Reflections on a Physician Assistant Entrance Exam: Does the Profession Need One?

ABSTRACT: Standardized entrance exams are used in many health professions as one way to objectively measure knowledge and facilitate comparisons across student groups. The physician assistant (PA) profession has historically not employed a profession-specific entrance exam, and the idea was never seriously explored until the Physician Assistant College Admissions Test was developed recently by a commercial assessment publisher, with field testing in some volunteer programs in 2018 and the exam's first administration in May of 2020. The 2020 Physician Assistant Education Association Presidents Commission chose to investigate the issues raised by a consensus-derived, PA-specific entrance exam to stimulate more informed discussion on the efficacy of such an exam. While it may have the potential to enhance efficiency in PA admissions and reduce variability in admissions requirements, a PA entrance exam would also likely introduce new challenges, including increased costs, impact on the diversity of the applicant pool, and incongruence with an increasingly holistic admissions process. The biggest barrier would likely be the lack of current consensus on the knowledge, skills, and attributes that matriculants need to be successful in the program and in clinical practice. Development of a consensus-derived PA entrance exam would be a complex, expensive, and time-consuming endeavor, requiring considerable attention to technical issues of psychometric quality, process transparency, and legal defensibility. Changes being made to health professions admissions practices due to the COVID-19 pandemic, including the dropping of test scores as a requirement by some institutions, may make some of the issues raised in this paper more timely than ever.

Willingness to perform induced abortion and associated factors among graduating midwifery, medical, nursing, and public health officer students of University of Gondar, Northwest Ethiopia: institution based cross sectional study.

BACKGROUND: In developing countries, abortion is often unsafe and a significant cause of maternal morbidity and mortality accounting for about 8% (4.7-13.2%) of maternal mortality worldwide. Internationally, safe abortion services are recognized as reducing maternal mortality, and liberalized abortion laws are associated with reduced mortality resulting from unsafe abortion procedures. However, health care providers have moral, social and gender-based reservations that affects their willingness towards providing induced abortion services. The purpose of this study was to assess willingness to perform induced abortion and associated factors among graduating Midwifery, Medical, Nursing, and Public health officer students of University of Gondar. METHODS: Institution based cross sectional study was conducted from March 29 to May 30, 2019. All graduating students available during data collection period were considered as study population. Stratified simple random sampling technique was used to select 424 study participants. Pre tested, semi- structured, self-administered questionnaire was used to collect data. Data analysis was done using SPSS version 20. Ethical clearance was obtained from School of midwifery under the delegation of institutional review board of university of Gondar. RESULTS: Two hundred ninety students out of 424 students were willing to perform induced abortion for indications supported by Ethiopian abortion law, making a proportion of 68.4% (95%Cl: 64.2, 72.9). Sex (Being male (AOR = 4.89, 95%CI: 3.02, 7.89)), religion (being orthodox than protestant (AOR = 10.41, 95%CI: 3.02, 21.57)), being Muslim than protestant (AOR = 5.73, 95%CI: 1.37, 15.92)) and having once or less a week religious attendance (AOR = 2.00, 95% CI: 1.20, 3.34) were factors associated with willingness towards performing induced abortion. CONCLUSIONS: According to this study willingness of students towards providing induced abortion services was good. However female students, protestant followers and those students with more than once a week religious attendance should be encouraged to support women's access to induced abortion services by referring them to other health care professionals willing to provide induced abortion services.

Distribution of licensed acupuncturists and educational institutions in the United States in early 2015.

In recent decades, acupuncture has been used more widely and extensively in the United States (U.S.). However, there have been no national surveys or analyses reported in academic journals on the number of practicing or licensed acupuncturists. This study was conducted to identify the approximate number of licensed acupuncturists active in 2015. The Board of Acupuncture or Board of Medicine in each state or U.S. territory was contacted to collect data. Online license information searching was also performed in order to get accurate numbers of licensed acupuncturists for those states in which a board was unable to be contacted. The study found that the number of licensed acupuncturists in 2015 in the U.S. was 34,481. Of this, more than 50% were licensed in three states alone: California (32.39%), New York (11.89%) and Florida (7.06%). The number of licensed acupuncturists increased 23.30% and 52.09%, compared to the year 2009 (n = 27,965) and 2004 (n = 22,671), respectively; increasing about 1,266 per year. There were 62 and 10 accredited acupuncture institutions providing master and doctoral degrees, respectively. The West Coast comprised 51.39% of degree granting programs, while the East Coast comprised 29.17%; together the coastal states housed more than 80% of all programs, with the remainder sprinkled across the southern (9.72%), northern (8.33%), and the middle/central states (1.39%). Forty-four states and the District of Columbia regulated acupuncture practice by law at the time of data collection. Acupuncture continues to be a quickly growing profession in the U.S.

