Multiple Mini-Interview Utilization in United States Physician Assistant Program Admission Processes.

PURPOSE: Health care program admission processes utilize multi-faceted approaches to evaluate cognitive and noncognitive attributes of applicants. The multiple mini-interview (MMI) was developed in response to the need for a reliable and validated tool to assess noncognitive factors and has been increasingly incorporated into the admissions process by physician assistant (PA) programs. The study's purpose was to explore the current implementation and utilization of the MMI within PA programs. METHODS: The study used a mixed-methods exploratory approach including a telephone survey and semi-structured interview of 11 PA programs using the MMI in their admissions process. Quantitative data collected included demographic information, MMI implementation characteristics, station structure, scoring, feasibility, satisfaction with MMI utilization, and MMI evaluation methods. RESULTS: During the 2015-2016 admissions cycle, the participating programs used from 5 to 10 stations, averaging 7 minutes per station, requiring 8 faculty, 2 staff, and 7 students per interview session. Despite variation in program size, number of applicants, and years of MMI utilization, all participating programs reported that they were satisfied with the format and would continue to utilize the MMI in the admissions process. CONCLUSIONS: While there is substantial literature describing the use of the MMI within health care programs globally, this study represents the first characterization of its use within PA programs on a national level. Although there was variation among PA program implementation of the MMI, our results are comparable to studies within other health care professions. Additional studies are necessary to further describe the MMI and its correlation with PA program educational outcomes and the impact on diversity.

Health Care Project Improvement Design: Proficiency Among University Faculty.

The purpose was to measure faculty members': (1) knowledge of quality improvement and patient safety (QIPS), (2) attitudes and beliefs about their own QI skills, and (3) self-efficacy toward participating in, leading, and teaching QIPS. Faculty completed an online survey. Questions assessed demographic and academic characteristics, knowledge, attitudes/beliefs, and self-efficacy. Knowledge was measured using the Quality Improvement Knowledge Assessment Tool-Revised (QIKAT-R). Participants provided free-text responses to questions about clinical scenarios. Almost half of participants (n = 236) self-reported that they were moderately or extremely comfortable with QIPS skills. Few were very (20%) or most (15%) comfortable teaching QIPS. Ninety-one participants attempted the QIKAT-R, and 78 participants completed it. The mean score was 16.6 (SD = 5.6). Despite positive attitudes and beliefs about their own QIPS skills, study results demonstrate a general lack of knowledge among surveyed faculty members. Faculty development efforts are needed to improve proficiency in participating, leading, and teaching QIPS projects.

Clinical Reasoning and Knowledge Organization: Bridging the Gap Between Medical Education and Neurocognitive Science.

PURPOSE: The purpose of this pilot study was 2-fold. The first was to investigate the conceptual relationship between previously validated methodologies. The second was to establish a linkage between medical education research and current neurocognitive science that accounts for knowledge organization during the clinical reasoning process. METHODS: Transcripts of Think Aloud interviews conducted after an objective structured clinical examination (n = 12) were coded and analyzed into 3 clinical reasoning competencies (semantic, diagnostic, and knowledge network organization). Correlational analyses were conducted to establish relationships between the 2 methodologies. Analyses of variance examined group differences. RESULTS: Significant correlations with large effect sizes were found between semantic, diagnostic, and knowledge network organization variables. Analysis of variance results approach significant difference in the knowledge network organization between weak versus strong diagnosticians. CONCLUSIONS: Knowledge network organization measurement can be used to discern differences in clinical reasoning and may offer explanations for the variation in health professionals' diagnostic performance.

Similarities and Differences Between Physician Assistant Program and Medical School Mission Statement Themes.

PURPOSE: The purpose of this study was to examine the concordance of US physician assistant (PA) program mission statements with those of US public- and private-sponsored medical schools. With the exception of a broader medical school focus on research, the authors hypothesized that little difference in mission statement congruence would be found in a comparison of medical schools and PA programs. METHODS: Mission statements of 209 of the 210 accredited US PA programs as of May 2016 were obtained and analyzed. Keywords and phrases were identified, coded, and analyzed using NVivo. Themes that previously reported medical school mission statement analyses (including education, research, service, primary care, diversity, prevention, provider distribution, and cost control) were examined. Additional themes of evidence-based medicine (EBM), interprofessional care, patient safety, and quality improvement were included in the analyses. RESULTS: Analyses revealed similar emphasis in both PA programs and medical schools on themes of education, prevention, and cost control, with dissimilar emphases on themes of research, service, primary care, diversity, and provider distribution. Physician assistant programs were more likely to emphasize interprofessional care than EBM, patient safety, or quality improvement. CONCLUSIONS: In the comparison of mission statements of medical schools and PA programs, much less congruence was found than had been hypothesized. Although this study examined the similarities and differences between the mission statements of US medical schools and PA programs, it did not examine the extent to which programs succeeded in meeting the stated missions. Additional research is necessary to understand the factors that determine whether mission statements are actualized in measurable deliverables.

