PAs' perspective on leadership in medicine.

OBJECTIVE: This study evaluated physician associate/assistant (PA) training and confidence in leadership and leadership skills, as well as where best to incorporate leadership training for the profession. METHODS: A quantitative survey was administered to assess PAs' perceptions of leadership and degree of leadership training during their primary PA education. The study also solicited where in the career trajectory leadership training is perceived to be most effective. Of the 284 participants who responded to the survey, 207 had complete responses that were used in the analysis. RESULTS: Nearly 92% of PAs agreed that they aspire to be leaders, and 93.2% agreed or strongly agreed that leadership training would be beneficial during PA school. Additionally, more than 50% of PAs agreed that they had no training but desired more regarding personal mastery, teaching, administration, ideals of a healthy workforce, vision and goal setting, getting results, coalitions, and system transformation. CONCLUSIONS: This study demonstrated that PAs desired supplemental training in leadership to cultivate career goals and reported that formal leadership training would be useful to cope with and overcome adversity in clinical practice.

Enhancing Physician Assistant Psychiatry Interviewing Skills Using Standardized Patients.

INTRODUCTION: The aim of this pilot study was to assess whether supplemental psychiatry training in the didactic year increases the scores on the Physician Assistant Education Association (PAEA) Psychiatry and Behavioral Health End of Rotation examination and psychiatry preceptor evaluation. METHODS: Data were obtained from the physician assistant (PA) students on PAEA Psychiatry and Behavioral Health End of Rotation examination and psychiatry preceptor evaluation for a single institution. Then, a comparison was performed for PA students who did not participate in supplemental psychiatry/behavioral health training (Cohort 1/historical control group; n = 62) and PA students who participated in supplemental psychiatric and behavioral health training (Cohort 2/experimental group; n = 63) to determine the effects of the groups. RESULTS: An independent t test demonstrated that the experimental group performed significantly better than the control group on both the Psychiatry and Behavioral Health PAEA End of Rotation examination and preceptor evaluation {control group (M = 83.4) and experimental group (M = 86.3; t [117] = 2.8; P < .05)} and the preceptor evaluation {control group (M = 90) and experimental group (M = 92.6; t [112] = 2.1; P < .05)}. In addition, both analyses demonstrated a moderate effect size (End of Rotation examination, d = 0.51; preceptor, d = 0.62). A multiple regression analysis was used to control for age, sex, grade point average (GPA), and training intervention. Age, sex, and GPA were found not to affect the results. However, treatment intervention was statistically significant for both the End of Rotation examination and preceptor evaluation scores. DISCUSSION: Supplemental training in behavioral health and psychiatry, which included a standardized patient encounter and an interactive session dedicated to psychiatry interviewing techniques, resulted in students performing better on the Psychiatry and Behavioral Health PAEA End of Rotation examination and preceptor evaluation.

Wellens syndrome: An important consideration in patients with chest pain.

ABSTRACT: Coronary artery disease (CAD) is the number one cause of death in the United States, and it is estimated that every 40 seconds one person experiences a heart attack. Among patients with chronic CAD, many will experience a potentially fatal complication known as acute coronary syndrome (ACS). Wellens syndrome is a rare form of ACS that indicates critical left anterior descending coronary artery occlusion and can be identified by its characteristic T-wave patterns on ECG. This syndrome also may go unrecognized by clinicians because of a lack of familiarity with the ECG findings. This article describes the Wellens ECG pattern and its significance in patients with chest pain.

Clinical Faculty Perceptions of Online Learning in Health Professions Education.

INTRODUCTION: The purpose of this study was to investigate clinical faculty perceptions of online learning in health professions education. METHODS: Clinical faculty members from various health professions programs in New York were surveyed to determine whether there was a relationship between clinical faculty members' attitudes toward online learning competencies and their ability to teach online. Additionally, this study explored what type of impact years of teaching experience and online training had on clinical faculty perceptions of online learning. RESULTS: The study received 60 responses from clinical faculty, most of whom were teaching on Long Island, New York. Although the findings were not significant for most variables, a t -test demonstrated a significant statistical difference between online training and faculty perceptions of online learning. When clinical faculty completed online training, they had a more positive attitude toward online learning. The study also found that clinical faculty members' attitudes toward technology in online learning positively influenced their ability to troubleshoot technical issues in online environments. Years of online teaching experience did not affect how clinical faculty perceived online learning; however, clinical faculty with 1-5 years and 6-10 years of teaching experience rated their attitudes and abilities the lowest out of all the groups. DISCUSSION: While there appears to be a correlation between faculty perceptions of online learning and online training, more research is needed to objectively determine which specific trainings would be most advantageous.

