Physician Assistants Research Articles

Predictive modelling of the UK physician associate supply: 2014–2038

IntroductionThe NHS Long Term Workforce Plan aims for 10,000 physician associates (PAs, formerly physician assistants) by 2036/7. This article uses three modelling approaches to project the UK PA supply from a baseline of 2014–2021 through to 2038 to forecast the profession's growth. MethodsThe number of cClinically available PAs’ (cPAs; qualified PAs either working clinically or seeking clinical employment) was estimated using raw data from the 2014–2021 Faculty of Physician Associates censuses. This provided baseline data for all models (linear regression (LRM), exponential regression (ERM) and time-series forecast (TSFM)). Attrition, using data from other healthcare professions, was also modelled. ResultsR2 values together with authors’ judgement ruled the LRM more realistic than the ERM. The LRM projected up to 8,232 cPAs by 2038, although attrition reduced this significantly. The TSFM optimistically projected an upper limit (95% confidence interval) of 13,922 cPAs by 2038. DiscussionThis article permits a wider view of potential PA numbers, with broad agreement between the LRM and the TSFM. It appears that future PA demand will be met, but factors such as attrition could impede this. Attrition itself may be mitigated through adequate resourcing, appropriate support mechanisms, and the development of a career structure. Professional regulation and legislation will further support PAs to work to their potential, subject to appropriate patient safety measures.

Single center experience developing sustainable genetics clinical care: a model to address workforce challenges in medical genetics

Purpose of review The national workforce shortage in genetics is being evaluated in order to identify a sustainable solution to the increasing demand for genomic services. An innovative solution to the short term needs is to integrate advanced practice providers (APPs) and embed genetic counselors into both outpatient and inpatient specialty care. Incorporating APPs into a genetic service is not unique in itself, but the method of implementation at Medical College of Wisconsin (MCW) was, at the time, unchartered. Recent findings There are >100 vacancies for board certified medical geneticists across the nation, training programs are not enrolling sufficient trainees to meet demand and more than a third of the current workforce plan to retire within the next 10 years. Summary The integration of advanced practice providers (nurse practitioners, midwives, physician assistants etc.) into both primary and specialty care has been an evolving practice since the mid-1900s and incorporating APPs into a genetic service was not unique in itself but the method of implementation was new at that time. This is a model to successfully develop a clinical practice model around a team-based structure incorporating nurse clinicians, advanced practice providers, genetic counselors, nutritionists, and physicians into an academic clinical genetics practice.

Exposure to ionizing radiation of medical staff performing vascular and interventional radiology procedures.

Vascular and interventional radiology procedures are characterized by high exposure of personnel to ionizing radiation. This study assessed the exposure of medical personnel to ionizing radiation during vascular radiology and mechanical thrombectomy procedures. During vascular radiology procedures, the exposure of 4 groups of workers participating in the procedures was analyzed, i.e., the main operating physician, an assistant physician, a sterile nurse, and a nurse. Measurements of exposure to ionizing radiation were performed using thermoluminescent dosimetry. The registered effective dose during 1 treatment in individual groups is, respectively: mean (M) ± standard deviation (SD) 75±15 μSv, 24±5 μSv, 13±3 μSv, and 8±2 μSv. During mechanical thrombectomy, the operating physician receives an effective dose of M±SD 9±2 μSv. The equivalent doses for the lenses for the operating physician and the doctor assisting during vascular radiology procedures are M±SD 1419±285 μSv and 987±198 μSv, respectively, and for the hands, including the left and right hands, M±SD 4605±930 μSv, 1420±284 μSv, 1898±380 μSv, 1371±274 μSv. If the principles of optimizing radiological protection are not applied during vascular radiology procedures, the permissible dose limits and operational limits equivalent to doses to lenses and hands may be exceeded. Exposure during vascular radiology procedures is comparable to exposure during nuclear medicine procedures in terms of the use of glucose labeled with radioactive fluorine. Int J Occup Med Environ Health. 2024;37(4).

