Maximizing Black applicant matriculation in U.S. PA programs: associations between the number of submitted applications and likelihood of matriculation.

BACKGROUND: Physician Assistants (PA) are important members of the medical team, and increasing diversity in healthcare professionals has been consistently associated with improved health outcomes for underrepresented minority patients. In this study of a national cohort of PA program applicants, we investigated whether the number of programs a student applied to (Application Number, AN) was significantly associated with increased likelihood of matriculation into a PA program. METHODS: We examined all applications (n = 27,282) to the 2017-2018 admissions cycle of the Central Application Service for Physician Assistants, which is utilized by over 90% of accredited PA programs in the US. As we a priori hypothesized that associations would be non-linear, we used natural cubic splines to estimate the associations between matriculation and AN, controlling for multiple metrics of academic achievement, experience, and applicant demographics. We subsequently used segmented regression analyses (modified poisson regression with robust error variance) to investigate log-linear associations above and below inflection points identified in the spline analyses. Additionally, we explored for effect modification by race/ethnicity. RESULTS: The strongest associations were observed between application number 2-7, and a threshold effect was observed at > 16 applications, beyond which there was no significant, incremental benefit in matriculation likelihood. Associations differed by race, particularly for application number 2-7, wherein the incremental benefit from each additional application was highest for Black applicants (Likelihood Ratio [LR]: 1.243, 95% CI: 1.136 to 1.360) vs non-Latinx White (LR: 1.098, 95% CI: 1.072 to 1.125), with no additional, incremental benefit beyond 7 program applications. For all other races, significant increased likelihoods of matriculation were observed until 16 program applications. CONCLUSIONS: These findings can help guide pre-PA advisors and PA programs, providing recommended thresholds to applicants on the most cost effective ways to increase their likelihood of admissions, and the PA profession as a whole by providing actionable information that can potentially increase Race/Ethnic diversity in the PA profession and, by extension, medical teams.

Recognizing and treating child overweight and obesity.

Primary care providers can help prevent and address child overweight and obesity, conditions that can affect children's present and future health as well as their psychologic, emotional, and social well-being. This article describes approaches to preventing, identifying, and addressing overweight and obesity using empathetic, practical, family-focused recommendations and actions.

Nonpharmacologic options for treating irritable bowel syndrome.

Irritable bowel syndrome (IBS) is a chronic functional disorder with no organic cause. Risk factors are multifactorial and treatment typically consists of antimotility or stimulant laxatives and antidepressants. This article reviews several newer areas of interest: probiotics, fecal microbiota transplant, a low FODMAP diet, and cognitive behavioral therapy.

A nonpharmacologic approach to managing insomnia in primary care.

Insomnia, or inadequate or poor sleep leading to significant distress or impairment in functioning, is a prevalent disorder treated by primary care providers (PCPs). With millions of people across the United States suffering from insomnia, PCPs must understand the disorder's pathophysiology, perpetuating factors, and treatment, as well as its effect on patient health and the economy. Although PCPs traditionally treat insomnia with pharmaceuticals, behavioral measures are effective and should be used whenever possible. This article reviews clinically relevant principles of diagnosing and treating insomnia, highlighting nonpharmacologic treatments.

PAs: Fifty years young.

The PA profession is 50 years young. Practicing PAs and current students hail from several generational categories ranging from Builders to Generation Z. This article reviews how different generations may have experienced PA program expansion, professional identity, state licensing, and prescription delegation. The authors sampled a cohort of PA program applicants about their views on what evokes optimism and concern for the PA profession. These themes mirror the recently paved professional road, while posing the all-important question: What construction lies on the horizon?

Evaluating scrotal masses.

Scrotal complaints can be challenging to diagnose because of overlapping signs and symptoms among various presentations. Failure to properly identify and manage testicular malfunctions such as testicular torsion, testicular cancer, varicocele, and hydrocele may lead to patient infertility, testicle loss, or death. This article describes proper assessment of scrotal masses, recognition of potentially life-threatening testicular conditions, and appropriate diagnostic evaluations for each pathology.

Updated treatment and prevention guidelines for pertussis.

Pertussis, commonly referred to as whooping cough, is one of the top 10 causes of death in children globally despite vaccine availability. Adhering to vaccination guidelines for both the primary childhood series as well as adolescent and adult boosters is crucial in preventing the spread of disease. However, due to vaccine failure, outbreaks occur every 3 to 5 years. As a result, early recognition and prompt treatment are instrumental in controlling the epidemic.

A guide for screening, diagnosing, and managing Chagas disease in the United States.

A potentially lifelong and fatal parasitic tropical infection, Chagas disease is increasing in the United States. This article reviews the causes and risk factors for Chagas disease and how PAs can screen, diagnose, and manage affected patients.

A study of empathy decline in physician assistant students at completion of first didactic year.

PURPOSE: This research investigated empathy trends among physician assistant (PA) students through their education and included gender differences and specialty job interest. This research partially replicates similar studies of medical and other health professions students. METHODS: The Jefferson Scale on Physician Empathy (SPE) was administered to PA students three times: (1) during matriculation, (2) near the end of their didactic training and (3) during their clinical education phase. Data were analyzed using both parametric (ANOVA) and nonparametric (binomial) methods. RESULTS: A total of 328 survey responses (270 females, 57 males, and one nonindicator) from the graduating classes of 2009 through 2014 at a northeastern university were collected and analyzed. Reliability for the JSPE was .80 (Cronbach) in this sample. Sixty-two percent had lower median JSPE empathy scores toward the end of their didactic training than at the time of matriculation (P = .0001), while the difference between empathy scores from years two and three was not significant (P = .37). Women were significantly more empathetic (mean = 5.05) at the time of matriculation than men (mean = 4.70, P = .0003), while both genders appeared to lose empathy in a parallel fashion during didactic training (P = .76). There was no association between empathy scores and prospective job category interest. CONCLUSION: These findings illustrate a decline in empathy among both genders during PA training, similar to other health care providers' educations, and support the need for further conversation regarding a role for empathy assessment and curricula in PA education.