Physician Assistant Programs Research Articles

Innovative Approach for Teaching Physician Assistant Students About Social Determinants of Health and Empowering Action.

Social determinants, the conditions in which people are born, grow, live, work, and age, play a crucial role in the health of individuals. The University of South Dakota Physician Assistant Studies Program uses a multimodal approach to teaching social determinants of health (SDOH) to students. The SDOH learning session consists of assigned presession reading, a didactic presentation introducing SDOH and their impact, and a table-top activity that simulates how SDOH affect individuals. During the table-top activity a list of community resources is available to help students locate services for the game characters when other resources have been depleted. Prior to entering clinical rotations, students will briefly review SDOH identification and connection to services during a training session for patient encounter logging. A check for implementation of learning will occur during the clinical phase by reviewing students' patient encounter logs for the presence of SDOH-related diagnoses and CPT codes. Although screening to identify SDOH and assisting patients through connecting them to services is not standard in all healthcare systems, PA students with the knowledge and tools can be prepared to provide this component of care to their patients.

Barriers to Research: A National Survey of Physician Assistant Faculty.

Success in research is a well-known challenge for physician assistant (PA) educators. Multiple barriers to research productivity have been proposed. This study examines potential barriers to PA research productivity. Two hundred forty-seven PA programs were stratified by region and Carnegie classification, creating 28 strata. One program was randomly sampled from each stratum, and faculty from sampled programs were invited to participate (N = 214). An electronic survey was deployed via Qualtrics. Data were analyzed, accounting for the stratified survey sample design. Reported are proportions with associated 95% confidence intervals. Survey response rate was 53% (N = 114). The mean age was 46.7 years [44.5, 48.8 years] and 61% [52.4, 70.4] of respondents were female. Most respondents (53.5%; [44.2, 62.8]) were assistant professors and reported being employed as PA faculty for a mean of 12.4 years [11.2, 13.7 years]. Most respondents (68.1%; [59.7, 76.6]) reported 0 peer-reviewed research articles regardless of number of years as faculty. Few reported an interest in research (22.3%; [14.3, 29.9]) or felt internally driven to perform research (35.4%; [26.6, 44.2]). Most pursued a faculty position to teach (78.1%; [70.5, 85.7]) and spent little time pursuing research. Only 15.8% ([9.7, 21.9]) received research mentorship. This study identified lack of interest in research by faculty and lack of mentorship engagement as important factors underlying the profession's poor scholarly output. Initiatives to increase scholarship must first focus on fostering individual interest and increasing motivation.

Exercise Prescription Related Coursework in Physician Assistant Program Curricula in the United States

Exercise Prescription Related Coursework in Physician Assistant Program Curricula in the United States

Family Matters: The Importance of Creating and Disseminating Inclusive Parental Leave Policies for Physician Assistant Programs.

Family Matters: The Importance of Creating and Disseminating Inclusive Parental Leave Policies for Physician Assistant Programs.

The Fate of Entrustable Professional Activities After Graduation: A Survey Study Among Graduated Physician Assistants.

Entrustable professional activities (EPAs) are used during training but may also have significance after graduation. This domain has not yet been much explored. We investigated the use of EPAs among alumni of Master Physician Assistant programs in the Netherlands, where EPAs have been used since 2010. We aim to describe if and how EPAs have a role after graduation. Are EPAs used for continuous entrustment decisions or when shifting work settings? In September 2020, all registered Dutch physician assistants (PAs) ( n = 1441) were invited to participate in a voluntary, anonymous survey focusing on the use of EPAs after graduation. Survey items included questions regarding the use and usefulness of EPAs, views on continuous entrustment decisions, and how PAs document their competence. A total of 421 PAs (response rate 29%) yielded information about the significance of EPAs after training. Among the respondents, 60% ( n = 252) reported adding new competencies and skills after graduation. One-third ( n = 120) of the respondents were trained in EPA-based programs. Almost all EPA-trained PAs (96%; n = 103) considered the EPA structure suitable to maintain and renew entrustment. Furthermore, PAs reported continued use of the EPA framework to seek formal qualifications through entrustment decisions. This study shows that EPAs can play an ongoing role for PAs after graduation. EPA-trained PAs overwhelmingly support the continuous use of the EPA framework for entrustment decisions from graduation until retirement.

