Academic Rank Disparities in Minoritized and Racialized Physician Assistant Educators.

PURPOSE: The aim of this study was to investigate the disparities in career progression and the need for inclusive mentorship in the physician assistant (PA) profession, specifically focusing on racial/ethnic minority faculty. METHODS: Pooled data from the Physician Assistant Education Association Program Survey in 2015, 2017, and 2019 were analyzed to examine the effect of PA faculty race/ethnicity on academic rank promotion. Logistic regression models were used to assess the association between faculty race/ethnicity and the likelihood of being in a middle/late-career (associate/professor) or early-career status (instructor/assistant), adjusting for confounding factors. RESULTS: The analysis revealed significant disparities in career progression, particularly for Black/African American and Hispanic faculty members, who were 44% less likely to be in late-career positions compared with White faculty. These disparities persisted even after accounting for gender, highest degree, region, and years in rank. The slower career progression experienced by minoritized faculty can have negative impacts, such as lower salaries, impostorism, reduced social capital, isolation, marginalization, burnout, and attrition. CONCLUSION: The findings highlight the urgent need for increased efforts to promote diversity and inclusion in the PA profession. Creating a more equitable academic environment requires addressing systemic biases, implementing inclusive mentorship initiatives, and promoting diversity in hiring and promotion decisions. By prioritizing equity, diversity, and inclusion, the PA profession can foster a more diverse, innovative, and satisfied workforce while reducing turnover. Continued research and evidence-based strategies are essential to effectively address these disparities and create a more inclusive and equitable environment in the PA profession.

Implicit Association Test Alone Is Not Sufficient to Increase Underrepresented Minority Representation in Physician Assistant Programs.

PURPOSE: Physician assistant (PA) program matriculants are consistently less diverse than the US population. This study evaluates whether administration of an Implicit Association Test (IAT) to PA program admission committees is associated with changes in the likelihood of (1) receiving an admission interview, (2) receiving an offer of admission, and (3) matriculation of individuals underrepresented in medicine (URiM). METHODS: Admission committees from 4 PA programs participated in an IAT before the 2019/2020 admissions cycle. Applicant outcome data (n = 5796) were compared with 2018/2019 cycle (n = 6346). Likelihood of URiM students receiving offers to interview, offers of admission, and matriculation were evaluated using random effects multiple logistic regression models. Fully adjusted random effects models included URiM status, year (control vs. intervention), multiplicative interaction terms between URiM and year, applicant age, and undergraduate grade point average (GPA) Secondary analyses examined associations of each race/ethnicity individually. RESULTS: Underrepresented in medicine status, age, and GPA were significantly associated with all admission outcomes ( P < .05). The intervention effect was not statistically significant. In sensitivity analyses examining each individual race rather than URiM status, our results did not importantly differ. CONCLUSION: Findings suggest admission committee member participation in IAT before admissions had no significant impact on the likelihood of admission of URiM students. This may suggest that making individuals aware of their implicit biases is not, in and of itself, sufficient to meaningfully affect the diversity of PA program admission metrics.

Severity, comorbidities, and adherence to therapy in Native Hawaiians/Pacific Islanders with obstructive sleep apnea.

STUDY OBJECTIVES: Considerable disparities in the prevalence, diagnosis, and management of obstructive sleep apnea (OSA) exist for minority groups in the United States. However, the impact of OSA on Native Hawaiian/Pacific Islanders (NHPIs) has not been evaluated. METHODS: We performed a retrospective review of patient records of NHPIs who underwent sleep apnea testing between 2014 and 2021 at a single center in Utah to characterize the distribution of comorbidities, disease severity, and treatment adherence. RESULTS: 140 of 141 NHPI patients who underwent sleep testing had OSA. High rates of obesity (94%) and other relevant comorbidities were found. OSA was mostly severe (57%), particularly in males with higher obesity. Adherence to continuous positive airway pressure was low (41% using for 4 or more hours on 70% of nights), and medical factors predicted whether adherence targets were met with modest accuracy (area under the curve 0.699). CONCLUSIONS: NHPIs at a single sleep center had a high prevalence of comorbidities in association with OSA, a skewed distribution toward severe disease suggestive of barriers to care or unique disease characteristics, and low adherence to continuous positive airway pressure. These findings suggest a high burden of OSA in this population, and further work to characterize barriers to identifying and treating OSA in NHPIs can improve chronic disease outcomes in NHPIs. CITATION: Locke BW, Sundar DJ, Ryujin D. Severity, comorbidities, and adherence to therapy in Native Hawaiians/Pacific Islanders with obstructive sleep apnea. J Clin Sleep Med. 2023;19(5):967-974.

Gender Disparities in Physician Assistant Educator Promotion and Compensation: A Mixed Methods Approach.