[Acupuncture schools in the Republic of China].

The materials of 48 acupuncture schools in the Republic of China were collected. Their features were analyzed in terms of school running, students enrolling, curriculum setting and course contents, etc. The acupuncture schools at that time were established by private organizations, and opened up correspondence education. These schools mainly relied on advertisements to enroll students, and partially got government supports. The students were on different levels. They emphasized systematic acupuncture curriculum and clinical practice. Most schools absorbed western contents into courses, while few schools taught traditional acupuncture theories. The education model of acupuncture school during the Republic of China was continued after the foundation of the nation, especially laying the foundation for the establishment of department of acupuncture.

Evaluation of School of health students' ethics position in Turkey.

BACKGROUND: The advances in science and technology increasingly lead to the appearance of ethical issues and to the complexity of care. Therefore, it is important to define the ethics position of students studying in health departments so that high quality patient care can be achieved. OBJECTIVES: The aim of this study was to examine the ethics position of the students at Shool of Health of an University in western Turkey. METHODS: The study design was descriptive and cross-sectional. The study population included 540 first, second, third, and fourth year students from the Departments of Nursing, Midwifery, and Rescue and Disaster Management in the 2013-2014 academic year. Data were collected with a Personal Identification Form and The Ethics Position Questionnaire. Obtained data were analyzed with Chi-square test, Confirmatory Factor Analysis, and Nested Analysis of Variance. Ethical considerations: Before conducting the research, approval was obtained from Ege University Clinical Research Ethics Committee in Izmir and written informed consent was taken from all the participants. FINDINGS: There was no significant difference in the mean scores for the Ethics Position Questionnaire between the students in terms of years and fields of study. Although the mean scores for the subscale idealism did not differ between fields of study, the mean scores significantly differed between years of study. However, the mean scores for the subscale relativism did not differ in terms of years and fields of study. DISCUSSION: Whether students are idealistic or relativistic in terms of ethical judgment will be effective in ethical decision-making skills during patient care. Therefore, we need to define the factors that influence students' ethics position in the future. CONCLUSION: It is suggested that the courses and practices that teach students to be aware of their ethics position to create an ethical outlook can be placed in the curriculum in health schools.

Survey of Chinese Medicine Students to Determine Research and Evidence-Based Medicine Perspectives at Pacific College of Oriental Medicine.

CONTEXT: Research literacy and the practice of evidence-based medicine (EBM) are important initiatives in complementary and alternative medicine (CAM), which requires cultural change within educational institutions for successful implementation. OBJECTIVE: To determine the self-assessed research and EBM perspectives of Chinese medicine Masters degree students at Pacific College of Oriental Medicine, New York campus (PCOM-NY). DESIGN AND METHODS: A survey with 17 close-ended questions and one open-ended question was administered through Survey Monkey to students at PCOM-NY. RESULTS: The survey was sent to 420 Masters students and 176 (41.9%) responded. Students in all four years of the Masters degree indicated a generally high degree of interest in, and support for the value of research. However, increasing years (one to four years) in the program was associated with lower interest in post-graduation research participation and entering the doctoral program, and the fourth year students reported low levels of interest in having greater research content and training in their Masters degree programs. Students who responded to the open-ended question (23% of respondents) expressed enthusiasm for research and concerns about the relevance of research in Chinese medicine. CONCLUSIONS: Consistent with findings in similar studies at CAM colleges, interest in research, and EBM of the PCOM-NY Masters students appeared to decline with increasing years in the program. Concerns around paradigm and epistemological issues associated with research and EBM among Chinese medicine students and practitioners warrants further investigation, and may be an important challenge for integrative medicine.

Critical Review of Data Evaluation in Teaching Clinics of Traditional Chinese Medicine Outside China: Implications for Education.

