Physician Assistant Training Programs Research Articles

(138) ARE WE THERE YET? ASSESSING OUR CURRENT STATE OF SEX MED EDUCATION

Abstract Introduction Sexual concerns are prevalent, but studies have demonstrated that patients often feel most comfortable if the clinician initiates the conversation. Many patients are hesitant to discuss sexual concerns with their providers for a variety of reasons including fear of judgment, lack of clinician knowledge, and concerns that these issues are abnormal or unusual. Clinician education plays an important role in helping to facilitate these difficult conversations. However, there has never been a broad assessment of education across medical training programs, while the most recent assessment of MD training programs occurred approximately a decade ago. Objective We set out to create and administer a survey to assess sexual medicine training across most major medical disciplines where sexual health matters may be discussed, including nurse practitioner, midwifery, physician, and physician assistant training. Methods A subcommittee of the ISSWSH Advocacy Committee was formed with members representing the medical disciplines to be surveyed. A survey was developed to gather data on sexual medicine education offered at nursing, midwifery, physician, and physician assistant training programs. The survey included a series of questions regarding content taught during these programs (checklists, open ended responses). The survey was approved by the Wake Forest IRB and distributed using RedCap to various institutions from the above disciplines throughout the United States. Results We received a total of 33 complete responses. 88.5% of respondents stated they used traditional lecture as their teaching method, whilst only 11.5% used simulation, and 7.7% used actual mechanical models. The majority of programs that responded spent 3-5 hours total dedicated to human sexuality and sexual function education. Interestingly, respondents noted that faculty involved in sexual medicine education were mostly OB/GYN in background (63%), followed by family medicine (18.5%) and urology (18.5%). While not all respondents indicated that their students were assessed on their knowledge after teaching, it was noted that the majority of programs that did respond indicated that examination was the most common mode of assessment. Only 33% of institutions noted having a regional or nationally recognized expert in the field. Conclusion It is essential that the accrediting bodies for medical programs incorporate the input of international societies such as ISSWSH (in collaboration with other sexual medicine organizations) to formulate an official statement and recommendations for a standardized curriculum for sexual medicine.

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.

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.

Routes to Rural Readiness: Enhancing Clinical Training Experiences for Physician Assistants.

The purpose of this study was to describe practices and experiences of rurally oriented physician assistant (PA) training programs in providing rural clinical training to PA students. A survey of PA program directors (PDs) included questions about program characteristics, student and clinical preceptor (CP) recruitment in rural areas, and barriers to, and facilitators of, rural clinical training. Programs that considered rural training "very important" to their goals were identified. We interviewed PDs from rurally oriented programs about their rural clinical training and rural CPs about their experiences training PA students for rural practice. We identified key themes through content analysis. Of 178 programs surveyed, 113 (63.5%) responded, 61 (54.0%) of which were rurally oriented and more likely than other programs to recruit rural students or those with rural practice interests and to address rural issues in didactic curriculum. The 13 PDs interviewed linked successful rural training to finding and supporting rural preceptors who enjoy teaching and helping students understand rural communities. The 13 rural CPs identified enthusiastic and rurally interested students as key elements to successful rural training. Interviewees identified systemic barriers to rural training, including student housing, decreased productivity, competition for training slots, and administrative burden. Physician assistant students can be coached to capitalize on their rural clinical experiences. Knowing how to "jump in" to rotations and having genuine interest in the community are particularly important. Student housing, competition for training slots, and lack of financial incentives are major system-level challenges for sustaining and increasing the availability of PA rural clinical training.

Everybody Copes: An Interprofessional Workshop on Stress, Coping, and Helping Primary Care Patients Manage Medical Stressors.

The value of psychological principles has become apparent in medical settings, especially with the rise of patient-centered care. We aimed to provide a curriculum informing medical providers about the theoretical basis and clinical utility of the social-cognitive model of stress and coping. This workshop was delivered to an interprofessional team of faculty and trainees. Our initial pedagogical approach was to relate the concepts of cognitive appraisals and coping strategies to participants' own stress responses. We then used didactic presentation and small-group activities to explore ways to promote adaptive coping with patients to improve health outcomes. Learners participated in a mindfulness exercise, conceptualized coping strategies given a hypothetical case scenario, and, in small groups, role-played a patient encounter to construct an effective coping repertoire for the patient. Participants completed a prework self-assessment and workshop evaluation form. The 2.5-hour workshop had 48 participants from five professions (medicine, education, physician assistant, pharmacology, psychology). We received 35 evaluations (73% response rate). Learners reported increased real-world skills (M = 8.0 out of 10) and feeling better prepared for working in interprofessional settings (M = 7.6 out of 10). Qualitative feedback suggested that participants recognized the importance of individual differences in coping with stress and felt they could categorize strategies into emotion- or problem-focused coping. This workshop provided participants with basic knowledge about the social-cognitive model of stress and coping and allowed them to practice newly learned skills in a role-play as an interprofessional medical care team.

