Physician Assistant Programs Research Articles

Assessing Student-Reported Perceptions of Prerequisite Usefulness in Preparation for Didactic Physician Assistant Education.

To gain admittance to a physician assistant (PA) school, applicants must complete program-specific prerequisite courses and experiences. The lack of standardization contributes to complexity, expense, and limits diversity. This research assessed current didactic PA students' perceptions of prerequisite courses, course delivery methods, and direct patient care (DPC) experiences to determine which were perceived as the most useful in preparation for didactic PA education. An online cross-sectional survey was sent to eligible PA students across the United States. The survey collected opinions on the usefulness of commonly required prerequisite courses, course delivery methods, and DPC experiences. Collected data underwent statistical analysis and qualitative analysis for open-response questions. A total of 527 students completed the survey. Greater than 50% reported prerequisite courses in science and psychology as well as speech, ethics, cardiopulmonary resuscitation (CPR), medical ethics, medical terminology, and nutrition "prepared them well" or "extremely well." The most frequently recommended educational delivery method was "in person." The DPC experiences reported to best prepare students were Medical Assistant, Certified Nursing Assistant, and Scribe. The reported recommended number of DPC hours was 1000 to 1499. Chi-square tests for courses that prepared students "well" and "extremely well" revealed that in-person delivery had a statistically significant association with anatomy, physiology, ethics, CPR, medical ethics, and Spanish. These significant findings should be considered by PA programs when evaluating their requirements for admission. Furthermore, PA education associations should consider universal requirements to reduce applicant barriers, complexity, and expense, which may lead to improved diversity.

Expressing the Complexities of the Student-Cadaver Relationship Through Visual Artwork.

Many physician assistant (PA) students first encounter death in the earliest days of their training when working with cadavers in the gross anatomy laboratory. Developing a deep knowledge of human anatomy is fundamental to health profession training programs and modern medical practice. Despite decreased laboratory hours and integration of technology and diagnostic imaging into modern anatomy courses, there remains value in the cadaver dissection experience. Medical learners experience diverse and complex feelings toward cadavers; learning to regulate one's personal responses within the anatomy laboratory is a skill that can be extrapolated to clinical practice. Art is one way for students to process their experiences with cadavers, and creating art for cadaver memorial ceremonies is an opportunity for student emotional processing while honoring the lives of their cadaveric teachers. A PA program in New England incorporated student art into a cadaver memorial ceremony, with 4 pieces of artwork and corresponding artist statements from that ceremony included in this piece. The works of art are visually diverse, but there is a shared sentiment in the artist statements of reflection, awe, appreciation, and humanity. Encouraging students to process complex experiences artistically may provide an enduring practice throughout a career in medicine.

Students’ Experiences with Interprofessional Service-Learning Global Health Education Pilot Program in Ghana

Interprofessional service-learning programs can help to break down the education and training silos between public health and health care in the United States. This paper describes the development and implementation of one such program between the University of Massachusetts, Amherst, School of Public Health and Health Sciences, Bay Path University Physician Assistant Program, and the Wa-West Health District in Ghana. The program brought together Master of Public Health students and Physician Assistant students to complete an applied practicum and training experience in a low-resource community that faces significant health care and public health delivery challenges. In 2017 and 2018, nine students participated in the two-year pilot program, UMass Amherst Interprofessional Integrated Service Learning and Community-Based Participatory Collaboration. Students completed projects designed by Ghanaian health officials over two summers in direct collaboration with the communities. Findings from the evaluation of the pilot program revealed that though the students faced some challenges with the program, such as language barriers, transportation issues due to poor roads, and difficulty scheduling meetings while completing their projects in Ghana, the majority described their experience as positive and were satisfied. Some expressed the idea that their experiences were something that they could incorporate into their current and future practices. In addition, they reported that interprofessional communications and collaborations were effective. Recommendations are offered to address the program’s challenges for its continuation and formalization.

