Physician Assistant Profession Research Articles

Compliance With Accreditation Standards on Diversity: Is Institutional Support the Missing Link?

The role of accreditation standards in fostering diversity and inclusion in academic programs remains poorly understood. Accreditation is one approach to increasing diversity through Standard A1.11. This study investigates the impact of the Accreditation Review Commission-Physician Assistant (ARC-PA) standards on diversity and inclusion in physician assistant (PA) programs and explores challenges faced by programs in achieving compliance. This qualitative exploratory study first reviewed diversity standards in accreditation documents among selected health professions; second, data on the frequency of citations from ARC-PA related to diversity were gathered and analyzed; finally, opinions from 23 PA faculty and leaders were solicited through semistructured interviews. Two research team members analyzed the data to identify themes. Most institutions sponsoring PA programs had preexisting diversity policies before the inception of standard A1.11 of the ARC-PA. Between June 2020 and March 2023, seven programs received 16 citations related to Standard A1.11. Interviews with faculty revealed 4 major themes: (1) the importance of institutional support, (2) early pipeline development of applicants, (3) prioritizing faculty and/or student diversity as key program goals, and (4) local context, with institutional support and pipeline development being most prominent. The inclusion of Standard A1.11 in the ARC-PA Standards signifies the growing recognition of diversity, equity, and inclusion (DEI) in PA education. Institutions can advance DEI in the PA profession by leveraging accreditation-related activities through leadership, partnerships, and accountability measures consistent with the institution's mission and applicable laws. Institutional support emerged as an important factor in compliance with diversity-related accreditation standards.

Reimagining Faculty Development: A 5-Year Journey of Outcomes and Lessons Learned of a Physician Assistant Faculty Fellowship

Introduction Faculty sufficiency remains one of the major bottlenecks in health workforce development. There is a need for effective models for practicing clinicians to successfully transition to academic teaching roles. This article describes outcomes and lessons learned at the 5-year mark for a statewide faculty development workforce initiative for the physician assistant (PA) profession at the PA Leadership and Learning Academy (PALLA) in Maryland. Methods The PALLA PA faculty fellowship is a state-funded workforce initiative that consists of a 10-month training program that includes synchronous workshops, asynchronous learning modules, experiential teaching opportunities, and completion of an individual project in the realm of scholarship/service under longitudinal mentorship. Programmatic outcomes were longitudinally tracked using the Kirkpatrick model of training evaluation to evaluate the faculty training program at 4 levels of criteria: reaction (level 1), learning (level 2), behavior (level 3), and results (level 4). Key performance indicators for the fellowship include the ability for fellow graduates to provide educational support to Maryland PA programs, engage in, and promote scholarship in the PA profession and build an academic portfolio. Results To date, 4 cohorts of PAs (23 individuals) have completed the fellowship. Learner reaction (level 1) evaluated through surveys, and interviews reveal a positive fellowship experience, with fellows noting benefits of the longitudinal nature of the experience and individualized mentorship and fellows self-report high level of achievement of fellowship learning goals (level 2). Local and national PA review of fellow curricular and scholarly products has been positive (level 3). After graduation, 9 fellows are engaged in faculty roles, providing academic support to local PA programs; 11 fellows have had scholarly products accepted; all fellow graduates have generated an academic portfolio; and 2 fellows have provided new service to PA organizations (level 4). Discussion Four years of fellowship data demonstrate positive impact across Kirkpatrick 4 levels of training evaluation. Nearly, all participants have new contributions in teaching, scholarship, or service roles because of the fellowship. Key lessons learned were the benefits of the longitudinal nature of the experience for scaffolding of learning and ongoing, individualized mentorship.

Perspective on the Journal of Physician Assistant Education : From Association Newsletter to Academic Peer-Reviewed Journal Celebrating 25 Years.

For 25 years, the Journal of PA Education (JPAE) and its predecessor publications have been the pre-eminent venues for disseminating and promulgating information and research on the physician assistant (PA) profession. In this article, former and current editors in chief have compiled a detailed history of the journal, its development, and its trajectory into the future, outlining the journey taken by Association of PA Programs/PA Education Association to catalog faculty scholarship through a peer-reviewed journal. Allowing for the referencing of articles and thus adding to the body of knowledge on PAs and PA education, JPAE has not only endured but thrived. This article speaks to the collective effort and excellence of staff, and the many volunteer reviewers, feature editors, and editorial board members who have nurtured JPAE along the way through numerous changes, challenges, and triumphs.

