Predictors of applicant pool racial and ethnic diversity among physician assistant education programs: a national cross-sectional cohort study.

BACKGROUND: Numerous studies have demonstrated that the increasing racial and ethnic diversity of the US population benefits from access to healthcare providers from similarly diverse backgrounds. Physician assistant (PA) education programs have striven to increase the diversity of the profession, which is predominantly non-Hispanic white, by focusing on admitting students from historically excluded populations. However, strategies such as holistic admissions are predicated on the existence of racially and ethnically diverse applicant pools. While studies have examined correlates of matriculation into a medical education program, this study looks earlier in the pipeline and investigates whether applicant - not matriculant - pool diversity varies among PA programs with different characteristics. METHODS: Data were drawn from the 2017-2018 Central Application Service for PAs admissions cycle. Applications to programs with pre-professional tracks and applicants missing race/ethnicity data were excluded, resulting in data from 26,600 individuals who applied to 189 PA programs. We summarized the racial and ethnic diversity of each program's applicant pools using: [1]the proportion of underrepresented minority (URM) students, [2]the proportion of students with backgrounds underrepresented in medicine (URiM), and [3]Simpson's diversity index of a 7-category race/ethnicity combination. We used multiple regressions to model each diversity metric as a function of program characteristics including class size, accreditation status, type of institution, and other important features. RESULTS: Regardless of the demographic diversity metric examined, we found that applicant diversity was higher among provisionally accredited programs and those receiving more applications. We also identified trends suggesting that programs in more metropolitan areas were able to attract more diverse applicants. Programs that did not require the GRE were also able to attract more diverse applicants when considering the URM and SDI metrics, though results for URiM were not statistically significant. CONCLUSIONS: Our findings provide insights into modifiable (e.g., GRE requirement) and non-modifiable (e.g., provisionally accredited) program characteristics that are associated with more demographically diverse applicant pools.

Does Community College Attendance Affect Matriculation to a Physician Assistant Program? A Pathway to Increase Diversity in the Health Professions.

PURPOSE: To explore whether community college (CC) applicants were a significant contributor to the diversity of matriculants to physician assistant (PA) programs and whether CC applicants were less likely to matriculate to PA programs than non-CC applicants. METHOD: The authors used national data from the 2016-2017 application cycle. They categorized applicants to PA programs into 5 pathways: HS-CC (applicant attended CC while in high school), first-CC (applicant attended CC before a 4-year university), 4Y-CC (applicant attended CC while at a 4-year university), post-CC (applicant attended CC after graduating from a 4-year university), and no-CC (applicant never attended CC). The authors used Pearson chi-square and Kruskal-Wallis H tests and the appropriate post hoc tests to assess whether applicants in the 4 CC pathways were more diverse in terms of their race, ethnicity, gender, rurality, and socioeconomic status than those in the no-CC pathway. They used logistic regressions to assess associations between the CC pathways and matriculation to a PA program. RESULTS: Among the 8,577 matriculants in the 2016-2017 application cycle, more than 75% attended a CC at some point. First-CC and post-CC matriculants were more likely to be Black (P < .001) or Hispanic (P < .001) and come from a disadvantaged background (P < .001) than no-CC matriculants. After adjusting for applicant demographics, academic performance, rurality and socioeconomic status, and application strategy, first-CC applicants had 17% lower odds of matriculating to a PA program than no-CC applicants (P < .001). CONCLUSIONS: CCs are an important pathway to the PA profession, with 3 of 4 matriculants having a CC background. However, lower matriculation rates among similarly qualified applicants who transferred from a CC to a 4-year university than among applicants with no-CC background suggest that PA programs are missing important opportunities for increasing student diversity and thereby the profession.

The Physician Assistant Student Experience: Diversity, Stress, and School Membership.

