Perspective on the Journal of Physician Assistant Education : From Association Newsletter to Academic Peer-Reviewed Journal Celebrating 25 Years.

ABSTRACT: For 25 years, the Journal of PA Education (JPAE) and its predecessor publications have been the pre-eminent venues for disseminating and promulgating information and research on the physician assistant (PA) profession. In this article, former and current editors in chief have compiled a detailed history of the journal, its development, and its trajectory into the future, outlining the journey taken by Association of PA Programs/PA Education Association to catalog faculty scholarship through a peer-reviewed journal. Allowing for the referencing of articles and thus adding to the body of knowledge on PAs and PA education, JPAE has not only endured but thrived. This article speaks to the collective effort and excellence of staff, and the many volunteer reviewers, feature editors, and editorial board members who have nurtured JPAE along the way through numerous changes, challenges, and triumphs.

Similarities and Differences Between Physician Assistant Program and Medical School Mission Statement Themes.

PURPOSE: The purpose of this study was to examine the concordance of US physician assistant (PA) program mission statements with those of US public- and private-sponsored medical schools. With the exception of a broader medical school focus on research, the authors hypothesized that little difference in mission statement congruence would be found in a comparison of medical schools and PA programs. METHODS: Mission statements of 209 of the 210 accredited US PA programs as of May 2016 were obtained and analyzed. Keywords and phrases were identified, coded, and analyzed using NVivo. Themes that previously reported medical school mission statement analyses (including education, research, service, primary care, diversity, prevention, provider distribution, and cost control) were examined. Additional themes of evidence-based medicine (EBM), interprofessional care, patient safety, and quality improvement were included in the analyses. RESULTS: Analyses revealed similar emphasis in both PA programs and medical schools on themes of education, prevention, and cost control, with dissimilar emphases on themes of research, service, primary care, diversity, and provider distribution. Physician assistant programs were more likely to emphasize interprofessional care than EBM, patient safety, or quality improvement. CONCLUSIONS: In the comparison of mission statements of medical schools and PA programs, much less congruence was found than had been hypothesized. Although this study examined the similarities and differences between the mission statements of US medical schools and PA programs, it did not examine the extent to which programs succeeded in meeting the stated missions. Additional research is necessary to understand the factors that determine whether mission statements are actualized in measurable deliverables.

Physician Assistant Contributions to Medical and Higher Education.

Physician assistant (PA) programs were often early adopters or initiators of innovative models of teaching, learning, and assessment. Examples of these influences include interprofessional education, competency-based education, objective-structured clinical examinations, problem-based learning, evidence-based medicine, team-based learning, and the multiple mini-interviews. In addition, the contributions and presence of PAs in the academic health center teaching environment have also fostered appreciation from other health professionals for the skill level and capacity of PAs on the care team. This directly led to the increased utilization of PAs in a growing number of specialties in both inpatient and outpatient settings. However, the rapid expansion of PA educational programs has strained the profession's ability to meet critical student clinical placement needs, and PA educators must adopt or develop innovative ways to reconfigure how clinical education is delivered and assessed, including the use of advanced technology and simulation.

Expansion of Physician Assistant Education.

Physician assistant (PA) educational programs were created in the 1960s to prepare a new type of health care practitioner. Physician assistant programs began as experiments in medical education, and later, they proved to be highly successful in preparing capable, flexible, and productive clinicians. The growth of PA educational programs in US medical education-stimulated by grants, public policy, and anticipated shortages of providers-has gone through 3 distinct phases. At present, such programs are in the midst of the third growth spurt that is expected to continue beyond 2020, as a large number of colleges and universities seek to sponsor PA programs and attain accreditation status. Characteristics of these new programs are described, and the implications of the current expansion of PA education are examined.

Student mental health implications for physician assistant education.

PURPOSE: This report examines student mental health and learning disabilities along the continuum from childhood to college by examining diagnosing and prescribing patterns and potential implications for physician assistant (PA) faculty based on the Standards of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) and the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5, Section 2, Specific Learning Disorders). METHODS: We reviewed existing data to compare decades of national patterns in diagnosing and prescribing for conditions that have known comorbidities with learning disabilities. By including quantitative and qualitative data from children, adolescents, undergraduate college students, and veterans, we illustrate the potential impact these patterns could have on some current and future applicants to PA educational programs and the requirements for PA faculty to address these needs. RESULTS: Multiple national data sources revealed increasing numbers of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), psychoactive prescriptions written for those under age 18, and self-reported increases in multiple psychological disorders among college students. More recent evidence shows a twofold increase in military veterans returning to college with posttraumatic stress disorder, traumatic brain injury, and depression. CONCLUSION: The growing numbers of students with conditions described in this report requires academic faculty to be aware of requirements to recognize and address their mental health service needs. PA educators could benefit from supplemental faculty development activities to help prepare them to recognize the pipeline patterns of a growing percentage of postsecondary students with mental health conditions and learning disabilities.