Physician assistants in the German inpatient care: barriers and enablers of integration

PurposeVarious health systems are challenged by a multifaceted crisis of increased service demand and workforce shortages. The effects are devastating and may end up in decreased access to care, poor quality of patient care and extreme demands on the workforce. The introduction of the physician assistant (PA) profession provided an avenue to address such challenges in several countries. In Germany, the integration of PAs has been proceeding slowly.Design/methodology/approachTo understand the integration of the profession in Germany, we conducted 15 expert interviews to reveal how the PA profession is perceived among healthcare experts as well as the barriers and facilitators of integration in inpatient care.FindingsOur results highlight a generally positive perception of PAs, particularly in terms of workload relief and bridging the gap between healthcare professionals. Nonetheless, barriers include resistance from healthcare workers unfamiliar with the PA role, while workforce shortages and collaborative teamwork facilitate integration.Originality/valueThese findings lay the groundwork for potential integration-enhancing strategies in Germany.

Leadership From a Different Lens: Shaping the Future of Healthcare Education.

Physician assistant (PA) educators are responsible for preparing the next generation of PAs to be not only healthcare providers but also healthcare leaders. Regardless of whether advanced practice providers choose to pursue formal leadership roles in healthcare, they will undoubtedly be expected to possess and exhibit leadership skills. The PA profession indicates leadership as an important professional competency, yet leadership training is rare in current curricula. The PA community should consider the importance of leadership training for educators as they influence future PAs and the way PA students will affect their future patients and the healthcare systems for which they work. The aim of this article was to bring awareness to the need for leadership skill training in PA education, to review common leadership styles in healthcare, and to offer practical leadership tips to healthcare educators.

Black and Hispanic Representation Declined After Increased Degree Requirements for Physician Assistants.

The physician assistant (PA) profession is one of the least racially and ethnically diverse health professions requiring advanced education. New PA graduates are even less diverse than the current PA workforce and less diverse than professions requiring doctoral degrees. Between 1995 and 2020, the percent of all PA graduates that were Black individuals fell from 7% to 3.1%, while Hispanic representation increased from 4.5% to 7.9%. Using the federal Integrated Postsecondary Education Data System, we examine the impact of transitions to master's degrees for PAs on Black and Hispanic representation between 1995 and 2020, using individual universities as the unit of analysis. After adjusting for state and year effects, PA programs that transitioned from bachelor's to master's degrees experienced a 5.3% point decline in Black representation and a 3.8% point decline in Hispanic representation. Relative to the already low proportions of Black and Hispanic graduates in PA programs, these declines are significant. Steps should be taken to ensure that underrepresented populations have greater access to PA education.

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.

Using Reflective Practice to Enhance Student Professionalism.

Reflective practice, critically reflecting on one's actions or attitudes to engage in the process of continuous adaptation and learning, has proven to be an effective strategy for improved patient care. Additionally, literature supports applying reflective practice for professional growth in medical providers. When contemplating professionalism training in physician assistant (PA) education, it is important to consider how to obtain buy-in from students. One way to do this is to link professionalism to the students' future career as a PA. The School of Physician Assistant Studies at Pacific University (the Program) created an Online Orientation Reflective Practice Assignment that was implemented during online orientation. Students were prompted to use reflective practice to create detailed "plans for success." The goal of this assignment was to reduce common professionalism missteps students often experienced. Data regarding the number of professionalism encounters per cohort, broken down into occurrences by curricular phase (didactic vs clinical), was tracked and collated using Microsoft® Excel®. The data was analyzed to determine trends. Implementation of the Online Reflective Practice Assignment for all PA students at the beginning of their education has increased student awareness of the Program's, and the profession's, expectations regarding professionalism and accountability. Thus far, the resulting number of professionalism missteps have not decreased year-over-year. We hypothesize that this is due to the difficulty meeting increased administrative expectations and burdens put on students during the pandemic. Students' use of reflective practice to review what went wrong and to create plans to avoid missteps in the future allows them to focus on productive next steps in building their professional identity. Implementation of the Online Orientation Reflective Practice Assignment has better prepared students for the expectations of the PA profession and provided them with a solid foundation to build their professional identity throughout their education and into their careers.

