Time to Pivot: A Guide to Holistic Admissions.

ABSTRACT: As an ever-increasing number of physician assistant (PA) programs moves toward holistic admissions, a better understanding of how to achieve their stated admission goals becomes more important. With the June 2023 US Supreme Court decision effectively ending affirmative action in higher education, navigating holistic admissions is now an even greater challenge. In this article, the PA Education Association's Presidents Commission offers a guide for programs to use in implementing holistic admissions at their institutions and key considerations. Is the process mission-driven? Does it follow principles of quality improvement and incorporate ongoing assessment of that process? Using data can be a constructive and insightful way to inform the process. The authors hope that tools, resources, and recommendations offered in this article will serve as valuable resources for any program attempting to institute or improve its holistic admissions process.

Meeting the Accreditation Standard for Diversity.

ABSTRACT: While increasing diversity has been an ongoing concern in physician assistant (PA) education, there is now a concentrated focus on diversity, equity, inclusion, and social justice, elevating these to top priorities. To achieve the goal of diversifying the PA workforce, PA programs, with their institution's support, must systematically inculcate strategies for overcoming and dismantling barriers against students of color and students underrepresented in medicine (URiM). These strategies should disrupt the status quo and expand structural processes that ensure successful diversification of students, especially URiM students, LGBTQ students, students from medically underserved areas, and first-generation college students.

A Tale of Two Curriculums: The Implications of Curriculum Design on Student Burnout.

INTRODUCTION: The purpose of this study was to determine whether a difference exists in the 3 subconstructs of burnout between 2 cohorts of physician assistant (PA) students in different curricula, and the impact of 4 modifiable curricular factors on student experiences of burnout. METHODS: Using a mixed-methods study design, 86 students completed the Maslach Burnout Inventory-General Survey for Students (MBI-GSS) 8 months postmatriculation. Focus group interviews expanded on the quantitative results and effects of the 4 modifiable factors. RESULTS: No significant statistical difference was found in the emotional exhaustion ( p = 0.35), cynicism ( p = 0.29), or professional efficacy ( p = 0.23) scores between the 2 cohorts of PA students. Students did not describe the exact dimensions of burnout; however, qualitative data provided 5 emergent codes based on their experiences. DISCUSSION: Despite curricular modifications to address student burnout in the Colorado Curriculum, a statistical difference in burnout scores was not found between the 2 student cohorts. Qualitative findings suggest that PA education programs should examine external factors and student-lived experiences that contribute to burnout in addition to curricular components.

Pipeline to the Physician Assistant Profession: A Look to the Future.

ABSTRACT: The current pipeline of physician assistant (PA) school applicants reflects the future workforce of the profession, which is why the admissions process with all its components and variables is so important. Many studies have shown that a workforce that represents the patients it cares for leads to improved health outcomes, especially among underrepresented minority populations. Yet, PA programs have made little progress over the past 2 decades in increasing the diversity of matriculants and graduates. As a profession, it is our collective responsibility to intentionally advance diversity, equity, and inclusion, and examining the admissions process would be the most logical place to start.

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.

Evaluation of Five Pulicides to Suppress Fleas on Black-Tailed Prairie Dogs: Encouraging Long-Term Results with Systemic 0.005% Fipronil.

Plague, a flea-borne disease, hampers efforts to restore populations of black-footed ferrets (Mustela nigripes), which occupy colonies of prairie dogs (Cynomys spp.) in North America. Plague is managed by infusing prairie dog burrows with DeltaDust® 0.05% deltamethrin, a pulicide that kills fleas. Experiments are needed to identify pulicides that can be used in rotation with DeltaDust for integrated plague management. In South Dakota, USA, we tested the efficacy of four pulicide dusts when applied at a rate of 8 g per burrow on colonies of black-tailed prairie dogs (Cynomys ludovicianus): Sevin® 5% carbaryl; Dusta-cide® 6% malathion; Alpine® 0.25% dinotefuran with 95% diatomaceous earth; and Tri-Die® 1% pyrethrum with 40% amorphous silica and 10% piperonyl butoxide. We also tested systemic 0.005% fipronil, which was distributed as ½ cup of laced grain per burrow. We sampled prairie dogs on 3294 occasions and detected 10,041 fleas. Sevin and Dusta-cide suppressed fleas but only for 1 month. Neither Alpine nor Tri-Die had any noticeable, consistent effect on fleas. Fipronil suppressed fleas by 97-100% for 3 months. The residual effect of fipronil persisted for ∼12 months. Efficacy of fipronil seems comparable with DeltaDust, which exhibited a residual effect for ∼10 months in prior studies. Continued research is needed to optimize fipronil treatments for plague management on prairie dog colonies.

RESISTANCE TO DELTAMETHRIN IN PRAIRIE DOG ( CYNOMYS LUDOVICIANUS) FLEAS IN THE FIELD AND IN THE LABORATORY.