INTRODUCTION: The gender wage gap is well documented in many industries. A disparity in salary between female and male physician assistant (PA) educators has been demonstrated, but disparities in academic rank have not been shown. The purpose of this study was to re-examine gender disparities in compensation to PA educators and to explore whether gender-based disparities exist in promotion to higher academic rank in this field. METHODS: An explanatory sequential mixed-methods design was used to determine differences in salary and rank by gender. PA Education Association Faculty and Directors Survey data from 2014, 2017, and 2019 were analyzed. A focus group was conducted to explain the findings and understand the barriers to promotion for female faculty. RESULTS: Female PA faculty members earn $7573 less than their male colleagues when controlling for all other variables. Female faculty members have an increased likelihood (RR 1.150) for being in early career stage versus late career stage. Obtaining a doctoral degree decreased the risk for being in an early career stage (RR 0.567) with men twice as likely to have a doctoral degree as women. DISCUSSION: Rank and salary disparities exist in PA faculty by gender. Female faculty are less likely to hold doctoral degrees or to be promoted to higher academic ranks, and they earn less than men. Degree level and career track are themes unique to the PA education profession, and further research is needed to understand their impact. With more women entering PA education, pay equity and promotion need to be addressed.

Increasing Racial and Ethnic Diversity at the University of Utah Physician Assistant Program.

BACKGROUND AND OBJECTIVES: Among the oldest in the nation, the University of Utah Physician Assistant Program (UPAP) serves the state of Utah and surrounding areas and is a division of the Department of Family and Preventive Medicine. Recognizing the need to produce health care providers from diverse racial and ethnic backgrounds, UPAP instituted structural changes to improve student compositional diversity. This paper is a presentation and evaluation of the changes made to determine their relationship with compositional diversity, ultimate practice setting, and national rankings. METHODS: UPAP changed diversity messaging, curriculum, efforts in admissions, recruitment, and retention to improve the representation of Black, Latinx, American Indian/Alaska Native, and Native Hawaiian/Other Pacific Islander students, as well as those from educationally and economically disadvantaged backgrounds. RESULTS: UPAP tripled the number of underrepresented minority matriculated students over the course of five admitted classes, while simultaneously increasing the proportion of students from educationally or economically disadvantaged backgrounds. UPAP maintains both high boards pass rate and top national rankings, (number two ranking in public physician assistant program and number four overall program in the United States). CONCLUSIONS: The UPAP experience demonstrates that intentional diversity efforts are associated with improvement in racial/ethnic diversity and national rankings. Other medical school graduate programs, specifically the medical doctor (MD), public health, and basic science programs can use this model to improve their compositional diversity.

Minority Physician Assistant Faculty: A Phenomenological Assessment of Factors Leading to Retention in the Faculty Role.

Improving racial and ethnic diversity in the physician assistant (PA) profession is important to providing better care for underserved communities. The recruitment and retention of minority PA faculty is one aspect of helping to attract and retain a more diverse student body. Previous research has indicated that minority status is associated with the increased attrition of PA faculty but has not provided insight into the specific factors involved in the retention or attrition of minority PA faculty. The purpose of this qualitative research study was to describe the experience of minority PA faculty through a critical race theory lens. We used a phenomenological approach using structured interviews of minority PA faculty. Better understanding of the experience of minority PA faculty might lead to improved efforts at recruiting and supporting a more diverse faculty workforce. We conducted 13 interviews of PA faculty representing a variety of underrepresented minorities, geographic regions, types of schools, and stages of their careers. Major themes that emerged across the participants' experiences included opportunities for success in the form of both internal and external support systems and mentorship. As a corollary, barriers to the retention of minority PA faculty including a lack of institutional support, gaps in mentorship, and lack of a solid support network were cited.

Perceived Discrimination, Harassment, and Abuse in Physician Assistant Education: A Pilot Study.

PURPOSE: A 2014 meta-analysis found that by graduation, 16.6% of medical students had reported abuse, harassment, or discrimination and that this hostile environment caused an increase in depression and anxiety. The purpose of this research study was to increase the understanding of discrimination and psychological/physical abuse in physician assistant (PA) education programs and the potential impact on student attrition. METHODS: Information was collected using an online, anonymous survey that asked about witnessed or experienced discrimination and psychological or physical abuse during the didactic and clinical years of training in PA programs in the United States. RESULTS: The survey received 1159 respondents, which represents 6.1% of total PA student enrollment. Up to 30% of respondents had witnessed or experienced discrimination, and up to 2.3% had experienced psychological abuse while in PA school. The majority of witnessed or experienced discrimination during PA education was not reported (<2%). Reports were not made because students feared retribution or they simply did not know who to report to, particularly if the incident involved faculty. CONCLUSION: Reducing the prevalence of discrimination in PA education requires recognition of this issue and targeted efforts to ensure that the infrastructure of every program is inclusive and values diversity of all kinds. The authors advocate that PA programs discuss their current institutional reporting structure; develop a universal curriculum on workplace violence, discrimination, and harassment; and develop value statements that explicitly identify diversity and equity as a core value as an important first step to improving the overall "climate" and culture of the program.

