Physician Assistant Programs Research Articles

Founding of the Association of Physician Assistant Programs and the Organization's Central Role in the Development of the Physician Assistant Profession.

The Physician Assistant Education Association (PAEA) (formerly Association of Physician Assistant Programs [APAP]) was founded in 1972 by early PA program leaders to encourage collaboration and discussion among program leaders and faculty on a wide range of issues of mutual concern. This article addresses the founding of the organization, which continues to represent PA programs today. It addresses the important accomplishments of APAP during the 1972-1974 period and describes in detail the essential contributions of APAP and its leaders in developing the PA profession. Included are discussions of "the Role of the Registry of Physicians' Associates," which was incorporated into APAP; the sponsorship of "the First National Conference on New Health Practitioners" in collaboration with AAPA; the "Launching a Joint National Office" for APAP and AAPA in Washington, DC, in 1973; and "Places at the Table," which reviews the successful efforts of APAP leaders to gain inclusion of AAPA and APAP in the Joint Review Committee on Educational Programs for Assistants to the Primary Physician (JRC-PA) for accrediting qualified programs, the contribution of APAP leaders to the development of the first Certification Examination for the Assistant to the Primary Care Physician by the National Board of Medical Examiners (NBME) in 1973, leadership in the founding of the National Commission on the Certification of Physician Assistants (NCCPA) in 1974, and collaboration with the Association of American Medical Colleges (AAMC) in developing interdisciplinary education and training. It concludes with a summation of the legacy of APAP (PAEA's) formative years.

Modern Role of the Physician Assistant Program Medical Director.

Modern Role of the Physician Assistant Program Medical Director.

Challenges of Clinical Education.

As we celebrate the 50th anniversary of the physician assistant (PA) profession and specifically PA education, think of the tens of thousands of clinical preceptors who were or currently still are involved in the education of PA students. The clinical phase of PA programs has become the rate-limiting issue in PA education. For decades, developing clinical education sites was relatively easy. Over the last decade, rapid expansion in medical, nurse practitioner, and PA education programs has resulted in greater challenges in obtaining necessary clinical training sites. This article attempts to address several of the current challenges in PA clinical education.

Evaluating Motivational Interviewing in the Physician Assistant Curriculum.

Motivational interviewing (MI) is an evidence-based technique that enables clinicians to help patients modify health behaviors. Although MI is an essential tool for physician assistants (PAs), the extent to which it is addressed in PA curricula in the United States is unknown. This study is a comprehensive description of MI education in PA programs in the United States. Data are from the 2014 Physician Assistant Education Association Annual Program Survey. Descriptive statistics were conducted on de-identified data from all 186 PA programs in the United States. Of the 186 PA programs surveyed, 72.58% (n = 135) reported at least one course providing MI training. Availability of courses providing training in skills essential to the MI process varied. Having a course with verbal communication training was most frequently endorsed, and having a course with training in developing discrepancy was least frequently endorsed. The most popular teaching modality was lecture (84.95%, n = 158), whereas only 41.40% (n = 77) and 58.60% (n = 109) reported role play with evaluation and standardized patient exercises with evaluation, respectively. More than 70% of programs included at least one course in their curriculum that provided training in MI, suggesting that PA programs recognize the importance of MI. Instruction in change talk was not provided in nearly half of the programs. Role-play and standardized patient exercises with evaluation were underused methods despite their proven efficacy in MI education. As the first comprehensive benchmark of MI education for PAs, this study shows that although most programs address MI, opportunities exist to improve MI training in PA programs in the United States.

A multi-state initiative to implement pediatric oral health in primary care practice and clinical education.