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.

Do Physician Assistant Training Programs Adequately Prepare PAs to Address Nutritional Issues in Clinical Practice?

The purpose of this study was to determine physician assistants' (PAs') current level of confidence to engage in nutrition-related tasks and their satisfaction with the nutrition education they received in PA school. To achieve this goal, a mixed-methods approach that consisted of 3 data collection phases (qualitative online discussions, quantitative survey, and qualitative interviews) was used to explore and measure PAs' perceptions of the education they received in PA school and through other sources and how confident they felt addressing nutrition-related issues in clinical practice. While 80% of PAs endorse the idea that PAs should be more involved in providing nutritional care to patients, the majority reported basic or no knowledge of the nutritional implications of chronic conditions (69%), inflammatory bowel disease (69%), nutritional needs over the lifespan (67%), and food allergies and intolerances (64%). Barriers to patient care included knowledge-related challenges when selecting lab tests based on patient profile (46%) and identifying needs based on various gastrointestinal diseases (67%) and when using diagnostic data to identify deficiencies (74%). Overall, 59% of PAs reported being slightly or very dissatisfied with the nutrition-related content in the curricula used to formally train PAs. The primary goal of every PA program is to prepare its graduates to be competent to enter clinical practice. Regarding nutrition, these data indicate that programs are failing to do so. PAs lack the confidence and ability to provide optimal nutritional care, which is staggering considering that nutrition is the first line of treatment in the prevention and management of numerous chronic diseases.

Interprofessional Leadership Development: Role of Emotional Intelligence and Communication Skills Training.

IntroductionAmong the many skills required for leading interprofessional health care teams, emotional intelligence and communication skills are critical to building professionalism, establishing patient trust, and providing optimal patient care. Nonetheless, these skills are often overlooked in medical training. We implemented a 2.5-hour workshop for interprofessional trainees to self-assess, reflect, and apply their emotional intelligence and communication skills.MethodsParticipants were interprofessional trainees, including internal medicine residents, medical students, and graduate students in clinical pharmacy, physician assistant, and health psychology training programs. The workshop consisted of reflective activities to self-assess emotional intelligence and communication styles; a didactic presentation focused on leadership, emotional intelligence, and communication styles; and a teamwork activity to apply emotional intelligence and communication skills.ResultsForty-four trainees participated in this workshop. After the workshop, trainees reported increased knowledge about positive strategies to communicate with team members, felt more comfortable working with other professionals to encourage positive team dynamics, and were more prepared to encourage leadership in their interprofessional teams. Examination of learner evaluations suggested that residents endorsed higher mean ratings than the other learner groups in knowledge attainment (p = .02) and meeting all learners' needs (p = .01).DiscussionThis workshop enhanced our trainees' self-reported comfort, awareness, and preparedness regarding using emotional intelligence and communication strategies. An interprofessional approach can be beneficial for leadership training in the health professions.

Attitudes Towards Mental Health Among Physician Assistant Students with Shared Living Experiences Through Synchronous Videoconferencing.

We tested the hypothesis that physician assistant (PA) students can benefit from exposure to senior PAs who share their living experiences with mental illness. First-year students from 5 PA programs were asked to participate in this mixed methods study. After completing a pre-activity survey, students from 3 programs participated in an intervention consisting of senior PA faculty sharing their mental health experiences, including treatment and recovery. A facilitated discussion followed, and students not exposed to the intervention served as controls. The qualitative component of the study was based on transcripts from 3 focus groups of students in the exposed group. We recruited 167 students from 5 PA training programs, 112 of whom (67%) completed baseline and endpoint assessments (37 in the exposed group, 75 in the control). The intervention resulted in significant improvements on the Opening Minds to Stigma (OMS-HC, p = 0.002, Cohen's d = 0.38) and Self-Stigma of Seeking Help (SSOSH, p = 0.006, d = 0.31) scales. Change in the OMS-HC was driven by its social distance (p = 0.003) and disclosure (p = 0.02) subscales. No comparable changes were found in the control group. We identified 3 overarching themes: 1) active elements of the intervention; 2) mutuality; and 3) peer relationships. Senior PAs sharing their lived experiences with mental illness proved to be an effective anti-stigma intervention for PA students. A candid, intimate, and confidential virtual learning space was feasible through synchronized videoconferencing. Our findings can inform programmatic interventions to address stigma, self-stigma, help-seeking behaviors, and the overall mental health of PA students.

