Developing a Genital Training Associate Program.

ABSTRACT: Genitourinary training associates (GTAs) are individuals educated to teach medical learners invasive exams and procedures using their own body. Through specified protocols, the GTA teaches exam techniques to students in a supportive environment while giving feedback to the learner to optimize skill acquisition. Additionally, this experience can teach best practices for future provider-patient communication. To help ensure access to GTAs for medical learners, physician assistant (PA) programs should consider developing a GTA training program at their institution. The purpose of this article is to outline the necessary steps to educate GTAs and develop a GTA training program.

PA licensure questions, the Americans with Disabilities Act, and seeking medical care.

OBJECTIVE: This study built on a recent publication to explore physician assistant (PA) licensure renewal applications, as well as PA likelihood to seek help for physical or mental health conditions. METHODS: We were able to obtain licensure renewal applications from 47 states. A national survey was then conducted to explore the connection between licensure questions and help-seeking behavior. RESULTS: Only 18 states were consistent with the Americans with Disabilities Act (ADA) in their approach to initial and renewal applications. Thirty-five percent of PAs expressed reluctance to seek help for a mental health issue due to concerns about licensure repercussions. States with applications that were inconsistent with the ADA were significantly more likely to express these concerns. CONCLUSIONS: Considerable stigma exists among PAs regarding seeking help for mental health issues. Problematic licensure questions increase this reluctance. Advocacy is needed to reduce stigma of mental health and substance use, and to modernize licensure applications.

Use of Moulage to Evaluate Student Assessment of Skin in an Objective Structured Clinical Examination.

PURPOSE: This study investigated the physician assistant (PA) student evaluation of skin and the use of moulage in an objective structured clinical examination (OSCE). METHODS: Clinical-year PA students participated in an OSCE, taking a history, completing a physical examination, and writing a focused clinical note. The standardized patient's history simulated a primary diagnosis of right-sided carpal tunnel syndrome and an incidental skin lesion consistent with melanoma, only if the student made an inquiry in this replication study. Faculty members' assessments of students' physical examinations were standardized using an agreed-upon rubric. Students completed an anonymous survey on the OSCE experience immediately following the activity. RESULTS: All students identified the primary diagnosis of carpal tunnel. Sixty-three percent of students verbalized examination of the skin; however, only 38% identified an atypical skin lesion in their clinical note documentation. Of those, only 33% of students referred the patient for biopsy. Most students believed that the use of moulage increased the realism of the standardized patient encounter. Sixty percent of students reported that they noticed a skin lesion but did not believe that it was part of the simulated experience. CONCLUSIONS: Moulage increased the realism of the OSCE. This study found that the ability of a student to verbalize the evaluation of a particular body system did not necessarily mean that they adequately or correctly assessed that system upon physical examination. Implementation of an OSCE and use of moulage provided an opportunity to explicitly assess student performance related to evaluation and assessment of skin. It provided a mechanism for meaningful, formative feedback of students' performance.

The physician assistant workforce in Indiana: preparing to meet future health care needs.

OBJECTIVE: This study identifies baseline demographic and descriptive statistics for physician assistants (PAs) in Indiana from 1978 to 2010. METHODS: Data were obtained from Indiana Professional Licensing Agency applications, the Indiana State Department of Health, and PA educational programs. Descriptive statistics were used to characterize the PA workforce as well as their supervising physicians. RESULTS: Most PAs working in Indiana were born and educated outside the state. Of those educated in Indiana, 77% obtained an initial license in Indiana; as of May 2010, 62% were still licensed in the state. In the past 8 years, Indiana had a 97% increase in active licensed PAs. Only 24% of PAs work in primary care; 92% work in metropolitan areas. For 40 years, PAs have increasingly worked in areas that are medically underserved or experiencing a shortage of health professionals. However, the overall numbers of PAs working in those areas remain low. CONCLUSIONS: More PAs in Indiana are practicing in medical specialties than in primary care. As health care policy and regulatory changes evolve, future studies will be needed to understand the impact on the health care workforce of Indiana PAs. This study will serve as a baseline for those studies.

Clinical coordination and the experiential year in physician assistant education.

PURPOSE: The purpose of this study was to examine how clinical coordination is accomplished within physician assistant (PA) education and to identify effective practices for placing PA students into experiential rotations. METHODS: A survey was sent to all fully accredited PA programs asking the clinical coordinators to provide information about themselves and their institutions, programs, activities, and the individuals for which they had responsibility. Data were analyzed using descriptive and inferential statistics. Ten independent variables were selected due to their expected potential to influence the following four dependent variables: length of most recent accreditation cycle, clinical coordination satisfaction, hours spent cultivating sites, and summed hours of clinical coordinator tasks that most directly impact students. Bivariate correlations between each independent variable and each dependent variable were calculated. The level of statistical significance was set at p < 0.05. RESULTS: Fifty-two out of 130 eligible programs (40%) responded in part to the survey. The tasks clinical coordinators performed and the level to which they were responsible to complete these tasks varied considerably. Clinical coordinators reported being satisfied with their roles, able to help others, and successful in their work. The correlation between clinical coordination satisfaction and the availability of the preceptor incentive of campus privileges was inversely significant (r(25) = -0.464, p = 0.01). CONCLUSION: This study provides an overview of PA program clinical coordination practices and may have implications for programs that wish to benchmark or develop strategies to normalize the activities associated with their program's experiential year.

Analysis of incomes of new graduate physician assistants and gender, 1998-2006.

The purpose of this study was to determine if there was a gender-based difference in starting incomes paid to new graduate physician assistants. Data obtained from the American Academy of Physician Assistants (AAPA) Division of Data Services and Statistics from 1998 through 2006, utilizing the Annual AAPA Physician Assistant Census and the Annual AAPA New PA Student Census, were analyzed using SPSS at an alpha level 0.05. A statistically significant difference was found between the incomes of male and female new graduates utilizing the t test for independent samples in each survey year and all years combined. In addition to gender, over 150 independent variables were evaluated by backward regression analysis. Gender remained statistically significant in all models of each year and all years combined. The results of the study indicate that female new graduate physician assistants received a lower income than their male counterparts, even when other confounders were considered.