To implement and study the effect of improving pediatric oral health by training primary care practices and training programs. In six New England States, primary care practices and clinical training programs (medical schools, residencies, physician assistant programs) were recruited and trained to incorporate pediatric oral health into medical practice. We measured the results of varying practice recruitment approaches and measured training outcomes based on self-reported implementation and state reported EPSDT CMS oral health claims. We trained 415 practices across six states with a 74 percent average retention rate of providing services at 6 months. This resulted in 136,963 preventive oral health services (fluoride varnish, oral health assessment, or screening). Thirty-five of 52 health education programs established pediatric oral health curricula. The average cost of recruitment, training, and follow-up for an office or an educational program is approximately $1,000/site. We have created an enduring infrastructure and model for primary care practices and education programs for training in pediatric oral health.

A Spatial Analysis of Physician Assistant Programs.

The Accreditation Review Commission on Education for the Physician Assistant projects a total of 273 accredited programs by the summer of 2020. Over the past 10 years, the number of Central Application Service for Physician Assistants (CASPA) applicants per seat has increased by 53%. However, no studies have addressed the current geographic relationship of applicants to programs and program growth. The purpose of this study was to describe the geospatial patterns and relationships of physician assistant (PA) programs and CASPA applicants. Program directory information for established (n = 159), satellite (n = 18), and new PA programs (n = 95) was mapped using ArcGIS software. Permanent US ZIP codes for PA applicants (n = 22,603) from the 2014 to 2015 CASPA admissions cycle were also mapped. Point data were used to calculate the nearest neighbor by program type. Correlation was used to measure the association between PA applicants, program class size, and state population metrics. Most of the 95 new PA programs were geographically close to established programs. The median distance of new programs to the nearest neighboring established program was 25.6 miles (mean 39, standard deviation 38). Both established and new PA programs were found to be highly clustered (Moran's I z score < 2.58, p = .01). The geographic distribution of the CASPA applicant pool was related to distribution of the US population, certified PAs, and practicing physicians. PA program growth has exceeded projections. The close proximity of new programs to established programs will likely result in continued competition for quality applicants, PA faculty members, and clinical training sites.

Development of a Quality Improvement Curriculum in Physician Assistant Studies.

The purpose of this project was to develop and evaluate a curriculum for physician assistant (PA) students addressing knowledge, skills, and attitudes (KSA) toward quality improvement (QI). Students (N = 77) completed a pretest rating their KSA. A curriculum was developed to improve KSA among didactic and clinical students. Two department-wide QI projects were developed for student participation. Students completed a posttest after completing curriculum components and changes in KSA had been measured. Postcurriculum implementation, QI knowledge, and skills increased significantly in most areas. Large improvements were seen in knowledge of Plan, Do, Study, Act models and life cycles of QI projects (p < .0001). Seven students (20%) participated in department-wide projects. Our curriculum model (1) was effective at improving students' QI knowledge and skills; (2) allowed students to participate in community-based QI projects; and (3) can be used by other PA programs looking to enhance their QI curriculum.

Return on investment of advanced practice medical degrees: NPs vs. PAs.

Salaries were abstracted from the 2012 Bureau of Labor Statistics database. The net present value (NPV) of PA and NP salaries was calculated with a 5% discount rate. Principal and interest for student loans was calculated at a 6% interest fixed-rate loan over 30 years. NPVs were then compared with projected ROI at retirement age. Relative career values were also given to each career choice, based on a retirement age of 65 years, which translates to about 41 years of employment for both PAs and NPs. PAs' and NPs' educational loans both equalled $129,484 on total repayment. The median annual salary of a PA was $90,930 and $89,960 for an NP. PA data yielded a 5% NPV of $781,323 compared with $764,348 for NPs. Of note, the 5% NPV of a 4-year nursing degree is $728,436. PAs have a slightly higher ROI compared with NPs. These findings may change due to adjustments in nursing training models. Many PA programs allow matriculation immediately after obtaining a bachelor's degree. NP schools often require nursing experience before entering their program. Some schools are considering an accelerated NP program, allowing immediate matriculation after obtaining a bachelor's degree. Because many NP programs have become doctoral degrees, the increased duration of training, higher tuition, and fewer years worked before retirement lower the overall NP ROI. A similar reduction in ROI was considered marginal in PAs who attend residency programs-though these programs are not required for PAs to practice. Comparison of an RN with a 4-year degree to an NP shows little increase in ROI. If interest rates rise, it will become fiscally preferable to remain in a nursing position. Other intangible qualities exist and need further research (for example, weighing the financial aspects with lifestyle or professional satisfaction).

