Journal of Physician Assistant Education最新文献

Introduction: The Accreditation Review Commission on the Education of the Physician Assistant, which accredits all US Physician Assistant (PA) programs, published standards in 2019 which specifically required programs to include instruction on medical care with respect to gender identity. The purpose of this study was to compare trends in the delivery of transgender content in US PA programs pre- and post-accreditation standard implementation.

Methods: Data were drawn from 2 separate national surveys of PA programs. The first was administered in 2018 (n = 236, response rate 100%) and the second in 2021 (n = 286, response rate 71.8%). Both included questions on hours spent and courses in which transgender health content was included. Chi-square tests were conducted to compare results between 2018 and 2021.

Results: There were statistically significant differences in PA programs reporting inclusion of transgender content between 2018 and 2021, with all courses reporting percent increases between the 2 timepoints. The largest percentage changes were in medical interviewing (43.6% in 2018, 75.5% in 2021) and infectious diseases (6.4% in 2018, 38.7% in 2021). The number of PA programs reporting <1 hour of transgender content decreased from 14.5% in 2018 to 1.6% in 2021.

Discussion: While accreditation standards are not the only contributing factor to the increases in transgender health curricular content in this study, the increases in curricula and delivery methods are pronounced. Findings suggest that accreditation standards may be a powerful strategy in ensuring health professionals receive the content necessary to care for people who are transgender.

Abstract: The physician assistant (PA) profession, historically grounded in a generalist educational model, is experiencing growing pressure to adapt to a workforce increasingly dominated by specialty practice. Questions have emerged regarding whether PA education should incorporate earlier opportunities for specialization. These questions are especially important now, given the potential transition of PA programs from master's to doctoral degrees. This article examines the historical foundations of the generalist model, current workforce and employer trends, the potential benefits and risks of early specialization, and possible middle-ground approaches to such a shift. This narrative is a call for a structured, profession-wide dialogue involving educators, policymakers, and clinicians to evaluate the implications of early specialization and guide the evolution of PA education in alignment with workforce needs and professional values.

Abstract: Professionalism is a fundamental principle of medicine affirmed as a student and applied as a health care provider. During graduate educational training, physician assistant (PA) students may fail to excel in professionalism standards, demanding an obligation for remediation. Physician assistant educators are charged with the construction and execution of effective professionalism remediation strategies for students to help ensure competent healthcare delivery upon graduation. The aim of this article is to provide clear, applicable professionalism remediation strategies to novice and experienced PA educators to be efficiently implemented with PA students through discovery of findings within published literature to be grouped into connecting themes. The article encompasses several identified themes linked to successful PA student remediation, such as remediation training for PA faculty, early remediation interventions, consideration of confounding factors upon remediation plans, PA student remediation reflections, as well as professionalism modeling within PA educators. Physician assistant faculty can impact the construction and execution of effective remediation strategies for PA students to help ensure competent health care delivery upon graduation.

Introduction: This study compares the value of web-based interactive case simulations (specifically, Aquifer) with paper-based case simulations among first-year physician assistant students working in small groups.

Methods: Forty-three first-year physician assistant (PA) students in the gastroenterology module preassigned to physical examination practice groups of 3 or 4 were randomly assigned to work through 2 cases in a crossover study. Roughly half the students were assigned to do a pancreatitis case on Aquifer while the other half worked through a pancreatitis case in a paper-based symptom-to-diagnosis simulation. The groups then switched so that each group changed to the other modality to work through a diverticulitis case. Students were surveyed at the conclusion of both exercises about the value of each modality for learning and for reinforcing learning and asked which modality they preferred.

Results: Forty completed surveys were returned. Nearly 75% of students preferred the manual symptom-to-diagnosis simulation, particularly for small group work, and the most cited reason was that it was "more realistic."

Discussion: Alhough many students found the wealth of information they could read about on Aquifer beneficial, especially when studying alone, students felt that they learned more from the group discussion during the traditional symptom-to-diagnosis case, had more fun learning, and preferred this type of exercise when working in small groups.

Introduction: This study aimed to evaluate whether physician assistant/associate (PA) students' sociodemographic factors were predictors of risk for mistreatment. A secondary analysis aimed to evaluate whether sociodemographic features were evenly distributed among respondents who answered mistreatment items.

Methods: Data originated from the PA Education Association End of Program Surveys (2018, 2019, 2021, and 2022). Independent variables were gender, race, ethnicity, and sexual orientation. Using logistic regression, odds ratios were calculated for 2 separate dependent variables: whether respondents experienced mistreatment and whether respondents completed mistreatment items.

Results: Surveys included 11,461 respondents, 3218 (28.1%) of whom experienced mistreatment; however, 3258 (28.4%) of respondents did not answer any mistreatment items. Analysis showed statistically significant sociodemographic factors for risk for mistreatment, but the model had poor fit ( P -value = 0; receiver operating characteristic [ROC] 0.553), possibly related to partial nonresponse bias. Completing mistreatment items was statistically significantly more likely for respondents who indicated they were gay or lesbian (odds ratio [OR] 1.52) or bisexual (OR 1.82) and less likely for respondents who indicated they were male (OR 0.68), sexual orientation "I don't know/prefer not to answer" (OR 0.65), Hispanic (OR 0.79), or not White (OR 0.49).