Interprofessional Education Activities for Students in Physician Assistant, Clinical Psychology, and Athletic Training Programs Utilizing Aspects of Team-Based and Problem-Based Learning Practices.

Interprofessional education (IPE) allows two or more professionals to learn from one another through partnership to improve patient outcomes. Implementation of IPE varies within health profession programs and universities, requiring programs to develop IPE activities that adhere to specific learning objectives or accreditation standards. These activities were a preliminary investigation on the feasibility of IPE activities at an institution with no substantial IPE infrastructure. Students integrated aspects of team-based learning (TBL), problem-based learning (PBL), and didactic components into diverse simulated patient cases with health profession students to develop skills in interdisciplinary patient-centered care. Lessons learned and future directions are discussed.

Medical and Allied Health Students’ Knowledge About Nutritional and Immunological Properties of Breast Milk

Abstract Objectives This study was conducted to determine medical and allied health students’ knowledge of immunological and nutritional aspects of breast milk, and to assess the preferred method for continuing education to improve knowledge about breast milk. Methods A descriptive study was conducted using an anonymous online survey administered to undergraduate and graduate students in medical, nursing, nutrition/dietetics and physician assistant training programs at a Midwestern university. A 40-item questionnaire, delivered in Qualtrics, had 5 demographic items, 29 multiple choice or true/false items about immunological and nutritional properties of breast milk, and 6 items on educational resources. Content validity of the survey was established using input from one member of IBCLC and three Registered Dietitians. A survey link was distributed by e-mail to 1396 prospective participants. Frequencies of responses, cross-tabulations, and descriptive statistics were determined. Between group differences knowledge scores were analyzed using independent t-test and ANOVA with post hoc tests (P < .05). Results The response rate was 5.6%. The mean knowledge score of the 78 participants was 49.5% ± 6.8% out of 29 items. The nutrition/dietetics students had the highest mean knowledge score of 51% ± 5%, followed closely by those from physician assistant (50% ± 7%), medical (49% ± 7%), and nursing (48% ± 8%) disciplines. The differences in mean knowledge scores among the students were not statistically significant (P = .948). Overall, 67% of students reported that the preferred method for continuing education to learn about breast milk was through an online course, over attending a seminar/workshop (60%), course in a class (37%), reading journal articles (34%), attending a professional meeting (32%), or learning from books (20%). Conclusions The low scores demonstrated a deficit in knowledge regarding the nutritional and immunological properties of breast milk among both medical and allied health students. Improving knowledge in this area by taking an online course was the preferred method by both undergraduate and graduate students in these health care fields. Funding Sources Indonesia Endowment Fund for Education (LPDP)

Addressing an Unmet Need: the Development of a Postgraduate Physician Assistant Training Program in Psychiatry.

Addressing an Unmet Need: the Development of a Postgraduate Physician Assistant Training Program in Psychiatry.

Culturally Inclusive Online Learning for Capacity Development Projects in International Contexts

This paper explores cultural inclusivity in online learning design by discussing two international capacity development projects; an online tutor mentor development program in Sri Lanka and a hybrid physician assistant training program in Ghana. Inclusivity involves establishing partnerships and conducting needs assessments to maximize the capacity that already exists within a given context, and addressing cultural factors that impact online learning: developing a learning community, negotiating identity, power, and authority, generating social presence, supporting collaboration, engaging in authentic inquiry-based learning, navigating interactions in a second language, and developing co-mentoring relationships to support learning. The paper provides a framework, WisCom (Wisdom Communities) to guide the design of culturally inclusive online learning incorporating lessons learned from international projects. By emphasising divergent thinking, consensus building, and the exploration of multiple solutions to complex, real-world problems, WisCom maximizes opportunities for participants’ diverse backgrounds and experiences to be valued.