Teaching empathy: comparison of a virtual reality experience using head-mounted display versus group streaming

ABSTRACT Empathy, an integral component of bedside manners, correlates with good healthcare provision. Training physician assistant (PA) students using Head-Mounted Display (HMD) virtual reality (VR) contributed to significant empathy increases. This pilot study, which relied on a retrospective analysis, compared a VR experience using HMD to a streamed modality (due to COVID safety) with PA students to measure empathy. We hypothesized that fully immersive and interactive HMD VR would lead to a statistically significant increase in empathy versus the streaming modality. The “Alfred Lab” VR allows viewers to “embody” a 74-year-old African American man with vision and hearing loss. The University of New England PA class of 2021 (n = 47) completed the HMD lab while the class of 2022 (n = 50) viewed the streaming modality as a group. Identical pre/post surveys were completed by each cohort. The analysis utilized paired sample t-tests, ANOVA, frequency analysis (quantitative), and content analysis with thematic coding (qualitative). The results for each cohort revealed a statistically significant increase in empathy (p < 0.05) after completing the VR lab (pre- to post-test results). The comparison of both cohorts (HMD versus group streaming) revealed no noteworthy difference. Streaming VR could improve access to PA programs unable to acquire expensive VR equipment yet still allow for the development of empathy.

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.

Non-native English-speaking applicants and the likelihood of physician assistant program matriculation

ABSTRACT Purpose Effective communication is critical in patient care. Multilingual medical providers, including Physician Assistants (PAs) can contribute to improved health care among patients with limited English proficiency; however, this is contingent upon matriculating multilingual providers. In this study, the association between prospective applicants’ self-reported English as second language (ESL) status and their likelihood of matriculation into a PA program was investigated. Methods Participants included applicants to five admission cycles of the Centralized Application Service for Physician Assistant from 2012 to 2020. Logistic regression was utilized to investigate association between applicant ESL status and odds of program matriculation in both bivariate and multivariable regression models. Models were adjusted for citizenship status, undergraduate grade point average, gender, age, race/ethnicity, number of programs applied to, and patient care hours. Results In unadjusted and adjusted models, ESL status was associated with a significantly lower odds of matriculation to a PA program across all study years. In adjusted multivariable models, associations were strongest for 2014–2015 where ESL status was associated with a 35% lower odds of matriculation (odds ratio 0.65, 95% confidence interval 0.56, 0.76) when controlling for demographics, citizenship status, patient care experience, and academic achievement. In sensitivity analyses restricting to (a) those with TOEFL scores ≥ 100, and (b) restricting to those ESL applicants without TOEFL scores, we did not observe important changes in our results. Conclusions Results indicated that non-native English-speaking applicants have lower odds of PA program matriculation. Decrements in matriculation odds were large magnitude, minimally impacted by adjustment for confounders and persistent across the years. These findings suggest that PA program admission processes may disadvantage non-native English-speaking applicants. While there are potential explanations for the observed findings, they are cause for concern. Matriculating and training PAs who have language concordance with underserved populations are important means of improving patient outcomes.

An Analysis of Mental Health Representation in the Technical Standards of Physician Assistant Programs.

The purpose of this descriptive research project was to examine the technical standards of physician assistant (PA) programs for mental health keywords, phrases, and themes. Each program's standards were analyzed, and keywords, phrases, and major themes were extracted and compared. The results demonstrate that most US PA programs include language related to mental health in their technical standards including theme areas of emotional health, emotional stability, mental health, emotional well-being, and stress management. No patterns between the wording of mental health content and accreditation status emerged. Given the increasing proportion of mental health diagnoses among the general population, and, by extension, applicants to PA training programs, institutions are encouraged to re-evaluate their technical standards to ensure they remain current and appropriate and contain language inclusive of mental health domains such as emotional stability, emotional health, and stress management.

Time to Pivot: A Guide to Holistic Admissions.

As an ever-increasing number of physician assistant (PA) programs moves toward holistic admissions, a better understanding of how to achieve their stated admission goals becomes more important. With the June 2023 US Supreme Court decision effectively ending affirmative action in higher education, navigating holistic admissions is now an even greater challenge. In this article, the PA Education Association's Presidents Commission offers a guide for programs to use in implementing holistic admissions at their institutions and key considerations. Is the process mission-driven? Does it follow principles of quality improvement and incorporate ongoing assessment of that process? Using data can be a constructive and insightful way to inform the process. The authors hope that tools, resources, and recommendations offered in this article will serve as valuable resources for any program attempting to institute or improve its holistic admissions process.

