Burnout, Personal, and Occupational Factors as Predictors of Physician Assistant Faculty Intent to Leave After the COVID-19 Pandemic.

INTRODUCTION: This study addressed whether burnout, personal, or occupational factors predicted physician assistant (PA) faculty intent to leave and established a new postpandemic national benchmark for PA faculty burnout and intent to leave. METHODS: In spring 2023, a nonexperimental, cross-sectional survey was emailed to 2031 PA faculty drawn from program faculty listings and the PA Education Association member database. Descriptive statistics were used to describe the sample, and a multiple regression analysis was conducted to analyze the predictive ability of the independent variables on intent to leave. RESULTS: The response rate was 30% (609 of 2031), with 496 responses (24.4%) included in the analysis. The sample reflected the population of PA faculty. The regression model significantly predicted intent leave (P < .001). The adjusted R2 was 0.46, indicating the combination of independent variables predicted 46% of the variance in PA faculty intent to leave. Significant predictors included emotional exhaustion and identifying as multiracial (P < .001), control and values (P < .01), and depersonalization, fairness, rewards, and clinical year faculty role (P < .05). The sample had moderate levels of burnout and experienced burnout at higher rates than in prepandemic studies. Physician assistant faculty in administrative leadership roles had the highest levels of burnout and intent to leave. Despite this, PA faculty intent to leave measures were similar to prepandemic levels. DISCUSSION: Several of the predictive variables were related to well-being and social-emotional aspects of the workplace. These findings have implications for institutional policies and practices that support faculty well-being and workplace culture to enhance retention.

A novel curriculum to train physician assistant students how to write effective discharge summaries.

Background: Physician assistants (PAs) are an integral part of inpatient care teams, but many PAs do not receive formal education on authoring discharge summaries. High-quality discharge summaries can mitigate patient risk during transitions of care by improving inter-provider communication. Objective: To understand the current state of discharge summary education at our institution, and describe a novel curriculum to teach PA students to write effective discharge summaries. Design: Students completed a pre-survey to assess both knowledge and comfort levels regarding discharge summaries. They wrote a discharge summary and received feedback from two evaluators, an inpatient provider (IPP) familiar with the described patient and a simulated primary care provider (PCP). Students completed a post-survey reassessing knowledge and comfort. Results: Prior to instituting this curriculum, the majority of students (92.9%) reported rarely or never receiving feedback on discharge summaries. Eighty-four of 88 (95.5%) eligible students participated. There was discordance between IPP and simulated PCP feedback on their assessment of the quality of discharge summaries; simulated PCPs gave significantly lower global quality ratings (7.9 versus 8.5 out of 10, p = 0.006). Key elements were missing from >10% of discharge summaries. Student response was favorable. Conclusion: Clinically relevant deficiencies were common in students' discharge summaries, highlighting the need for earlier, structured training. IPPs and simulated PCPs gave discordant feedback, emphasizing differing needs of different providers during transitions of care. This novel curriculum improved students' knowledge and confidence.

A Program's Analysis of Communication Methods With Clinical Preceptors.

PURPOSE: Preceptors value communication with physician assistant (PA) educational programs. This study describes preceptors' perspectives about one PA program's established and new communication strategies to promote preceptor development and retention. METHODS: An electronic survey of preceptors was conducted in December 2014. Quantitative and qualitative data were analyzed using descriptive statistics. RESULTS: Eighty-eight of 209 preceptors completed the survey (42% response rate). Preceptors reported satisfaction with communication frequency and quality. The most preferred topics were preceptor benefits, teaching strategies, feedback about students' performance, and program policy updates. Many preceptors reported not receiving communications sent by mail. A majority of preceptors preferred site visits at least once per year and in person. CONCLUSIONS: Understanding preceptors' preferred topics helped the study program increase its emphasis on those topics. Knowledge that many preceptors do not receive mailed communications has prompted the program to use electronic communication for all communication types. The results reinforced the program's approach to site visits.

Caring for breast cancer survivors in primary care.

Women with a history of breast cancer compose the largest group of cancer survivors. Physician assistants and nurse practitioners can play a key role in caring for cancer survivors in primary care settings. This article provides a brief overview and synthesis of current breast cancer guidelines, other resources, and clinical observations that may help primary care providers to translate plans developed by oncology specialists into primary care delivery.