The Texas health workforce benefit of military physician assistant program veterans.

PURPOSE: Little is known about the benefits to society of the educational development of health personnel in the military who return to civilian life and continue their careers. The U.S. Department of Defense has produced physician assistants (PAs) since the early 1970s, and PA training is now consolidated into one location in Texas as the Interservice Physician Assistant Program (IPAP). We studied redistribution of PAs upon service departure to determine if IPAP attendance had an effect on the Texas PA workforce. METHODS: The Texas Medical Board dataset of licensed PAs was examined to identify program attended, practice specialty by supervising physician designation, practice location, and primary care or specialty care practice designation. Primary care was defined as family medicine, general pediatrics, or general internal medicine. All other designations were classified as specialty practice. RESULTS: Of 6016 licensed Texas PAs, 425 (7.0%) reported attending a military PA training program. Of the 254 PAs in full-time civilian clinical practice, 148 (58.3%) reported practice in primary care settings, and 106 (41.7%) reported specialty clinical practice settings. DISCUSSION: With the average military officer retirement age of 47 years and the 2010 average U.S. retirement age of 64 years for men and 62 for women, an estimated 16 years of community workforce productivity is provided per veteran PA following completion of military service. We estimated over 47,000 outpatient visits are provided per PA following military service. The care provided can be measured as a positive return-on-investment of taxpayer-provided education.

Institutional sponsorship, student debt, and specialty choice in physician assistant education.

Physician assistant (PA) educational programs emerged in the mid 1960s in response to health workforce shortages and decreasing access to care and, specifically, the decline of generalist physicians. There is wide diversity in the institutional sponsorship of PA programs, and sponsorship has trended of late to private institutions. We analyzed trends in sponsorship of PA educational programs and found that, in the past 15 years, there were 25 publicly sponsored and 96 privately sponsored programs that gained accreditation, a 3.84:1 private-to-public ratio. Of the 96 privately sponsored programs, only seven (7.3%) were located within institutions reporting membership in the Association of Academic Health Centers, compared to eight of the 25 publicly sponsored programs (32%). In 1978, a large majority (estimated 43 of the 48 then-existing PA programs) received their start-up or continuing funding through the US Public Health Service, Section 747 Title VII program, whereas in 2012 there were far fewer (39 of 173). The finding of a preponderance of private institutions may correlate with the trend of PAs selecting specialty practice (65%) over primary care. Specialty choice of graduating PA students may or may not be related to the disproportionate debt burden associated with attending privately sponsored programs, where the public-to-private tuition difference is significant. Moreover, the waning number of programs participating in the Title VII grant process may also have contributed to the overall rise in tuition rates among PA educational programs due to the loss of supplemental funding.

A comparison of behavioral and multiple mini-interview formats in physician assistant program admissions.

PURPOSE: The interview remains a widely used tool in health professions program admissions. The purpose of this study was to compare the use of a behavioral interview format with the multiple mini-interview format in measuring desired noncognitive behaviors. METHODS: This dual cohort, observational, comparative study used a polytomous rating-scale model to analyze the results from two homogeneous groups of physician assistant (PA) program applicants (total N = 176). One group (n = 93) participated in two 20-minute behavioral interviews conducted by two raters per interviewee. The behavioral format included questions related to past behaviors and performance as a way to identify latent professionalism characteristics. The second group (n = 83) completed ten separate 7-minute stations with one rater per station. Each of the mini-stations assigned a specific topic and/or task to be completed. The score distributions related to applicant performance and station difficulty were plotted using Rasch analysis software. RESULTS: The behavioral interview format and multiple mini-interview had similar model fit. The behavioral interview did not adequately measure differences in applicant characteristics. In contrast, the multiple mini-interview measured more variation in noncognitive traits and identified better matching of station difficulty and person ability. CONCLUSIONS: In this study the multiple mini-interview format was a more reliable admissions tool in detecting latent professionalism attributes among PA program applicants. The multiple mini-interview format appeared to measure professional potential and organizational fit better than the behavioral interview format. A larger study across several programs may provide additional support for these findings.

