Oral Health Care Strategies in Rural Communities: A Case Study.

ABSTRACT: Dental caries affect 97% of the world's population during their lifetime. Early childhood caries are the number one chronic disease affecting young children, and it disproportionately affects children of low-income families. American Academy of Pediatrics recommends fluoridated toothpaste to all children starting at tooth eruption, regardless of caries risk. In addition, fluoride varnish is recommended in all children every 3 to 6 months from tooth emergence until they have an established dental home. The health disparities that are most apparent in the rural communities are inadequate prenatal care, low birth weight, cancer, chronic respiratory disease, heart disease, unintentional injury, and stroke. When it comes to oral health, water fluoridation is one of the most cost-effective strategies in preventing dental caries. The need for oral health education in physician assistant/associate (PA) programs is well documented. Implementation has largely been performed using interprofessional education. This article describes an interprofessional education program that teaches PA students to apply fluoride varnish so that they are practice-ready when they graduate and practice medicine.

Feasibility of Interprofessional Education in a Community Pharmacy.

OBJECTIVE: To evaluate student learning, preceptor opinions, and feasibility of conducting interprofessional education in a community pharmacy. METHODS: Six pharmacy and 6 physician assistant students from 2 universities were paired to practice together in a community pharmacy for 1 day and clinic or emergency department for 1 day. Investigator-developed surveys were completed anonymously by students and preceptors. Students self-assessed learning and team attitudes. Preceptors evaluated team functioning and provided feedback. Students and preceptors attended separate focus groups to discuss their experiences. RESULTS: Students reported improved understanding of discipline-specific roles. Students stated shared learning would improve future ability to work on a team (n = 9), helped with understanding patients' clinical problems (n = 8), and improved professional communications (n = 8). Students thought teams avoided healthcare delivery errors (n = 12), improved patient care (n = 11), increased efficiency (n = 8), and increased interventions (n = 7) compared to solo practice. Some students (n = 6) felt preceptors did not provide enough feedback. Students and preceptors stated the project should be continued. Students suggested improving orientation by including team functioning expectations and insuring patient availability for medication therapy management reviews. Preceptors wanted more training on providing team feedback and thought the experience should be longer to accommodate physician assistant student orientation to pharmacy operations. CONCLUSIONS: Interprofessional education in a community pharmacy was feasible and resulted in students learning about discipline roles, team functioning, and team care. Additional training and orientation for both students and preceptors are needed. More than 1 day at each practice site is needed to enhance interprofessional learning and skills.

Using community pharmacies and team observed structured clinical encounters (TOSCEs) for interprofessional education and training.

INTRODUCTION: Collaborative practice improves patient outcomes and is a needed student skill. An interprofessional education and collaborative practice (IPECP) program was developed using community pharmacies, clinics, and emergency departments. This study's purpose was to assess student pharmacists' team attitudes and skill development after the IPECP using team observed structured clinical encounters (TOSCEs). METHODS: Nineteen pairs of fourth-year pharmacy and second-year physician assistant students practiced together in a community pharmacy (two days) and clinic or emergency department (two days). They completed TeamSTEPPS training and two team modules. Assessments included TOSCEs and pre/post attitude surveys. RESULTS: Students significantly increased all TOSCE domain skills with pre- to post-mean score (SD) of: team communications 3.0 (0.5) to 4.1 (0.5), collaboration 2.8 (0.6) to 4.0 (0.5), roles and responsibilities 2.4 (0.4) to 3.8 (0.5), patient-centered care 2.8 (0.5) to 4.1 (0.6), conflict management 2.8 (0.5) to 4.1 (0.6), team functioning 2.7 (0.6) to 3.9 (0.6), and global performance 2.8 (0.6) to 4.0 (0.5). Afterwards, students reported positive attitudes about team-based patient care. All students stated the experience increased patient and healthcare professional communication skills and understanding of patient problems, and decreased errors. Most students (84%) agreed team care increased interventions compared to individually provided care. Most students (84%) thought the experience was worthwhile, and 68% agreed the IPECP program should be continued. CONCLUSIONS: This study supports that IPECP can be conducted in a community pharmacy and clinic or emergency department to improve student team skills as evidenced by documented team skills development during TOSCEs.

Informed Practice: Students' Clinical Experiences in the Undergraduate Phase of an Accelerated Physician Assistant Program.

This qualitative study explored the clinical experiences of students in an accelerated physician assistant (PA) program. The participants were either certified nursing assistants (CNAs) or emergency medical technicians-basic (EMTs-B). The study was designed to elicit (1) how the participants perceived their older patients and (2) how the participants' experiences might affect their own future communications, bedside manner, and clinical preparedness as PAs. This study used a focus group to explore students' clinical experiences before the graduate phase of their accelerated PA program. Five female and 2 male PA students (N = 7) participated in the study. All participants were 23 years old and worked as either a CNA or an EMT-B. Results fell into 2 basic themes: informing practice and forming relationships. Regarding the first theme, participants felt that their experience as entry-level health care providers allowed them to improve their communication skills and bedside manner and to provide greater comfort to patients. Regarding the second theme, participants gained appreciation for older people and began to recognize the knowledge deficits and learning needs of their patients. The results suggested that a student's clinical experience as a CNA or an EMT-B before entering a PA program has a positive effect on the student's personal and professional development. The participants acquired greater appreciation and respect for older patients and members of the health care team.

Academic Integrity Across Physician Assistant Programs in the United States.

