,2.53±0.98 and 2.42±1.06, respectively. While support social media inclusion in physician assistant, worthwhile addition to the lectures and Useful addition to physician assistant curriculum was 1.84±0.64, 1.77±0.72 and 2.02±0.88, respectively. Conclusion: Many physician assistants and medical students are already using social media as an informal part of their studies. Some difficulties were also identified by physician assistant students in finding a well-established educational social media. Many PA educators used our data in designing curriculum of PA students. More studies are needed to focus on social media use and its effects on examination education and learning.

The State of Genetics and Genomics Education in US Physician Assistant Programs.

This study aimed to assess the current landscape of genetics-genomics education in physician assistant (PA) student training. A 25-question electronic survey was emailed to program directors of the 273 accredited PA programs. Questions represented PA program demographics and 4 domains: curricular characteristics and perceived adequacy; content; curricular approaches and instructional methods; and intent, barriers, and perceived needs for an optimal curriculum. A total of 115 PA program representatives (42%) returned the survey. More than two-thirds of responding programs do not require a prerequisite genetics course for matriculation. Most programs (48%) include 1 to 10 contact hours of genetics-genomics content and use various content delivery methods and approaches. Most programs (67%) use PA program faculty to teach genetics-genomics as part of one course or many courses throughout the curriculum (85%) using didactic lectures (97%). The most significant barrier to developing an optimal curriculum is an already overloaded curriculum (71%). Physician assistant educators welcome supportive resources, such as genetic case studies (96%). The study findings elucidate the current state of genetics-genomics education in PA programs. Every responding program reports that genetics-genomics is integrated into their curriculum; however, no standardization exists between programs. Although medical genetics-genomics has changed and advanced rapidly since a similar survey was conducted 14 years ago, the number of contact hours is unchanged, and genetics-genomics content is less dispersed throughout PA curricula. To create genetic-competent and genomic-competent PAs, education must evolve to stay current with ongoing advancements in genomic science.

The feasibility of self-directed POCUS training in Physician Assistant education

The increasing use of Point of Care Ultrasonography (POCUS) in medicine and healthcare prompted this pilot study, which aims to gain insight into the feasibility of online, self-directed POCUS training in the Physician Assistant (PA) curriculum. A mixed-method approach was used, gathering and analyzing data obtained from two cohorts of students in their didactic phase of training. Students completed a baseline survey, followed by the completion of several self-directed POCUS training modules, after which a post-survey was obtained. Seventy-six percent of the students had never used POCUS before. At the completion of the training, students demonstrated an increased level of confidence and comfort level using POCUS. The self-directed, self-paced, online format was not very favorable among the students. The recommendations for modifications, to incorporate live hands-on instruction were well received. It is important for PA programs to evaluate all aspects of a proposed POCUS training, including students’ perception, for a more meaningful learning experience.

An Integrated Point-of-Care Ultrasound Curriculum: An Evidence-Based Approach.

Point-of-care ultrasound (POCUS) has been demonstrated to improve students' medical knowledge and clinical exam skills and advances patient care through numerous diagnostic and therapeutic applications. Despite the growing use of ultrasound in medical education and clinical practice, few physician assistant (PA) programs have successfully integrated POCUS education into their curricula. This manuscript describes an evidence-based approach for integrating POCUS education throughout a 2-year PA curriculum, with the goal of serving as a useful guidepost for other PA programs as they strive to incorporate this valuable skill into their curricula.

Differences in perceived clinical knowledge uptake among health profession students and licensed clinicians receiving buprenorphine waiver training in Oregon

Background: Addressing the opioid crisis requires an understanding of how to train both health professional students and practicing clinicians on medications for opioid use disorder (mOUD). We designed a robust evaluation instrument to assess the impact of training on perceived clinical knowledge in these different categories of learners. Methods: We enrolled 3rd and 4th year medical, physician assistant (PA), and nurse practitioner (NP) students, as well as practicing PAs, NPs, and physicians to undertake the Drug Addiction Treatment Act (DATA) Waiver Training for mOUD. We designed and implemented a cross-sectional survey to assess perceived change in clinical knowledge as a result of training in opioid use disorder and satisfaction with training. Results: Twenty-one MD/DO and 45 NP/PA students, and 24 practicing MD/DO and 27 NP/PAs completed the survey. Among health professional students (n = 66) and practicing clinicians (n =51), perceived clinical knowledge scores increased significantly (p < 0.001) for all 13 variables. Program evaluation scores for the buprenorphine waiver training were high with no statistical differences between students and practicing clinicians. Overall, the majority of participants indicated they would recommend the training to a colleague (Students’ score = 4.84; practicing clinician scores = 4.53; scale = strongly disagree = 1 to strongly agree = 5). Conclusions: Our novel instrument allowed us to determine that the implementation of buprenorphine waiver trainings for health professional students and practicing clinicians leads to significant increases in perceived knowledge, interest and confidence in diagnosing and treating OUD. Although the buprenorphine waiver can now be obtained without training, many waivered providers still do not prescribe buprenorphine; integrating training into medical, NP, and PA curriculum for students and offering the training to practicing clinicians may increase confidence and uptake of mOUD.