Protein microarray analysis of mammary epithelial cells from obese and nonobese women at high risk for breast cancer: feasibility data.

BACKGROUND: Obesity is a well-established risk factor for cancer, accounting for up to 20% of cancer deaths in women. Studies of women with breast cancer have shown obesity to be associated with an increased risk of dying from breast cancer and increased risk of developing distant metastasis. While previous studies have focused on differences in circulating hormone levels as a cause for increased breast cancer incidence in postmenopausal women, few studies have focused on potential differences in the protein expression patterns of mammary epithelial cells obtained from obese versus nonobese women. METHODS: Protein expression was assessed by reverse-phase protein microarray in mammary epithelial cells from 31 random periareolar fine needle aspirations performed on 26 high-risk women. RESULTS: In this pilot and exploratory study, vimentin (unadjusted P=0.028) expression was significantly different between obese and nonobese women. CONCLUSIONS: Vimentin is integral both to adipocyte structure and function and to the epithelial-to-mesenchymal transition needed for cancer cell metastasis. Further research is needed to confirm this finding and determine the possible effects of the adipocyte microenvironment on the initiation and progression of breast cancer in high-risk women. IMPACT: Differential protein expression patterns obtained from a future expanded study may serve to elaborate the underlying pathology of breast cancer initiation and progression in obese women and identify potential biomarkers of response to preventative interventions such as dietary changes and exercise.

Breast self-examination: defining a cohort still in need.

BACKGROUND: The value of breast self-examination (BSE) to detect early breast cancer is controversial. METHODS: Within an institutional review board-approved prospective study, 147 high-risk women were enrolled from 2004 to 2007. Yearly clinical examination, BSE teaching, and mammography were performed simultaneously followed by interval breast magnetic resonance imaging (MRI). Women underwent additional BSE teaching at 6 months. Women reporting a mass on BSE underwent clinical evaluation. RESULTS: Fourteen breast cancers were detected in 12 women. BSE detected 6/14 breast cancers versus 6/14 detected by MRI and 2/14 by mammography. Of 24 masses detected by BSE, 6/24 were malignant. The sensitivity, specificity, and predictive value of BSE to detect breast cancer were 58.3%, 87.4%, and 29.2%, respectively. The sensitivity, specificity, and predictive value of a Breast Image Reporting and Data System (BI-RADS) score of >or=4 on MRI were 66.7%, 88.9%, and 34.8%, respectively. CONCLUSIONS: BSE detects new breast cancers in high-risk women undergoing screening mammogram, CBE, and yearly breast MRI.

Reproducibility of random periareolar fine needle aspiration in a multi-institutional Cancer and Leukemia Group B (CALGB) cross-sectional study.

BACKGROUND: Random periareolar fine needle aspiration (RPFNA) is a research technique developed to assess short-term breast cancer risk in women at increased risk of breast cancer. Although there is increasing acceptance of RPFNA, neither the reproducibility nor the inter-institutional compatibility of RPFNA has been established. To address these key limitations, the Cancer and Leukemia Group B (CALGB) Prevention Group tested the reproducibility of RPFNA in a multi-institutional cross-sectional study. METHODS: Sixty-three high-risk women from five CALGB institutions (Duke, Ohio State, Roswell Park, Dana Farber, and Vermont) underwent RPFNA from July 1, 2007 to June 30, 2008. Duplicate bilateral RPFNA was performed on each woman by a single investigator on a single day. Masood Cytology Index score was assessed by a single blinded cytopathologist. RESULTS: There was a high degree of statistical agreement in the Masood Cytology Index scores of duplicate RPFNA samples from the same breast, with a Spearman correlation coefficient of 0.8312 (P < 0.0001). Importantly, although there was agreement in duplicate samples from the same breast, there was lack of agreement between duplicate samples from the opposite breast. CONCLUSIONS: This multi-institutional study shows that RPFNA is a highly reproducible measure of breast cytology in a cooperative group cross-sectional trial. RPFNA did not show a high degree of agreement between breasts, suggesting that breast cancer risk and progression may occur at different rates in individual breasts from a single woman. These studies provide proof-of-principle for future RPFNA-based cooperative group prevention studies.