Examining the Impact of Implicit Bias Education in Healthcare Students.

Implicit bias is prevalent in healthcare, possibly because of the practices employed during healthcare education. However, the impact of healthcare education on student beliefs and attitudes has not been well studied. Students entering healthcare careers have the unique opportunity to become educated on their biases and to be given tools to actively avoid implicit bias. By having an awareness of the impact that implicit bias can have on the future interactions of healthcare students, educators can make a profound difference on the experiences of not only the student, but also the patients they will treat. In this commentary, we explore current research on the impact of implicit bias education on healthcare student beliefs and clinical practice. Additionally, we review a framework to assist faculty in designing curricula to implement implicit bias education.

Focusing on cultural humility in pharmacy assessment tools.

INTRODUCTION: Many pharmacy programs have been reviewing their curricula to ensure that unconscious bias is not interwoven throughout. However, few programs have looked at their assessment tools to determine if unconscious bias exists in them. Since research on unconscious bias in assessment tools is currently limited, this study was developed to explore how race, ethnicity, age, and gender were used in multiple-choice item banks at one pharmacy program. METHODS: A total of 27 pharmacy test banks, including examinations from first-, second-, and third-year pharmacy curricula, were examined. The exams administered in the 27 courses provided 3621 questions for review and coding based on reference to race, ethnicity, age, and gender. RESULTS: Of the total 3621 exam items reviewed, 40 referenced race. Of those 40, it was determined that race was only applicable/relevant to two (5%) of the questions, linked to Whites. Gender breakdown was 56% male and 45% female, with no mention of transgender. Gender was central to 72 of the 426 questions. Age was mentioned in 381 of the questions and was central in only 46. Ethnicity was not mentioned in any of the questions. In none of the questions were these variables self-identified. CONCLUSIONS: The routine mention of race in preparation of materials such as question banks, with no specified goal, risks contributing to racial bias. The goal of all pharmacy educators is to graduate pharmacists that possess sound academic knowledge, clinical skills, and the cultural humility to provide quality care to their patients.

Integrating Oral Health into Health Professions School Curricula.

Oral health is essential to human health. Conditions associated with poor oral health involve all organ systems and many major disease categories including infectious disease, cardiovascular disease, chronic pain, cancer, and mental health. Outcomes are also associated with health equity. Medical education organizations including the Association of American Medical Colleges and National Academy of Medicine recommend that oral health be part of medical education. However, oral health is not traditionally included in many medical school, physician assistant, or nurse practitioner curricula. Several challenges explain this exclusion including lack of time, expertise, and prioritization; we therefore provide suggestions for integrating oral health education into the health professions school curriculum. These recommendations offer guidance for enhancing the oral health curriculum across institutions. We include key organizational and foundational steps, strategies to link oral health with existing content, and approaches to achieve curricular sustainability.

Managing a patient with acute colonic diverticulitis.

ABSTRACT: Acute diverticulitis is a common condition in Western society with the potential for substantial patient morbidity. Depending on the severity, the patient's clinical presentation and treatment options vary considerably, leaving uncertainty about optimal management. Traditionally, surgery was recommended to prevent complications, persistent symptoms, and recurrent episodes. Improvements in the understanding of the disease's natural history, diagnostic imaging, and long-term outcomes have prompted changes to diagnosis and treatment guidelines.

Hypogonadism in men: Updates and treatments.

ABSTRACT: Hypogonadism is a clinical syndrome of testosterone deficiency that presents with nonspecific symptoms of sexual dysfunction, fatigue, and decreased strength or muscle mass. Men with obesity, diabetes, and other comorbidities are at higher risk for hypogonadism. Patients presenting with symptoms should be tested for low testosterone and treated with testosterone replacement. Testosterone therapy carries risks and must be closely monitored. Patients treated for hypogonadism may experience improvement of symptoms and quality of life.

A Call to Action for Cultural Humility in Pharmacy Education Student Assessments.