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.

ENHANCING TELEHEALTH CLINICAL SERVICES AND CHRONIC DISEASE SELF-MANAGEMENT FOR OLDER ADULTS DURING COVID-19

Abstract During the pandemic, providers shifted to telemedicine to ensure patient safety. Under a federally funded cooperative agreement, the Florida State University College of Medicine’s Department of Geriatrics partnered with a Federally Qualified Health Center to assess rural older adults’ perceptions about telehealth and identify potential barriers. The quality improvement study used a convenience sample to survey patients aged ≥ 65 (n=62) at one rural clinic. 54.8% of respondents indicated they would not use telehealth for any care or preferred to receive most or all care in person. Conversely, 32.8% indicated a willingness to receive some care via telehealth. The survey also assessed the need for self-management devices, including blood pressure cuffs. There was not a consistent positive relationship between persons requesting devices and those who were telehealth willing. Devices were distributed to enhance telehealth visits and at-home monitoring. Clinic staff provided patients hands on training for device use and connection to EMR. Informal qualitative reports suggest patients are more empowered to utilize telehealth services and self-manage conditions. COVID-19 also limited access to community blood pressure screenings. The Tallahassee Senior Center and FSU Physician Assistant program distributed devices to community-dwelling older adults. PA students provided hands on training to aid in device familiarity and digital connectivity. Almost all older adult participants aged &amp;gt;60 strongly agreed “after the presentation I feel ready to use the blood pressure cuff at home.” Clinical and community-based activities can help older adults who lack digital fluency feel more confident in using telehealth services and self-management devices.

Association Between Stress and Program Length in Underrepresented Minority Physician Assistant Students.

The purpose of this study was to determine if there was a relationship between physician assistant (PA) program length and stress measures in PA students, particularly PA students classified as underrepresented minorities in medicine. The stress measures included emotional and physical well-being. The 2019 End of Program survey data were analyzed using multiple regression to determine if emotional and physical well-being could be predicted by PA program length, age, gender, PA school debt, and UR minority in medicine status. Shorter PA programs were associated with higher physical well-being scores, although there was no difference between UR minority in medicine and non-UR minority in medicine students. Older students, males, and students with higher levels of PA school debt had lower scores for emotional and physical well-being. Shorter program lengths should be considered for optimal physical well-being in all students. Further research is needed to understand optimal program length and experiences of these students .

Assessing the Utility of Mental Health First Aid Training for Physician Assistant Students.

Physician assistant (PA) students are at increased risk for anxiety and depression compared with the general population. The demands of studying medicine can contribute to a decline in mental health, which may impede a student's ability to progress in his or her PA program. Mental Health First Aid (MHFA) is one strategy that can be used to increase mental health literacy, promote help-seeking behavior, reduce stigma, and improve confidence in providing help to individuals showing signs of a mental health disorder. The aim of this outcomes assessment was to assess PA students' satisfaction with the MHFA course and their posttraining confidence in using the skills learned. Participants were PA students (N = 435) across 9 PA programs in their didactic year of training who had completed an MHFA course through the PA Foundation's Mental Health Outreach Fellowship. MHFA postcourse evaluations, completed by the PA students, were analyzed to determine PA students' satisfaction with the course and their posttraining confidence in using the skills learned to help both themselves as well as the general population. The mean of the MHFA course evaluation items corresponding to satisfaction with the course was 4.82 (maximum score of 5), and the mean of the items corresponding to posttraining confidence in using the skills learned was 4.74 (maximum score of 5). When asked, "Would you recommend this course to others?" 99.3% of the PA students trained in MHFA answered "yes," indicating a high level of satisfaction with the training they had received. PA students who received MHFA training from the PA Foundation's Mental Health Outreach fellows showed high levels of satisfaction with the MHFA course and posttraining confidence in using the skills learned.