PA Scholars: What Drives and Inhibits Success?

The full expression of an educator includes scholarship, yet many physician assistant (PA) educators are not published. Several barriers unique to PA education are often cited to explain this phenomenon. However, some in the PA profession have become prolific writers despite working in the same environment. In this study, authors strove to understand what motivated these productive faculty by posing 2 research questions: (1) What are the drivers of success for high-performing PA scholars and (2) how do high performing PA scholars overcome barriers? A qualitative study using a constructivist, grounded theory approach explored the experiences and motivation of PA-credentialed educators who published >5 peer-reviewed articles and whose body of work achieved an h -index of >3. High-performing scholars valued scholarship as a creative outlet and a rewarding pursuit. Scholars achieved a sense of fulfillment in their work. Research and writing were described as protective against burnout. Participants viewed barriers differently than other educators. Barriers were acknowledged, but participants developed strategies to overcome obstacles. Mentorship was seen as crucial to success. A nuanced understanding of PA research and the characteristics associated with high-performing PA scholars emerged. The study identified developmental stages associated with the formation of a scholar. Progression from prescholar to mature scholar has important implications for initiatives designed to increase scholarship and provides evidence to support the claim that scholarship positively affects job satisfaction, personal well-being, and talent retention.

Academic Rank Disparities in Minoritized and Racialized Physician Assistant Educators.

The aim of this study was to investigate the disparities in career progression and the need for inclusive mentorship in the physician assistant (PA) profession, specifically focusing on racial/ethnic minority faculty. Pooled data from the Physician Assistant Education Association Program Survey in 2015, 2017, and 2019 were analyzed to examine the effect of PA faculty race/ethnicity on academic rank promotion. Logistic regression models were used to assess the association between faculty race/ethnicity and the likelihood of being in a middle/late-career (associate/professor) or early-career status (instructor/assistant), adjusting for confounding factors. The analysis revealed significant disparities in career progression, particularly for Black/African American and Hispanic faculty members, who were 44% less likely to be in late-career positions compared with White faculty. These disparities persisted even after accounting for gender, highest degree, region, and years in rank. The slower career progression experienced by minoritized faculty can have negative impacts, such as lower salaries, impostorism, reduced social capital, isolation, marginalization, burnout, and attrition. The findings highlight the urgent need for increased efforts to promote diversity and inclusion in the PA profession. Creating a more equitable academic environment requires addressing systemic biases, implementing inclusive mentorship initiatives, and promoting diversity in hiring and promotion decisions. By prioritizing equity, diversity, and inclusion, the PA profession can foster a more diverse, innovative, and satisfied workforce while reducing turnover. Continued research and evidence-based strategies are essential to effectively address these disparities and create a more inclusive and equitable environment in the PA profession.

Characteristics of Hybrid Learning Among Health Professions Programs: A Mixed-Methods Study.

To characterize current trends in hybrid education within the physician assistant (PA) profession, specifically program design, drivers, and outcomes in comparison with physical therapy hybrid education. This was a mixed-methods study involving secondary data analysis and focused interviews with stakeholders to triangulate the data. Compared with traditional PA programs, hybrid programs have similar admission requirements, higher cost of tuition, larger class size, and higher attrition rate than national mean. Physician Assistant National Certifying Exam outcome data are in line or slightly lower than national scores. Technological advancements and need for faculty/learner flexibility by time and location are frequently cited driving forces. There is a growing trend toward hybrid education among health professions. Other than cost, attrition rate, and immersion experiences, characteristics of hybrids are similar to traditional programs. It is relevant for PA educators to understand how this educational design may shape the future of PA graduates. Long-term impact should be evaluated with future studies.

The Role of Mentoring in Recruiting and Retaining Minority Physician Assistant Faculty.