Primary care team characteristics associated with video use: a retrospective national study at the Veterans Health Administration

ObjectiveTo examine primary care (PC) team members’ characteristics associated with video use at the Veterans Health Administration (VA).MethodsVA electronic data were used to identify PC team characteristics associated with any video-based PC visit, during the three-year study period (3/15/2019-3/15/2022). Multilevel mixed-effects logistic regression models on repeated yearly observations were used, adjusting for patient- and healthcare system-level characteristics, and study year. We included five PC team categories: 1.PC providers (PCP), which includes physicians, nurse practitioners, physician assistants, 2.Nurses (RN/LVN/LPN/other nurses), 3.Mental health (MH) specialists, 4.Social workers (SW), and 5.Clinical pharmacists (PharmD).Population54,494 PC care team members nationwide (61,728,154 PC visits; 4,916,960 patients), including 14,422 PCPs, 30,273 nurses, 2,721 MH specialists, 4,065 SWs, and 3,013 PharmDs.ResultsThe mean age was 46.1(SD = 11.3) years; 77.1% were women. Percent of video use among PC team members varied from 24 to 84%. In fully adjusted models, older clinicians were more likely to use video compared to the youngest age group (18–29 years old) (example: 50–59 age group: OR = 1.12,95%CI:1.07–1.18). Women were more likely to use video (OR = 1.18, 95%CI:1.14–1.22) compared to men. MH specialists (OR = 7.87,95%CI:7.32–8.46), PharmDs (OR = 1.16,95%CI:1.09–1.25), and SWs (OR = 1.51,95%CI:1.41–1.61) were more likely, whereas nurses (OR = 0.65,95%CI:0.62–0.67) were less likely to use video compared to PCPs.ConclusionsThis study highlights more video use among MH specialists, SWs, and PharmDs, and less video use among nurses compared to PCPs. Older and women clinicians, regardless of their role, used more video. This study helps to inform the care coordination of video-based delivery among interdisciplinary PC team members.

Adrien Rist (1841–1923), membre de la Société Médico-Psychologique (1881) et fondateur d’une maison de santé privée à Versailles « La Châtaigneraie » (1889) (Partie I)

Professor Edouard Rist (1871–1956), a former president of the Academy of Medicine (1948), wrote an unpublished text entitled “His Memories”. This text allows us to sketch the portrait of his father: Adrien Rist (1841–1923) and to review the professional career of this alienist doctor who always had a deep sense of loyalty and attachment to France and its culture. Coming from a family of surgeons, his grandfather Jean-Louis Rist (1769–1839) was a surgeon of the Grande-Armée like his uncle Côme Damien Rist (1760–1826) and their father Jean Népomucène Sébastien Rist (1725–1798) was too a surgeon in Wissembourg. It was under the July Monarchy that A. Rist (1841–1923) was born in Strasbourg. Raised in a Protestant family, he enrolled at the Military Health Service School in Strasbourg. He left the school after one year to enroll in the medical school of the same city. However, he finished his medical study in Paris. After his externship, he was accepted as an intern on December 26, 1864. Five years later (1869), he was a doctor of medicine and became the first one to make known in France the psychophysical law of Gustav Théodor Fechner (1801–1887), which bridges the gap between psychology and the exact sciences. Then, he returned to Strasbourg where he opened a medical practice and started to prepare for the aggregation in physics at the University of Göttingen (Germany). He stayed there long enough to fall in love with Emma Cornelia Gess (1848–1928), a native of Württemberg, to whom he married on April 5, 1870. Three months after his marriage, the war with Prussia broke out. During the conflict, his wife gave birth in Strasbourg to a boy named Edouard (1871–1956). Thus, his new family life and the Franco-Prussian war and its outcome deterred him from passing the aggregation. But also, A. Rist chooses to leave Alsace so as not to renounce his French nationality. After a brief stay in Le Havre (Normandy), he decided to expatriate to Switzerland. In order to be able to practice in this country, A. Rist passed the examinations in the canton of Vaud where he provided an important memorandum on the legislation of insane persons. In 1867, the Champ de l’Air Hospital for the insane was transferred to the Bois-de-Cery located near Lausanne where six years later (1873) a new hospital called “Asile de Cery” was inaugurated. Authorized to practice in Switzerland, A. Rist became in 1873 the first doctor-director of the Bois-de-Cery. A few years earlier, the first private psychiatric clinic in Romanisch Switzerland opened: La Métairie. In 1877, he became the director of this establishment located not far from the previous one at about forty kilometers away still on the banks of Lake Geneva. Board of Directors of this private establishment composed of a majority of Geneva bankers was able to receive about forty patients of well-to-do condition who came from all over the world. A. Rist lived there with his family and the organization at La Métairie was based on the participation of the insane in the family life of the doctor. A. Rist's children (Edouard, Charles, Elisabeth and Eve) founded the “Children's Society” which aimed to give concerts and theatrical performances to the patients of La Métairie. Also, they contributed when patients ran away. At the Métairie, A. Rist received the visit of Alexandrovitch Herzen (1839–1906) who was a professor of physiology at the medical faculty of Lausanne (1881) and whose father, Alexander Ivanovich Herzen (1812–1870) was the father of Russian populist socialism. However, the separation from his children who were studying in France and the tragic death of his daughter Elisabeth at the age of 17 were two factors that led to his return to France. In 1889, A. Rist and his wife decided to leave La Métairie. Rudolf Friedreich Fetscherin (1829–1892), a former assistant physician at the Waldau (Bern; 1859) succeeded him. A. Rist moved to Versailles near Paris where he opened a nursing home at 11 rue des Deux-Moulins: La Châtaigneraie.