Sylvatic plague poses a substantial risk to black-tailed prairie dogs ( Cynomys ludovicianus) and their obligate predator, the black-footed ferret ( Mustela nigripes). The effects of plague on prairie dogs and ferrets are mitigated using a deltamethrin pulicide dust that reduces the spread of plague by killing fleas, the vector for the plague bacterium. In portions of Conata Basin, Buffalo Gap National Grassland, and Badlands National Park, South Dakota, US, 0.05% deltamethrin has been infused into prairie dog burrows on an annual basis since 2005. We aimed to determine if fleas ( Oropsylla hirsuta) in portions of the Conata Basin and Badlands National Park have evolved resistance to deltamethrin. We assessed flea prevalence, obtained by combing prairie dogs for fleas, as an indirect measure of resistance. Dusting was ineffective in two colonies treated with deltamethrin for >8 yr; flea prevalence rebounded within 1 mo of dusting. We used a bioassay that exposed fleas to deltamethrin to directly evaluate resistance. Fleas from colonies with >8 yr of exposure to deltamethrin exhibited survival rates that were 15% to 83% higher than fleas from sites that had never been dusted. All fleas were paralyzed or dead after 55 min. After removal from deltamethrin, 30% of fleas from the dusted colonies recovered, compared with 1% of fleas from the not-dusted sites. Thus, deltamethrin paralyzed fleas from colonies with long-term exposure to deltamethrin, but a substantial number of those fleas was resistant and recovered. Flea collections from live-trapped prairie dogs in Thunder Basin National Grassland, Wyoming, US, suggest that, in some cases, fleas might begin to develop a moderate level of resistance to deltamethrin after 5-6 yr of annual treatments. Restoration of black-footed ferrets and prairie dogs will rely on an adaptive, integrative approach to plague management, for instance involving the use of vaccines and rotating applications of insecticidal products with different active ingredients.

Are Physician Assistants Needed in Guatemala? A Survey of Potential Urban and Rural Users.

PURPOSE: The shortage of trained health care personnel has been increasing worldwide. With the physician assistant (PA) profession, created in the United States in the 1960s, expanding globally, this study sought to ascertain whether PAs can be an innovative solution to this crisis. METHODS: We conducted a convenience sample survey to assess the need for and acceptability of future PA professionals in Guatemala. Eighty-nine doctors, nurses, and community members from rural and urban areas of Guatemala participated in the survey. RESULTS: More urban (70%) than rural (58%) respondents found it difficult to access a doctor, with cost being the major reason (34%). Access in rural areas was reportedly limited by lack of doctors and inaccessible office hours. CONCLUSIONS: Most survey respondents considered PAs to be suitable and potentially helpful providers for Guatemala, with a preference for competencies in the diagnosis of serious illnesses, drug prescription, labor and delivery attendance, and care for injuries and fractures, especially in rural locations. Belonging to the community was deemed very important for a PA who would practice in the country.

Curriculum influence on interdisciplinary oral health education and practice.

OBJECTIVES: Oral diseases are very prevalent across the lifespan and impact overall health, yet are largely preventable. The Smiles for Life (SFL) curriculum was created to educate healthcare providers about oral disease and support integration of oral health and primary care. This study examines SFL's influence on clinical practice and education. METHODS: Surveys were sent to registered users of SFL. Users who self-identified as direct care providers (DCPs), or educators, were included in the analysis. RESULTS: Survey response rate was 18 percent, with 87 percent identifying as DCPs and 13 percent as educators. Across professions, 85 percent of DCPs reported SFL influencing their practice to some degree, with variance among profession type and experience. DCPs most commonly reported that SFL led them to improve how they conduct oral health activities, with 60 percent performing the activity more skillfully following completion of SFL. Fluoride varnish application was the most common practice behavior initiated, and caries risk assessments was the oral health activity affected to the greatest degree. A majority of educators (94 percent) reported that SFL led them to incorporate or enhance oral health in their teaching. SFL helped educators emphasize the importance of oral health, improved their ability to teach content, raised motivation, and reduced barriers to teaching oral health. CONCLUSIONS: Data supports that SFL is positively influencing oral health practice across professions, especially in areas of caries risk assessment and fluoride varnish application. SFL improves the frequency and quality with which DCPs and educators participate in oral health activities, and facilitates oral health inclusion in primary care.

Update on pediatric oral healthcare.

As part of the patient-centered medical home, clinicians are being asked to apply fluoride varnish and perform oral examinations in children. This article reviews the latest national recommendations for fluoride varnish use to prevent dental caries.

Advancing oral health in physician assistant education: evaluation of an innovative interprofessional oral health curriculum.

PURPOSE: The impact of an oral health curriculum was evaluated by measuring increases in knowledge about oral health topics and implementation of oral health skills in the clinical year. METHODS: A 3-year, longitudinal oral health curriculum was developed and implemented. Student knowledge of oral health concepts was evaluated before and 2 years after the curriculum was implemented. Student performance of oral health skills was evaluated in the clinical year by electronic patient logging. RESULTS: Students demonstrated significant and persistent gains in knowledge following the initiation of the curriculum. Students used oral health skills in the clinical year, particularly in the area of patient education about oral health. DISCUSSION: Incorporation of an oral health curriculum can lead to lasting knowledge about basic oral health concepts and increased performance of oral health skills in the clinical year.