The MEDEX Northwest Physician Assistant Program: A Synopsis.

The MEDEX Northwest Physician Assistant Program: A Synopsis.

First Insights into Scope of Practice and Salary of Physician Assistants, A New Healthcare Profession, in Germany

In 2010, the first government-approved physician assistant (PA) program was introduced at the Baden-Wuerttemberg Cooperative State University Karlsruhe (DHBW). There are not sufficient data regarding the scope of practice and salary of our graduates. Therefore, the aim of the present study was to obtain information regarding these. The survey included all graduates (2 classes, n=27). A specific questionnaire was developed, including 37 questions e. g. on the current employment status, scope of practice, salary and job satisfaction regarding the PA program and career. A descriptive analysis of the data was carried out using SPSS. 25 graduates participated in the survey (96.1%); the average age of participants was 32.2 years (25-53 years). 88% (n=22) were employed as a PA, most of them worked in internal medicine (n=11) or surgery (n=9). Responsibilities that are often or very often assigned to the PAs are preparing final documents, taking over a coordinating role in the therapeutic team, as well as participation in taking patient medical history and conducting physical examinations. In two-thirds of respondents, the gross monthly base salary (full-time position) was about 3000 euros. 77.3% (n=17) of graduates were generally satisfied or very satisfied with their current situation. It appears that graduates of the DHBW are well integrated into the staff structure of hospitals, as far as the scope of practice and average salary are concerned. Further studies on the integration of this new profession in Germany and on their extended scope of practice in comparison to established healthcare professions will be conducted.

Interprofessional Education in Anatomy: Using Q Methodology to Determine Student Perceptions

Interprofessional education (IPE) is critical for preparing healthcare students for the collaborative components of their future careers. Anatomic dissection is an ideal IPE activity because all healthcare professionals require anatomy training and dissection demands extensive student interaction in a sensitive environment. The purpose of this study was to determine which aspects healthcare students perceived to contribute to the development of their (individual) interprofessional skillset within the context of McMaster University's 10‐week IPE gross anatomy dissection course.We used Q‐methodology to identify the students' common viewpoints regarding the course. A total of 26 students from the Medical, Nursing, Midwifery, Physician Assistants, Occupational Therapy and Physiotherapy programs participated in this study. Students were asked to sort a Q‐sample of 43 statements based on their viewpoints regarding the IPE dissection course. The 43 statements were developed from interviews with students who had previously completed the course.Using the centroid factor extraction and varimax rotation, three salient factors (groups) emerged. The groups were named based on distinguishing statements as follows: 1) Anatomy IPE Enthusiasts; 2) Practical IPE Advocates; 3) Skeptical IPE Anatomists. The Anatomy IPE Enthusiasts believed that students from different disciplines brought unique anatomical knowledge and each group member guided others through difficult material. The Practical IPE Advocates expressed that they would be much stronger advocates for interprofessional teams in the future as a result of taking the course. The Skeptical IPE Anatomists strongly disagree that learning with students from different disciplines helped them gain a solid understanding of their roles in the context of other healthcare professionals, and felt that there was not much benefit from the IPE program compared to other non‐interdisciplinary programs.It is critical to understand student perceptions of IPE programs in order to best prepare these students for their future collaborative careers. These findings can help the course developers make further adjustments in the course structure, content and delivery to address some of the issues highlighted by the students, and to further emphasize the topics that were well‐received by the students. Finally, we hope that these results will be helpful to other interprofessional educators, especially those whose program has an anatomy framework.

