Non-native English-speaking applicants and the likelihood of physician assistant program matriculation.

PURPOSE: Effective communication is critical in patient care. Multilingual medical providers, including Physician Assistants (PAs) can contribute to improved health care among patients with limited English proficiency; however, this is contingent upon matriculating multilingual providers. In this study, the association between prospective applicants' self-reported English as second language (ESL) status and their likelihood of matriculation into a PA program was investigated. METHODS: Participants included applicants to five admission cycles of the Centralized Application Service for Physician Assistant from 2012 to 2020. Logistic regression was utilized to investigate association between applicant ESL status and odds of program matriculation in both bivariate and multivariable regression models. Models were adjusted for citizenship status, undergraduate grade point average, gender, age, race/ethnicity, number of programs applied to, and patient care hours. RESULTS: In unadjusted and adjusted models, ESL status was associated with a significantly lower odds of matriculation to a PA program across all study years. In adjusted multivariable models, associations were strongest for 2014-2015 where ESL status was associated with a 35% lower odds of matriculation (odds ratio 0.65, 95% confidence interval 0.56, 0.76) when controlling for demographics, citizenship status, patient care experience, and academic achievement. In sensitivity analyses restricting to (a) those with TOEFL scores ≥ 100, and (b) restricting to those ESL applicants without TOEFL scores, we did not observe important changes in our results. CONCLUSIONS: Results indicated that non-native English-speaking applicants have lower odds of PA program matriculation. Decrements in matriculation odds were large magnitude, minimally impacted by adjustment for confounders and persistent across the years. These findings suggest that PA program admission processes may disadvantage non-native English-speaking applicants. While there are potential explanations for the observed findings, they are cause for concern. Matriculating and training PAs who have language concordance with underserved populations are important means of improving patient outcomes.

PA applicant U.S. citizenship status and likelihood of program matriculation.

BACKGROUND: Barriers to matriculation into Physician Assistant (PA) programs and entry into the PA profession have disproportionate impact on historically marginalized groups. This study evaluates if U.S. citizenship status is associated with likelihood of matriculation in PA Programs. METHODS: Data from five Centralized Applicant Services for Physician Assistants (CASPA) admissions cycles (2012-2021) was evaluated cross-sectionally for the primary outcome of binary matriculation status (yes/no). Bivariate and multivariate logistic regression was utilized to investigate associations between self-identified U.S. citizenship status and likelihood of PA program matriculation. Models controlled for important potential confounders, including age, gender, race/ethnicity, non-native English speaker, patient care experience hours, total undergraduate grade point average (GPA), and number of applications submitted to various programs. RESULTS: Non-U.S. citizen status was statistically associated with persistent lower likelihood of PA program matriculation compared to U.S. citizenship. Odds of matriculation were 41% [OR 0.59 (95% CI: 0.51, 0.68; p <.001)] to 51% [OR 0.49 (95% CI: 0.41, 0.58; p <.001)] lower in unadjusted models. Odds were 32% [OR 0.68 (95% CI: 0.56, 0.83; p <.001)] to 42% OR 0.58 (95% CI: 0.48, 0.71; p <.001) lower when adjusting for important covariates. The lowest likelihood occurred in 2012-2013 with 51% lower odds of matriculation and in 2016-2017 with 42% lower odds when accounting for important covariates. DISCUSSION: PA programs are charged with improving diversity of clinically practicing PAs to improve health outcomes and better reflect patient populations. This analysis shows that non-U.S. citizenship may be a barrier to PA school acceptance. PA schools should raise awareness and create means and accessibility for admissions for this underrepresented group.

Automating research data collection.

This article reviews the capabilities, advantages, and disadvantages of three forms of automated data collection-scannable data forms, Web-based forms, and handheld computers-compared with the current standard of data entry by hand on paper forms. Each of these methods is reviewed with respect to ease of use, experience required of designer, end-user training requirements, costs, flexibility, speed, accuracy/error rate, potential for data loss, need for technical support, and equipment and/or software requirements. A discussion of their appropriate application to various kinds of studies is included, followed by examples of research studies using each of these methods.

HandiStroke: a handheld tool for the emergent evaluation of acute stroke patients.

BACKGROUND: The management of acute stroke is time-sensitive. Clinical decision making requires data not only from laboratory testing and neuroimaging, but also from a detailed history and neurologic examination. The neurologic examination provides baseline information and assists in differentiating acute stroke from its mimickers. There is a need for tools to facilitate the evaluation and decision making in the acute stroke patient to make the correct diagnosis and, when indicated, to properly administer intravenous thrombolytic therapy. OBJECTIVES: The goals of this project were to create a standardized, handheld software program to aid physicians in their evaluation of patients presenting to the emergency department (ED) with acute ischemic stroke, and to create an educational tool with which residents and other health care professionals can gain a level of proficiency in treating these patients. RESULTS: A comprehensive handheld tool was created that incorporates a National Institutes of Health Stroke Scale (NIHSS) calculator, inclusion criteria, absolute contraindications, and relative warnings for thrombolytic use (i.e., recombinant tissue plasminogen activator), and a weight-based dosing calculator that flows in a logical and clinically relevant format. Additionally, the program includes reference materials and guidelines for clinical management to further assist the clinician. CONCLUSIONS: Applications of this program include reformatting for use as a data-gathering tool in future clinical studies investigating the treatment of stroke patients, increasing the use and documentation of the NIHSS within the ED in acute ischemic stroke patients, and improving protocol adherence for rt-PA use.