Whither the PA doctorate?

ABSTRACT: New perspectives have been brought to bear in the discussion of the topic of the physician associate/assistant (PA) doctoral degree in general and the entry-level PA doctorate in particular. Both the Physician Assistant Education Association (PAEA) and the American Academy of Physician Associates (AAPA) have sought and supported formal research investigations into the question. Evidence from studies shows that perceived benefits and risks are strongly influenced by the lens of the various stakeholders; that most PAs believe that the master's degree is enough for clinical practice; and that most clinical PAs and PA students are not in favor of an entry-level doctorate. Lessons learned from other healthcare professions that have transitioned to a clinical doctorate only marginally serve as a model for the PA profession. PA organizations need to fully own and embrace the task of leading the discussion and reaching a definitive conclusion in the determination of PA doctoral education. Failure of the PA profession to act decisively on the doctoral degree question would essentially default this decision to colleges and universities, which tend to have a vested economic interest in new types of degrees.

Exploring the impacts of learning modality changes: Validation of the learning modality change community of inquiry and self-efficacy scales.

The rapid learning environment transition initiated by the COVID-19 pandemic impacted students' perception of, comfort with, and self-efficacy in the online learning environment. Garrison's Community of Inquiry framework provides a lens for examining students' online learning experiences through three interdependent elements: social presence, cognitive presence, and teaching presence. Researchers in this study developed and validated the Learning Modality Change Community of Inquiry and Self-Efficacy scales to measure health professions students' self-efficacy with online learning, while exploring how cognitive, social, and teaching presence is experienced by students who transition from one learning environment to another. The two scales demonstrate strong validity and reliability evidence and can be used by educators to explore the impacts of learning modality changes on student learning experiences. As learning environments continue to evolve, understanding the impact of these transitions can inform how educators consider curriculum design and learning environment changes.

A continuing professional development imperative? Examining trends and characteristics of health professions education doctoral programs.

BACKGROUND: Despite the long-standing faculty development initiatives for improving teaching skills in the health professions, there is still a growing need for educators who are formally trained in educational theory and practice as health professions schools experience dramatic demand and growth. Graduate programs in health professions education (HPE) provide an avenue for health professions' faculty continuing professional development to enhance their knowledge and skills for teaching and curriculum leadership roles. There has been a proliferation of certificate, master's, and doctoral programs in HPE over the last two decades to respond to the growing need for well-prepared faculty educators and program leadership. The purpose of this study was to identify and describe current HPE doctoral programs in United States (U.S.) and Canada. METHODS: The study first examined doctoral programs in HPE identified in earlier studies. Next, we searched the literature and the web to identify new doctoral programs in the U.S. and Canada that had been established between 2014, when the prior study was conducted, and 2022. We then collated and described the characteristics of these programs, highlighting their similarities and differences. RESULTS: We identified a total of 20 doctoral programs, 17 in the U.S. and 3 in Canada. Of these, 12 programs in the U.S. and 1 program in Canada were established in the last 8 years. There are many similarities and some notable differences across programs with respect to degree title, admission requirements, duration, delivery format, curriculum, and graduation requirements. Most programs are delivered in a hybrid format and the average time for completion is 4 years. CONCLUSIONS: The workforce shortage facing health professional schools presents an opportunity, or perhaps imperative, for continuing professional development in HPE through certificate, master's, or doctoral programs. With the current exponential growth of new doctoral programs, there is a need to standardize the title, degree requirements, and further develop core competencies that guide the knowledge and skills HPE graduates are expected to have upon graduation.

Developing and evaluating an instrument to assess perceptions of an entry-level physician associate doctoral degree.

