Student Performance Metrics and the Physician Assistant National Certifying Exam ® : A 3-Year Multi-Institutional Study.

INTRODUCTION: Given the 2019 Physician Assistant National Certifying Exam (PANCE) blueprint update from the National Commission on the Certification of Physician Assistants, it is imperative that programs conduct analyses of student performance metrics and PANCE scores. The purpose of this multi-institutional study was to examine the relationship between PANCE scores and student performance metrics/attributes from PA program graduates from 2017-2019. METHODS: A multiple linear regression was calculated to predict PANCE score indicators based on student attributes and performance metrics from 3 PA programs. Metrics included: PAEA End of Rotation exams, PACKRAT scores, academic performance in clinical medicine didactic courses, cumulative grade point average, and select demographic and admissions attributes (age, sex, and first generation to attend college). Descriptive statistics were employed to provide contextual information and an overview of the included data points. RESULTS: A significant regression equation was found with r-square of 0.709. Clinical Medicine II didactic course grades, PACKRAT I & II scores, and PAEA End of Rotation Exam scores in Family Medicine and Internal Medicine were all significant predictors of PANCE score. DISCUSSION: In consideration of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) Standards and expectations for ongoing self-assessment, including PANCE analysis, this research was timely and necessary. To date, there is very limited research regarding student performance metrics given the PANCE blueprint update in 2019, and these data are critical to aid programs in ongoing development and best preparation for learners.

Specialty certification and clinical flexibility.

The ability for PAs to easily move from one specialty to another without additional formal training is a unique feature of the profession that is valued by PAs and their employers. Specialty certification has been viewed as a threat to this flexibility, yet 73% of PAs are in specialty practice. How can the desire to preserve flexibility be balanced against the desire of specialized PAs to distinguish themselves in their chosen specialty? This article reviews the issue of specialty certification in the context of contemporary PA practice and concludes that although specialty certification remains a threat to the flexibility of the PA model, it may be appropriate in some situations. In particular, specialty certification may be appropriate as a means for promotion within healthcare systems so long as it is not used as a requirement for entry into specialty practice, credentialing, or third-party reimbursement. A portfolio model may give stakeholders an alternative way to assess the experience and competencies of PAs in specialty practice areas.

Attitudes Toward Academic Dishonesty in Health Profession Students.

INTRODUCTION: Academic dishonesty of health profession students may negatively impact the clinical environment. This study examined the attitudes, experiences, and behaviors of nursing, physician assistant, and physical therapist students towards academic dishonesty and explored differences based on demographic variables. METHODS: A survey was administered to health profession students in their last semester of the program. RESULTS: 120 students responded. Most reported never observing or participating in activities of academic dishonesty. Collaborating on assignments when instructed not to and falsifying aspects of patient encounters were the two most frequent activities reported. CONCLUSIONS: Teamwork and peers may negatively influence academic integrity in some circumstances. Educators should consider strategies to promote individual accountability as well as integrity when reporting clinical findings.

Improving Clinical Risk Stratification at Diagnosis in Primary Prostate Cancer: A Prognostic Modelling Study.