PURPOSE: This article investigates whether students' stress and psychological sense of school membership (PSSM), which influence their ability to navigate the rigors of PA education, vary by their demographic characteristics. METHODS: In 2017, 4050 matriculating and 2718 graduating PA students reported their demographics and feelings of stress. Graduating students also reported their PSSM. Multiple regressions explored whether students' demographics were associated with their stress and PSSM. Stress analyses controlled for student type (ie, matriculating versus graduating). RESULTS: Female, underrepresented minority (URM), and graduating students reported more stress when compared to male, non-URM, and matriculating students. URM students reported lower PSSM relative to non-URMs. CONCLUSION: URM students' experiences from entering a profession that is predominantly non-Hispanic White may increase stress and reduce PSSM, possibly contributing to lower educational satisfaction and on-time completion rates identified in previous research.

Strength in Differences? The Importance of Diversity to Students When Choosing a Physician Assistant Program.

PURPOSE: Physician assistant (PA) programs are the linchpin of endeavors to increase the diversity of the PA profession. Key to this role is understanding whether students from various backgrounds value certain program attributes differently. The current study investigated whether PA students' demographic characteristics were associated with their likelihood of having considered program diversity, and the importance they placed on program diversity when selecting a program to attend. METHODS: In 2017, 3882 recently matriculated PA students provided key demographic information (ie, gender, race, and ethnicity) and indicated whether they had considered student body and faculty diversity when choosing PA programs to attend. Those who had considered a factor then reported how important it was to them for their program to have that attribute. The current study investigated whether students' demographic characteristics were associated with their likelihood of considering PA program diversity and their subsequent ratings of the importance of program diversity. RESULTS: Female, Asian, and underrepresented racial and ethnic minority students, compared with male and non-Hispanic white students, were significantly more likely to consider program diversity when choosing PA programs to attend and rated program diversity as being more important. CONCLUSIONS: Program diversity is a greater concern for female and racial and ethnic minority students when selecting PA programs to attend. Less diverse programs could potentially increase their appeal to minority students by highlighting opportunities to connect with communities of color outside of the PA program and by prioritizing the recruitment of minority faculty.

Predicting Physician Assistant Program Matriculation Among Diverse Applicants: The Influences of Underrepresented Minority Status, Age, and Gender.

PURPOSE: Health professions schools can foster a diverse medical workforce by ensuring equal educational access for students of varied backgrounds. This study examined how physician assistant (PA) applicants' demographic characteristics and prior academic history affected likelihood of PA program matriculation. METHOD: The authors used national application data from the 2015-2016 PA application cycle to investigate associations between applicants' underrepresented minority (URM) status, age, and gender, and likelihood of matriculating into a PA program. Effects were examined alone and after adjusting for other demographics and potential confounders (number of applications submitted, patient care hours, academic achievement). The authors tested whether odds of matriculation differed among demographic subgroups with and without current Graduate Record Examinations (GRE) scores. RESULTS: In univariate models, likelihood of matriculation was lower among URM, older, and male applicants. In fully adjusted models, the URM effect became nonsignificant and the gender effect reversed, while older applicants remained less likely to matriculate. URM and age, but not gender, effects differed by GRE status; only URMs and older applicants without current GRE scores were less likely to matriculate than non-URMs and younger applicants. CONCLUSIONS: Findings that URMs, older individuals, and men had lower matriculation odds changed when controlling for academic achievement and GRE status, indicating the importance of these components in the admissions process. URM and age findings were contingent on GRE status such that odds of matriculation decreased among URM and older applicants without GRE scores, suggesting that standardized test requirements may be a barrier to PA workforce diversity.

Filling the Gaps: Predicting Physician Assistant Students' Interest in Practicing in Medically Underserved Areas.