BACKGROUND: Most health professions in the United States have adopted clinical or practice doctorates, sparking an ongoing debate on whether physician assistants/associates (PAs) should transition from a master's to a doctorate as the terminal degree for the profession. Although more studies are anticipated, there is no validated instrument assessing perceptions of various stakeholders regarding an entry-level PA doctoral degree. The objective of this study was to develop and evaluate a novel self-report measure to assess perceptions of an entry-level PA doctoral degree. METHODS: A multifaceted, mixed-methods approach was adopted. Based on a comprehensive literature review of the doctoral transition experiences in other health professions, an initial version of perceptions of an entry-level terminal PA doctoral degree scale (PEDDS) was generated. This scale was pilot tested with a group of PA faculty, students, and clinicians. Then, a cross-sectional survey consisting of 67 items was conducted with a national random sample of practicing PAs and PA students. Additionally, semi-structured interviews were conducted to ensure the validity of PEDDS. A principal component analysis (PCA) was conducted to reduce the number of items and reveal the underlying structure of PEDDS. RESULTS: The PCA confirmed 10 factors of PEDDS consisting of 53 items as the best-fit factor structure with adequate internal consistency of subscales. Those factors include a) expected positive impact on the PA profession, b) expected impact on prerequisites, (c) expected impact on the student preparedness as PA faculty and educators, (d) expected impact on the student preparedness as clinicians, (e) expected impact on accreditation and certification, (f) expected impact on curriculum, (g) expected impact on PA educators, (h) expected positive impact on diversity, (i) expected negative impact on the PA profession, and (j) expected impact on the student competency. CONCLUSIONS: The present study highlights the need to develop valid and reliable measurements to assess perceptions regarding the transition to the entry-level doctorate across health professions. This study could be used to guide further discussion of the entry-level doctorates for PAs and other health professions by bridging the gap of existing literature related to valid, reliable, and standardized measures on this topic.

A physician assistant entry-level doctoral degree: more harm than good?

BACKGROUND: As most health professions in the United States have adopted clinical or practice doctorates, there has been an ongoing debate on whether physician assistants (PAs) should transition from a master's to a doctorate as the terminal degree. The authors examined perceived risks, benefits and impact of transitioning to an entry-level PA doctoral degree. METHODS: A multi-prong, mixed-methods approach was used that included a literature review and collecting quantitative and qualitative data using a survey and interviews. Bivariate analysis and binomial logistic regression were performed to evaluate relationships between perceptions/perspectives on an entry-level PA doctoral degree and the anticipated impact of it causing more harm than good to the PA profession. Deductive content analysis was used to analyze the qualitative data. RESULTS: Of 636 PA clinicians and students (46% response rate), 457 (72%) disagreed that an entry-level PA doctoral degree should be required. More than half of the respondents (54%) agreed that it should be offered but not required and 380 respondents (60%) agreed that an entry-level doctoral degree would cause more harm than good. Race, educational attainment, occupation, and length of practice as a PA were significantly associated with having a perception of causing more harm. There was strong positive association between the perception of a doctoral degree causing more harm with expectations of having a negative impact on the availability of clinical training sites (OR = 4.39, p < .05). The most commonly cited benefits were parity with other professions and competitive advantage, whereas the perceived risks were increased cost for education, decreased diversity in the profession, and negative impact on the PA/physician relationship. CONCLUSIONS: The major takeaway of our study was that perceived benefits and risks are strongly influenced by the lens of the stakeholder. While the majority of PAs and students appear to be not in favor mainly due to the potential harm, the proportion of those in favor is not insignificant and their views should not be ignored. Addressing concerns with key stakeholders could help the PA profession to transition to a doctoral degree with minimal adverse impact.

Curriculum essentials of an entry-level PA doctoral degree.

OBJECTIVES: With increasing discussion of physician assistant (PA) doctoral education, investigation of curriculum essentials and competencies has become relevant. METHODS: We conducted a national mixed-methods study comprising a survey and semistructured interviews to capture stakeholders' views on essential curricular elements for PA doctoral education. RESULTS: If the PA profession decides to transition to a terminal doctoral degree, 75% of respondents indicated this would require new content, with half indicating it would require significant change to the curriculum, enhance PA educational rigor, and change the competencies of the new graduate. The majority of respondents favored a bridge program model and the Doctor of Medical Science (DMSc) as the degree title. CONCLUSIONS: Overall, respondents agreed that transition to an entry-level PA doctoral degree would affect various aspects of the curriculum. As the prospect of an entry-level PA doctoral degree gains further attention, additional debate on curriculum essentials and competencies is warranted.

Bioinformatics for medical students: a 5-year experience using OMIM® in medical student education.

PURPOSE: Given advances in genomic medicine, medical students need increased confidence in clinical genetics skills to address multiple genetic conditions. After success of first-year medical school instruction in the Online Mendelian Inheritance in Man (OMIM®) database, we report the impact on gaining confidence in broad clinical genetics skills in 5 subsequent years. METHODS: We collected 5 years of successive pre- and postintervention survey based self-assessments on medical student use of genetic medicine information resources and confidence in genetic medicine skills. To assess retention of confidence in these skills, we administered a follow-up survey to students after 1-2 years of clinical rotations. RESULTS: We found a consistent, statistically significant increase in students' confidence in clinical genetics skills after the first-year OMIM educational session, with confidence retention above baseline up to 2 years after the educational exposure. Skills include ability to generate a differential diagnosis for genetic conditions, share information with patients and families, and find accurate information on genetic conditions. The majority agreed that increased use of OMIM will better prepare students to achieve these skills. CONCLUSION: Integration of the OMIM database in first-year education is an effective instructional tool that may provide a lasting increase in confidence in clinical genetics skills.