Thematic analysis of personal statements in physician assistant program admissions.

PURPOSE: The written personal statement is widely used in health professions program admissions. The purposes of this study were to identify the common themes manifesting in the personal statements of physician assistant (PA) program applicants and to measure the odds of matriculation while controlling for other admission covariates. METHODS: This study was a retrospective mixed-method observational study of CASPA admissions data. From the aggregate pool of 14,682 CASPA applications in the 2009-2010 admissions cycle, we randomly selected a subset of 600 unique de-identified applicants with complete application data. We coded the major themes and subthemes for each personal statement. We then performed maximum likelihood logistic regression analysis that compared the odds of matriculation based on the major themes and known cognitive admission variables. RESULTS: We identified eight major themes including altruism and the desire to help people, challenges and hardships, experience, key accomplishments, personal characteristics, positive perception of PA career attributes, role models, and a religious or spiritual quest. The only major theme increasing the odds of matriculation was role models, specifically exposure to a PA role model. Grade-point average far exceeded all other variables influencing the odds of matriculation. CONCLUSIONS: In this study, we found the personal statement to be an unreliable tool for predicting successful PA program matriculation.

Physician assistant distribution in Texas-Mexico border counties: public health implications.

PURPOSE: Texas Medical Board physician assistant (PA) data were assessed to assist workforce education and planning strategies for PA programs in regions with high percentages of Hispanic populations. METHODS: Data were assessed for gender, ethnicity, program attended and current employment addresses within the 14 Texas-Mexico border counties. RESULTS: Of the 329 border county PAs, 227 self-reported as Hispanic (69%), and 53% were female. Remarkably, 72% of all Hispanic PAs attended two of the six public Texas PA Programs. CONCLUSIONS: The Sullivan Commission report of 2004 concluded that the primary cause of poor public health care for minorities resulted from unequal representation of minorities in the health care professions. Two public Texas PA programs have made substantial contributions to public health care access in poverty-stricken border areas by educating and placing Hispanic PAs within medically underserved communities.

Workweek restrictions and specialty-trained physician assistants: potential opportunities.

The increasing use of physician assistants (PAs) in surgical settings is part of a continuing trend of PA specialization, and many graduate medical education (GME) programs in teaching hospitals have hired PAs to augment physician housestaff duties. PAs have been shown to be effective in these roles by contributing to the continuity of care and enhancement of resident educational experiences. One strategy for educating and training specialty PAs to help augment perioperative surgical workforce needs for acute and critically ill patients is PA postgraduate training programs, which are typically offered as formal 1 year experiences following entry-level PA education and based on the GME model. Many academic health centers (AHCs) are well positioned to host such educational programs by collaborating with PA educators to develop additional surgical postgraduate training programs. We propose a model to produce an increased supply of specialty-trained PAs to serve as permanent hospital-based clinicians who could enable surgical residency training programs to meet critical resident education and operative experience needs by providing team-oriented and physician-supervised perioperative care.

Physician assistant education in the United States.

As physician assistant (PA) programs developed in the 1960s, curriculum models emerged around the central themes of physician-dependent practice and competency-based education. By 2007, there were 136 accredited programs in the United States, with 108 (79%) offering a master-degree curriculum. PA program preclinical and clinical curricula are typically evenly divided in length, and the typical U.S. PA program has a full-time attendance curriculum of 26.5 continuous months. In academic year 2005-2006, the typical PA student was a 27-year-old white woman with a 3.4 overall grade point average and 29 months of prior health care experience who matriculated with a baccalaureate degree into a master-degree PA program. In the 2005 application cycle, the number of applicants per available seat was 2.25 for both allopathic medical schools and PA programs. The transition to a predominately master-degree curriculum resulted in new challenges for PA faculty development, and the number of PA educators with terminal academic degrees continues to lag behind the educational needs of training programs. The topic of PA specialty training and recognition remains controversial. Although the PA profession has prospered since inception, concerns exist regarding workforce issues such as the appropriate balance of autonomy and supervision, role delineation, and the continuing trend toward specialization. The omission or inaccurate classification of PAs within U.S. health care access and workforce literature projects an incomplete picture, and it is important to consider the contributions PAs have made and will continue to make in addressing the nation's health care needs.