The physician assistant profession (PA) is experiencing a proliferation of PA programs nationally, creating a demand for PA faculty to educate and train future PA clinicians. Current data show that the number of minority PA educators is insufficient to train a diverse PA workforce. Previous studies have explored the high turnover rate of minority PA faculty, their retention, and attrition. Guided by the social-ecological model (SEM), the purpose of this phenomenological study was to explore the lived experiences of Black and Hispanic minority PA faculty in PA education to gain further insights about the specific role that mentoring has played in their recruitment and retention. Qualitative data were collected from a purposive sample of 6 minority PA faculty using semi-structured telephone interviews. This study's findings identified specific SEM constructs-specifically individual, interpersonal, and institutional levels of mentoring-that may influence minority PA faculty recruitment and retention efforts. The participants in this study identified several recruitment and retention factors, including formal and informal mentoring, support, and guidance. Challenges related to lack of pedagogical training and lack of administrative support for meaningful professional development were reportedly overcome by the assistance of colleagues within and outside of their programs. The findings of this study provide insights necessary to inform professional practice initiatives among PA program leaders and institutional leadership to engage in dialogue and coordinate efforts involving the implementation of effective professional development and mentoring structures.

Type of Health Care Experience Impact on PA Education Association End of Rotation Exam Scores.

The physician assistant (PA) profession is based on previous healthcare experience (HCE), yet few studies have examined the influence of HCE on outcomes. This exploratory study examined possible differences between type of HCE and End of Rotation scores as a surrogate for clinical acumen and medical knowledge. Participants included consecutive classes of PA students (2017-2020) from a single public institution (N = 196). Self-reported HCE was used to classify students into HCE groups: group 1, lower decision-making professions; and group 2, higher decision-making professions. Group 1 (n = 124) and group 2 (n = 72) had no significant difference in the 7 individual End of Rotation exam scores and HCE ( p =.163 to .907). A correlation was found between average End of Rotation exam score and PANCE scores ( r =.80, p ≤ .001). The impact of HCE during the clinical year of education and its influence on noncognitive attributes, such as communication skills and professionalism, is not known. HCE might have a role in hard to measure noncognitive, nonquantifiable qualities.

Licentiate of Medicine and Licentiate of Surgery

M.L.L.S. is an acronym for the 4 year “Licentiate of Medicine and Licentiate of Surgery” degree which is the physician assistant degree I propose for the most populous country on the continent of Africa [1] sub-Saharan African countries with fewer inhabitants such as Ghana, Kenya, Uganda, South Africa and Zambia already have the physician assistant profession. Nigeria does not. Holders of the MLLS will be addressed as “doctors” and not “physician assistants”, “clinical officers” “physician associates”, “assistant doctors”, “medical licentiates” or any other distinguishing terms. [2-3] Their distinguishing factor from regular [MBBS] doctors will be the shorter duration of study, name of the degree and a lower salary which must never fall below 70% of the regular doctor’s salary. Entry requirements for admission will be less stringent than for MBBS students and it is assumed that MBBS students who fail exams may find solace in the less intensive MLLS program. This MLLS degree however will be a terminal one. Holders will not be allowed to specialize and will remain general practitioners for the rest of their lives. Here is why the MLLS is needed in Nigeria: Relatively low Average Life expectancy, large number of HIV type 2 at risk people, high maternal mortality rate, high infant mortality rate, many deaths from malaria, cholera and typhoid fever, low doctor patient ratio, many living below poverty line, many internally displaced people and many victims of VVF.

Patient Experience With Primary Care Physician Assistants in Ontario, Canada: Impact of Trust, Knowledge, and Access to Care.

Physician assistants (PAs) have been integrated into primary care settings to reduce wait times and to optimize continuity of care. Though previous studies suggest that PA utilization leads to improved healthcare access, few studies have investigated patient experience with primary care PAs in Canada. The objective of this study is to explore patient perspectives on primary care PAs in Ontario. A patient survey was developed and distributed to patients seen by PAs in 4 family medicine practices across Ontario, Canada. Results demonstrate that many patients are highly satisfied with their experience including the PA's ability to address their medical needs, establish rapport, and provide fast access to care (including same-day and after-hours appointments). Despite preferring to see a physician for more complex concerns, participants felt that PAs demonstrate similar medical knowledge, competencies, and scope of practice as family physicians. Patients demonstrated a solid understanding of the PA role and recognized the collaborative PA-physician relationship. These findings describe successful patient awareness and acceptance of the PA profession, largely due to positive PA-patient interactions in family medicine settings.