Experience of Nurses in Carrying Out the Main Duties and Functions of Nurses at UPT Puskesmas Panamas, Kapuas Regency, in 2023 / 2024

This research explores the experiences of nurses in carrying out their main duties and functions at the Panamas Community Health Center. Qualitative methods with a phenomenological approach are used to gain an in-depth understanding of this phenomenon. Data was collected through in-depth interviews with 12 nurses selected by purposive sampling. Data analysis using the Colaizzi method produced five main themes: (1) Nurses' activities in health services, (2) Tasks carried out by community health center nurses, (3) The importance of good health program management, (4) Management of duties and authority in health services, and (5) Shortage of health and non-health personnel and multifunctionality in health services. Research results show that nurses often have to take over the roles of doctors, administrative staff, and pharmacists due to limited human resources even though these tasks should not be their responsibility. This causes nurses to lose focus in carrying out their main duties, nurses feel that their main role as care providers is disturbed. Nurses also run various health programs and serve as physician assistants, although these roles often exceed their duties. The importance of good health program management was emphasized, as many participants experienced difficulties in achieving targets, reporting and patient monitoring. Management of tasks and authority includes handover of tasks, delegation of daily tasks, and delegation of authority, however socialization to staff has not been comprehensive. Lack of human resources causes nurses to carry out multiple roles which hinders their professional development. This research recommends strengthening competency and further training for nurses, increasing legal awareness regarding the delegation of authority, integrating health management education in the nursing curriculum, as well as increasing the number and qualifications of human resources in community health centers.

Prevalence and Practice Characteristics of Advanced Practice Providers in Upper-Extremity Surgery, 2013–2021

This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to2021. Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed. From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue. There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue. With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.

Broadening the View of Holistic Care: Integrating Arts and Humanities Into Physician Assistant Education.

The integration of arts and humanities (A&H) into physician assistant (PA) preclinical curriculum may enhance student performance and improve their patient rapport. Arts and humanities content could promote the personal and professional qualities we desire in clinicians including competence, compassion, and empathy. The aim of this research was to determine what PA students report learning from A&H modules designed to foster personal insight and perspective-taking. The "Introduction of Humanities & Arts into Physician Assistant Education" (IHAPAE) project is an intercampus collaboration between 2 Midwest Universities. The IHAPAE faculty collaboratively created and delivered A&H-based modules within first-year communication courses. Two cohorts of PA students (N = 130) participated in modules and subsequently attended exploratory focus groups to elicit their perceptions of the A&H curriculum. Using a constructivist grounded theory approach for data analysis, we found that PA students perceived multiple benefits. Specifically, module content promoted reflection and stress reduction, improved their continuity of care notes, provided utility in cultivating empathy in patient communication, and introduced students to A&H approaches they could recommend to patients. The process model that emerged from student perceptions fits well with existing emotional regulation theory and provides empirical evidence for cultivation of empathy and patient-centeredness. Given the positive outcomes of our project, PA programs should consider the value of incorporating the A&H activities into their curriculum to enhance the student experience and develop essential provider attributes and skills.

Gaining consensus on a protocol for general surgery physician assistants in the management of non-compressible abdominal haemorrhage in military austere environments: a Delphi study

BackgroundNon-compressible abdominal haemorrhage (NCAH) is a potentially preventable cause of death due to injury. Limited exploratory laparotomy by a non-surgeon is a temporary intervention to sustain life until definitive surgical...