An Examination of Predictors of Attrition in Physician Assistant Programs

The purpose of this study was to explore the relationship between program characteristics and attrition rates. Program graduation rates, attrition rates, and Physician Assistant National Certifying Examination (PANCE) pass rates were extracted from program websites from February-March 2021 and summarized for 2018, 2019, and 2020. Means were compared across categories of independent variables. Attrition rates and PANCE pass rates were correlated. Prerequisites and attrition rate were evaluated with multiple regression. Mean attrition rates varied little across years. Significant differences in mean attrition were limited to a few US Census Bureau regions or divisions. No significant correlation between the total number of prerequisite courses or total prerequisite credits and attrition existed. In 2020, mean attrition rate was statistically significantly greater when biochemistry was required (M = 6.89, SD = 7.04) than when not required (M = 4.91, SD = 4.75) and was statistically significantly lower when an additional chemistry course was required (M = 3.65, SD = 4.00) than when not required (M = 5.93, SD = 5.82). No significant predictors of attrition were found with regression. The mean attrition rates have been relatively stable from 2018-2020, suggesting that the presence of prerequisite coursework has no significant impact on attrition rates. This suggests that specific prerequisites may not predict success in a program, supporting the idea of decreasing or eliminating prerequisites. Additional studies are needed to understand the factors, including specific combinations of prerequisites, that predict completion of a physician assistant program.

Physician Assistants' Training and Self-Perceived Competencies to Work with Survivors of Intimate Partner Violence.

The purpose of this research was to assess physician assistant (PA) education and training on the diagnosis, management, and treatment of survivors of intimate partner violence (IPV), as well as perceived current vs. desired skills in tasks related to the management and treatment of IPV. Participants in 2 studies included a convenience sample of attendees at an annual PA conference (study 1) and PAs in the United States who were randomly selected to be administered an online survey related to their PA practice (study 2). In 2 studies, PAs reported low perceived competence to treat and manage patients who are survivors of IPV. More than half of the respondents (51.2%) had received training to work with survivors of IPV. Almost 3 in 5 indicated that they felt adequately prepared, and almost 3 in 10 regularly asked patients about IPV. Gaps between current and desired perceived skills to treat and manage survivors of IPV were larger among PAs who had previous training related to IPV compared with PAs with no prior training. Guidance for PA educators may improve PA education and increase competencies among new PAs. Without more substantial guidance from an accrediting body, PA programs are left responsible for implementing IPV curriculum. Professional associations as well as constituent and specialty organizations that provide continuing medical education have an equally important role in strengthening skills and abilities among PAs.

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.

Physician Assistant Program Perseveres Through COVID-19 Pandemic.

The COVID-19 pandemic has disrupted almost every aspect of life globally, with higher education one of many direct targets. Institutions and educators have been faced with urgent crises of how to conduct business as usual while maintaining expectations of high standards and uncompromised goals. As physician assistant (PA) educators at Seton Hall University, we rallied and brainstormed approaches to daily instruction to keep students on track and faculty both effective and sane. We tapped technological resources offered by our university, learned countless new skills, and adapted classroom activities to online virtual platforms. Creativity and flexibility became the norm as we modified the way we did everything while remaining laser focused on the ultimate objectives. Our intention was to provide insight, motivation, and, at a minimum, an example of how to do things differently when faced with roadblocks. We were inspired by an editorial by Mary Jo Bondy, DHEd, MHS, PA-C, former CEO of the Physician Assistant Education Association, in which she called for collective innovation, collaboration, publication, and circulation of stories. With that charge, we assembled a detailed account of how a didactic team within our faculty maneuvered the challenges created by COVID-19, in hopes of adding to the arsenal of small triumphs in this uncharted territory.

Multi-Institutional Physician Assistant Student Perception of Simulated Emergency Room Cases.

During clinical experiences, physician assistant (PA) students are required to participate in the management of multiple patients simultaneously. One method of preparing students for clinical experiences is through the use of simulation. Simulation allows development of decision-making and teamwork skills. 1,2 A previous study of nursing students in a multiple-patient simulation demonstrated improved student readiness to care for multiple patients. 2 The present study evaluated the effect of using simulation on PA student comfort with managing multiple patients in an emergency room setting. Four PA programs participated in this quasi-experimental pretest-posttest design. Four simulation days were held, each with 4 standardized cases. Half of the students acted as standardized patients, while the remainder of the students managed patients in small groups. Surveys were administered before and after the emergency medicine course. Descriptive statistics and statistical analysis for significance were performed using Excel and SPSS. Posttest results indicated significant improvement in student confidence in emergency scenarios, ability to perform a focused medical history, ability to choose and interpret laboratory values, time management, prioritizing patients in a simulated environment, and selecting appropriate treatment. Students reported satisfaction with the experience, feedback, and debriefing. Participation in these simulations increased student interest in pursuing a position in emergency medicine upon graduation. In clinical rotations, PA students are expected to manage multiple patients with a variety of conditions. In this study, students were initially uncomfortable managing multiple patients. Student comfort increased after a simulation experience. Increased opportunities for students to select appropriate diagnostics and treatment may increase their overall comfort in management of patients during rotations.

