Comparative analysis of Physician Assistant/Associate National Certifying Examination (PANCE) performance trends: pre and during COVID-19 era.

BACKGROUND: COVID-19 significantly impacted physician assistant/associate (PA) education programs. Most programs transitioned didactic and clinical education from in-person to remote, and clinical training opportunities diminished. Graduates of accredited PA programs take the Physician Assistant National Certifying Examination (PANCE), a five-hour exam with 300 multiple-choice questions, and must attain or exceed the scaled passing score of 350 (range: 200-800). We examined first-time examinees' trends in PANCE scores and passing rates three years prior to the pandemic and three years during. METHODS: We analyzed data (N = 59,459) from the National Commission on Certification of Physician Assistants. The two primary outcomes were PANCE scores and pass rates. The main exposure was the timeframe: three years pre-pandemic (2017-2019) and three years during the pandemic (2020-2022). The 2017-2018 scores were equated to the new passing standard implemented in 2019. Covariates included age, gender, years the PA program has been accredited, program region, and rural-urban setting. Analyses consisted of descriptive, bivariate, and multivariate statistics. RESULTS: The mean PANCE score and pass rate during the six-year study period were 463 and 93%, respectively. In unadjusted analyses comparing each year individually, mean PANCE score was highest in 2020 and lowest in 2022 than in all other years except for 2017. When comparing each pandemic year to the pooled three pre-pandemic years and adjusting for test-taker and PA program covariates, examinees scored significantly higher in 2020; there was no difference in 2021, and they scored lower in 2022. When controlling for covariates, examinees had 1.24 higher odds of failing in 2022 compared to the pooled pre-pandemic period. CONCLUSION: Findings suggest that PANCE scores and pass rates were impacted during the third year of the pandemic. PANCE assesses if examinees have the essential clinical knowledge to enter the PA profession. It is crucial to determine whether the pandemic affected PANCE scores and pass rates to ensure PAs provide safe and high-quality patient care.

Individual values, the social determinants of health, and flourishing among medical, physician assistant, and nurse practitioner students.

The purpose of this study is to explore how demographics and individual values, qualities, and personality traits are associated with perceptions of flourishing among medical (MD), physician assistant (PA), and nurse practitioner (NP) students. Current MD, PA, and NP students from two academic medical centers were recruited to participate in this cross-sectional study between August 6 and October 9, 2023. Participants completed the Secure Flourish Index (traditional SFI) and then applied a percentage weight to each of the six flourishing domains based on perceived relative importance to their overall flourishing. Additional survey questions included demographics and multiple validated instruments: WellRx, 2 Question Maslach Burnout Inventory, Brief COPE Inventory, the Short Grit Scale, and Duke University Religion Index. Descriptive statistics, ANOVA, correlation, and regression analyses were performed with an alpha of 0.05. A total of 393 of 1820 eligible students began the survey (21.6%) while 280, (15.4%) were included in the analysis. Traditional SFI scores were higher with higher grit (r = .368, p < .001). Traditional SFI scores were lower with higher WellRx (r = -.336, p < .001), burnout (r = -.466, p < .001), or avoidant (r = -.453, p < .001) coping style. Scores were about 10 points lower for students who had considered leaving training in the past 6 months (M = 75.3, SD = 16.2) than those who had not (M = 85.6, SD = 14.4; p < .001). The SFI domain of physical and mental health had the highest relative percentage weight (20.2% (SD 8.4)) but was second to lowest in mean domain flourishing score (mean 6.5, SD 1.7). While participants placed high value on physical and mental health, they reported relatively low flourishing in this area. Targeted interventions to improve the ability for students to cope with the hardships of training and life, as well as supports structured to address the social and structural determinants of health may improve flourishing among students with similar values.

Gaining consensus on a protocol for general surgery physician assistants in the management of non-compressible abdominal haemorrhage in military austere environments: a Delphi study.