Ready or Not: A Crossover Study of (Un)graded Individual Readiness Assurance Tests in Team-Based Learning.

OBJECTIVE: This study aimed to measure the effects of graded vs ungraded individual readiness assurance tests (iRATs) on the students' test scores and achievement goals in a team-based learning classroom. METHODS: A 2 × 2 crossover study was conducted in a required second-year pharmacotherapy course. Teams 1 to 8 were assigned to a UG iRAT during the first half of the course, followed by a G iRAT the second half of the course (G/UG group). Teams 9 to 16 were assigned to the opposite grading sequence (ie, UG/G). A multivariate analysis of variance was used to analyze the differences in test scores, as measured using iRAT and examination scores. A separate multivariate analysis of variance was used to examine the differences in achievement goals. RESULTS: There was a significant difference in test scores based on the iRAT grading condition. Individual readiness assurance tests were higher in the G condition (72.51% vs 67.99%); however, the examination scores were similar in the G and UG conditions (81.07% vs 80.32%). There was no statistically significant difference in the achievement goals based on the iRAT grading condition. CONCLUSION: In a required second-year pharmacotherapy course that uses team-based learning, student performance on the iRAT was modestly lower in the UG iRAT condition; however, the students' examination scores were unchanged. Achievement goals were unchanged based on the iRAT grading condition.

A Bibliometric Analysis of the 100 Most Cited Articles on Problem-Based Learning in Medical Education.

Problem-based learning (PBL) is an instructional approach used in medical education that is characterized by solving problems in small groups with tutor guidance. More than 50 years since PBL's inception, many questions remain to be addressed about its processes and learning outcomes. The purpose of the study was to examine the bibliometric characteristics of the 100 most cited articles on PBL in medical education and to identify landmark papers that have made significant contributions to PBL research. Results were systematically reviewed for citation frequency, publication year, journal, article type, article focus, authors, author collaboration, and country collaboration. The number of citations ranged from 81 to 3531 times cited with 31,041 total citations. The articles were contributed by 211 authors in 23 journals and most articles (68%) were published in Medical Education, Academic Medicine, and Medical Teacher. The majority of the articles (71%) originated from Netherlands, Canada, and the United States and six prolific authors were identified. Almost half of the articles are classified as empirical research. Article foci included theoretical foundations of PBL, curriculum design, learning outcomes and processes, tutors, assessment, guides to PBL implementation, commentaries, and student well-being. The strong author and country collaborations indicate continued global interest in the PBL instructional method, which is likely to remain an active topic of research as the evidence of its effectiveness over traditional instructional methods as well as its most impactful components is inconclusive.

Characteristics of Hybrid Learning Among Health Professions Programs: A Mixed-Methods Study.

PURPOSE: To characterize current trends in hybrid education within the physician assistant (PA) profession, specifically program design, drivers, and outcomes in comparison with physical therapy hybrid education. METHODS: This was a mixed-methods study involving secondary data analysis and focused interviews with stakeholders to triangulate the data. RESULTS: Compared with traditional PA programs, hybrid programs have similar admission requirements, higher cost of tuition, larger class size, and higher attrition rate than national mean. Physician Assistant National Certifying Exam outcome data are in line or slightly lower than national scores. Technological advancements and need for faculty/learner flexibility by time and location are frequently cited driving forces. CONCLUSIONS: There is a growing trend toward hybrid education among health professions. Other than cost, attrition rate, and immersion experiences, characteristics of hybrids are similar to traditional programs. It is relevant for PA educators to understand how this educational design may shape the future of PA graduates. Long-term impact should be evaluated with future studies.

Physician Assistant Faculty Perceptions Regarding Ongoing Self-assessment and Accreditation.

