Student Performance Metrics and the Physician Assistant National Certifying Exam ® : A 3-Year Multi-Institutional Study.

INTRODUCTION: Given the 2019 Physician Assistant National Certifying Exam (PANCE) blueprint update from the National Commission on the Certification of Physician Assistants, it is imperative that programs conduct analyses of student performance metrics and PANCE scores. The purpose of this multi-institutional study was to examine the relationship between PANCE scores and student performance metrics/attributes from PA program graduates from 2017-2019. METHODS: A multiple linear regression was calculated to predict PANCE score indicators based on student attributes and performance metrics from 3 PA programs. Metrics included: PAEA End of Rotation exams, PACKRAT scores, academic performance in clinical medicine didactic courses, cumulative grade point average, and select demographic and admissions attributes (age, sex, and first generation to attend college). Descriptive statistics were employed to provide contextual information and an overview of the included data points. RESULTS: A significant regression equation was found with r-square of 0.709. Clinical Medicine II didactic course grades, PACKRAT I & II scores, and PAEA End of Rotation Exam scores in Family Medicine and Internal Medicine were all significant predictors of PANCE score. DISCUSSION: In consideration of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) Standards and expectations for ongoing self-assessment, including PANCE analysis, this research was timely and necessary. To date, there is very limited research regarding student performance metrics given the PANCE blueprint update in 2019, and these data are critical to aid programs in ongoing development and best preparation for learners.

Factors Influencing Physician Assistant Student Attrition Rates.

INTRODUCTION: The aim of this study was to assess factors that influence student well-being and attrition and to compare faculty perceptions to the realities of student experience. METHODS: Three anonymous online surveys were distributed, one for each group of currently enrolled students, faculty/staff, and attritted students. RESULTS: Faculty estimated that an average of 12.8% of PA students in their program have considered dropping out in the past 6 months, while 22.9% of students self-reported considering dropping out in the past 6 months. The most frequently cited factors for considering dropping out were mental health and lack of connection to the program. Mental health was the highest cited reason for having taken or having considered taking a leave of absence. DISCUSSION: Faculty perceptions in this study were incongruent with the actual situations of their students. Mental health issues and a lack of connection to programs were the largest influencers of attrition.

Comparing the Effectiveness of Virtual and In-Person Delivery of Mindfulness-Based Skills Within Healthcare Curriculums.

Purpose: To promote well-being, healthcare education programs have incorporated mindfulness-based skills and principles into existing curriculums. Pandemic-related restrictions have compelled programs to deliver content virtually. Study objectives were to determine (1) whether teaching mindfulness-based skills within physician assistant (PA) programs can promote well-being and (2) whether delivery type (virtual vs. in-person) can impact the effectiveness. Methods: During this 2-year study, a brief mindfulness-based curriculum was delivered to incoming first-year students at six PA programs, while students at two programs served as controls. The curriculum was delivered in-person in year one and virtually in year two. Validated pre- and post-test survey items assessed mindfulness (decentering ability, present moment attention and awareness, and psychological flexibility) and well-being (perceived stress and life satisfaction). Results: As expected, coping abilities and well-being were adversely impacted by educational demands. The mindfulness-based curriculum intervention was effective in increasing mindfulness and life satisfaction, while decreasing perceived stress when delivered in-person. Virtual curricular delivery was effective in decreasing perceived stress but not improving life satisfaction. Over half of the participants receiving the curriculum reported positive changes on mindfulness measures with approximately 14-38% reporting a change of greater than one standard deviation. Changes on mindfulness measures explained 30-38% of the reported changes in perceived stress and 22-26% of the changes in life satisfaction. Therefore, the mindfulness curriculum demonstrated statistically significant improvements in measures of mindfulness and mitigated declines in life satisfaction and perceived stress. Conclusion: Mindfulness-based skills effectively taught in-person or virtually within PA programs successfully promote well-being.

Wellness in Physician Assistant Education: Exploring Mindfulness, Well-Being, and Stress.