BACKGROUND: Non-compressible abdominal haemorrhage (NCAH) is a potentially preventable cause of death due to injury. Limited exploratory laparotomy by a non-surgeon is a temporary intervention to sustain life until definitive surgical intervention by trauma surgeons can be obtained. This study aims to establish consensus on a protocol for general surgery physician assistants performing limited exploratory laparotomy to manage NCAH in an austere environment. METHOD: This study included anonymised trauma surgeons and general surgery physician assistants from military and civilian backgrounds. Participants were recruited from various professional surgical organisations, including direct interaction with trauma surgeons and surgical physician assistants. Participants used a modified Delphi survey with a 9-point Likert scale in two rounds. The two surveys were categorised into three parts: protocol for NCAH (part A), the potential role of general surgery physician assistants (part B) and measures of success (part C). A total of 24 statements were voted on and assessed. Votes were divided into three zones: agreement (median 7-9), uncertain (median 4-6) and disagreement (median 1-3). To reach a consensus, 70% agreement was required within a zone. If more than 30% of the votes fell outside of a specific zone, consensus was not achieved. After consensus, the original protocol was revised in an online meeting with experts. RESULTS: The initial analysis involved 29 participants. After 2 survey rounds, 19 out of 24 statements reached a consensus. Part A: 10 statements gained consensus, including in austere environments, controlling NCAH can be challenging. A qualified general surgery physician assistant should intervene. A focused assessment with sonography for trauma examination can be used for screening. Bleeding can be managed with packing and pressure. After managing the haemorrhage, the abdominal wall should be left open with a temporary closure technique. Part B: nine statements gained consensus, including in austere locations, a licensed general surgery physician assistant with a minimum of 3 years of experience working under the supervision of a trauma/general surgeon can perform interventions for limited exploratory laparotomy for patients with NCAH. Part C: general surgery physician assistants will be required to have the same success rates as any qualified surgeon. CONCLUSION: Gaining consensus and implementing a revised protocol for managing NCAH by general surgery physician assistants is attainable. General surgery physician assistants will need formal training to manage NCAH. With the support of trauma surgeons who provide direct and indirect supervision, general surgery physician assistants can develop a comprehensive understanding of the necessary skills and make sound decisions when treating patients with this condition. This teamwork can also increase surgical capacity and potentially decrease mortality rates for patients with NCAH in austere environments.

Leaving the profession as a medical assistant: a qualitative study exploring the process, reasons and potential preventive measures.

BACKGROUND: Worldwide growing shortages among health care staff are observed. This also holds true for medical assistants in Germany. Medical assistants mainly work in outpatient care and are the first point of contact for patients while performing clinical and administrative tasks. We sought to explore profession turnover among medical assistants, that is, in terms of the underlying decision-making process, the reasons for leaving the medical assistant profession and potential retention measures from the perspective of former medical assistants. METHODS: For this qualitative study, we conducted semi-structured telephone interviews with 20 former medical assistants between August and November 2023. Eligible for participation were medical assistants who (i) were of legal age, (ii) completed medical assistant vocational training and ii) were formerly employed as a medical assistant, but currently employed in another profession. The interviews were recorded, transcribed verbatim and content-analyzed. RESULTS: Former medical assistants expressed various, often interrelated reasons for leaving the profession. These were changes in priorities throughout their career (e.g., in terms of working hours and salary), a constant high workload, barriers to further training, poor career prospects, and poor interpersonal relationships particularly with supervisors, but also within the team and with patients as well as the perception of insufficient recognition by politics and society. Suggestions of former medical assistants to motivate medical assistants to stay in their profession included amongst others higher salaries, more flexible work structures, improved career prospects, and more recognition from supervisors, patients, and society. CONCLUSION: Our study provides insights into the complex decision-making process underlying ultimate medical assistant profession turnover. In light of an already existing shortage of medical assistants, we suggest to further explore how the suggested interventions that aim at retention of working medical assistants can be implemented.

PAs and NPs in liver transplantation: Perceptions, implementation, and effect.

OBJECTIVES: This study assessed the use and perceptions of physician associates/assistants (PAs) and NPs at liver transplant centers and sought to determine their financial effect. METHODS: Leaders of liver transplant programs performing 25 or more transplants in 2020 were contacted to complete an 11-question survey about the role and effect of PAs and NPs in liver transplant. A single-center retrospective analysis compared length of stay (LOS) and readmission rates for primary liver transplants and simultaneous liver-kidney transplants before and after a dedicated PA team was established. Chi-square and t -test analyses were performed. RESULTS: The survey achieved a 77% response rate, and 98% of institutions reported using PAs and NPs. The single-center study found the mean LOS post-transplant was significantly shorter in the post-PA cohort ( P = .0005). No significant difference was found in 30-day readmission rates. CONCLUSIONS: PAs and NPs are used broadly across the post-liver transplant care continuum. Using LOS as a surrogate financial marker suggests that a dedicated PA and NP team may contribute to cost savings.

PA leadership: Implementation, structure, and sustainability.

ABSTRACT: Physician associate/assistant (PA) leaders are essential to healthcare and critical to a healthcare organization's success. In this article, the second of a two-part series on PA leadership, we summarize methods for implementing and sustaining PA leadership opportunities and organizational structures.

International medical graduates and PAs: A history and update.