The prevalence of ultrasound curricula in a sampling of U.S. physician assistant programs and recommendations for common ultrasound objectives: A national survey.

An increasing number of practicing physician assistants (PAs) are using ultrasound (US) in clinical settings. However, a lack of US learning objectives for PA students limits the optimal integration of this imaging modality in PA curricula. This study surveyed PA program directors across the United States to create a list of US learning objectives for PA students and to gauge their attitudes toward integrating US into anatomy curricula. Thirty-one of the 280 PA program directors responded to the survey. While 87% of participants reported that their institution includes ultrasound in its curriculum, 71% disagreed that the state of the use of ultrasound throughout their PA curriculum is fine and needs no modification. Based on the responses of the survey participants, this study categorized US learning objectives into high, medium, low, and no agreement for integration in PA curricula. As over half of the learning objectives (73%, 43/59) had high agreement for inclusion in curricula, this study demonstrates an opportunity for educators to include US in PA curricula.

Perceptions of Adult Obesity Education: A Pilot Study.

This pilot research study, conducted at a large academic healthcare facility, used mixed methodology to (1) administer a survey to a group of primary care trainees and faculty and (2) conduct key informant interviews with the program directors, or their delegates of these primary care training programs, so as to gain insight into respondents' perceptions about their training on adult obesity. To maintain confidentiality of the key informants, they were defined as "Administrators." Faculty and trainees were from family medicine and internal medicine residency programs, as well as family nurse practitioner and physician assistant training programs. This study used a quantitative survey and four qualitative key informant (Administrator) interviews. Descriptive statistics, χ2, or Fisher exact tests were used to analyze select survey responses. Administrator interviews were analyzed with thematic analysis. Survey respondents (n = 75) included primary care trainees (n=34), faculty (n=30), other (n=2), did not answer (n=9). Surveys indicated that additional training is needed for bariatric surgery, weight loss medications, and clinical nutrition. The three highest ranked topics in the surveys on adult obesity were basic nutrition, behavioral weight management, and a rotation on adult obesity. Most agreed on the need for interprofessional collaboration, a centralized obesity treatment center, and an introductory obesity course. Key themes from the four Administrator interviews revealed the need: for more training; to build upon current curriculum; use innovative technology; fiscal challenges; and time management. Both faculty and trainees perceive that academic and clinical training on adult obesity is inadequate, and that trainees need more education on such topics as nutrition, physical activity, behavioral health, antiobesity medications, and bariatric surgery. Competency to treat varied by topic. It also showed that more interprofessional collaboration and a centralized obesity treatment center are needed. Recommendations included integrating modular units about obesity into already established primary care training programs and providing additional resources.

The Relationship Between Unprofessional Social Media Posts and Personality Traits Made by Physician Assistant Students.

Research has indicated that physician assistant (PA) students use social media in their medical education; however, research is scant on whether PA students use social media unprofessionally. This study aimed to determine if PA students badmouth others or post pictures or comments depicting substance use and whether a relationship exists between personality and unprofessional posts. PA Program Directors were emailed and asked to disseminate an anonymous survey to their students. The survey included descriptive questions, questions regarding badmouthing and substance use posts, and the Mini-International Personality Item Pool. Data analysis included descriptive statistics, Spearman's correlation coefficient, and Mann-Whitney U with p < .05 indicating significance. Recruitment resulted in n = 497 participants. Clinical year students made significantly more alcohol-related posts than didactic students (p = .01) and were significantly less conscientious (p ≤ .01). Didactic students badmouthed professors significantly more than clinical year students (p < .05). Females made significantly more alcohol-related posts (p ≤ .01); however, males badmouthed friends more (p = .02). A statistically significant relationship was identified between extraversion and all types of badmouthing (p < .05), alcohol-related (p < .001), and recreational drug (p = .02) posts, and between neuroticism and badmouthing professors (p = .02); conversely there was a significant negative correlation between conscientiousness and badmouthing professors (p = .01). Medical educational programs should address professionalism concerning social media with a program policy to encourage a professional and ethical digital profile.