An important topic in the conversation on the education of pharmacy students evolves around methods of pedagogy and assessment and attention to diversity and inclusion. Well-intentioned educators may introduce bias into their teachings and assessment tools by focusing on diseases with a higher rate of presentation in minorities without engaging in conversations about why these health disparities exist. When considering the content and structure of a curriculum, it is also important to review its assessment tools, with attention to cultural humility in multiple-choice examinations, case-based presentations, and even observed structured clinical examinations. Disregarding this component of the conversation may lead students to have an unconscious impression that social constructs are biological markers for a disease. Students may recall not only what they learned in a classroom setting, but often the content included in their assessments as well. By writing test items that are culturally responsible, unconscious bias can be reduced and test items can better measure the knowledge that educators intend to assess. As pharmacy educators perform programmatic reviews, attention should be directed toward unconscious bias, not only in the curricula but also in evaluation and assessment tools.

Call to Action: Addressing Social Determinants of Health in Pharmacy Practice.

Social determinants of health (SDOH) are conditions in which individuals are born, live, work, learn, play, and age that affect health, risks, functioning, and outcomes. SDOH are recognized barriers to care, risk factors for certain diseases, and associated with poorer health outcomes. Screening for SDOH in physician practices and hospitals is reportedly low. The accessibility of pharmacists and established relationships with patients make pharmacy settings ideal for identifying and mitigating social needs. An evaluation of the impact of SDOH on health outcomes and opportunities for pharmacists to embed screening into practice is warranted.

Childhood Immunization and COVID-19: An Early Narrative Review.

The COVID-19 pandemic has evolved into arguably the largest global public health crisis in recent history-especially in the absence of a safe and effective vaccine or an effective anti-viral treatment. As reported, the virus seems to less commonly infect children and causing less severe symptoms among infected children. This narrative review provides an inclusive view of scientific hypotheses, logical derivation, and early analyses that substantiate or refute such conjectures. At the completion of a relatively less restrictive search of this evolving topic, 13 articles-all published in 2020, were included in this early narrative review. Directional themes arising from the identified literature imply the potential relationship between childhood vaccination and COVID-19-either based on the potential genomic and immunological protective effects of heterologous immunity, or based on observational associations of cross-immunity among vaccines and other prior endemic diseases. Our review suggests that immune response to the SARS-CoV-2 virus in children is different than in adults, resulting in differences in the levels of severity of symptoms and outcomes of the disease in different age groups. Further clinical investigations are warranted of at least three childhood vaccines: BCG, MMR, and HEP-A for their potential protective role against the SARS-CoV-2 virus.

The role of percutaneous coronary intervention in managing patients with stable ischemic heart disease.

A major outcome of cardiology research over the last 2 decades is the finding that intensive medical management of patients with stable ischemic heart disease is as effective as revascularization procedures in preventing cardiac events and death. This finding has generated management guidelines that often are overlooked because of misplaced enthusiasm for revascularization procedures.

Fluctuations in Stress Over Time During the First Year of Health Science Programs.

PURPOSE: Psychological adjustment can impact individuals at various points during the formative years of their educational process. Health science programs can be highly stressful and potentially negatively impact physical and psychological health. This study intended to explore the fluctuations in stress levels in health science students during their first year of graduate school. METHODS: Study participants included students enrolled in four graduate health sciences programs: Doctor of Physical Therapy (DPT), Occupational Therapy (OT), Speech-Language Pathology (SLP), and Physician Assistant (PA). Students completed the Brief Symptom Inventory (BSI) during the first week of graduate school (time 1), during the last 2 weeks of semester 1 (time 2), and at mid-semester for semester 2 (time 3). Subscales on the BSI included anxiety, depression, obsessive compulsive, phobia and somatization. RESULTS: A total of 79 students completed the scale at all three time points. Mean anxiety scores changed over time from time 53 at time 1, 57 at time 2, to 54 at time 3. At the three time points, mean depression scores were 53, 56, and 53; mean obsessive-compulsive scores were 57, 63, 59; mean phobia scores 51, 50, and 50; and mean somatization scores 49, 54, and 51. DISCUSSION: There are notable fluctuations in anxiety levels in health science students, and therefore, it is necessary to assist students in developing effective stress management techniques to help moderate the negative consequences of stress.

Physician Assistant Students' Competency to Identify and Diagnose Autism Spectrum Disorder.