Aversion to pragmatic randomised controlled trials: three survey experiments with clinicians and laypeople in the USA

ObjectivesPragmatic randomised controlled trials (pRCTs) are essential for determining the real-world safety and effectiveness of healthcare interventions. However, both laypeople and clinicians often demonstrate experiment aversion: preferring to implement either...

Wound Itch: An Update.

To present current evidence regarding the physiology, assessment, and management of wound itch. This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and registered nurses with an interest in skin and wound care. After participating in this educational activity, the participant will:1. Summarize current understanding of itch physiology.2. Apply current evidence to the management of wound itch.

Patterns of utilization of advanced practice providers in reproductive endocrinology: a 2023 national survey

ObjectiveTo evaluate the current utilization of advanced practice providers (APPs) within the field of reproductive endocrinology and infertility (REI). DesignCross sectional. SubjectsA total of 201 APPs surveyed through the American Society of Reproductive Medicine APP Professional Group. ExposureAnonymized online survey. Main Outcome MeasuresDemographics, scope of practice and responsibilities, and training and onboarding. ResultsRespondents were primarily Family Nurse Practitioners (FNPs, 26.4%), Women’s Health Nurse Practitioners (WHNPs, 33.3%), or Physician Associates (PAs, 29.8%). Two-thirds (67.4%) reported that their scope of practice is limited by their employer or practice, 43.5% by state restrictions, and 25.2% by insurance. Survey respondents reported that 44.4% of their time at work is dedicated to performing procedures and scans and 30.6% to conducting consults and follow-ups. The most commonly reported duties were physical exams (88.6%), intrauterine inseminations (IUI; 86.6%), saline sonohysterograms (79.6%), endometrial biopsies (76.6%), ultrasounds (74.6%), and problem visits such as for pain, cysts, and bleeding (73.1%). The majority of survey respondents (61.7%) reported having autonomy in deciding protocols and treatment options for patients in their practice. Respondents described their onboarding training as including observation/on-the-job training (94.0%), independent reading of texts and journals (66.7%), ASRM online courses (45.3%), formal orientation (34.8%), and practice-organized training programs (29.4%). ConclusionsAPPs are highly trained members of the care team, but continue to be underutilized within the field of REI. Improvements in educational resources and/or use of a formalized program to train APPs to their full scope of practice may help increase clinic efficiency and improve patient access to care.

Doctor simulator: Delta-Age-Sex-AdaIn enhancing bone age assessment through AdaIn style transfer.

Bone age assessment assists physicians in evaluating the growth and development of children. However, deep learning methods for bone age estimation do not currently incorporate differential features obtained through comparisons with other bone atlases. To propose a more accurate method, Delta-Age-Sex-AdaIn (DASA-net), for bone age assessment, this paper combines age and sex distribution through adaptive instance normalization (AdaIN) and style transfer, simulating the process of visually comparing hand images with a standard bone atlas to determine bone age. The proposed Delta-Age-Sex-AdaIn (DASA-net) consists of four modules: BoneEncoder, Binary code distribution, Delta-Age-Sex-AdaIn, and AgeDecoder. It is compared with state-of-the-art methods on both a public Radiological Society of North America (RSNA) pediatric bone age prediction dataset (14,236 hand radiographs, ranging from 1 to 228 months) and a private bone age prediction dataset from Zigong Fourth People's Hospital (474 hand radiographs, ranging from 12 to 218 months, 268 male). Ablation experiments were designed to demonstrate the necessity of incorporating age distribution and sex distribution. The DASA-net model achieved a lower mean absolute deviation (MAD) of 3.52 months on the RSNA dataset, outperforming other methods such as BoneXpert, Deeplasia, BoNet, and other deep learning based methods. On the private dataset, the DASA-net model obtained a MAD of 3.82 months, which is also superior to other methods. The proposed DASA-net model aided the model's learning of the distinctive characteristics of hand bones of various ages and bothsexes by integrating age and sex distribution into style transfer.

A pragmatic approach to teaching physician assistant students basic pain management.

Chronic pain is increasing in prevalence, with new cases now outnumbering those of diabetes, depression, or hypertension. Advanced practice providers have reported that their training in pain management inadequately prepared them to care for patients suffering from painful conditions. In response, the authors of this work developed a basic pain management conceptual framework to provide physician assistant (PA) students with the foundational knowledge necessary to manage and treat patients suffering from a wide variety of painful conditions. The devised framework activity includes categories of pain management such as conservative therapies, medications, injections, minimally invasive procedures, and moderately to highly invasive procedures. This framework can be incorporated into the existing PA educational curriculum and presented alongside a realistic pain patient case study. Furthermore, other health science educational programs, such as nurse practitioner or pharmacy programs, could adopt this framework to increase student knowledge in pain management.