OBJECTIVES: The increasing acceptance of traditional Chinese medicine (TCM) worldwide has highlighted the importance of ensuring the provision of high-quality TCM clinical education. This clinical training should be partly guided by a robust assessment of patient data outcomes in TCM teaching clinics. We undertook a comprehensive literature review to examine the data evaluation in TCM teaching clinics outside China and its implications for TCM education. METHODS: Literature was retrieved via MEDLINE (from 1946 to January 2015), EMBASE (from 1980 to February 2015), and Google Scholar for studies conducted outside China. The search was restricted to English articles reporting empirical findings related to the assessments of patient data in TCM teaching clinics, with implications for TCM education in countries other than China. RESULTS: Only seven articles from six studies met the inclusion criteria. The characteristics and main symptoms of patients who received any TCM treatment in the context of teaching clinics among all included studies were similar. Symptom relief as well as a high level of patient satisfaction with TCM treatment were found in TCM teaching clinics. Conventional healthcare providers and other complementary practitioners were not the main source of referral to TCM practitioners but rather patients׳ friends/relatives. Patients received acupuncture treatment more frequently than treatments utilizing Chinese herbal medicine in teaching clinics. A standardized and consistent framework for patient records within TCM teaching clinics is currently lacking. There was no robust study which "translated" TCM clinic data evaluation findings into implications for TCM education and clinical training. CONCLUSIONS: Recognizing that TCM evolves over time and its practice varies in different settings, there is an urgent need to conduct large-scale, rigorous evaluations of TCM clinic data to address the findings of our review, with the purpose of better informing TCM education and clinical training in countries beyond China. Expansions for scientific efforts supporting TCM education are essential to ensure that qualified TCM practitioners are able to provide safe, efficacious, and cost-effective TCM treatment modalities.

La inauguración de la Casa de Salud de Santa Cristina de Madrid y su Escuela de Matronas / The opening of the Casa de Salud de Santa Cristina de Madrid and its school of midwifery

INTRODUCCIÓN: La Casa de Salud de Santa Cristina y Escuela Especial de Matronas fue una de las primeras escuelas para matronas fundadas en Madrid y en España. El edificio que la albergaba, un hospital destinado a cuidados obstétrico-ginecológicos, se inauguró en la capital de España en 1924, veinte años después de la colocación de la primera piedra. OBJETIVO: Analizar los orígenes de la institución, y explicar cómo fueron los primeros años de su funcionamiento y las repercusiones que esto tuvo sobre el colectivo de matronas de la época. MATERIAL Y MÉTODO: Investigación histórica que utiliza diversas fuentes primarias, como el informe de su primer director, José Gálvez Ginachero, y otros documentos procedentes de diferentes fuentes hemerográficas y documentos de archivo originales obtenidos en diversos archivos nacionales. RESULTADOS: En sus primeros años de funcionamiento, la Casa de Salud de Santa Cristina y Escuela Especial de Matronas (posteriormente, Escuela Oficial de Matronas) formó a estas profesionales con el objetivo de que fuesen fundamentalmente meros auxiliares para los médicos en el parto. Se han localizado en los archivos a 32 matronas que estudiaron en la institución desde su inauguración hasta el curso 1934/1935. Aunque el número inicial de alumnas fue escaso, con los años fue incrementándose progresivamente. CONCLUSIONES: La inauguración de la Casa de Salud de Santa Cristina mejoró la formación práctica de estas profesionales, pero también se convirtió en una herramienta para su control y su subordinación profesional a la figura del médico. También constituyó el inicio de la institucionalización del parto en Madrid

INTRODUCTION: The Casa de Salud de Santa Cristina and its school of midwifery was a women's hospital and one of the first schools for mid-wives on Madrid and also in Spain which opened in 1924, twenty years after its founding stone was laid. AIM: The purpose of this historiographic essay is to show the origins of this hospital, to explain the first years of its functioning and its consequences on midwifery care during childbirth. METHODOLOGY: Historical research which uses primary sources such as the report of José Gálvez Ginachero, the first director in the institution, and other files obtained from hemerographic sources of information and original archive documents from various national archives. RESULTS: The Casa de Salud de Santa Cristina and its school of midwifery formed midwives in order to be merely assistants for doctors. We have found 32 midwives formed in this institution during the first ten years of its functioning. In the beginning, only two or three midwives a year, but this number was progressively growing on. CONCLUSIONS: The opening of the Casa de Salud de Santa Cristina improved the practical training of midwives but also was a way for professional control and subordination of midwives in Spain. It also contributed to the institutionalization of childbirth in Madrid

Status of complementary and alternative medicine in the curricula of health colleges in Saudi Arabia.

