Managing heartburn and reflux in primary care.

ABSTRACT: This article describes an algorithmic approach to caring for patients presenting with heartburn and reflux, including empiric treatment with acid-suppression therapy and a data-driven approach to diagnostic testing. This article also reviews the efficacy and safety profile of the widely available and commonly used proton pump inhibitors. Refining our approach to diagnostic testing can reduce time to diagnosis, better control patients' symptoms, and limit complications of longstanding disease.

Opioid use disorder and motivational interviewing: Training physician assistants for the epidemic.

OBJECTIVES: (1) To evaluate the effectiveness of a curriculum on physician assistant (PA) students' knowledge about opioid use disorder (OUD) treatment and management and (2) present student satisfaction with the curriculum. METHODS: Three cohorts of PA students completed pre- and post-intervention questionnaires about their knowledge of motivational interviewing (MI) for OUD. One cohort of students completed the 11-item questionnaire without exposure to the intervention (control group). Students' satisfaction with the curriculum was assessed as was their pre- and post-intervention knowledge about using MI for OUD. Bivariate statistical tests were used to analyze the quantitative data. RESULTS: Three hundred complete and usable responses were obtained from the four cohorts of PA students (n = 300, 87.7 percent response rate). The intervention groups answered a higher number of items correctly (median = 7) than the control group (median = 6, Wilcoxon sign test M = 31, p < 0.0001). Among the intervention group, there was not a statistically significant between cohort difference on: (1) the number of identical pre- and post-intervention questionnaire items answered correctly (Chi-square = 3.77, DF = 2, p = 0.15), and (2) the total number of items answered correctly on the post-intervention questionnaire (Chi-square = 0.32, DF = 2, p = 0.85). Student comments suggest students were supportive of the curriculum, with improvements noted on how to deliver the material. CONCLUSIONS: An educational intervention using MI for PA students was found to be valuable, and students who completed the intervention had greater knowledge about using MI with OUD patients than those who did not complete the training. The size of the effect was small, and more research on the curriculum is necessary prior to widespread adoption.

COVID-19 and Physician Assistant Faculty Burnout: A Year into the Pandemic.

PURPOSE: The psychological effects of COVID-19 have been extensive and have affected health care workers and educators alike. The aims of this study were to evaluate how the COVID-19 pandemic has impacted PA faculty and their attitudes toward work. METHODS: Two quantitative, pre/post surveys were offered to 21 PA faculty at one institution prior to and then one year into the COVID-19 pandemic. PA faculty perceptions of workplace culture and burnout were included in the online surveys. RESULTS: Data were collected on 17 PA faculty (81% response rate). There was a statistically nonsignificant decrease in faculty disengagement (2.1 v 2.1, p = 0.87) and a statistically significant increase in faculty exhaustion (2.2 v 2.5, p = 0.005). There were statistically significant increases in communication, value, job satisfaction, and wellbeing workplace items. CONCLUSION: As many workplace protocols remain changed as a result of COVID-19, institutions should monitor and adjust processes to reduce the risk of burnout for faculty.

Training Physician Assistants to Use Medical Interpreters Effectively.

PURPOSE: To examine the internal consistency of a validated instrument for physician assistant (PA) communication skills with interpreters and evaluate a training activity focused on effectively working with interpreters during a standardized patient assessment. METHODS: Six cohorts of PA students completed training on how to communicate with patients who required an interpreter. Students then completed an assessment with a limited English-proficient patient and interpreter. Student competency was assessed using a previously validated measure. Data were analyzed using a multivariable Poisson regression model. RESULTS: There were usable data on 439 PA students. The median number of areas that students performed/partially performed was 10 out of 12 (inter-quartile range: 3). The Poisson regression model revealed significant differences between cohorts. Areas for further training include using Teach-Back (n = 203) and thanking the interpreter (n = 170). CONCLUSIONS: Although the PA students performed well, there is considerable room for improvement in certain communication techniques.

Safety in Numbers: Successful Student-Approved Case-Based Interprofessional Safety Workshop Utilizing Simulated Real-Life Safety Cases.

Introduction: Increasing emphasis on medical trainee competence in patient safety and quality improvement processes has led to development of various safety and quality curricula. Methods: Curriculum surveys indicated our medical school's module-based safety and quality improvement curriculum did not meet student satisfaction benchmarks. We developed a single-day interprofessional patient safety workshop combining students from three different health care training programs (medical doctor, physician assistant, nurse anesthetist). Clinical facilitators from each profession were paired with institutional safety and quality officers. A novel curriculum was created based on a real patient safety case: Students were charged with conducting key interviews of those involved in the event as a root cause analysis (RCA) and developing a process improvement plan based on their RCA findings to present to a panel of institutional executives. Pre- and postevent surveys were completed and analyzed by trainee program. Results: This workshop improved students' attitudes regarding interprofessional education and expanded their knowledge of investigating safety events. Overall, assessed knowledge and attitudes improved 53% over the previous safety curriculum. Eighty-one percent of students agreed or strongly agreed that the workshop helped them think about the health care system in a new and different way. One corrective action suggested by a student group during the executive panel was later adopted by our institution and resulted in a permanent change to our health care system. Discussion: This case-based interprofessional workshop was well received by students and facilitators and allowed purposeful interactions between students in different arenas of medical training.