Adopting Graduate Competencies in Opioid Prescribing for Massachusetts Physician Assistant Programs: A Statewide Public Health Response

Opioid addiction has become a national epidemic. Morbidity and mortality from prescription and synthetic opioid use and abuse have increased at an alarming rate in recent years. Ensuring that physician assistant (PA) graduates have the knowledge to become safe prescribers of medications, including opiates, is a goal of PA training programs. Achieving that goal requires fostering PA student competence regarding current issues in pain control, drug use and misuse, polypharmacy, diversion, self-medication, and substance use disorder. We present a public health approach to addressing that need. Our approach involved developing consensus among the 9 PA programs in Massachusetts concerning the adoption and implementation of statewide, graduate core competencies for the prevention and management of prescription drug misuse. The process implemented in Massachusetts could be used as a model in other states and might be relevant to addressing other public health crises. We present the adopted competencies as well as individual PA programs' curricular approaches.

Response to: "Emergency Medicine Physician Assistant Postgraduate Training Programs: Program Characteristics and Training Curricula".

Response to: "Emergency Medicine Physician Assistant Postgraduate Training Programs: Program Characteristics and Training Curricula".

Commentaries on health services research

Commentaries on health services research

Policy effect on physician assistant education diversity

At the University of Washington's MEDEX Northwest physician assistant training program in Seattle, Wash., Vanessa Bester is assistant director and assistant professor and Keren Wick is an associate professor, director of research, and graduate programs, and director of academic outreach.

Burnout in Rural Physician Assistants: An Initial Study.

To assess the prevalence and causes of burnout in rural physician assistants. (PA in this article refers to personal accomplishment. To avoid confusion, we will spell out physician assistant throughout the article, instead of using PA to refer to both physician assistant and personal accomplishment.) Physician assistants who practice in rural communities were asked to complete the Maslach Burnout Inventory. A preliminary assessment of burnout was determined using the 3 Maslach Burnout Inventory subscale scores: emotional exhaustion, depersonalization, and personal accomplishment, as well as causes of burnout assessed for a correlation to personal and professional factors. Burnout within the rural physician assistant population responding to this survey (response rate = 11.3%) was measured to have high to moderate emotional exhaustion and depersonalization subscores (64% each) and a low to moderate personal accomplishment subscore (46%). The rural physician assistant population who responded to this survey exhibited burnout correlating to feelings of professional isolation and various workplace conditions such as the adequacy of administrative support and control over workload. To begin addressing burnout within this community, we suggest adjusting rural physician assistant workload and support, enhancing professional communications, and addressing burnout prevention techniques within physician assistant training programs.

Perceived efficacy and utility of postgraduate physician assistant training programs.

The purpose of this study was to explore graduates' perceptions of the efficacy and perceived utility of postgraduate physician assistant (PA) programs. Using an online tool, a survey was sent to postgraduate PA program graduates that contained demographic questions and descriptive questions examining the perceived utility of completing a postgraduate PA program. Surveys were e-mailed to 149 graduates of postgraduate PA programs; 113 responded (75% response rate). After completing postgraduate training, 97% of graduates felt their training made them more competitive in the job market; 74% believed time from orientation to full productivity was reduced; and 95% would recommend completion of a postgraduate training program. Completion of a postgraduate PA program is an alternative to on-the-job training. Graduates perceived that the benefits from these programs include increased competitiveness in the job market, decreased onboarding time, and overall enhancement of their professional careers.

The Benefits of a Physician Assistant and/or Nurse Practitioner Psychiatric Postgraduate Training Program

In 2008, Regions Hospital in Saint Paul, Minnesota, began an advanced practice psychiatric provider fellowship program. Our mental health department offers a 1-year postgraduate psychiatric training program for physician assistants (PAs) and nurse practitioners (NPs) interested in obtaining further expertise in psychiatry. This is one of three current programs in the USA that offers postgraduate training for PAs and was the first postgraduate program for NPs in the field of psychiatry. The students participate in a 12month program where the primary areas of focus are adult inpatient, crisis, and outpatient mental health services. Additionally, the fellows receive training in the management of substance abuse disorders as well as comorbid acute and chronic medical conditions. The motivation for developing this program was to increase access and expertise in treating psychiatric illness in the community, on inpatient psychiatric units, and outpatient clinics. The mission is to graduate PAs and NPs who demonstrate clinical expertise, ethical behavior, leadership skills, cultural awareness, professionalism, and ongoing commitment to learning.