Utilizing Supplemental Online Modules for Physician Assistant Student Electrocardiogram Interpretation Training.

The literature suggests that graduating medical and physician assistant (PA) students lack competency in electrocardiogram (ECG) interpretation. This project aimed to determine whether use of perceptual adaptive learning modules (PALMs) would improve PA students' ECG interpretation, alter self-perceptions of their ECG education, or both. PALMs were incorporated into the PA curriculum after lecture-based ECG learning. Students' pretest, posttest, and delayed-posttest scores were then compared. Students' ability to correctly interpret ECGs (accuracy) and the percentage of ECGs accurately interpreted within 15 seconds or less (fluency) also were evaluated. Finally, students' perceptions of PALMs and overall ECG training were assessed. PALM training improved ECG interpretation accuracy and fluency (p < .0001), as well as delayed-posttest accuracy and fluency (p < .0001). The majority of student respondents felt supplemental training enhanced their learning. These perception results combined with data on ECG interpretation improvement supports continued use of supplemental PALMs in ECG interpretation training.

Developing Clinical Reasoning in a Physician Assistant Curriculum: The University of Sheffield approach.

Clinical reasoning remains a key area for development amongst clinical students across the world. Physician assistant (PA) roles (physician associate in the United Kingdom) are rapidly expanding, and there is a need to ensure that this core skill is reflected in course curricula. This article presents how the University of Sheffield has integrated clinical reasoning into the curriculum for its PA course. This includes recognizing the need to consider different approaches to reasoning and how they are taught, the assessment of reasoning across Miller's pyramid, and other considerations that contribute to embedding reasoning within the course. We discuss the implications of our approach and comment on issues that we may need to consider in the future.

Determining the Best Time to Integrate Opioid Use Disorder Training into the Curriculum Based on Student Perceptions.

The clinical phase of physician assistant (PA) education has been reported to be the best time period to deliver opioid prescribing education (OPE) and opioid addiction education (OAE); however, there are no current published studies that evaluate the timing of OPE and OAE instruction in PA curricula. This pilot study compared didactic and clinical phase cohorts' perceived confidence in their ability to evaluate patients with opioid use disorder (OUD) after receiving identical training at different time points within the curriculum. As expected, clinical phase students displayed high confidence levels in their abilities both before and after implementation of OUD-focused patient simulations. Interestingly, didactic phase students' confidence levels were comparable to clinical phase students' confidence levels after participating in the patient simulations. Our findings suggest that students can benefit from this training in both phases of the curriculum, which may encourage and help PA programs to insert this important and timely information into their curriculum.

Integrating an evidence-based medicine curriculum into physician assistant education: Teaching skills for lifelong decision-making!

Background: Medical knowledge continuously evolves and to help health care providers to stay up to date, the evidence-based medicine (EBM) model has emerged. The practice of EBM requires new skills of the health care provider, including directed literature searches, the critical evaluation of research studies and the direct application of the findings to patient care. Methods: This paper describes the integration and evaluation of an evidence-based medicine course sequence into a Physician Assistant curriculum utilizing the expertise from faculty trained in basic science, nursing and primary care practice. Results: Collaboration of faculty with different educational backgrounds resulted in a course series that was equally strong in all aspects of EBM. This new course sequence teaches students to manage and use the best clinical research evidence to competently practice medicine. To assess the effectiveness of the EBM sequence a survey was developed and administered at the beginning and end of the sequence. Conclusion: EBM knowledge gained is essential to effective clinical decision making and this newly developed tool specifically helps to identify student competencies within the defined course objectives. Contributing to the uniqueness of the tool are case-based questions requiring integration of EBM knowledge by the student.

Designing a Physician Assistant Curriculum Consistent With the Modernization of Health Care.

Designing a Physician Assistant Curriculum Consistent With the Modernization of Health Care.