PURPOSE: The current study examined stress reduction activities most commonly used by matriculating physician assistant (PA) students to better understand how students are approaching self-care and management of stress. In particular, the study examined levels of mindfulness and well-being to understand how these relate to various stress reduction approaches at the time of matriculation. METHODS: Newly matriculated students at 9 PA programs located across the nation were surveyed (n = 294). Validated survey instruments assessed levels of mindfulness and general well-being. Stress reduction activities were also assessed. Univariate and multivariate analyses were used to examine levels of mindfulness and levels of well-being to see how these relate to various stress reduction approaches. RESULTS: The survey response rate was 72%. Nearly one-third of respondents (32%) identified meditation as one of their stress reduction activities, and more than half (53%) reported having participated in mindfulness practice at least once in the past year. Sixty-four percent of students reported awareness of mindfulness practices, while only 16% reported frequent practice within the year prior to matriculation. When looking at variables of interest, decentering and psychological flexibility were significant in accounting for student-reported perceived stress and life satisfaction. CONCLUSION: PA students are likely receptive to mindfulness-based interventions that have the potential to improve well-being and reduce stress. There is opportunity for programs to incorporate reliable and structured training within curricula that effectively increases levels of mindfulness and, in doing so, can lead to improvement in perceived stress and life satisfaction. Further research may assist educators in the development of strategies to promote student and clinician wellness.

Minority Physician Assistant Faculty: A Phenomenological Assessment of Factors Leading to Retention in the Faculty Role.

Improving racial and ethnic diversity in the physician assistant (PA) profession is important to providing better care for underserved communities. The recruitment and retention of minority PA faculty is one aspect of helping to attract and retain a more diverse student body. Previous research has indicated that minority status is associated with the increased attrition of PA faculty but has not provided insight into the specific factors involved in the retention or attrition of minority PA faculty. The purpose of this qualitative research study was to describe the experience of minority PA faculty through a critical race theory lens. We used a phenomenological approach using structured interviews of minority PA faculty. Better understanding of the experience of minority PA faculty might lead to improved efforts at recruiting and supporting a more diverse faculty workforce. We conducted 13 interviews of PA faculty representing a variety of underrepresented minorities, geographic regions, types of schools, and stages of their careers. Major themes that emerged across the participants' experiences included opportunities for success in the form of both internal and external support systems and mentorship. As a corollary, barriers to the retention of minority PA faculty including a lack of institutional support, gaps in mentorship, and lack of a solid support network were cited.

Perceived Discrimination, Harassment, and Abuse in Physician Assistant Education: A Pilot Study.

PURPOSE: A 2014 meta-analysis found that by graduation, 16.6% of medical students had reported abuse, harassment, or discrimination and that this hostile environment caused an increase in depression and anxiety. The purpose of this research study was to increase the understanding of discrimination and psychological/physical abuse in physician assistant (PA) education programs and the potential impact on student attrition. METHODS: Information was collected using an online, anonymous survey that asked about witnessed or experienced discrimination and psychological or physical abuse during the didactic and clinical years of training in PA programs in the United States. RESULTS: The survey received 1159 respondents, which represents 6.1% of total PA student enrollment. Up to 30% of respondents had witnessed or experienced discrimination, and up to 2.3% had experienced psychological abuse while in PA school. The majority of witnessed or experienced discrimination during PA education was not reported (<2%). Reports were not made because students feared retribution or they simply did not know who to report to, particularly if the incident involved faculty. CONCLUSION: Reducing the prevalence of discrimination in PA education requires recognition of this issue and targeted efforts to ensure that the infrastructure of every program is inclusive and values diversity of all kinds. The authors advocate that PA programs discuss their current institutional reporting structure; develop a universal curriculum on workplace violence, discrimination, and harassment; and develop value statements that explicitly identify diversity and equity as a core value as an important first step to improving the overall "climate" and culture of the program.

Impact of a personal CYP2D6 testing workshop on physician assistant student attitudes toward pharmacogenetics.

AIM: We assessed the impact of personal CYP2D6 testing on physician assistant student competency in, and attitudes toward, pharmacogenetics (PGx). MATERIALS & METHODS: Buccal samples were genotyped for CYP2D6 polymorphisms. Results were discussed during a 3-h PGx workshop. PGx knowledge was assessed by pre- and post-tests. Focus groups assessed the impact of the workshop on attitudes toward the clinical utility of PGx. RESULTS: Both student knowledge of PGx, and its perceived clinical utility, increased immediately following the workshop. However, exposure to PGx on clinical rotations following the workshop seemed to influence student attitudes toward PGx utility. CONCLUSION: Personal CYP2D6 testing improves both knowledge and comfort with PGx. Continued exposure to PGx concepts is important for transfer of learning.

Assessing Performance and Learning in Interprofessional Health Care Teams.