Successful Development and Implementation of a Large Virtual Interprofessional Education Activity Applying the Social Determinants of Health.

Interprofessional education (IPE) activities provide students insight into healthcare teams, shared decision-making, and social determinants of health (SDOH). Virtual IPE activities with large student populations or across multicampus have not been evaluated. The study aimed to explore the interprofessional competency growth in students, across several disciplines, following participation in a large-scale, virtual IPE activity. Students from pharmacy, medicine, social work, and physician assistant programs across Tennessee participated in an IPE patient case and SDOH in fall 2020 and fall 2021. Pre- and postsurveys included Likert ranking of 16 statements based on the 2011 Interprofessional Education Collaborative (IPEC) framework. A total of 607 students completed surveys (overall response rate, 76%). Wilcoxon signed-rank tests were performed on the pre-/postsurvey data, in aggregate and by discipline. Significant increases in all IPEC competency statements were seen, both in aggregate (100% of statements with p < 0.001) and in pharmacy (100% of statements with p < 0.001) and medicine subgroups (94% of statements with p < 0.001). Implementing large virtual IPE activities involving a complex patient case and SDOH significantly increased student IPEC competency outcomes for participating students, whether in aggregate or on a discipline-specific basis.

A Look into Motivations and Barriers to Student Involvement at the SHARING Clinic, a Student-Run Free Clinic

Background: The University of Nebraska Medical Center (UNMC) is the host of a student-run free clinic (SRFC) called SHARING (Student Health Alliance Reaching Indigent Needy Groups) which has been serving uninsured patients in the Omaha metro area since 1997. Interprofessional student volunteers from medicine, pharmacy, nursing, medical laboratory science, physical therapy, and physician assis-tant programs operate under the supervision of an attending physician at each clinic. As a quality improvement project regarding volunteer recruitment, a survey of students was undertaken to de-termine the motivations and barriers to participation at SHARING.&#x0D; Methods: An anonymous, web-based survey hosted on Microsoft Forms was sent once to current UNMC students using their institutional email addresses. The survey included Likert scale as well as open- and closed-ended questions. Themes were identified in the responses to the open-ended ques-tions and tallied.&#x0D; Results: Out of 1,310 students surveyed, 137 participated for a response rate of 10.5%. Of those who responded, 65% had previously volunteered at SHARING, and their top motivators included gaining clinical experience and helping people in need of free healthcare. Likert scale questions indicated that volunteers were satisfied with their experiences and improved their empathy, clinical reasoning, and interprofessional skills. Of those who had not participated at SHARING, the top barriers were reported to be lack of time for volunteering and feeling inadequately prepared to offer medical care.&#x0D; Conclusion: Decreasing barriers to participation is important for a successful SRFC to be staffed by busy student volunteers. Suggestions for improved participation included a more detailed training program, more flexibility in clinic scheduling, academic incentives such as awards/recognition, and prioritization of advertising efforts. Due to the limited number of respondents to this survey, a wider study may give more detailed feedback that could lead to further quality improvement measures.

A cross-sectional survey of German PA employment and workforce entry.

The contribution of physician assistants (PAs) to the German healthcare workforce has increased significantly since their introduction in 2005. From five training programs, the number has increased to the current 18, with 560 PAs awarded the PA bachelor of science degree as of 2020. Despite the growth, researchers lack systemic and reliable empirical data that provide insight into the German PA educational and professional profile. The German University Association Physician Assistant (DHPA) undertook the first nationwide cross-sectional survey on PAs in Germany to understand the German PA movement. This survey aimed to describe German PAs' entry into the profession and PA educational and job satisfaction. PA alumni of all universities affiliated with the DHPA and all subscribers of the Facebook online social media platform PA Blog were invited to complete an online questionnaire. Of the 282 PAs who completed the survey, 77% were female and under age 25 years. Almost all (94%) were employed, predominantly as PAs (91%, 241 of 265), although some held other positions. Most worked full time (87%), with some citing child-care needs as reasons for part-time employment (n = 21). Few reported unemployment (1.4%, 4 of 282). Eighty-two percent said they would probably or very likely choose the same course of study again. Most employed participants found the inclusion of frequent rotations between didactic and clinical training in PA programs beneficial. However, a small number of participants (26.8%) agreed that German PA programs' didactic and clinical teaching objectives were well aligned. German PAs have a high level of satisfaction with their profession and report low unemployment. Improvement in the alignment of didactic and clinical educational objectives to improve academic qualifications and satisfaction emerged as an area of research.