ABSTRACT: During the 1980s and 1990s, international medical graduates (IMGs) sought legal and educational measures aimed at obtaining licensure as physician associates/assistants (PAs). Proponents of IMGs asserted that their ethnic backgrounds and identification with their respective communities could increase access to care for some segments of the population and therefore should be permitted pathways to qualify as PAs. A variety of legal measures were introduced into state legislatures in at least five states and were firmly opposed and defeated by the PA profession. Recent attempts by IMGs to obtain licensure as PAs have occurred in Puerto Rico and Arizona. In their haste to address healthcare access and satisfy various constituencies, state legislators and regulatory boards fail to recognize established professional norms. This is occurring as medical organizations are examining alternative pathways for state licensure of physicians who have completed training and/or practiced outside of the United States. PA organizations, particularly state chapters, must be vigilant in upholding qualifications for practice and licensure standards, and state PA organizations must work to convince legislators to avoid using PA professional regulations to solve a workforce issue that is essentially an issue of physician medical education remediation.

Leveraging telementoring platforms to enhance PA capacity and education.

ABSTRACT: Telementoring is a valuable workforce development resource that connects subject matter experts with healthcare providers via videoconferencing. This technology can deliver training, education, and ongoing technical support to build workforce capacity. Arizona State University (ASU) has leveraged a widely used telementoring platform, Project ECHO, to disseminate best practices in palliative medicine. The model has increased clinician knowledge and confidence, and the learning network may provide protective factors for clinician wellness. The replicable and inclusive nature of telementoring platforms creates educational opportunities to align learners across the didactic and clinical years of medical training, as well as into early- and midcareer for physician associates/assistants (PAs). Telementoring programs can be used across the PA learning continuum, including in PA training programs.

Difficult Conversations: A Collaborative Interprofessional Simulation for Social Work, Athletic Training and Physician Assistant Programs.

Students graduating from professional healthcare programs are expected to demonstrate competence in their area of study to enter the workforce and immediately start working with people. High expectations and a fast-paced environment are typical aspects of these professional positions and often result in higher rates of burnout, compassion fatigue, and lack of empathy, leading to an overall decrease in patient satisfaction. As a result, patients who face difficult situations may often feel as though their needs are not being addressed. The purpose of this study was to examine the effectiveness of a shared educational module and simulated patient encounters on improving student confidence and competence engaging in difficult conversations with patients regarding intimate partner violence, substance abuse, and suicidal ideation. Students in the social work (n=14), athletic training (n=7), and physician assistant degree programs (n=20) participated in a collective learning module focusing on patient-centered care (PCC) skills required for having difficult conversations with patients. After students completed the shared learning module and prior to the simulated experience, students were given the Inter-professional Teams in Difficult Conversations Self-Assessment survey, a self-assessment tool measuring level of competence in engaging in difficult conversations. Students were then assigned to one of three rooms at random and varied in topic from intimate partner violence, substance abuse, or suicidal ideation. After the simulation, students completed the Inter-professional Teams in Difficult Conversations Self-Assessment survey again. Standardized patients (SP) also completed the Patient-Professional Interaction Questionnaire (PPIQ) immediately after the simulated experience. As hypothesized, students self-reported very high confidence in their ability to engage in difficult conversations using PCC, but SPs reported feeling little empathy or understanding of their situation from the students. Findings from this research demonstrate the disconnect in transfer of knowledge from understanding what PCC skills are to implementing them during difficult conversations.

The Contribution of Postprofessional Doctorates to the Career Development of Healthcare Workers: A Scoping Review.

INTRODUCTION: Doctorate education and implications for career trajectory for postprofessional healthcare workers like physician assistants/associates (PAs) remain under¬studied. PURPOSE: This scoping review identified findings from existing literature on the contribution of postprofessional doctorate (PPD) degrees to the career development of non-entry-level healthcare workers to inform the con¬temporary emergence of PA-specific doctorate programs in the United States. METHODS: The research followed the Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Eligible sources examined career advancement outcomes, curriculum, and terminal projects of PPD degree programs for postprofessional healthcare workers. Empirical studies, literature reviews, and commentaries were included. Multiple relevant databases, Google, and Google Scholar were searched. Citation chaining and hand searching of relevant journals were also completed. Screening and data extraction were conducted using Covidence. RESULTS: Among 1,605 sources identified, 24 met eligibility criteria. Most sources examined the Doctor of Nursing Practice and referenced clinical acumen, professional visibility, scholarly capability, leadership readiness, teaching preparation, and self-confidence. CONCLUSION: Findings about PA PPD degrees were limited. Sources exploring other professions demonstrated career development and educational outcomes, making assessment of results challenging. Future research should delineate critical competencies required for doctor¬ate-prepared PAs.