PURPOSE: Physician assistants (PAs) are well situated to provide much-needed care in medically underserved areas (MUAs). Therefore, it is critical to understand the factors that make PA students want to practice in MUAs. The current study investigated how 3 student characteristics-underrepresented minority (URM) status, geographic origin, and family socioeconomic status-were associated with PA students' interest in practicing in MUAs after graduation. METHODS: Upon their matriculation in 2016, 4329 PA students provided key demographic information (ie, gender, age, race, ethnicity, geographic origin, and an indicator of family socioeconomic status) and reported their interest in working in an MUA after graduation. Multiple linear regression was used to predict students' level of interest in practicing in an MUA, and multiple logistic regression was used to predict students' likelihood of expressing interest in practicing in an MUA. All analyses controlled for students' gender and age at matriculation. RESULTS: All 3 student characteristics were independently associated with interest in practicing in an MUA, such that URM students, students from rural backgrounds, and less affluent students expressed greater interest in practicing in an MUA after graduation compared with their non-URM, suburban, and more affluent counterparts. CONCLUSION: Demographic commonalities may drive PA students' interest in practicing in an MUA after graduation.

Family First? The Costs and Benefits of Family Centrality for Adolescents with High-Conflict Families.

Youth who do not identify with or value their families (i.e., low family centrality) are considered to be at risk for maladjustment. However, the current study investigated whether low family centrality may be adaptive in negative family contexts (i.e., high family conflict) because youth's self-worth should be less tied to the quality of their family relationships. Multilevel models using daily diaries and latent variable interactions using longitudinal questionnaires indicated that, among a sample of 428 Mexican American adolescents (49.8% male, M age = 15.02 years), lower family centrality was generally detrimental to youth's well-being. However, for youth in adverse family environments, low family centrality ceased to function as a risk factor. The present findings suggest that family centrality values play a more nuanced role in youth well-being than previously believed, such that low family centrality may be an adaptive response to significant family challenges.

Adolescent-Peer Relationships, Separation and Detachment from Parents, and Internalizing and Externalizing Behaviors: Linkages and Interactions.

Most research exploring the interplay between context and adolescent separation and detachment has focused on the family; in contrast, this investigation directs its attention outside of the family to peers. Utilizing a latent variable approach for modeling interactions and incorporating reports of behavioral adjustment from 14-year-old adolescents (N = 190) and their mothers, we examine how separation and detachment relate to adolescent peer relationships, and whether peer relationships moderate how separation and detachment relate to adolescent internalizing and externalizing behaviors. Positive peer relationships were both associated with lower detachment and sharply attenuated relations between detachment and higher adolescent internalizing and externalizing. Separation from parents was unrelated to peer relationships, and regardless of whether peer relationships were positive, separation was not related to adolescent internalizing and externalizing. We integrate these findings with those from family-focused investigations and discuss their substantive and clinical implications.

Adoptive and Nonadoptive Mother-Child Behavioral Interaction: A Comparative Study at 4 Years of Age.

Comparable samples of low-risk adopted and nonadopted children and mothers were observed during 3 tasks at age 4 years. Quality of mother-child interactions, child level of functioning in 4 domains, and maternal parenting satisfaction and social support were assessed. Adopted children were as competent as nonadopted children on measures of developmental functioning. Both groups of mothers expressed high satisfaction and support as parents. However, ratings of child, maternal, and dyadic behavior when interacting were all lower for adoptive dyads than for nonadoptive dyads, and adoptive dyads with boys accounted for the maternal and dyadic group differences.

The relations of family members' unique and shared perspectives of family dysfunction to dyad adjustment.

Among a community sample of families (N = 128), this study examined how family members' shared and unique perspectives of family dysfunction relate to dyad members' shared views of dyad adjustment within adolescent-mother, adolescent-father, and mother-father dyads. Independent of a family's family perspective (shared perspective of family dysfunction), the adolescent's unique perspective was associated with lower security and higher conflict with both mother and father; the father's unique perspective was associated with lower security and higher conflict with the adolescent, as well as lower marital quality with mother; and the mother unique perspective was associated with lower marital quality with the father. Moreover, for adolescent-parent dyads, compared with the parent unique perspective, the adolescent unique perspective was more strongly associated with dyad adjustment. These findings indicate that both shared and unique views of the family system-the adolescent's unique view in particular-independently relate to the health of family subsystems. They also suggest that research, as well as therapeutic interventions, that focus on just the shared view of the family may miss important elements of family dysfunction.