PURPOSE: While the processes of ongoing self-assessment and accreditation provide significant benefits to physician assistant (PA) programs, faculty members are often challenged by the required procedures and standards set by accreditation agencies. This study explored faculty perspectives regarding the processes of ongoing self-assessment and accreditation in PA programs. METHODS: A qualitative research design centered around semistructured interviews was used. A total of 26 participants were recruited, including PA program directors, associate program directors, directors of assessment and accreditation, past Accreditation Review Commission on Education for the Physician Assistant commissioners, accreditation consultants, deans, and PA Education Association leaders. DATA COLLECTION: Semistructured one-on-one interviews were conducted by 8 members of the research team through Zoom video conferencing. Data were collected until saturation was reached. DATA ANALYSIS: The interview recordings were transcribed and analyzed independently by 3 researchers. The transcripts were imported into NVivo, a qualitative data analysis software, for coding and inductive thematic analysis. RESULTS: Six emergent themes were identified under 2 major categories: facilitators and challenges. Facilitators for conducting continuous programmatic review and analysis include it takes a village, internal and external support, and sustained faculty development, whereas challenges are lack of knowledge and time, unclear expectations, and inflexibility. CONCLUSION: The study highlights factors associated with facilitating the ongoing self-assessment process. However, a number of challenges were also identified. The study suggests opportunities for intervention at the program, institution, and profession level.

Consensus Competencies for Postgraduate Fellowship Training in Global Neurology.

BACKGROUND AND OBJECTIVES: Use a modified Delphi approach to develop competencies for neurologists completing ≥1 year of advanced global neurology training. METHODS: An expert panel of 19 United States-based neurologists involved in global health was recruited from the American Academy of Neurology Global Health Section and the American Neurological Association International Outreach Committee. An extensive list of global health competencies was generated from review of global health curricula and adapted for global neurology training. Using a modified Delphi method, United States-based neurologists participated in 3 rounds of voting on a survey with potential competencies rated on a 4-point Likert scale. A final group discussion was held to reach consensus. Proposed competencies were then subjected to a formal review from a group of 7 neurologists from low- and middle-income countries (LMICs) with experience working with neurology trainees from high-income countries (HICs) who commented on potential gaps, feasibility, and local implementation challenges of the proposed competencies. This feedback was used to modify and finalize competencies. RESULTS: Three rounds of surveys, a conference call with United States-based experts, and a semistructured questionnaire and focus group discussion with LMIC experts were used to discuss and reach consensus on the final competencies. This resulted in a competency framework consisting of 47 competencies across 8 domains: (1) cultural context, social determinants of health and access to care; (2) clinical and teaching skills and neurologic medical knowledge; (3) team-based practice; (4) developing global neurology partnerships; (5) ethics; (6) approach to clinical care; (7) community neurologic health; (8) health care systems and multinational health care organizations. DISCUSSION: These proposed competencies can serve as a foundation on which future global neurology training programs can be built and trainees evaluated. It may also serve as a model for global health training programs in other medical specialties as well as a framework to expand the number of neurologists from HICs trained in global neurology.

Accreditation in the Health Professions: Implications for Physician Assistant Education.

ABSTRACT: The accreditation process of health professions educational (HPE) programs is an essential ingredient in preparing a qualified healthcare workforce. Accreditation ensures that minimum standards are met by educational programs and contributes to pedagogical integrity, consistency, and academic policies and practices, leading to the desired quality of graduate outcomes. In this study, we analyzed key characteristics, policies, and practices for accreditation in 5 health professions to highlight emerging trends and discern implications for the physician assistant (PA) profession. There is growing evidence of movement toward outcome-based accreditation versus process-oriented accreditation and collaborative engagements between programs and the accreditors. Agencies are providing online discussion platforms and direct mentorship and, at the height of the coronavirus pandemic, offered virtual site visits. At an institution level, we observed a trend towards structured faculty development on accreditation, implementation of technology infrastructure for data collection, visualization and analysis, and the use of consultants for outsourcing certain elements of the accreditation process. There is a wide spectrum of approaches, from prescriptive to liberal, by the various accrediting agencies in enforcing compliance. A balance is desirable for the institutional-accreditor relationship to work effectively.

Building an Advising Model for Physician Assistant Education.

ABSTRACT: Physician assistant education is balancing an explosion of new programs, an increase in novice faculty, and expectations from accreditation standards to track student progress longitudinally. The traditional "one-size fits all" model of advising will not meet the demands of this changing educational environment. This article introduces a longitudinal advising model that integrates various strategies from existing models such as proactive, appreciative advising, and the GROW (Goal, Reality, Options, Will) coaching model with a focus on the goal of achieving the new Physician Assistant Education Association (PAEA) Competencies for the New Graduate.