PURPOSE: Teamwork has become an integral part of health care delivery. Such emphasis on teamwork has generated the need to systematically measure and improve the learning and performance of health care teams. The purpose of this study was to develop a comprehensive assessment instrument, the Interprofessional Education and Practice Inventory (IPEPI), to evaluate learning and performance in interprofessional health care teams. METHODS: The 12-month study commenced in three 4-month phases: (1) a panel of 25 national and international experts participated in the Delphi process to identify factors influencing team learning and team performance; (2) the research team analyzed the findings from the two Delphi rounds to develop the IPEPI; and (3) a cohort of 27 students at the university engaged in clinical simulations to test and refine the IPEPI. RESULTS: Findings suggest key factors that significantly influence team learning and performance include whether the group is able to foster a climate of mutual respect, adopt effective communication strategies, develop a sense of trust, and invite contributions from others. Additionally, in assessing organizational factors, participants indicated those factors that significantly influence team learning and performance include whether the organization is patient-centered, creates a culture of safety (not blame), and supports individual and team learning. CONCLUSIONS: These findings highlight the critical role assessment plays in enhancing not just interprofessional education or interprofessional practice, but in essence advancing interprofessional education and practice--which requires an integrated examination of how health care professionals learn and perform in teams.

Race, ethnicity, and the physician assistant profession.

The physician assistant (PA) profession has long had a focus on providing primary healthcare to all. In order to best serve an increasingly diverse population, we examine the racial and ethnic diversity trends experienced in PA education and the PA profession, in the context of national demographics, and the racial and ethnic diversity of other health professions. We also offer recommendations to improve the racial and ethnic diversity of the PA profession.

Integrating executive coaching and simulation to promote interprofessional education of health care students.

This study used executive coaching and simulation to enhance interprofessional teamwork by promoting collaboration and leadership capacity in health professional students attending undergraduate programs. A mixed methods approach to program evaluation was used. A statistically significant (p<0.05) increase was noted pre- and post-program on the Team Assessment Inventory. Qualitative analysis of reflective essays and focus group interviews revealed that students participated as a career-building opportunity and because they wanted to gain a better appreciation for the roles and contributions of other health care providers. The themes that emerged related to aspects of the process students found helpful, lessons learned about professional roles, and the meaning of leadership in the context of interprofessional teams. Students also provided recommendations for future studies. Findings suggest that integrating executive coaching and simulation in interprofessional education may have the potential to create meaningful experiences for health professional students. While more empirical research is needed to investigate this potential, in terms of how executive coaching and simulation may increase professional collaborative care and improve the quality of health care delivery, the initial insights seem promising.

Assessment of competency in electrocardiogram interpretation of graduating physician assistant students.

PURPOSE: This study assessed the competency in electrocardiogram (ECG) interpretation of the 2011 physician assistant (PA) class at George Washington University School of Medicine and Health Sciences. METHODS: A survey and 22-item ECG examination were completed by 51 students prior to graduation. Six strips were critical ECGs. RESULTS: The students scored 50.7% on the 22 ECGs and 68.0% on the six critical ECGs. Students who were more confident regarding their ability to accurately interpret ECGs and those who took a cardiology elective performed statistically significantly better on the 22 ECG examination (P = .005 and P = .032 respectively) but not on the six critical ECGs (P = .130 and P = .132 respectively). There were no significant associations between scores on either the 22 ECGs or six critical ECGs and students' perceived sufficiency of ECG training and desire for more ECG training. CONCLUSION: The students' overall scores indicate the need for improved training in ECG interpretation skills.

Does perspective-taking increase patient satisfaction in medical encounters?

PURPOSE: To assess whether perspective-taking, which researchers in other fields have shown to induce empathy, improves patient satisfaction in encounters between student-clinicians and standardized patients (SPs). METHOD: In three studies, randomly assigned students (N = 608) received either a perspective-taking instruction or a neutral instruction prior to a clinical skills examination in 2006-2007. SP satisfaction was the main outcome in all three studies. Study 1 involved 245 third-year medical students from two universities. Studies 2 and 3 extended Study 1 to examine generalizability across student and SP subpopulations. Study 2 (105 physician assistant students, one university) explored the effect of perspective-taking on African American SPs' satisfaction. Study 3 (258 third-year medical students, two universities) examined the intervention's effect on students with high and low baseline perspective-taking tendencies. RESULTS: Intervention students outscored controls in patient satisfaction in all studies: Study 1: P = .01, standardized effect size = 0.16; Study 2: P = .001, standardized effect size = 0.31; Study 3: P = .009, standardized effect size = 0.13. In Study 2, perspective-taking improved African American SPs' satisfaction. In Study 3, intervention students with high baseline perspective-taking tendencies outscored controls (P = .0004, standardized effect size = 0.25), whereas those with low perspective-taking tendencies did not (P = .72, standardized effect size = 0.00). CONCLUSIONS: Perspective-taking increased patient satisfaction in all three studies, across medical schools, clinical disciplines, and racially diverse students and SPs. Perspective-taking as a means for improving patient satisfaction deserves further exploration in clinical training and practice.