OBJECTIVES: To assess the status of complementary and alternative medicine (CAM) education in health colleges in Saudi Arabia. METHODS: A cross sectional descriptive study was conducted including all medical, dentistry, pharmacy, nursing, allied medical science, and health colleges in Saudi Arabia. A semi- structured questionnaire was designed to collect information covering CAM tracks, courses and contents in the college's curricula, available postgraduates programs, continuing medical education activities, number of colleges staff members specialized or interested in CAM. RESULTS: Out of 110 health colleges in Saudi Arabia, 90 (81.1%) participated in the survey. There is no CAM specialized track or postgraduate education in any health college. Eleven (12.2%) colleges are teaching CAM courses in their curricula. Fifteen (16.7%) colleges are teaching topics related to CAM in different study subjects. Five (5.6%) colleges conducted continuing medical education (CME) activities related to CAM. Among faculty members, there are only 16 CAM specialists working in 7 colleges and 84 interested staff members, working in 20 colleges. Colleges of pharmacy are more interested in CAM education compared to other colleges with 42.9% (6/14) of them have CAM courses in their curricula, (p=0.006). Also, they have more faculty CAM specialists (p=0.026) compared to other colleges. CONCLUSION: There is a low and diverse attention given to CAM in medical education in Saudi Arabia. There is a need for a national plan to review health colleges curricula to prepare health care providers for the integration of evidenced based CAM practices.

Profiles of traditional Chinese medicine schools.

Many schools of academic doctrines have emerged throughout the development history of traditional Chinese medicine (TCM) due to geographic, time, Shicheng (mentor-apprentice system) and academic diversities. Classic TCM School, Classic Formula School and Febrile Disorder School, though all lacking a clearly demonstrable or continuous Shicheng relationship, are nevertheless so classified because of their consistency in reference to the classic TCM works. Each of the Four Famous Masters of Jin and Yuan Dynasties had its distinctively different academic doctrine, resulting in the establishment of individually integrated academic schools. The emergence of the Warming and Tonifying School in late Yuan and early Ming Dynasties was realized as a means to rectify the ill effects of the cool and cold medications prevalent at the time. On the other hand, the advent of the Warm Disease School and the rise of the Confluence School embodied the close relationship carried by TCM academic schools to contemporary historical background. Looking at this development history, it is evident that the development of TCM academic schools could flourish only if it allows dissenting, yet mutually tolerant, opinions. In present medical environment where TCM and Western medicine are of equal importance, Classic TCM Schools, TCM Modernization Schools and Integrative Medicine Schools should all receive emphasis to foster development.

Profiles of traditional Chinese medicine schools / 中国结合医学杂志

Many schools of academic doctrines have emerged throughout the development history of traditional Chinese medicine (TCM) due to geographic, time, Shicheng (mentor-apprentice system) and academic diversities. Classic TCM School, Classic Formula School and Febrile Disorder School, though all lacking a clearly demonstrable or continuous Shicheng relationship, are nevertheless so classified because of their consistency in reference to the classic TCM works. Each of the Four Famous Masters of Jin and Yuan Dynasties had its distinctively different academic doctrine, resulting in the establishment of individually integrated academic schools. The emergence of the Warming and Tonifying School in late Yuan and early Ming Dynasties was realized as a means to rectify the ill effects of the cool and cold medications prevalent at the time. On the other hand, the advent of the Warm Disease School and the rise of the Confluence School embodied the close relationship carried by TCM academic schools to contemporary historical background. Looking at this development history, it is evident that the development of TCM academic schools could flourish only if it allows dissenting, yet mutually tolerant, opinions. In present medical environment where TCM and Western medicine are of equal importance, Classic TCM Schools, TCM Modernization Schools and Integrative Medicine Schools should all receive emphasis to foster development.

Admission characteristics and academic performance of podiatric and osteopathic medical students at Des Moines University.

BACKGROUND: Podiatric and osteopathic medical students at Des Moines University take the same basic science medical curriculum. The first course students complete is medical biochemistry. The final common course is the second-year medical pharmacology course. Attrition typically occurs between these academic offerings. We sought to compare admissions data, retention rates, and academic performance between these two groups of medical students for the classes of 2008 to 2011. METHODS: Average admission scores, performance scores for the biochemistry and medical pharmacology courses, and retention rates for the 2008 to 2011 classes were obtained from the registrar and enrollment offices. One-way analysis of variance was used to compare the scores of the two cohorts. Linear regression was used to identify changes across time. RESULTS: The DO students showed significantly better performance than the DPM students in matriculating overall and science grade point averages, total Medical College Admissions Test scores, retention rates, and the medical biochemistry course (P < .01). There was no difference in the performance of the student groups in the medical pharmacology course. The DPM student scores across the four classes increased for both academic courses, whereas the DO student scores remained at the same level for medical biochemistry, at a rate of 0.74% per year (R(2) = 0.50), and pharmacology, at a rate of 0.90% per year (R(2) = 0.49). CONCLUSIONS: Admissions data and initial academic performance of osteopathic medical students were higher than those of podiatric medical students. Once attrition occurred in year 1, the difference in academic performance between these groups of students was no longer statistically significant, and students in both medical programs at that time in the curriculum are equally academically qualified.