Enhancing the Integration of Race and Health Discussion in Physician Assistant Curriculum.

This article offers a unique perspective on integrating historical and contemporary issues of racism and public health within physician assistant (PA) education, specifically through the lens of personal experience as a public health data analyst during the COVID-19 pandemic. By highlighting the intersection of race, health equity, and education, this article underscores the need for PA programs to incorporate and enhance comprehensive training on the structural determinants of health and the impact of systemic racism on patient care.

Patterns and correlates of traumatic stress, depression, anxiety, and moral injury in U.S. health care providers late in the COVID-19 pandemic.

Providing health care during the COVID-19 pandemic has been associated with a high mental health burden for health care providers. This study examined patterns of responses and correlates of class membership across commonly assessed mental health symptoms, psychosocial functioning, and moral injury for providers in the United States in Fall 2022. A convenience sample of 1,504 primary care physicians, pediatricians, nurse practitioners, and physician assistants who had been in practice for three or more years (Mage = 46.1 years, SDage = 11.3, 58% male) completed self-report measures in an online, opt-in panel survey from September to November 2022. Using latent class analysis, three classes were identified: No/Low Symptoms (64.8%), High Moral Injury (19.9%), and Elevated Symptoms (15.2%). Several factors were correlated with class membership including age, sex, social support, personal risk of COVID-19, pandemic-related work stressors, proportion of COVID-19 patients seen at the height of the pandemic, and death of a patient due to COVID-19. This study found high levels of mental health symptoms, and problems with psychosocial functioning and moral injury in health care providers well past the pandemic's peak. The results also demonstrated the importance of considering the unique contribution of moral injury to psychosocial functional difficulties experienced by health care providers during the pandemic given their defined role as essential workers. These findings have implications for preventing and managing mental health problems and burnout among providers postpandemic as well as for future pandemics at both the organizational and individual levels. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attracting medical school graduates to residency programs in remotely located hospitals: the challenge lies beyond financial incentives

BackgroundRecruitment to residency programs in hospitals located in other than major hubs (“remotely located”) is a challenge in many countries. In 2011, the Israeli Ministry of Health launched a 10-year financial incentive to encourage physicians to enroll in residency programs in such hospitals. Nearly 1 billion New Israeli Shekels (260 million US$) were invested in that program which had only limited success. As a new physician association’s collective agreement is impending, we aimed to measure the effectiveness of selected incentives in attracting medical school graduates to residencies in remotely located hospitals.MethodsThis study included Israeli medical students in their final year of medical school. We used an online questionnaire with multiple-choice demographic questions and a 5-point Likert scale to gauge the effect of various incentives on their preference for residency location.ResultsBetween July and November 2022, 522 students responded (405 studied in Israeli medical schools [out of 705 students] and 117 in foreign medical schools [out of 1936 students]). Forty-two percent had at least one clerkship in a remotely located hospital, and 24% had included at least one remotely located hospital among their top five choices for internship. Only 13% reported that they prefer a residency program in those institutions. The incentive selected by students as most persuasive was government assistance in acceptance to and financial support for a fellowship abroad, followed by a financial grant and fewer on-call hours. Only 7% of the students indicated that no incentive would influence them to choose a remotely located hospital for their residency training. Medical education in a remotely located university and the choice of at least one remotely located hospital among the top five choices for internship were significantly associated with positive incentive receptivity, whereas male sex and older age were associated with negative receptivity.ConclusionThis study on the attitudes of Israeli medical school graduates toward incentives aimed at attracting them to residencies in remotely located institutions revealed that career development opportunities and assistance in obtaining fellowships might influence their choice.

A Comparison of Telesimulation Using the Virtual Resus Room and In Situ Simulation in Pediatric Emergency Medicine.