Development of a Quality Improvement Curriculum in Physician Assistant Studies.

PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

The Expanding Role of Advanced Practice Providers in Urologic Procedural Care.

OBJECTIVE: To understand the role of Advanced Practice Providers (APPs) in urologic procedural care and its change over time. As the population ages and the urologic workforce struggles to meet patient access demands, the role of APPs in the provision of all aspects of urologic care is increasing. However, little is currently known about their role in procedural care. MATERIALS AND METHODS: Commonly performed urologic procedures were linked to Current Procedural Terminology (CPT) codes from 1994 to 2012. National Medicare Part B beneficiary claims frequency was identified using Physician Supplier Procedure Summary Master Files. Trends were studied for APPs, urologists, and all other providers nationally across numerous procedures spanning complexity, acuity, and technical skill set requirements. RESULTS: Between 1994 and 2012, annual Medicare claims for urologic procedures by APPs increased dramatically. Cystoscopy increased from 24 to 1820 (+7483%), transrectal prostate biopsy from 17 to 834 (+4806%), complex Foley catheter placement from 471 to 2929 (+522%), urodynamics testing from 41 to 9358 (+22,727%), and renal ultrasound from 18 to 4500 (+24,900%) CONCLUSION: We found dramatic growth in the provision of urologic procedural care by APPs over the past 2 decades. These data reinforce the known expansion of the APP role in urology and support the timeliness of ongoing collaborative multidisciplinary educational efforts to address unmet needs in education, training, and guideline formation to maximize access to urologic procedural services.

Advanced Practice Providers in U.S. Urology: A National Survey of Demographics and Clinical Roles.

INTRODUCTION: Projections suggest a significant shortage of urologists coupled with an increasing burden of urological disease due to an aging population. To meet this need, urologists have increasingly partnered with advanced practice providers. However, to this point the advanced practice provider workforce has not been comprehensively evaluated. Understanding the impact of advanced practice providers on the urology workforce is essential to maximize collaborative care as we strive for value and quality in evolving delivery models. METHODS: A 29-item, web based survey was administered to advanced practice providers identified by the AUA (American Urological Association), UAPA (Urological Association of Physician Assistants) and SUNA (Society of Urologic Nurses and Associates), querying many aspects of their practice. RESULTS: A total of 296 advanced practice providers completed the survey. Advanced practice nurses comprised 62% of respondents while physician assistants comprised the remaining 38%. More than two-thirds of the respondents were female and median age was 46 years. Only 6% reported having participated in formal postgraduate urological training. Advanced practice providers were evenly divided between institutional and private practice settings, and overwhelmingly in urban or suburban environments. The majority of advanced practice providers practice in the ambulatory setting (74%) and characterize their practice as general urology (72%). Overall 81% reported performing procedures independently, with 63% performing some procedures considered to be of moderate or high complexity. CONCLUSIONS: Advanced practice providers are active in the provision of urological care in many roles, including complex procedures. Given future workforce needs, advanced practice providers will likely assume additional responsibilities. As roles shift we must ensure we have the necessary educational and training opportunities to equip this vital part of our workforce.

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.

Exploring physician assistant data sources.

OBJECTIVES: To assess four physician assistant (PA) proprietary datasets and inform researchers about data quality for addressing healthcare policy and workforce questions. METHODS: The quality of datasets was assessed by experienced researchers. Descriptive analysis included overview, collection methodology, variables, and availability. Assessment included each dataset's strengths and limitations. RESULTS: Datasets from the American Academy of Physician Assistants, National Commission on Certification of Physician Assistants, Physician Assistant Education Association, and Optum Provider360 Database include overlap in variables reflecting organizational mission and/or design. Attributes include variables for validation; limitations were lack of public use files, requirements for specific data requests or data purchase. The datasets do not have unique identifiers and cannot easily be linked. CONCLUSIONS: The PA datasets contain variables of interest but are limited in scope. Better data collection and shared platforms could further the understanding of PA workforce characteristics and contributions to American healthcare. Researchers await more comprehensive, longitudinal, linked, and publicly available datasets.

Physician assistant specialty choice: a factor analysis.

PURPOSE: The purpose of this study was to identify factors related to physician assistant (PA) graduates' specialty choice. METHODS: A web-based cross-sectional study of PAs graduating between 2007 and 2009 was conducted (N = 12,128). Factor analysis was performed on 897 useable survey responses. The cohort profile resembles that of recent AAPA census data regarding demographic and specialty choice distribution. RESULTS: Principal component factor analysis of perception items identified five factors that explained 52.6% of the response variance. Factors included personal satisfaction, intellectual challenge, patient care commitment, image of primary care, and professional satisfaction. The influence items analysis yielded five factors, explained 45.2% of the variance, and included practice environment, nature of patient care, lifestyle, employment opportunities, and risk aversion. These factors parallel previous findings of Hauer, et al. CONCLUSIONS: Identification of factors affecting specialty choice should provide an enhanced understanding to organizations as they explore strategies to increase recruitment and expansion of the primary care workforce.