An Exploration into the Physician Assistant Entry-Level Doctoral Degree: Lessons Learned From Across Health Professions.

ABSTRACT: This article explores current trends in the ongoing debate about transitioning to an entry-level doctoral degree for the physician assistant (PA) profession and identifies lessons learned from the disciplines of nursing, pharmacy, and physical therapy, which have already transitioned to an entry-level doctoral credential. We conducted a mixed-method study that involved an interprofessional systematic literature review and an examination of publicly available databases. Based on lessons learned from other health professions, a model for implementation of an entry-level doctoral degree for the PA profession is presented here. Recommendations for the profession include establishing a clear objective for doctoral degree transition, providing flexibility for options in program delivery, and transitioning through a phased approach. Further studies are warranted to explore risks and benefits in detail and to establish PA doctorate essentials, competencies, and an accreditation plan before the profession transitions to an entry-level doctoral credential.

Forecasting the physician assistant/associate workforce: 2020-2035.

Background: Physician assistant/associates (PAs) are healthcare professionals whose roles expand universal access across many nations. PAs fill medical provider supply and demand gaps. Our paper reports a forecasting project to predict the likely census of PAs in the medical workforce spanning from 2020 to 2035. Methods: Microsimulation modelling of the American PA workforce was performed using the number of clinically active PAs employed in 2020 as the baseline. Graduation rates and PA programme expansion were parameters used to predict annual growth; attrition estimates balanced the equation. Two models, one based on data from the US Bureau of Labor Statistics (BLS) and another based on National Commission on Certification of Physician Assistants (NCCPA) data were used to estimate future annual PA census numbers. Results: As of 2020, the BLS estimated 125,280 PAs were in the medical workforce; the NCCPA estimate was 148,560 PAs in active practice. The BLS model predicted approximately 204,243 clinically active PAs by 2035; the NCCPA-based model predicted 214,248 PAs in clinical practice. Conclusions: A PA predictive model based on four data sources projects that the 2035 census of clinically active PAs to be between 204,000 and 214,000: a growth rate of approximately 35%.

Advancing Physician Assistant Faculty Development: A New Model.

PURPOSE: The purpose of this article is to describe the development, implementation, and evaluation of an innovative physician assistant (PA) faculty development model. METHODS: The Maryland Physician Assistant Leadership and Learning Academy's (PALLA's) executive team developed a 10-month fellowship designed to build a skilled faculty pipeline. The fellowship framework was grounded in the PA educator competencies, the 3 pillars of academia, and the 5th edition Accreditation Standards for Physician Assistant Education. The self-perceived impact of the fellowship was evaluated through multiple surveys. RESULTS: Survey results show that all of the learning activities met fellows' expectations, and fellows indicated strong agreement in self-perceived achievement in meeting the fellowship outcome goals. CONCLUSION: Study results provide evidence that formal training increases self-perceived competence in clinicians transitioning to academia. PALLA can serve as a model for other states to ensure faculty capacity within PA education.

Cross-Cultural Chronotypes: Educating Medical Students in America, Malaysia and the UAE.

This article was migrated. The article was marked as recommended. Background: Ample data demonstrates that sleep deprivation leads to impaired functioning including cognitive performance, memory and fine motor skills. Medical students represent a professional sector in which optimizing cognitive performance and functioning is critical from a personal, public health and safety perspective. Aims: To characterize chronotypes of an international cohort of medical students and determine if chronotype is affected by demographics or latitude. Samples: 328 students from medical schools in the United States (US), Malaysia and United Arab Emirates (UAE) were assessed for differences in chronotype and sleep habits. Methods: A cross-sectional, questionnaire-based study from medical schools in the US, Malaysia and UAE between 2013 and 2015. Results: There was a significant difference in mean waking times for Malaysian students who reported awakening earlier than US or UAE students. Malaysian students were most likely to feel their best earlier in the day and consider themselves a "morning type." UAE students were more likely to do "hard physical work" later in the day, followed by US and Malaysian. On average, US students were less likely to shift their bedtime later if they had no commitments the next day. Overall, mean chronotype score was "neither" type for all three groups however the Malaysian group showed a significant preference for morning hours in some individual questions. Conclusion: Medical student sleep patterns vary internationally but chronotype may not. Improving sleep education globally, with awareness of the effects of chronotype, could ultimately result in improved sleep awareness, potentially influencing physician wellbeing, patient care and safety.