Coming of Age in Physician Assistant Education: Evolution of Program Characteristics

This study aimed to describe the characteristics of physician assistant (PA) programs developed in 3 previously defined time periods. Data were extracted from the websites of 238 PA programs, including admissions, curriculum, faculty, and program characteristics. Institutional characteristics were gathered from the Carnegie Classification website and the US Census Bureau. Program characteristics were analyzed in 3 groups based on when the program was first accredited-early (before 1980), middle (1980-1999), and current (2000-2019). Early (n = 40), middle (n = 69), and current (n = 129) phase programs are similar regarding the number of admissions, curriculum, faculty, program, and institutional characteristics. Program phase had the greatest effect on undergraduate GPA of matriculating students, the number of PA faculty at the rank of professor, and the size of the admitted cohort. The effect size was medium for outcomes including the number of required biology, chemistry, or physics prerequisites; the probability that the program required a graduate record examination for admission; the number of PA program faculty at the rank of associate professor; the annual tuition and fees; and the probability that the PA program was housed with a medical school. The data describe some of the similarities and differences among the programs established in the 3 previously described time periods in the history of PA education. With the recent surge in new programs, there is value in deepening our understanding of how newer programs compare with more established programs.

Effects of Teaching Evidence-Based Medicine on Physician Assistant Students' Critical Appraisal, Self-Efficacy, and Clinical Application: A Randomized Controlled Trial.

To use a randomized controlled design to explore the effects of evidence-based medicine (EBM) education on physician assistant (PA) students' EBM knowledge, self-efficacy, and evidence-seeking behavior in a simulated clinical situation and to present a model of EBM competence. Sixty-one didactic-year PA students from one Midwestern University (2 sequential cohorts) were randomized to receive the standard PA curriculum plus EBM training (intervention) or the standard PA curriculum only (control). Evidence-based medicine knowledge was measured with a validated Fresno test. Self-efficacy was measured with a validated Likert scale. Clinical application of EBM skills was measured with an objective structured clinical examination (OSCE). Evidence-based medicine education led to significant improvements on the Fresno and self-efficacy tests, both within and between groups. On the OSCE, the intervention group performed no better than the control group. Higher Fresno pretest scores were significantly related to decreasing improvements in the posttest scores: R = -0.634. Teaching EBM to PA students improved their EBM knowledge and self-efficacy but not their clinical application. Future research should focus on enhancing EBM evaluation and application in the clinical setting.

Implementation of Point-of-Care Ultrasound in a Physician Assistant Curriculum.

This study evaluated the benefits and challenges of implementing point-of-care ultrasound (POCUS) training in a physician assistant program curriculum. Physician assistant students were introduced to POCUS during 2 semesters of Physical Diagnosis. The students were assessed for understanding of applications, effectiveness in obtaining images of target anatomy, and the time required to obtain those images. Student attitudes and the cost of implementation were also recorded. After 13 hours of training, the 24 students were able to obtain all the target anatomy images and describe the associated structures with an average accuracy rating of 97%. Understanding of POCUS in clinical applications, including recognition of abnormal scan images, was assessed at an average of 85%. Student attitudes toward POCUS were assessed with 88.69% affirming "strongly agree." Although the costs associated with implementation might vary depending on the setting, they were feasible in our program. Our study confirmed that POCUS training can be effectively implemented with faculty time burdens and costs that are not prohibitive.

Physician Assistant Students' Competency to Identify and Diagnose Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers. A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected. A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD. The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.

Assessing Burnout and Interest in Wellness Programs in Physician Assistant Students

Burnout among health care professionals and preprofessional health care students is of growing concern because of its detrimental effects on performance, mental health, and physical health. Research to date has focused primarily on physicians and medical students. The purpose of this study was to assess burnout and the quality of life among physician assistant (PA) students and gauge their interest in specific wellness interventions that address those issues in their PA program. An online survey consisting of validated measures for burnout and quality of life was completed by 320 PA students from all 8 Virginia PA programs (n = 8). Additionally, student interest in various wellness interventions was assessed, including preferences for timing and delivery, to inform development of a tailored well-being component in the PA curriculum to reduce burnout. We found burnout to be prevalent among PA students, with 79.69% reporting high levels of emotional exhaustion; 56.56% of students met the criteria for cynicism. Survey participants rated stress reduction (n = 290, 90.63%) and burnout (n = 299, 93.44%) as primary issues that need to be addressed in the PA student population. Furthermore, 77.50% of participants expressed interest in participating in a wellness intervention designed to reduce burnout. Given the high prevalence of burnout in the PA students surveyed, resources and potential interventions that reduce burnout need to be identified. The current study identified PA students' perceived needs and interest in various aspects of potential wellness interventions in the PA program. Students preferred an emphasis on stress reduction and burnout, which can be used to develop a tailored well-being curriculum to promote work-life balance and stress management for PA students.

Does Pre‐Clerkship physician assistant POCUS training improve Knowledge and confidence in Clerkship?

