Accreditation Outcomes: Does Program Director Experience Matter?

PURPOSE: The program director (PD) is responsible for providing effective leadership and possessing knowledge of accreditation. The aim of this study was to evaluate whether a PD's experience in higher education affects the accreditation outcome. METHODS: This cross-sectional study includes Physician Assistant (PA) programs that underwent an accreditation visit between January 2012 and January 2022. Data analysis was primarily descriptive, stratified by demographic variables, and outcomes of accreditation standards. Inferential analysis included chi-squared tests of statistical independence. RESULTS: The chi-squared analysis test of statistical independence of PD's experience and accreditation decision identified a statistically significant association between the PD's experience as a PD and the accreditation outcome for continuing reviews. However, a minimum of 3 years of experience in higher education and the accreditation outcome were statistically independent for provisional and continuing reviews. CONCLUSION: Few PDs are hired with more than 3 years of PD experience, but they tend to have more higher education or PA program educational experience. A PD's years of higher education experience was not associated with accreditation outcome, which may suggest that other supports are more critical for achieving and maintaining accreditation.

An Examination of Predictors of Attrition in Physician Assistant Programs.

INTRODUCTION: The purpose of this study was to explore the relationship between program characteristics and attrition rates. METHODS: Program graduation rates, attrition rates, and Physician Assistant National Certifying Examination (PANCE) pass rates were extracted from program websites from February-March 2021 and summarized for 2018, 2019, and 2020. Means were compared across categories of independent variables. Attrition rates and PANCE pass rates were correlated. Prerequisites and attrition rate were evaluated with multiple regression. RESULTS: Mean attrition rates varied little across years. Significant differences in mean attrition were limited to a few US Census Bureau regions or divisions. No significant correlation between the total number of prerequisite courses or total prerequisite credits and attrition existed. In 2020, mean attrition rate was statistically significantly greater when biochemistry was required (M = 6.89, SD = 7.04) than when not required (M = 4.91, SD = 4.75) and was statistically significantly lower when an additional chemistry course was required (M = 3.65, SD = 4.00) than when not required (M = 5.93, SD = 5.82). No significant predictors of attrition were found with regression. DISCUSSION: The mean attrition rates have been relatively stable from 2018-2020, suggesting that the presence of prerequisite coursework has no significant impact on attrition rates. This suggests that specific prerequisites may not predict success in a program, supporting the idea of decreasing or eliminating prerequisites. Additional studies are needed to understand the factors, including specific combinations of prerequisites, that predict completion of a physician assistant program.

Course Prerequisites: Here, There, and Everywhere. Time to Standardize?

INTRODUCTION: This study's aim was to examine prerequisite course requirements and compare them to previous studies with a secondary aim to examine potential differences relative to program characteristics. METHODS: Data were extracted from the websites of 265 entry-level physician assistant (PA) programs from October 2020 until December 2020. Course prerequisites as well as number of courses and semester hours required were described and examined according to program location, phase, Carnegie Classification, association with a medical school, and the public/private status of the sponsoring institution. RESULTS: Of 264 PA programs, more than 50% of programs required 6 common prerequisites: anatomy, physiology, microbiology, statistics, general chemistry, and psychology. The total number of unique prerequisite courses was 28 for all programs with a reduction in humanities and social sciences semester hours compared to previous studies and a slight increase in credit hours required for the common 6 courses. Total prerequisite hours and courses required were higher for master's programs; private, not-for-profit programs; newly established programs; and those not associated with a medical school. Newer programs are generally located in private, not-for-profit educational institutions that are not associated with a medical school. Programs in the Mountain Division required a lower number of prerequisites, and the South Region required the greatest number of prerequisite courses and semester hours. DISCUSSION: The present study demonstrates a difference in prerequisite requirements across the country. This could translate to increased cost and a potential barrier to those considering a career as a PA.

Physician Assistant Education Community Assumptions About an Entry-level Doctoral Degree.