INTRODUCTION: Over 80% of the nearly 1 million men diagnosed with prostate cancer annually worldwide present with localised or locally advanced non-metastatic disease. Risk stratification is the cornerstone for clinical decision making and treatment selection for these men. The most widely applied stratification systems use presenting prostate-specific antigen (PSA) concentration, biopsy Gleason grade, and clinical stage to classify patients as low, intermediate, or high risk. There is, however, significant heterogeneity in outcomes within these standard groupings. The International Society of Urological Pathology (ISUP) has recently adopted a prognosis-based pathological classification that has yet to be included within a risk stratification system. Here we developed and tested a new stratification system based on the number of individual risk factors and incorporating the new ISUP prognostic score. METHODS AND FINDINGS: Diagnostic clinicopathological data from 10,139 men with non-metastatic prostate cancer were available for this study from the Public Health England National Cancer Registration Service Eastern Office. This cohort was divided into a training set (n = 6,026; 1,557 total deaths, with 462 from prostate cancer) and a testing set (n = 4,113; 1,053 total deaths, with 327 from prostate cancer). The median follow-up was 6.9 y, and the primary outcome measure was prostate-cancer-specific mortality (PCSM). An external validation cohort (n = 1,706) was also used. Patients were first categorised as low, intermediate, or high risk using the current three-stratum stratification system endorsed by the National Institute for Health and Care Excellence (NICE) guidelines. The variables used to define the groups (PSA concentration, Gleason grading, and clinical stage) were then used to sub-stratify within each risk category by testing the individual and then combined number of risk factors. In addition, we incorporated the new ISUP prognostic score as a discriminator. Using this approach, a new five-stratum risk stratification system was produced, and its prognostic power was compared against the current system, with PCSM as the outcome. The results were analysed using a Cox hazards model, the log-rank test, Kaplan-Meier curves, competing-risks regression, and concordance indices. In the training set, the new risk stratification system identified distinct subgroups with different risks of PCSM in pair-wise comparison (p < 0.0001). Specifically, the new classification identified a very low-risk group (Group 1), a subgroup of intermediate-risk cancers with a low PCSM risk (Group 2, hazard ratio [HR] 1.62 [95% CI 0.96-2.75]), and a subgroup of intermediate-risk cancers with an increased PCSM risk (Group 3, HR 3.35 [95% CI 2.04-5.49]) (p < 0.0001). High-risk cancers were also sub-classified by the new system into subgroups with lower and higher PCSM risk: Group 4 (HR 5.03 [95% CI 3.25-7.80]) and Group 5 (HR 17.28 [95% CI 11.2-26.67]) (p < 0.0001), respectively. These results were recapitulated in the testing set and remained robust after inclusion of competing risks. In comparison to the current risk stratification system, the new system demonstrated improved prognostic performance, with a concordance index of 0.75 (95% CI 0.72-0.77) versus 0.69 (95% CI 0.66-0.71) (p < 0.0001). In an external cohort, the new system achieved a concordance index of 0.79 (95% CI 0.75-0.84) for predicting PCSM versus 0.66 (95% CI 0.63-0.69) (p < 0.0001) for the current NICE risk stratification system. The main limitations of the study were that it was registry based and that follow-up was relatively short. CONCLUSIONS: A novel and simple five-stratum risk stratification system outperforms the standard three-stratum risk stratification system in predicting the risk of PCSM at diagnosis in men with primary non-metastatic prostate cancer, even when accounting for competing risks. This model also allows delineation of new clinically relevant subgroups of men who might potentially receive more appropriate therapy for their disease. Future research will seek to validate our results in external datasets and will explore the value of including additional variables in the system in order in improve prognostic performance.

Attitudes Toward Academic Dishonesty in Physician Assistant Students.

PURPOSE: The purpose of this study was to assess physician assistant (PA) students' attitudes and experiences toward academic dishonesty during training and to determine whether PA students self-report cheating during PA school. METHODS: An anonymous, quantitative, exploratory, descriptive survey was sent to clinical-year PA students enrolled in PA programs accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). RESULTS: A sample of 493 self-selected PA students in their clinical year of training responded to the survey. Only 3% of clinical-year PA students self-reported cheating during PA school. Males self-reported significantly higher rates of cheating in PA school than females. The most common cheating behavior that clinical-year PA students reported either observing or hearing about in PA school was receiving information about an exam prior to its administration (70.9%). The attitudinal statement that respondents most strongly agreed with was that "cheaters in PA school just end up hurting themselves in the long run." The strongest predictor for cheating in PA school was a history of cheating as an undergraduate. CONCLUSION: This study confirmed previous research indicating that academic dishonesty exists in PA education. It also determined that clinical-year PA student attitudes toward and experiences with academic dishonesty vary.