The role of gastroesophageal reflux in exercise-triggered asthma: a randomized controlled trial.

BACKGROUND: Exercise-triggered asthma (ETA) develops when physical activity triggers asthma symptoms during or directly after exercise. In patients prone to symptoms of supra-esophageal reflux, exercise may trigger gastroesophageal reflux (GER), resulting in such symptoms. AIMS: To determine the prevalence of abnormal pH in patients with ETA and to determine whether acid suppression improves symptoms in ETA patients. METHODS: We performed a randomized double-blind trial of rabeprazole versus placebo in the treatment of patients with ETA. Patients underwent treadmill protocol to determine their VO(2 max). Next, pH testing was initiated while undergoing a 30-min treadmill program exercising them at 65% of their VO(2 max). They were subsequently randomized to rabeprazole or placebo for 10 weeks. At the end of 10 weeks, exercise testing was repeated. RESULTS: A total of 31 patients completed the study (20 asthmatics, 11 non-asthmatics). Twenty-two out of 30 (73%) subjects had abnormal pH studies. For all subjects, rabeprazole improved symptoms more than placebo (P = 0.03). The association was stronger in the pH-positive group (P = 0.009). CONCLUSION: Acid reflux is common in ETA patients. Many patients with exercise-related respiratory symptoms are misdiagnosed as chronic asthmatics. Exercise-related symptoms improve with the use of acid suppression. This study suggests that ETA patients may benefit from acid suppression.

Further evidence for the role of genes on chromosome 2 and chromosome 5 in the inheritance of pulmonary function.

The spirometric measurements FEV1, FVC, and the ratio FEV1/FVC are used in the diagnosis of lung function disorders. Therefore, understanding the genetics underlying these spirometric measurements will increase our knowledge of the genetics of pulmonary function. FEV1 and FVC were measured on 264 members of 26 Utah Genetic Reference pedigrees, originally collected for the Centre d'Etude du Polymorphisme Humain genetic mapping project. Using segregation analysis, we inferred major locus inheritance of the FEV1/FVC ratio, although we could not distinguish between a dominant or recessive mode of inheritance. No evidence of major locus inheritance was found for either FEV1 or FVC. Suggestive evidence of linkage for the ratio FEV1/FVC was found on chromosome 2 (heterogeneity lod = 2.36, dominant model) and chromosome 5 (heterogeneity lod = 2.23, recessive model), replicating linkages from other studies. In addition, nonparametric variance component linkage analysis showed linkage of FEV1/FVC in both of these regions, providing further support to the results. No nonparametric lod scores over 1.5 were obtained for either FEV1 or FVC.

Lack of effect of Rhodiola or oxygenated water supplementation on hypoxemia and oxidative stress.

OBJECTIVE: This study investigated the effects of 2 potentially "oxygen promoting" dietary supplements on hypoxia and oxidative stress at a simulated altitude of 4600 m. METHODS: Fifteen volunteers (ages 20-33) received 3 separate 60-minute hypoxic exposures by breathing 13.6% oxygen at an ambient barometric pressure of 633 mm Hg (simulating the partial pressure of oxygen at 4600 m elevation). Each subject received, in random order, treatments of a 7-day supply of placebo, Rhodiola rosea, and an acute dose of stabilized oxygen dissolved in water. Arterialized capillary blood oxygen samples (PcO2) were measured at baseline and at 30 and 60 minutes of exposure. Pulse oximeter oxyhemoglobin saturation (SaO2) was measured at baseline and at every 10 minutes of hypoxic exposure. Oxidative stress markers measured included baseline and 60-minute exposure serum lipid peroxides (LPO) and urine malondialdehyde (MDA). RESULTS: For each treatment group, PcO2 decreased by approximately 38% from baseline to 60-minute hypoxic exposure. Similarly, SaO2 also decreased among groups from approximately 97 to 81%. Serum lipid peroxides increased significantly in the placebo group and decreased significantly from baseline in response to the stabilized oxygen treatment (P = .02); there was a trend for decreased LPO with the Rhodiola treatment (P = .10). There were no significant changes for MDA among groups. CONCLUSIONS: The 2 dietary supplements investigated did not have a significant effect on blood oxygenation after 60 minutes of sedentary hypoxic exposure. Hypoxia-induced oxidative stress was observed in the control group only. Both supplements appeared not to increase oxidative stress and may decrease free radical formation after hypoxic exposure compared with the control.

Chronically inhaled salmeterol improves pulmonary function in heart failure.

Inhaled beta-agonists are commonly prescribed for the symptoms of exercise intolerance in heart failure despite a paucity of data regarding their safety and efficacy. This was a prospective, randomized, double-blind, double-dummy, placebo-controlled 14-day cross-over study to determine if chronic inhaled salmeterol therapy 84 microg every 12 hours improved pulmonary function without augmentation of neurohormonal systems or ventricular ectopy in 8 symptomatic heart failure subjects with left ventricular ejection fraction (LVEF) <40% and FEV1