During the COVID-19 pandemic, there was a marked shift toward telesimulation in medical education. Limited studies exist comparing the effectiveness of online and offline simulation education. The goals of this study are to evaluate active learners' perceived effectiveness of telesimulation versus in situ simulation and to identify potential shortcomings of existing online teaching platforms. Through participant evaluations after a simulation, we compared telesimulation using the Virtual Resus Room (VRR) to in situ simulation in the domains of (1) self-efficacy, (2) fidelity, (3) educational value, and (4) teaching quality. Study subjects included medical and pharmacy residents and medical students completing their pediatric emergency medicine rotation at two children's hospitals as well as nurses, nurse practitioners, and physician assistants who were recently hired and orienting to their new roles in the emergency department. Learners used a modified Michigan Standard Simulation Experience Scale to evaluate either a telesimulation or in situ simulation case. Survey responses were compared using Wilcoxon rank sum tests with Bonferroni correction for multiple comparisons. In overall assessment, in situ simulation was rated higher than telesimulation. There were significant differences noted related to perceived realism, utility in training device-related skills, and utility in training team-building skills. All P values were less than 0.0036. There were no significant differences between simulation types in perception of physical examination fidelity, instructor adequacy, or self-efficacy. Telesimulation using the VRR is comparable to in situ simulation in learners' perception of improvement in self-efficacy and of teaching quality for pediatric emergency medicine topics. However, participants felt less able to practice tactile and communication skills virtually. Further innovation is needed to improve learners' experience with fidelity and educational value.

Nephrology Provider Engagement in Comprehensive Shared Decision-Making Discussions With Older Adults: Results of a Cross-Sectional Survey.

Background: The largest patient group initiating dialysis for end-stage renal disease is persons over 75 years. Evidence indicates pre-dialysis shared decision-making discussions between nephrology providers and older adults are infrequent and often do not include an option for conservative management of symptoms without dialysis. Aims: To assess and compare behavioral determinants of nephrology providers' use of comprehensive pre-dialysis shared decision-making discussions with older adults. A secondary aim was to prepare the bases for tailored behavioral intervention(s) for nephrology providers by identifying the determinant(s) that should be targeted to elicit change in comprehensive shared decision-making intentions and the resulting behavior. Methods: A cross-sectional survey based on the Theory of Planned Behavior was completed by nephrologists from a state organization and nephrology advance practitioners from a national organization, either in person or online via Qualtrics. Results: Survey respondents included nephrologists (n=29), and nurse practitioners (n=37) and physician assistants (n=7), combined, were predominantly female (83%) and White American (67%). Spearman rho correlation results showed attitude, social norm, and perceived behavioral control were correlated with shared decision-making behavior for one or both groups. Significant differences were present between the two groups for determinants and behaviors. Conclusion: Based on the determinants predominantly influencing SDM behavior of nephrology advance practitioners, behavioral interventions targeting the determinants of Social Norm and Perceived Behavioral Control are warranted. All determinants can be utilized in behavioral interventions for nephrologists.Opportunity exists for collaboration between providers to develop consistent and effective methods of SDM discussion that fit into a typical workday.

A Pilot Interprofessional Education Curriculum for Optimizing Mental Health in Chronic Pain Treatment and Understanding Interprofessional Practice.

With the urgent need for clinicians capable of responding to the opioid crisis, an interprofessional education (IPE) pilot curriculum was launched to assess trainee self-efficacy in managing chronic pain and mental health conditions, and attitudes toward interprofessional practice among resident physicians, family nurse practitioners (FNP), and physician assistant (PA) students. This study involved the implementation of a pilot curriculum consisting of five interactive IPE sessions. All invited trainees across two academic institutions were asked to complete the assessments. Self-efficacy in managing chronic pain and mental health was measured at baseline and following IPE training using a researcher-developed tool, while attitudes toward interprofessional practice were measured with the Attitudes Toward Health Care Teams scale. Resident physicians were compared to FNP/PA students to examine differences between groups and within groups over time. The final analysis involved 25 trainees who attended at least one IPE training session and completed pre-session and post-session surveys. The total pre-session survey and post-session survey response rate was 37.5% (n=36). Self-efficacy in chronic pain management improved among the resident physician (mean=3.85 ±0.40) and FNP/PA groups (mean=3.84±0.46) (p=0.05 and p=0.001), respectively. Self-efficacy in mental health management was not significantly improved among resident physicians (mean=3.41±0.49, p=0.48), but improved among FNP/PA students (mean=3.46±0.31, p<0.001). There was no difference in attitudes toward interprofessional practice. While IPE training did not result in attitudinal changes toward interprofessional practice, it shows potential for improving self-efficacy in managing chronic pain and mental health, particularly among FNP/PA trainees. This study was limited by a small sample size of trainees included in the finalanalysis.