Trends and outcome from radical therapy for primary non-metastatic prostate cancer in a UK population.

BACKGROUND: Increasing proportions of men diagnosed with prostate cancer in the UK are presenting with non-metastatic disease. We investigated how treatment trends in this demographic have changed. PATIENT AND METHODS: Non-metastatic cancers diagnosed from 2000-2010 in the UK Anglian Cancer network stratified by age and risk group were analysed [n = 10,365]. Radiotherapy [RT] and prostatectomy [RP] cancer specific survival [CSS] were further compared [n = 4755]. RESULTS: Over the decade we observed a fall in uptake of primary androgen deprivation therapy but a rise in conservative management [CM] and radical therapy [p<0.0001]. CM in particular has become the primary management for low-risk disease by the decade end [p<0.0001]. In high-risk disease however both RP and RT uptake increased significantly but in an age dependent manner [p<0.0001]. Principally, increased RP in younger men and increased RT in men ≥ 70y. In multivariate analysis of radically treated men both high-risk disease [HR 8.0 [2.9-22.2], p<0.0001] and use of RT [HR 1.9 [1.0-3.3], p = 0.024] were significant predictors of a poorer CSM. In age-stratified analysis however, the trend to benefit of RP over RT was seen only in younger men [≤ 60 years] with high-risk disease [p = 0.07]. The numbers needed to treat by RP instead of RT to save one cancer death was 19 for this group but 67 for the overall cohort. CONCLUSION: This study has identified significant shifts in non-metastatic prostate cancer management over the last decade. Low-risk disease is now primarily managed by CM while high-risk disease is increasingly treated radically. Treatment of high-risk younger men by RP is supported by evidence of better CSM but this benefit is not evident in older men.

Incidence of glioma in a northwestern region of England, 2006-2010.

BACKGROUND: Gliomas are important because they affect disproportionately high numbers of people of working age and have a poor prognosis. Neurosurgeons were concerned about a possible recent cluster of glioma cases in a northwestern region in England. METHODS: All patients aged 18-89 years in Lancashire and South Cumbria with a histologically confirmed glioma diagnosed at the Royal Preston Hospital between January 1, 2006, and December 31, 2010, were ascertained. Clinical information was extracted from hospital records. Completeness of case referral to Royal Preston Hospital was checked against the National Cancer Registry and National Brain Tumour Registry records for the same period. For a comprehensive assessment of regional incidence, age-standardized incidence rates of all gliomas diagnosed in adults (aged 15 years and older) in the study area were then compared with those for the North West region and England as a whole. Rates for the North West region in defined small area-units ("Middle Super Output Areas") were also investigated to assess any small-area variation in the region during the decade to 2010. RESULTS: There were 435 glioma patients from Lancashire and South Cumbria diagnosed at the Royal Preston Hospital between 2006 and 2010, with case ascertainment verified to be complete by the National Cancer Registration Service. The age-standardized incidence rate of gliomas in the study area was 7.10 per 100,000 in 2006-2010, which was minimally different from the rate for all cancer networks in England over the 10 years from 2001. Small-area analysis confirmed lack of major variation in glioma rates in the North West region of England. CONCLUSION: Glioma incidence rates in England have remained stable by region and over time during the last decade.

An exploratory analysis of research directors in US physician assistant programs.