Integration of acupuncture into family medicine teaching clinics.

OBJECTIVES: As growing numbers of patients use complementary and alternative medicine (CAM), improvement is needed in communication between providers of CAM and allopathic medicine. This study describes collaborative acupuncture clinics (CACs) run by providers from Oregon Health and Science University (OHSU) and the Oregon College of Oriental Medicine (OCOM) in the setting of family medicine teaching clinics. It examines patient demographics, quality of education for medical learners, referral practices of primary care physicians (PCPs), and quality of communication between acupuncturists and PCPs at these clinics. DESIGN: Demographic data were abstracted from electronic medical records of patients treated at least three times in the CACs between 2006 and 2007. A survey on quality of education at the CACs was given to acupuncture interns, medical students, and acupuncture supervisors. A separate survey collected information from PCPs at the family medicine clinics regarding referral practices to acupuncture and quality of communication between PCPs and acupuncturists. RESULTS: Of the 96 patients seen at the clinics, 74% were female, 76% were European-American, and the mean age was 45.9 years. Sixty-one percent (61%) of patients were insured through private insurance, 31.3% had Medicare or Medicaid, and 7.3% did not have insurance. Most of the 51 acupuncture providers who responded were satisfied with the quality of education at the CACs. Eighty percent of responding PCPs had referred at least one patient to the CACs. The majority of referrals was for a pain condition. Most PCPs would find a summary of the acupuncture visit helpful. Referral practices to different modalities were most influenced by patient interest and physician's belief in whether or not the modality would help. CONCLUSIONS: Demographics of patients at the CACs were comparable to those of patients seen in other acupuncture clinics. The collaborative structure of the CACs allowed for a unique learning experience and improved communication between providers of CAM and conventional medicine.

The impact of microbial surveys on disinfection protocols in a chiropractic college environment.

OBJECTIVE: A baseline microbial survey was conducted to identify the microbes present on the headpieces of chiropractic adjusting tables from across the Western States Chiropractic College, Portland, Ore, facilities. This included the instructional adjustive technique laboratories, the student health center, the campus outpatient clinic, and an off-site clinic. The objective of this study was to evaluate the effect of disinfection protocols over time at a chiropractic college. METHODS: Four samplings were done for a 12-month period. A total of 69 treatment tables were tested. Sampling was done directly to blood agar (5% sheep blood) plates. Data obtained from the clinic locations were analyzed using linear regression models. RESULTS: Identification of microbes by differential staining and biochemical analysis yielded a variety of gram-positive bacteria in all 4 surveys. The numbers of bacterial colonies decreased in the second survey after changes to disinfection protocols. The number of colonies continued to remain below baseline in the third and fourth surveys. Methicillin-resistant Staphylococcus aureus was found in the clinics in 3 of 4 surveys. Methicillin-resistant S aureus was not detected in the technique laboratories. CONCLUSIONS: Various microbes were identified on the headpieces of adjusting tables in the college instructional technique laboratories and college clinics. Changing the disinfection protocols reduced the number of bacteria found in the second survey. In addition, the third and fourth surveys showed fewer bacterial colonies than baseline, suggesting that compliance with disinfection protocols continued over time.

Hand hygiene and treatment table sanitizing in chiropractic teaching institutions: results of an education intervention to increase compliance.

OBJECTIVE: The purpose of this study was to test an educational intervention designed to increase hand and treatment table sanitizing on 3 chiropractic college campuses using a theory-based intervention. The second purpose is to see if an increase in observed hand hygiene would be noted as a result of the intervention. METHODS: Students at 3 campuses were surveyed, and their attitudes and practices of hand and table sanitizing were observed. The education intervention was developed using ecological theory of health promotion and involved educating staff and students along with a focus on modeling proper behaviors. The surveys were analyzed and generated frequencies. chi(2) analysis and logistic regression models were used to explore effects. RESULTS: The education campaign was associated with increases in desired behaviors regarding both hand hygiene and table sanitizing. Good hand hygiene practices increased 35% (odds ratio [OR], 1.35; 95% confidence interval [CI], 1.03-1.77), and observed practices increased more than 2-fold (OR, 2.6; 95% CI, 1.90-3.52). A 30% increase in table sanitizing was noted as well (OR, 1.30; 95% CI, 1.04-1.64). CONCLUSIONS: Educational interventions after a theory-based model can have an initial impact on increasing hand hygiene and table sanitizing. Further studies should look at a policy component as an effect modifier and whether long-term effects will be seen from such an intervention.