Discussion: The sociodemographic factors evaluated were inadequate to predict mistreatment of PA students, but sociodemographic factors were associated with willingness to complete mistreatment questions. Qualitative research is needed to determine why respondents who are male, Hispanic, or not White are reluctant to complete mistreatment questions. Findings could inform survey improvements to more accurately measure health professions student mistreatment.

Introduction: This paper examines student resistance to arts and humanities (A&H) educational content and whether it is durable over time among physician assistant (PA) students.

Methods: A cohort of PA students from a Midwest university medical center (N = 64) participated in ten A&H modules as part of their didactic curriculum. Focus groups assessed student responses to the modules at 2 time points: after completion of all modules and again after their clinical rotations. We coded and analyzed the data using a grounded theory approach.

Results: We found that cohort resistance to A&H changed over time. During the didactic curriculum, students attributed their struggles to an impression that they performed module tasks poorly or to a lack of interest in particular A&H activities. They reported feelings of vulnerability or anxiety, which they did not appreciate. In contrast, after clinical rotations, we heard no A&H resistance. Instead, PA students spoke of seeing greater value in A&H after its use in patient encounters, preceptor discussions/modeling, and their own increased participation in A&H due to the easing of time constraints.

Discussion: While PA students were initially resistant to the A&H activities when they were first presented during their didactic education, their perceived value of the activities became more positive over time following experience in the clinical setting during clerkships. Assessing resistance at 2 different points in the educational trajectory leads us to conclude that initial resistance to A&H education diminishes as the content connects to clinical practice through experience.

Abstract: Longitudinal integrated clerkships support robust patient-student and student-preceptor relationships, encourage patient advocacy by students, and foster continued humanism in professional practice. While such programs prevail in medical student education, little is known about the impact of longitudinal integrated clerkships on other health professionals' education. In 2018, the Cambridge Health Alliance collaborated with the Boston University Physician Assistant program to implement one of the first longitudinal integrated clerkships for physician assistant students. Data from 5 years of this program demonstrate that participants of the longitudinal integrated clerkship were as successful as their colleagues on their end-of-curriculum exams, and 100% of them passed the Physician Assistant National Certifying Exam on their first attempt. Longitudinal patient follow-up fostered trust between students and patients and between students and faculty. As a result, students had increased opportunities for more in-depth patient counseling, with a focus on preventative medicine, as documented in their encounter logs. An additional benefit was the retention at Cambridge Health Alliance of half of the students in the program as they advanced into clinical practice. This longitudinal integrated clerkship expands upon the benefits of student-patient relationships, allows for continued clinical success, and enhances interest in continuing to care for diverse patient populations. This model fosters interprofessional education through shared preceptors and tutorials with medical students. Longitudinal integrated clerkships may also provide a way for the health care systems to recruit future employees and navigate provider retention.

Abstract: To review the existing literature that examines the potential effect artificial intelligence (AI) has on increasing health care student self-efficacy related to objective structured clinical examinations (OSCEs). This review examines current research on student self-efficacy related to OSCE assessment, strategies to increase student self-efficacy and confidence, and emerging studies on applying AI in health care education. This analysis will identify how AI tools might affect student preparation unique to OSCE assessments. Current evidence suggests that despite the widespread acceptance of OSCEs as a valid assessment tool to measure student proficiency in clinical skills, these types of assessments generate disproportionately lower self-efficacy in students preparing for OSCEs than traditional written assessments. Studies show that although student performance on OSCE assessments is not affected by their anxiety, they continue to harbor a negative perception of this type of examination. Evidence has shown that study strategies that enhance student self-efficacy and confidence through preparatory resources produce a mitigating effect on student anxiety. Emerging research has shown evidence that student engagement with, or to produce, AI-generated preparatory tools creates a more self-efficacious student who is confident in their ability to take and pass an OSCE. Using AI as a tool for students to prepare for OSCE assessments holds promise. Training students to engage with AI to generate study tools that focus on strengthening areas where knowledge gaps or weaknesses exist can help to improve their clinical skills and reasoning. Being more self-efficacious and familiar with these tasks only builds self-confidence in performing them.

Introduction: In partial fulfillment of accreditation requirements, physician assistant (PA) programs analyze various performance indicators to identify correlation to Physician Assistant National Certifying Exam (PANCE) outcomes. While numerous studies have identified correlating performance indicators, research defining actionable, program-specific intervention criteria is limited. To address this need, we aim to determine if interventions implemented by the program based on indicator cutpoints were effective in reducing the number of potential PANCE failures.

Methods: This retrospective study includes students in cohorts 2019 to 2024 from the University of North Texas Health Science Center PA Program (n = 426). Pearson correlation and regression analysis was performed to identify cutpoints for program indicators of PANCE performance. At-risk student performance after counseling and intervention was then analyzed.

Results: Students with 5 or more indicators below the cutpoint were projected to fail the PANCE. Cohorts 2019 to 2023 had 5 or fewer projected PANCE failures each year, while cohort 2024 had 13 projected failures. With targeted intervention and counseling initiated early in the program, the 2024 cohort had a significantly lower rate of PANCE failure among those projected to fail compared to previous cohorts (2024: 8%; 2023: 50%; 2021: 40%; 2020: 50%).

Discussion: Monitoring student progress through both didactic and clinical phases, using a combination of cutpoints for programmatic assessments and course performance, allows for timely and individualized interventions that can enhance PANCE pass rates. The noted reduction in the PANCE failure rate for cohort-specific high-risk students highlights the success of this approach and underscores the value of personalized counseling, tailored interventions, and access to resources throughout the program.