PURPOSE: The purpose of this study was to investigate the current and anticipated utilization of research directors in physician assistant (PA) programs in the United States. METHODS: The study employed a descriptive, cross-sectional design. Research directors and/or PA program directors responded to a web-based survey assessing the characteristics and responsibilities of current and anticipated faculty or staff responsible for performing research and/or evaluation activities. Descriptive analyses were performed using SPSS 21.0. RESULTS: Ninety respondents (53.8%) from 167 PA programs participated in the survey. The majority of programs (70%) employed a designated individual responsible for research and/or evaluation within the program. Nearly 37% of respondents affirmed that they specifically employed (n = 26) or planned to hire (n = 7) a "research director." Some of the major duties of research directors were coordinating research activities, assisting with the program's annual report and accreditation documents, teaching research and/or evidence-based medicine courses, and assisting and mentoring faculty in research. The majority of research directors (61.5%) were doctorally prepared. CONCLUSION: This study provides a better understanding of the roles, responsibilities, and educational backgrounds of research directors within the PA educational community. Research directors are a viable option to help meet the growing expectation of faculty to produce research and other scholarly work. The research director's role may vary from program to program based on its unique needs and level of research experience.

Population-based trends in use of surgery for non-small cell lung cancer in a UK region, 1995-2006.

OBJECTIVE: To assess time trends in use of surgery in patients with non-small cell lung cancer (NSCLC) in a UK region. METHODS: Cancer registration data for patients diagnosed with NSCLC between 1995 and 2006 in the East of England were analysed. Rates of surgery use for different age, gender, diagnosis period, tumour subtype and deprivation quintile groups were examined. RESULTS: The analysis included 18,767 patients with NSCLC. During the study period, 13% of patients were treated by surgery. Use of surgery decreased over time from 15% in 1995-1997 to 11% in 2004-2006 (p=0.022). Initial socioeconomic differences in surgery use narrowed significantly over time (p=0.028) and became non-apparent at the end of the study period. CONCLUSIONS: Use of surgery in patients with NSCLC decreased during the study period, possibly reflecting increasing quality of preoperative staging processes. Initial socioeconomic inequalities in surgery use became undetectable at the end of the study period. The findings provide baseline information to support comparisons with patterns of clinical management in more recent years.

Trends in the use of radiotherapy and radical surgery for patients with bladder urothelial cell carcinoma in East Anglia, 1995-2006.

OBJECTIVE: • To examine the use of radiotherapy and radical surgery for bladder urothelial cell carcinoma (UCC) before, during and after national initiatives for reorganization of uro-oncology services. PATIENTS AND METHODS: • Population-based data (1995-2006) from a cancer registry with stable coding practices were analysed. • Bladder UCC was defined using relevant International Classification of Disease site and morphology codes. • Time trends in the use of radiotherapy and radical surgery, and other predictors of their use were examined. RESULTS: • Of 4639 bladder UCC patients aged ≥40 years (76% men), stage information was available for 4303 (93%). • Morphology and stage case mix remained stable during the study period. • Radiotherapy use decreased significantly (from 31% in 1995-1998 to 22% in 2003-2006, P < 0.001) among patients of any stage, whilst radical surgery use increased significantly (from 8 to 13%, P < 0.001), particularly among stage II-IV patients. • The proportion of patients treated by both radiotherapy and surgery also decreased notably (from 4.0 to 1.1%). • Women were significantly more likely to present in stages II-IV [odds ratio (OR) = 1.22, 95% confidence interval (CI) = 1.06-1.40, P = 0.005], and less likely to be treated with radiotherapy (OR = 0.84, 95% CI: 0.72-0.99, P = 0.036). CONCLUSIONS: • Use of radical surgery in UCC invading bladder muscle increased and use of radiotherapy decreased during the study period, most probably reflecting the increasing availability of specialist surgical management. Sociodemographic variation in treatment was limited to lower use of radiotherapy in women. • Further research should encompass treatment timeliness and other aspects of care quality, as well as exploring potential differences in endoscopic treatments for disease not invading bladder muscle.

Physician assistant specialty choice: a factor analysis.