PURPOSE: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by deficits in communication and reciprocal social interactions. Little research has focused on the evaluation of developmental/behavioral pediatric education in the physician assistant (PA) curriculum. Therefore, the aims of this study were to evaluate whether PA students received training in identifying the red flags of ASD, using screening tests such as the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Additionally, the study sought to determine if PA students received education on the evaluation and management of children with ASD along with the methods to communicate effectively with their caretakers. METHODS: A survey open to PA students was administered by the American Academy of PAs. Demographic information along with questions on knowledge and perceptions related to ASD were asked. Perceptions of preparation to discuss ASD with patient caregivers were assessed, along with vaccination beliefs, and training information was collected. RESULTS: A total of 213 PA students answered the survey. Students received training regarding the red flags for ASD as well as ASD-related skills. Of note, 58.2% did not receive training on administration of the M-CHAT-(R/F) and 54.9% did not receive training to provide care to patients with ASD; 77.8% received training to understand pediatric developmental milestones. PA students overwhelmingly rejected the suggestion that there is a link between vaccines and ASD. CONCLUSION: The importance of diagnosing ASD as early as possible has been demonstrated by years of research; yet, this study concludes that many students still do not feel comfortable recognizing the red flags or using screening tools. Although the majority of PA students received training to understand developmental milestones, many did not know how to administer the M-CHAT-(R/F), which is key to making an early diagnosis.

Towards Earlier Identification: Physicians Assistants' Perceptions of their Ability to Identify, Diagnose, and Refer Patients with Autism Spectrum Disorder.

Early detection is imperative for children with autism spectrum disorder (ASD) to achieve optimal functioning. Knowledge of early signs of ASD, as well as open communication, can mitigate delayed diagnosis. This study explored physician assistants' (PA) abilities to diagnosis ASD as well as gathered information on their training. A majority of respondents who see pediatric patients received training on developmental milestones, but far fewer received training to identify red flags for ASD. Few PAs are talking with every patient's caregivers about a variety of behavioral health conditions, not just ASD. Overall, PAs rated their current skills working with patients with ASD lower than their desired level, suggesting a desire to become more adept at meeting their patients' needs.

G6PD deficiency: An update.

Although glucose-6-phosphate dehydrogenase (G6PD) deficiency is less known in Western countries than in the Middle East and Africa, global migration and immigration are bringing ethnic groups with the highest incidence of this inherited genetic disorder into the US healthcare system. The G6PD enzyme is critical to protecting erythrocytes against oxidative stress, and deficiency may lead to hemolysis in the presence of certain environmental factors such as infection and some medications and foods. Neonatal jaundice, favism, and hemolysis are associated with exposure to increased oxidative stressors in patients with G6PD deficiency. By recognizing the potential for G6PD deficiency, clinicians can screen for the disorder and teach affected patients how to avoid triggers that result in harmful clinical manifestations.

Impact of Variations in PACKRAT Administration: A Retrospective Review.

The Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) was developed to be an objective, comprehensive self-assessment tool for students. When the PACKRAT exam was initially developed, its goal was to help students determine what level of knowledge they currently possessed and what they had to learn prior to graduation. The purpose of this study was to review PACKRAT test-taker scores over the past 5 years and analyze the variations in test administration. Deidentified PACKRAT scores, exam length in minutes, and proctored or unproctored status, along with time extensions were analyzed from 2013 to 2018. Descriptive statistics and frequency counts were used to summarize the data. An independent samples t-test was used to determine if there was a difference in test-taker scores between proctored and unproctored exams. The 83,271 student test-taker exam data were analyzed, and time ranged from 180 to 360 minutes with a mean of 226.5 minutes. When comparing test-taker scores between proctored and unproctored exams, the mean scores were 145.02 and 144.77, respectively, with no significant difference. The Physician Assistant Clinical Knowledge Rating and Assessment Tool can be confidently used and compared to national scores whether a program administers the exam proctored or without a proctor. The average time taken for exam completion is close to the recommended 225 minutes that is suggested by Physician Assistant Education Association PACKRAT exam developers.

Recognizing autism spectrum disorder.

Autism spectrum disorder (ASD), previously called autism, is a developmental condition that can cause significant social, communication, and behavioral challenges. Early symptoms of ASD can easily be overlooked. Clinicians who can recognize the symptoms of ASD can help children get prompt referral to specialists and early intervention, which is key to improving developmental outcomes for children with ASD.