Early Predictors of Students at Risk of Poor PANCE Performance.

The purpose of this study was to identify early predictors in the physician assistant (PA) program curriculum that could be used to identify students "at risk" of failing the Physician Assistant National Certifying Examination (PANCE), allowing for early intervention. Previous literature implicates grades on foundational coursework as promising early predictors of PANCE performance. Secondary data analyses were performed using student data from 2003 to 2014 school years in the PA program at a large university. Path analysis indicated that grades from foundational coursework were the strongest early predictors of PANCE performance, accounting for over half of the variance in PANCE performance. Although admission criteria provide some indication of how a student might perform on the PANCE, foundational coursework is the best early predictor of PANCE performance based on this research. Remediation strategies may be most successful when targeting students who have difficulty in these classes during their first year.

Efficacy of a Physician Assistant Student-Developed Behavior Change Program at a Local Free Clinic.

A quality assurance and quality improvement assessment was conducted to evaluate the efficacy of a behavior change program developed by physician assistant (PA) students at a local free clinic. Physician assistant students developed and implemented a program using motivational interviewing and healthy lifestyle behavioral counseling at a local free clinic. Twenty-eight patients participated in the program over 5 cohorts. A retrospective chart review was used to collect data. Weight and body mass index (BMI) data were gathered retrospectively from patients' charts corresponding to the 6 months before the program, at the start of the program, at the end of the 12-week program, and at 3 and 6 months after the program. Significant differences were found between the start and end of the program for weight (P < .001) and BMI scores (P < .001). The mean weight decreased from 111.98 (standard deviation [SD] = 33.47) to 109.00 kg (SD = 33.93). The weight loss ranged from 0.45 to 9.53 kg, and 75% of participants lost weight. The mean BMI decreased from 41.21 (SD = 10.64) to 40.13 (SD = 10.98). Differences were maintained at 3- and 6-month follow-ups. However, only half the sample's data were available at follow-ups because some patients did not return to the free clinic during that time period. A program facilitated by PA students and designed to help patients make healthy diet and exercise changes can be a valuable resource for free clinics and patients and an excellent clinical opportunity for PA students. To strengthen the program's commitment to maintenance of weight loss, program components of continued follow-up and engagement of patients should be explored and developed.

Predictors of Physician Assistant Faculty Intent to Leave Academia: A Rasch Regression Analysis.

The purpose of this research was to investigate whether a previously developed and validated measure of intention to stay in academia for physician assistant (PA) faculty could also be used to inform PA faculty intent to leave academia and return to full-time clinical practice. A secondary analysis of the national survey data of PA faculty (n = 427) was conducted using a Rasch regression model. The 19 items from the previously validated Supportive Environment Scale were examined as potential predictors of the dichotomous outcome of intent to leave academia. In this analysis, PA faculty who were somewhat or very likely to leave academia were compared with those who were not at all likely to leave academia. Five items from the Supportive Environment Scale emerged as a linear meaningful measure that predicted intent to leave. These predictors included the following: recognition by administration, support for scholarly work, a fair promotion process, a sense of institutional community, and support of the PA program by administration. Rasch prediction maps were produced that allowed for powerful visualization of prediction and identification of areas for intervention. The intent of PA faculty to leave academia and return to clinical practice can be meaningfully predicted by 5 items. Importantly, these items are in the purview of institutional administrators and can be used to target PA faculty retention efforts.