Didactic Physician Assistant Students’ Perceptions of Evidence-Based Medicine Resources: A Preliminary Investigation

Evidence-Based Medicine (EBM) instruction is required for physician Assistant (PA) students. This pilot study surveyed didactic PA students at three geographically diverse PA programs at the end of their didactic EBM course to understand which attributes of EBM resources they find most and least useful, and their self-efficacy in searching and appraising medical literature. Thematic analysis identified the most important student-reported attributes of a resource. PA students in this sample preferred UpToDate and PubMed as their top EBM tools based on attribute ratings. However, each database included in this pilot study received positive feedback, despite a low usage rate across institutions. The most important attributes were ease of use/search, information presentation, and conclusion/critical appraisal skill. After one EBM course, on average, students rated their self-efficacy searching the literature and appraising the literature as “moderately confident.” This suggests that instructors and librarians have an opportunity to expose students to more tools as well as encourage “the right tool for the right job.”

Review of an Initial Physician Assistant Training Program Orthopaedics Course Curriculum Using Kern's 6-Step Process

Graduating an average of 169 graduates per year, the Interservice Physician Assistant Program (IPAP) is the largest physician assistant training program in the world. The IPAP orthopedics course is a 4-credit hour course that started as approximately 60 hours of lecture, 9 hours of laboratory practice to prepare for an Objective Structured Clinical Examination, and 4 hours of splinting laboratory. After several cohorts performed poorly on the second block exam and student critiques voiced the need for course revision, the curriculum committee formed a sub-committee to review the course content and structure. The primary course instructor was familiar with Kern's 6-step approach to curriculum development and proposed using the Kern’s approach for the curriculum review and revision. This article aims to demonstrate the use of Kern's 6-step approach for review and revision of an introductory orthopedic course curriculum. This article shows how an IPAP curriculum sub-committee executed the 6 steps of the Kern’s process: (1) problem identification and general needs assessment, (2) targeted needs assessment, (3) development of goals and objectives, (4) development of educational strategies, (5) implementation, and (6) evaluation and feedback. To our knowledge, this is the first example of a physician assistant program using Kern's 6-step process to revise a curriculum. Thus far, the revisions show a positive change, indicating that other physician assistant programs could conduct similar reviews using the Kern’s 6-step approach.

The Oregon Wellness Program: Serving Healthcare Professionals in Distress from Burnout and COVID-19

ABSTRACT Clinicians are reluctant to seek mental health services. They fear loss of livelihood and disciplinary action. The Oregon Wellness Program (OWP) is a state-wide consolidated mental health initiative formally established in 2018 as a physician, physician assistant, acupuncturist, and podiatrist program. OWP is self-referral, not-mandated, strictly confidential, and free. Reporting to oversight bodies is forbidden. Utilization increased from 228 clients to 349 clients (a 53% increase) and 405 visits to 625 visits (a 54% increase) from 2019 to 2020 respectively, coinciding with the first COVID-19 pandemic surge. Between April 2019 and the end of August 2020, 41 of 433 (9.5%) individuals who were provided mental health services returned 77 program evaluation surveys, indicating satisfaction with the program (96%), its helpfulness to them personally (99%), and changes made in their personal lives (80%). The burnout response rate fell with increased visits and reallocation of activities within their practices increased (39%). A survey of mental health professionals corroborated positive results of their clients. The OWP can serve as a model for healthcare professional support programs. Collaboration among healthcare organizations, professional, and oversight bodies is essential. Increasing sustainable funding to pay for expanding services for dentists and nurses, assuring access for rural clinicians, and developing research tools to capture a more robust sample of responses remain priorities.