PA applicant U.S. citizenship status and likelihood of program matriculation

BackgroundBarriers to matriculation into Physician Assistant (PA) programs and entry into the PA profession have disproportionate impact on historically marginalized groups. This study evaluates if U.S. citizenship status is associated with likelihood of matriculation in PA Programs.MethodsData from five Centralized Applicant Services for Physician Assistants (CASPA) admissions cycles (2012-2021) was evaluated cross-sectionally for the primary outcome of binary matriculation status (yes/no). Bivariate and multivariate logistic regression was utilized to investigate associations between self-identified U.S. citizenship status and likelihood of PA program matriculation. Models controlled for important potential confounders, including age, gender, race/ethnicity, non-native English speaker, patient care experience hours, total undergraduate grade point average (GPA), and number of applications submitted to various programs.ResultsNon-U.S. citizen status was statistically associated with persistent lower likelihood of PA program matriculation compared to U.S. citizenship. Odds of matriculation were 41% [OR 0.59 (95% CI: 0.51, 0.68; p <.001)] to 51% [OR 0.49 (95% CI: 0.41, 0.58; p <.001)] lower in unadjusted models. Odds were 32% [OR 0.68 (95% CI: 0.56, 0.83; p <.001)] to 42% OR 0.58 (95% CI: 0.48, 0.71; p <.001) lower when adjusting for important covariates. The lowest likelihood occurred in 2012-2013 with 51% lower odds of matriculation and in 2016-2017 with 42% lower odds when accounting for important covariates.DiscussionPA programs are charged with improving diversity of clinically practicing PAs to improve health outcomes and better reflect patient populations. This analysis shows that non-U.S. citizenship may be a barrier to PA school acceptance. PA schools should raise awareness and create means and accessibility for admissions for this underrepresented group.

PAs in Myanmar: Courage and humanitarianism required.

Myanmar might be the most recent country to graduate its first class of physician assistants (PAs). The country has a history of medics serving in underserved areas, but graduated its first six PAs in 2020, after a 5-year training program. These clinicians will care for a largely rural population, who live in areas of unreliable infrastructure and security. The PA profession in Myanmar aims to reduce maternal mortality, graduate 75 PAs by 2029, and improve access to healthcare in remote regions.

Accreditation in the Health Professions: Implications for Physician Assistant Education.

The accreditation process of health professions educational (HPE) programs is an essential ingredient in preparing a qualified healthcare workforce. Accreditation ensures that minimum standards are met by educational programs and contributes to pedagogical integrity, consistency, and academic policies and practices, leading to the desired quality of graduate outcomes. In this study, we analyzed key characteristics, policies, and practices for accreditation in 5 health professions to highlight emerging trends and discern implications for the physician assistant (PA) profession. There is growing evidence of movement toward outcome-based accreditation versus process-oriented accreditation and collaborative engagements between programs and the accreditors. Agencies are providing online discussion platforms and direct mentorship and, at the height of the coronavirus pandemic, offered virtual site visits. At an institution level, we observed a trend towards structured faculty development on accreditation, implementation of technology infrastructure for data collection, visualization and analysis, and the use of consultants for outsourcing certain elements of the accreditation process. There is a wide spectrum of approaches, from prescriptive to liberal, by the various accrediting agencies in enforcing compliance. A balance is desirable for the institutional-accreditor relationship to work effectively.

The PA profession in Israel: A half-decade perspective.

Implementation of physician assistants (PAs) in EDs throughout Israel began in May 2016. The profession is now showing some progress but at a relatively slow rate. This article provides an overview of Israel and its healthcare system, and describes the implementation, deployment, education, training, and scope of practice of PAs in Israel, plus recent developments and suggestions for advancing the profession.

The PA profession in Liberia: A case study in pioneering innovation and resiliency.

In Liberia, the physician assistant (PA) profession began in the mid-1960s. PAs have had a major role in providing access to healthcare for patients, many of whom live in poverty and reside in remote areas where access to physicians may be severely limited. In 1964, representatives from UNICEF selected Agnes N. Dagbe, MS, RN, to be the first director of a new PA program to be developed at the Tubman National Institute of Medical Arts. Dagbe was sent to Russia to learn about their feldsher profession, which served as a significant source of inspiration for the newly emerging PA profession in Liberia. To date, Liberia has faced extreme shortages of physicians, the ravages of two brutal civil wars over a 14-year period (1989-2003), as well as outbreaks of the Ebola and COVID-19 viruses. Now, more than 54 years since the first class graduated, PAs are vital for the delivery of essential healthcare services for the citizens of Liberia.