Utility of Noncognitive Admission Variables in the Prediction of Academic Success

Background: Graduate healthcare education programs commonly rely on cognitive measures such as grade point average for admission to their programs. Noncognitive measures are also collected at the time of application, with less information known about their utility in prediction of academic outcomes. This analysis observed the following noncognitive admission domains and their relationship with PA student academic success: employment hours, shadowing experience hours, research hours, hours spent in extracurricular activities, healthcare related activity hours, leadership experience, patient care experience hours, teaching hours, and volunteerism hours.&#x0D; Objective: This archival analysis aims to determine if noncognitive admission variables are predictive of Physician Assistant National Certifying Examination (PANCE) failure or academic attrition at a West Texas Physician Assistant (PA) Program.&#x0D; Methods: Institutional Review Board exemption was obtained; then a series of univariate logistic regression models were constructed to predict using applicant self-reported cumulative experience hours. Five cohorts (n=235) were evaluated by noncognitive variables using R statistical software (version 4.1.2).&#x0D; Results: Patient care experience hours showed a positive association with PANCE failure, while healthcare and teaching experience had positive trends with attrition. High GPA was protective against attrition when controlled for employment, research, and shadowing experiences, and also when controlled for leadership and patient care experience. High GPA was not a protective factor for PANCE failures.&#x0D; Conclusion: Contrary to our hypotheses, increased self-reported experiences did not show a protective effect against PANCE failure or attrition but were instead detrimental.

Developing Disability-Focused Pre-Health and Health Professions Curricula

People with disabilities (PWD) comprise a significant part of the population yet experience some of the most profound health disparities. Among the greatest barriers to quality care are inadequate health professions education related to caring for PWD. Drawing upon the expertise of health professions educators in medicine, public health, nursing, social work, and physician assistant programs, this forum showcases innovative methods for teaching core disability skills and concepts grounded in disability studies and the health humanities. Each of the essays offers practical guidance for developing curricular interventions appropriate for students at various levels of training and familiarity with disability to be implemented in classroom discussions, case-based learning, lectures, panels, and clinical simulations across the full spectrum of pre-health and health professions education.

Physician Assistant Student Attitudes About People With Serious Mental Illness.

This study explored the attitudes of physician assistant (PA) students toward the future care of individuals with serious mental illness (SMI). Physician assistant student education offers a unique opportunity to confront and reduce bias toward individuals with SMI. However, no previous literature has documented PA student attitudes toward SMI. Preclinical students (n = 7) from a single PA program were invited to participate in 2 focus groups exploring attitudes toward the future care of patients with SMI. The focus groups lasted approximately 60 minutes and were conducted by non-PA faculty using a question guide. Four themes emerged from interviews: perceptions about the population, knowledge of mental health conditions, approach to care, and program curriculum input. Several themes aligned with the participant's level of training. Participants demonstrated didactic knowledge yet lacked clinical exposure to provide context. Future studies should focus on developing interactive learning techniques to prepare students for patients with SMI.

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.

Development of a Needs Assessment for Low-income Seniors in Cleveland Ohio: A student-driven Interprofessional Approach.

Older persons with low socioeconomic status in the United States have different and unique health needs compared to younger persons. As part of a student-led, interprofessional partnership, we performed a needs assessment of community dwelling older persons with low socioeconomic status in an urban location within Ohio, USA. Three entities participated in the needs assessment: a student-run health clinic, a Federally Qualified Health Center, and an apartment complex of the study population. Health professional students from medical, dental, nursing, social work, nutrition, and physician assistant programs led the needs assessment process. The process consisted of multiple phases, which included preliminary literature review, survey development, data collection, and analysis. The final survey was multidisciplinary, with six content areas covered in 37 items. One hundred nineteen survey responses were received, and multiple areas of need were identified including food insecurity, dental care access, and mental health. 93% of participants had at least one unmet health need and 39% of respondents met our classification for high need. The needs of the local study population had key differences from previously published data in more generalized populations of older community-dwelling individuals in the United States, notably lower utilization of dental care (43% vs. 66%), increased prevalence of possible food insecurity (30% vs. 17%), and increased use of age-appropriate preventive cancer screening services. Multiple areas of need were successfully identified through a student-led interprofessional needs assessment. Future student teams can address the identified needs, again through interprofessional collaborations. This process may have unique benefits to help build robust community-academic partnerships, while fostering interprofessional collaborative opportunities among healthcare students.