PURPOSE: This study described the assumptions that PA educators hold regarding the option and/or transition to a doctoral entry-level degree for PA graduates. METHODS: A cross-sectional electronic survey of all members of accredited PA programs was administered. The survey comprised 32 Likert-type statements that measured respondents' level of agreement ranging from strongly disagree to strongly agree and general demographic information. Mean scores are reported for each Likert statement and then compared with analysis of variance and post hoc testing for subgroups of baseline variables. RESULTS: Responses indicate wide-ranging opinions regarding the adoption of an entry-level doctoral degree for PAs. However, the preponderance of responses appeared more neutral or in opposition to an entry-level doctoral degree. The statement with the strongest level of agreement was that "consideration of the entry-level doctoral degree was really about competing with advanced practice nurses." Educators who were PAs and those who were physicians differed significantly in their responses for 17 of 32 statements. CONCLUSION: Most respondents believed that the master's degree is "enough for clinical practice." If there is not a deliberate discussion informing the transition to a doctoral entry-level degree, then the change is likely to occur at the individual program level as it did with the transition from a certificate to a bachelor's degree and then to a master's degree. If the PA profession moves to the acceptance of an entry-level doctoral degree, the PA professional organizations should continue to be involved in developing a measured plan forward.

Accreditation 101: Develop, Assess, and Report Program Goals.

The aim of this article is to highlight the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) accreditation requirements for PA program goals, describe methods for writing effective goals, provide examples and analysis of hypothetical goals, and encourage the use of effective reporting strategies. Programs are encouraged to use one of 3 mnemonic conventions with each providing a useful framework for identifying key elements of goals: FAST, SMART, and Objectives and Key Results. These 3 acronyms are easy to remember and will yield goals that are consistent with the requirements of ARC-PA.

Recognizing and responding to sex-trafficked minors in the healthcare setting.

Nearly 6,100 reports of sex trafficking were made to the United States Human Trafficking Hotline in 2017; 29% of those reports involved minors. Physician assistants (PAs), especially those working in emergency medicine and primary care, are among the few frequently accessed healthcare providers who have the opportunity for a private conversation with a sex trafficking victim or survivor. PAs must be able to recognize the risk factors and signs of trafficking and respond in a trauma-informed, survivor-centered manner. Connecting trafficking victims, survivors, and at-risk youth with wraparound services is critical to their well-being.

Coming of Age in Physician Assistant Education: Evolution of Program Characteristics.

PURPOSE: This study aimed to describe the characteristics of physician assistant (PA) programs developed in 3 previously defined time periods. METHODS: Data were extracted from the websites of 238 PA programs, including admissions, curriculum, faculty, and program characteristics. Institutional characteristics were gathered from the Carnegie Classification website and the US Census Bureau. Program characteristics were analyzed in 3 groups based on when the program was first accredited-early (before 1980), middle (1980-1999), and current (2000-2019). RESULTS: Early (n = 40), middle (n = 69), and current (n = 129) phase programs are similar regarding the number of admissions, curriculum, faculty, program, and institutional characteristics. Program phase had the greatest effect on undergraduate GPA of matriculating students, the number of PA faculty at the rank of professor, and the size of the admitted cohort. The effect size was medium for outcomes including the number of required biology, chemistry, or physics prerequisites; the probability that the program required a graduate record examination for admission; the number of PA program faculty at the rank of associate professor; the annual tuition and fees; and the probability that the PA program was housed with a medical school. CONCLUSION: The data describe some of the similarities and differences among the programs established in the 3 previously described time periods in the history of PA education. With the recent surge in new programs, there is value in deepening our understanding of how newer programs compare with more established programs.

Physician Assistant Program Goals: A Thematic Analysis.

PURPOSE: The purpose of this study was to provide a descriptive analysis of the goals of the accredited physician assistant (PA) programs across the country in order to obtain a baseline understanding of their themes. METHODS: Initial review of the goals resulted in the identification of recurring themes. The goals were evaluated relative to meeting the requirements specified in Standard A3.14 of the Accreditation Review Commission on Education for the Physician Assistant, including listing the goal with the defined benchmark expected and the program's progress in reaching the goal. Accreditation status was compared. RESULTS: Of the 238 accredited PA programs at the time of the study, 157 (66%) had Accreditation-Continued status, 56 (24%) were Accreditation-Provisional, and 25 (11%) had Accreditation-Probation status. The median number of 5 goals per program did not vary dependent on accreditation status. Only 43 of 238 PA programs (18%) provided goals with required benchmarks and supporting outcomes on their webpages. Almost all programs included at least one goal (and often more than one) with the theme of student acquisition of knowledge, skills, and attitudes needed to be a PA. Other commonly included themes in programmatic goals included the "capacity" of students to graduate from the PA program and become employed, valuing diversity and cultural differences, a comprehensive and strong curriculum, as well as alumni who are self-directed, lifelong learners. CONCLUSION: Program goals should be reviewed to ensure they include benchmarks that define success and report progress or outcomes in achieving those goals. Thematic analysis provides a powerful summary that then can be used to make conclusions across a large set of program data.