PURPOSE: The purpose of this study was to describe how academic integrity is addressed in physician assistant (PA) programs across the United States. METHODS: A descriptive survey was developed dividing questions into 2 groups: demographic information and academic integrity questions. The survey tool was distributed to program directors at all PA programs in the United States that were both fully accredited and provisionally accredited. RESULTS: A total of 171 surveys were distributed with a response of 110 surveys. Most institutions have honor codes in place (86.14%), with most having had an honor code for more than 10 years (62.38%). A notable percentage (25.45%) of program directors believes that academic integrity is a problem at their institution. Overall, 45.45% responded that academic integrity is voiced as an issue by faculty in all disciplines at their institution. Yet, when participants were asked to rate their concern about academic integrity at their program, 49.50% had little or no concern, 30.69% were neutral, and 19.80% reported great or extreme concern about academic integrity within their program. CONCLUSIONS: This study provided baseline data on how academic integrity is currently addressed in PA programs. Drawing from this baseline data and the review of the literature, the next step is to develop academic integrity recommendations that PA programs can adopt.

Predicting physician assistant students' professionalism by personality attributes.

PURPOSE: The purpose of this study is to determine whether personality characteristics, both positive and negative, predict the level of professionalism in physician assistant (PA) students. METHODS: Both the Millon College Counseling Inventory (MCCI) and a physician assistant professionalism scale (PA Professional Scale) were administered to 82 PA students in 5 multiple years at University of Detroit Mercy, a private-university PA program with an end point of a master's degree. Cluster analysis determined natural groupings of healthy and unhealthy personality characteristics, and the two personality clusters were compared to each of 15 professionalism parameters. Significant correlations were determined using a two-tailed Pearson correlation. RESULTS: The "healthy" personality clusters characterized by conscientiousness and outward directedness were significantly predictive for the professionalism attributes of taking full responsibility for self, volunteering for others, dressing professionally, punctuality, participating in class, ability to give and receive criticism, and seeking out new challenges. The "unhealthy" cluster was negatively correlated to taking full responsibility, volunteerism, trustworthiness, dressing professionally, being punctual, giving and receiving criticism, and taking on new challenges. CONCLUSION: Healthy personality characteristics do predict high levels of self-reported professionalism according to this study. Conversely, unhealthy personality characteristics will predict a low level of self-reported professionalism. Personality profiles can be incorporated into the admission process to select a higher percentage of candidates who value and emulate professionalism, producing better practitioners.

Admission variables as predictors of PANCE scores in physician assistant programs: a comparison study across universities.

PURPOSE: The purpose of this study was to create a model of cognitive and noncognitive measures that could estimate the probability of achieving a given level of performance on the Physician Assistant National Certifying Examination (PANCE). METHODS: A retrospective records review of admissions information used by six universities was conducted to discover which factor had the most impact on the dependent variable of the PANCE score. Multiple predictors were measured: undergraduate grade point average (uGPA), graduate GPA, prerequisite grades, Graduate Record Exam (GRE)-verbal, GRE-quantitative, GRE combined, interview scores, years of health care experience, age, gender, and first-year scores on the Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT). While PACKRAT scores are not applicable to admission selection, they are a strong midpoint predictor of PANCE performance. Multiple regression analysis was used to develop prediction equations. Expectancy tables were developed to provide estimation of PANCE performance, given the various score ranges on each of the predictor variables. RESULTS: Four predictors made a significant contribution to the final regression equation: GPA, GRE-verbal, GRE-quantitative, and PACKRAT scores. The PACKRAT scores were consistently the best predictors of performance on the PANCE. Each of these four predictors can be plugged into predictability tables to estimate the probability of achieving various score intervals on the PANCE. CONCLUSION: A model of equations and predictors can be used to project how successful a physician assistant (PA) graduate will be on PANCE performance. Years of health care experience, grades on prerequisites, and demographics were not significant predictors across programs but did have significance in certain individual institutions. Future research should examine which specific noncognitive traits measured in interviews can add value to predictability.

Physician assistant students' attitudes and behaviors toward cheating and academic integrity.

PURPOSE: To examine physician assistant (PA) students' attitudes towards academic integrity. Three integrity factors were assessed: academic environment, personal cheating behaviors, and perceived seriousness of specific cheating behaviors. METHODS: After receiving local IRB approval, an anonymous online survey was disseminated to PA students at the University of Detroit Mercy. Ninety-four potential participants were contacted through the university's email account. Respondents were directed to an online site to complete the academic integrity survey. This descriptive study was part of a larger study of students in the whole college, including the PA department, in order to determine baseline data prior to instituting a college-wide honor code. RESULTS: The response rate was 52% (n = 49). The majority of respondents (86%) indicated "never" having seen another student cheat during an exam. Respondents perceived cheating during a test or exam campuswide as occurring "never" (47%) or "very seldom" (42%). All (100%) respondents reported that they had "never" personally turned in work done by another student or purchased from a "paper mill." All participants (100%) responded "never" to not taking vital signs and reporting approximates. A few respondents (8%) reported getting test questions and answers from another student. Respondents' perceptions of the seriousness of cheating behaviors varied. Working with others when asked to do individual work was considered "not cheating" by 14% of respondents; 35% indicated that not taking vital signs and reporting approximates was less serious than cheating. CONCLUSIONS: PA students have a self-reported high level of integrity in general course assignments, tests and exams, and clinical courses. This apparent high level of academic integrity may be a result of admissions practices and of various program practices throughout the curriculum, including an honor agreement acknowledged by PA students that reinforces what is expected of them.