PURPOSE: The purpose of this study was to identify factors related to physician assistant (PA) graduates' specialty choice. METHODS: A web-based cross-sectional study of PAs graduating between 2007 and 2009 was conducted (N = 12,128). Factor analysis was performed on 897 useable survey responses. The cohort profile resembles that of recent AAPA census data regarding demographic and specialty choice distribution. RESULTS: Principal component factor analysis of perception items identified five factors that explained 52.6% of the response variance. Factors included personal satisfaction, intellectual challenge, patient care commitment, image of primary care, and professional satisfaction. The influence items analysis yielded five factors, explained 45.2% of the variance, and included practice environment, nature of patient care, lifestyle, employment opportunities, and risk aversion. These factors parallel previous findings of Hauer, et al. CONCLUSIONS: Identification of factors affecting specialty choice should provide an enhanced understanding to organizations as they explore strategies to increase recruitment and expansion of the primary care workforce.

Population based time trends and socioeconomic variation in use of radiotherapy and radical surgery for prostate cancer in a UK region: continuous survey.

OBJECTIVE: To examine variation in the management of prostate cancer in patients with different socioeconomic status. DESIGN: Survey using UK regional cancer registry data. SETTING: Regional population based cancer registry. PARTICIPANTS: 35 171 patients aged >or=51 with a diagnosis of prostate cancer, 1995-2006. MAIN OUTCOME MEASURES: Use of radiotherapy and radical surgery. Socioeconomic status according to fifths of small area deprivation index. RESULTS: Over the nine years of the study, information on stage at diagnosis was available for 15 916 of 27 970 patients (57%). During the study period, the proportion of patients treated with radiotherapy remained at about 25%, while use of radical surgery increased significantly (from 2.9% (212/7201) during 1995-7 to 8.4% (854/10 211) during 2004-6, P<0.001). Both treatments were more commonly used in least deprived compared with most deprived patients (28.5% v 21.0% for radiotherapy and 8.4% v 4.0% for surgery). In multivariable analysis, increasing deprivation remained strongly associated with lower odds of radiotherapy or surgery (odds ratio 0.92 (95% confidence interval 0.90 to 0.94), P<0.001, and 0.91 (0.87 to 0.94), P<0.001, respectively, per incremental deprivation group). There were consistently concordant findings with multilevel models for clustering of observations by hospital of diagnosis, with restriction of the analysis to patients with information on stage, and with sequential restriction of the analysis to different age, stage, diagnosis period, and morphology groups. CONCLUSIONS: After a diagnosis of prostate cancer, men from lower socioeconomic groups were substantially less likely to be treated with radical surgery or radiotherapy. The causes and impact on survival of such differences remain uncertain.

Trends and variation in the management of oesophagogastric cancer patients: a population-based survey.

BACKGROUND: Previous evidence indicates potential variation in the quality of care of cancer patients. We aimed to examine whether recent changes in the treatment of oesophagogastric cancers have been distributed equally among different patient subgroups. METHODS: We analysed population-based cancer registry data about the treatment patterning of oesophagogastric cancer (other than oesophageal squamous cell carcinoma) during 1995-2006. RESULTS: There were 14,077 patients aged > or =40 years (69% men). There was only limited information on stage, and no information on co-morbidity status. During successive triennia, curative surgery use decreased from 28% to 20% (p < 0.001) whilst chemotherapy use increased from 9% to 30% (p < 0.001). Use of palliative surgery and of radiotherapy increased significantly but modestly (7% to 10%, and 9% to 11%, respectively). In multivariable logistic regression adjusting for age group, gender, diagnosis period and tumour type, curative surgery and chemotherapy were used less frequently in more deprived patients [per increasing deprivation group Odds Ratio (OR) = 0.96, 95% Confidence Interval (CI) 0.93-0.99, and OR = 0.90, 95%CI 0.87-0.93, respectively, p < 0.001 for both)]. Chemotherapy was also used less frequently in women (OR = 0.76, p < 0.001). CONCLUSIONS: During the study period, curative surgery decreased by a third and chemotherapy use increased by more than three-fold, reflecting improvements in the appropriateness and quality of management, but chemotherapy use, in particular, was unequal, both by socioeconomic status and gender.