Evaluation and management of a large incidentally discovered renal mass.

Increasingly, renal cell cancer is diagnosed because of an incidental finding of a renal mass on an imaging study. Incidentally discovered masses are more likely to be small and, if malignant, represent localized renal cell cancer. The imaging features of the tumor and patient characteristics inform the management options, which favor a nephron-sparing approach over radical nephrectomy. Clinical stage at the time of diagnosis has important prognostic implications for the patient. This article reviews the presentation, diagnostic evaluation, and management of an incidentally discovered renal mass.

Sharpening the attack on non-small cell lung cancer.

Advanced non-small cell lung cancer (NSCLC) has long been a diagnosis with few treatment options and poor outcomes. However, recent discoveries about the molecular biology of NSCLC are changing the way it is treated. Driver mutations that cause uncontrolled cancer cell proliferation have been discovered in some types of NSCLC. This has led to the discovery of therapies that can target a specific driver mutation in advanced NSCLC and halt cancer progression. This article reviews standard treatment of NSCLC and explores the targetable mutations of NSCLC, available targeted treatments, treatment obstacles, and the future of targeted therapy in NSCLC.

Basic skills workshop for physician assistant educators: effects of participation on perceived mastery of teaching skills and job satisfaction.

PURPOSE: The study examined participation in the Basic Skills Faculty Development Workshops (BSW) offered by the Physician Assistant Education Association (PAEA). The aim was to determine the effects of participation on perceived mastery of teaching skills and job satisfaction. METHODS: The 1,290 faculty and program director members of PAEA were invited to complete an electronic survey regarding their past participation in a BSW, levels of satisfaction with various aspects of their work, and their perception of their level of mastery of various teaching skills. Additionally, those who had participated in these workshops completed a section on colleague relationships that were developed or strengthened through workshop participation. RESULTS: Approximately half (n = 248) of the 493 respondents had participated in a BSW. Mean scores for satisfaction with salary, rank, position, and overall satisfaction did not differ significantly according to BSW participation. Perceived mastery of various teaching skills was significantly higher for nonattendees of BSW. However, controlling for "years in physician assistant education" nullified that association. Attendees reported a mean of 1.02 (SD = 1.47) new mentoring relationships and 2.45 (SD = 2.97) new peer relationships. Satisfaction with current position was significantly positively correlated with the number of colleague relationships. The number of new and strengthened mentor relationships correlated significantly with perceived mastery of advising students. CONCLUSIONS: Basic Skills Workshop attendees experience acceleration in their perceived mastery of teaching skills, closing the proficiency gap between them and their more-experienced colleagues who did not attend a Basic Skills Workshop. Also, participation is associated with an increased number of colleague relationships, which has a positive effect on satisfaction.

Increasing diagnostic certainty: the clinical value of the likelihood ratio.

The LR has the potential to be a valuable tool to mitigate uncertainty in the diagnostic process for clinicians in any area of medicine. With more and more LRs being published in the literature and the ready availability of the likelihood nomogram, there has never been a better time to put this tool to work in both inpatient and outpatient settings. PA students can be exposed initially to LRs in their diagnostic medicine lectures, followed by application of the principles in case-based exercises in clinical medicine or as part of their evidence-based medicine curriculum. Clinical-year PA students can then be encouraged to use LRs in their clinical rotations as they collaborate with preceptors in the diagnostic decision-making process. Exposure to and application of LRs in the didactic and clinical aspects of the curriculum are likely to increase their comfort level with this valuable tool and enable them to use it with ease in their future clinical practices.