Impact of Integrated Pharmacology Instruction by Principal Faculty Pharmacists in Two Physician Assistant Programs: A Retrospective Study.

In recent years, there has been a growing trend toward integrating pharmacology instruction into physician assistant (PA) programs by dedicated PA faculty pharmacists. Pharmacists train to become medication experts. Incorporating pharmacist instruction in a PA program during the didactic year provides PA students with an early opportunity to experience interprofessional education and interdisciplinary synergy through clinical application. This article presents a retrospective study that aims to evaluate the impact of integrated pharmacology instruction by principal PA faculty pharmacists on student satisfaction and standardized assessment metrics. Student satisfaction was measured by course evaluations and exit/alumni surveys. Standardized metrics included Physician Assistant Clinical Knowledge Rating and Assessment Tool and Physician Assistant National Certifying Exam assessments. The findings indicate that having a principal faculty member with specialized expertise in pharmacology has improved the overall course satisfaction, knowledge, and competence of PA students and perceptions of the relevance and effectiveness of pharmacology instruction in their clinical practice. The results of this study support the value of using pharmacist faculty members in PA programs to enhance the quality of pharmacology instruction and ultimately contribute to the success of PA students in their professional careers.

Physician Assistant Gender Differences in Research, Professional Goals, and Perceptions of Support.

The majority of Physician assistant (PA) educators are women, yet men proportionately publish more and advance further in academic rank. This study examined if research interest, promotion goals, and perceptions of institutional support differed between PA educators with different gender identities. This is a subset analysis of a previously published cross-sectional study. PA programs were stratified by region and Carnegie classification and were sampled by a stratified random sampling method. PA faculty from selected programs were invited to participate in an anonymous survey. Data were analyzed to account for the stratified sample design. Means and proportions with associated 95% confidence intervals are described. There was a 51% response rate (N = 110). Sixty-three percent of respondents identified as female and 36% as male. Men had a mean of 5.67 (0.17, 11.16) career research articles and women had 1.56 (0.68, 2.44) articles. Fifteen percent (3.7%, 26.3%) of men were full professor compared to 4.3% (0, 9.1%) of women. When transitioning to a faculty role, 72.5% (58.4%, 86.6%) of men and 52.9% (41%, 64.7%) of women felt supported by their institution. Both genders valued promotion, but 80% (67.6%, 92.4%) of men reported having clear 5-year goals compared to 58.8% (46.6%, 71%) of women (P = .034). There was no statistical difference in publications between men and women in this study. Women felt less supported when transitioning to a faculty role compared to men. Both men and women valued promotion equally, but men reported working towards that goal more intentionally. This study found few consistent differences in the attitudes and behaviors towards scholarship between men and women.

Accreditation Outcomes: Does Program Director Experience Matter?

The program director (PD) is responsible for providing effective leadership and possessing knowledge of accreditation. The aim of this study was to evaluate whether a PD's experience in higher education affects the accreditation outcome. This cross-sectional study includes Physician Assistant (PA) programs that underwent an accreditation visit between January 2012 and January 2022. Data analysis was primarily descriptive, stratified by demographic variables, and outcomes of accreditation standards. Inferential analysis included chi-squared tests of statistical independence. The chi-squared analysis test of statistical independence of PD's experience and accreditation decision identified a statistically significant association between the PD's experience as a PD and the accreditation outcome for continuing reviews. However, a minimum of 3 years of experience in higher education and the accreditation outcome were statistically independent for provisional and continuing reviews. Few PDs are hired with more than 3 years of PD experience, but they tend to have more higher education or PA program educational experience. A PD's years of higher education experience was not associated with accreditation outcome, which may suggest that other supports are more critical for achieving and maintaining accreditation.