Developing Clinical Faculty Understanding of Interprofessional Education: An Inter-institutional, Interprofessional Approach

Introduction: The call for increasing interprofessional education requires institutional support for educators in the clinical environment. Innovative ideas, such as partnering with multiple universities and programs to facilitate an interprofessional workshop, have the opportunity to reach a broader group of clinical educators. The purpose of this study was to examine the attitude of healthcare professionals towards interprofessional learning, familiarity with concepts of interprofessional teaching, and interprofessional practice, and to examine the influence of an interprofessional faculty development workshop on participant familiarity with concepts of interprofessional teaching and learning. Methods: The occupational therapy, physical therapy, and physician assistant programs from two universities collaborated to implement an all-day inter-institutional, interprofessional clinical faculty development workshop. Community clinical educators who participated in the event were surveyed pre- and post-workshop to examine their attitude, readiness, and knowledge of interprofessional learning and teaching. Using the revised version of the Readiness of Interprofessional Learning Scale, the following subscales were measured and analyzed: 1) Teamwork and Collaboration, 2) Negative Professional Identity, 3) Positive Professional Identity, and 4) Roles and Responsibilities. Results: Forty-three participants representing six different healthcare professions completed pre- and post-course surveys. Forty-four percent reported participating in interprofessional education. Overall, the attendees reported the value of the workshop as a 4.6 on a 5.0 point Likert scale, with 5.0 being the highest rating. Self-reported familiarity of the fundamental concepts of interprofessional teaching, interprofessional practice, and interprofessional education improved up to 32% following participation in the workshop. The highest increase in familiarity was in the area of knowledge of interprofessional practice and education. Participants reported high levels of agreement about the value of teamwork, collaboration, and positive professional identity. Conclusion: Integrating the Core Competencies for Interprofessional Collaborative Practice into educational programs and clinical practice can facilitate improved understanding of professional roles and improved collaborative practice.

Integrating interprofessional experience throughout a first-year physician assistant curriculum improves perceptions of health care providers

Abstract Purpose Interprofessional collaboration is essential in Physician Assistant (PA) practice. Therefore, a three-semester sequence of Hospital Community Experience (HCE) was implemented during the didactic phase of the PA program providing students with weekly opportunities to shadow/observe health care professions. Methods This longitudinal, cohort study evaluated the effect of the HCE on PA students' perceptions of other health care professions prior to HCE, immediately after HCE, and one year later, after the clinical clerkships. The Interprofessional Perception Scale (IPS) survey was used to assess perceptions. Results Comparison of the IPS between the Pre-HCE and subsequent time points revealed statistically significant positive change in perception of other health care professions while also identified some areas for future research and curricular intervention. The greatest number of statistically significant changes occurred in statements which related to how other professions viewed the PA profession and how other professions worked with PAs. Conclusion The interprofessional HCEs emerged to be important in shaping the desired interprofessional professional identity of PA students.

Self-Directed Learning in Physician Assistant Education: Learning Portfolios in Physician Assistant Programs.

Self-directed learning (SDL) portfolios are underused in the educational process and should be considered by physician assistant (PA) programs. Clinicians such as PAs are responsible for self-identifying their learning needs, competencies, and ongoing educational requirements. This article introduces an outline for SDL in the PA profession, for direct use by learners and indirect use by educators. Without a plan, many professionals may lack the insight, motivation, and knowledge needed to improve their skill set and establish goals for individual lifelong learning. This study conducted a review of the literature. Then, by incorporating SDL portfolios into PA educational methodologies, it constructed a concept map for individuals to monitor, self-direct, and actively participate in their own learning in academic settings and throughout their career.

Expansion of Physician Assistant Education.

Physician assistant (PA) educational programs were created in the 1960s to prepare a new type of health care practitioner. Physician assistant programs began as experiments in medical education, and later, they proved to be highly successful in preparing capable, flexible, and productive clinicians. The growth of PA educational programs in US medical education-stimulated by grants, public policy, and anticipated shortages of providers-has gone through 3 distinct phases. At present, such programs are in the midst of the third growth spurt that is expected to continue beyond 2020, as a large number of colleges and universities seek to sponsor PA programs and attain accreditation status. Characteristics of these new programs are described, and the implications of the current expansion of PA education are examined.

The MEDEX Northwest Physician Assistant Program

The MEDEX Northwest Physician Assistant Program

Commentaries on health services research

Commentaries on health services research