IntroductionWith the technological progress of different types of portable Ultrasound machines, there is a growing demand for all health care providers to perform bedside Ultrasonography, also known as Point of Care Ultrasound (POCUS). This technique is becoming extremely useful as part of the Clinical Skills/Anatomy teaching in the undergraduate Medical field curriculum.Teaching/training health care providers how to use these portable Ultrasound machines can complement their physical examination findings and help in a more accurate diagnosis, which leads to a faster diagnosis and better patient outcomes. In addition, using portable Ultrasound machines can add more safety measurements to every therapeutic/diagnostic procedure when it is done under an Ultrasound guide. Ultrasound is one of the different imaging modalities that health care providers depend on to reach their diagnosis, while also being the least invasive methodAimTo assess the effect of pre‐clerkship POCUS training on their knowledge and confidence of POCUS training during their clerkshipMethodThe research we report in this manuscript is a preliminary qualitative study. It provides the template for future models for teaching hands on Ultrasound for all health care providers in different learning institutions.The McMaster Physician Assistant program is a two‐year course; we introduce POCUS training to the first and second year Physician Assistant curriculum. We have a total of 24 Physician Assistant students at each level of the program; at each level we divide them into three equal groups, supervised by a tutor. Each group uses one portable General Electric Ultrasound machine, which is projected onto a large plasma screen. We dim the room lights to get better quality screen images. Our session lasts for 90 minutes, the first 20 minutes being an introduction to how to use the machine and probe orientation, as well as some anatomy landmarks. Every student will have the chance to scan their peers at least one time during our session.Our objective is a pure “hands on” scanning of the neck and the abdomen performed by the students. With the correlations to their anatomy background knowledge, they were able to identify normal Thyroid Glands and major neck vessels, Liver, abdominal Aorta, inferior vena cava, Gall Bladder, and the Kidneys.ResultA questionnaire was handed to the second year (clerkship) Physician Assistant students to evaluate their hands on ultrasound session experience. And the effect of their previous POCUS training at pre‐clerkship level in enhancing more confidence on their most recent training. Answers were collected and data was analyzed into multiple graphs (as illustrated in this poster).Discussion and ConclusionThese results illustrate the importance of the prior POCUS training for Physician Assistant students at their pre‐clerkship level, to build up more confidence in their scanning ability, improve the orientation of their ultrasound images, and to better understand the relation of the probe’s position to the corresponding images during their clerkship POCUS training.Support or Funding InformationEducation program anatomy, McMaster University

Exploring the Effectiveness of Mindfulness and Decentering Training in a Physician Assistant Curriculum.

Several studies have documented the effects of physician assistant (PA) training on students' perceived stress and life satisfaction. Innovative curriculum design incorporating effective stress management resources may help address this concern. Mindfulness and decentering training was incorporated into a first-quarter course for PA students. It included lecture, in-class demonstrations and practice, and out-of-class activities. Mindfulness (Experiences Questionnaire; Acceptance and Action Questionnaire) and general well-being (Satisfaction with Life Scale; Perceived Stress Scale) were assessed precourse, postcourse, and during follow-up. Students reported a significant increase in levels of mindfulness postcourse, which remained stable at a 4-month follow-up. These findings were consistent regardless of prior mindfulness practice. More importantly, changes in the levels of mindfulness significantly predicted changes in life satisfaction and perceived stress. Stress management resources can be incorporated into PA courses through innovative curriculum design to help students cope with the demands of PA school.

The Relationship Between Physician Assistant School Admissions Exam (PA-CAT) and Undergraduate Performance Measured by Science GPA and Cumulative GPA"

Purpose: Physician Assistant (PA) programs often set minimum GPA and graduate record examination (GRE) requirements for admission, citing that candidates with higher admission scores will perform better in the PA program. However, to date, there are limited published studies with inconsistent results that have investigated the validity of using these preadmission characteristics to predict performance in PA programs or on the Physician Assistant National Certifying Exam (PANCE). The development of a physician assistant college admission test (PA-CAT) that has predictive validity to determine PANCE success would give PA admissions committees an additional resource to make decisions. This study was conducted to determine the strength of the relationship between PA-CAT and undergraduate cumulative and science GPA. Methods: The PA-CAT is comprised of 180 questions covering 12 subject areas based on research identifying the relative importance of that subject to success in the PA curriculum. The exam was administered through a secured computer-based testing to 479 newly admitted PA students across the United States. Regression analysis was conducted with Rasch scale scores as the dependent variable and two independent variables (undergraduate GPA and undergraduate science GPA). Results: The PA-CAT Rasch scale scores are positively correlated with undergraduate GPA (r=0.16) and undergraduate science GPA (r=0.22). Although these correlation coefficients are statistically significant (pConclusion:Early results from this research study demonstrates there is a statistically significant relationship between the PA-CAT and undergraduate science GPA in newly admitted PA students. Limitations of the study include the fact that students voluntarily took this exam without consequence. Further study is needed to determine if the exam can be generalized to the entire PA applicant pool thereby providing a valid instrument for admissions decisions.