Nurse practitioner and physician assistant transition to practice: A scoping review of fellowships and onboarding programs.

BACKGROUND: Newly graduated nurse practitioners (NPs) and physician assistants (PAs) benefit from transition-to-practice (TTP) support to move successfully into practice. Transition-to-practice programs (i.e., onboarding programs and fellowships/residencies) hold promise for improving workforce outcomes. PURPOSE: The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs. METHODOLOGY: Using the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included for review if they addressed fellowships/residencies or onboarding programs for NPs or PAs. Final data extraction involved 216 articles. RESULTS: The pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships/residencies, NPs, and programs set in United States nonrural, acute care settings, and academic health centers. CONCLUSIONS/IMPLICATIONS: There is a gap in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, there are few articles that assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas.

NP and PA transition to practice: A scoping review of fellowships and onboarding programs.

OBJECTIVES: Newly graduated NPs and physician associates/assistants (PAs) benefit from transition to practice (TTP) support to move successfully into practice. TTP programs (such as onboarding programs, fellowships, and residencies) hold promise for improving workforce outcomes. The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs. METHODS: Using the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included if they addressed fellowships, residencies, or onboarding programs for NPs or PAs. Final data extraction involved 216 articles. RESULTS: The pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships or residencies, NPs, and programs set in nonrural, acute care US settings and in academic health centers. CONCLUSIONS: A gap exists in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, few articles assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas.

Scarcity of Primary Care Positions May Divert Physician Assistants Into Specialty Practice.

BACKGROUND: Physician assistants (PAs) are often suggested as a partial solution to predicted primary care workforce shortages, but a declining proportion of PAs are entering primary care practice. Policy efforts have focused on increasing primary care PA supply, but low labor market demand might be constricting the primary care PA pipeline. METHOD: In this descriptive, cross-sectional study, we compare primary care and specialty job postings to each other and to occupied PA positions. Job posting data for 2014 are from a leading labor analytics firm. RESULTS: Only 18% of job postings were in primary care, compared with 27% of occupied PA positions. The proportion of postings that were for primary care varied widely by state (9% to 40%) and were highest in the West. DISCUSSION: Job availability is a potential barrier to PAs practicing in primary care, especially in some locations. Other job factors are examined and policy solutions are suggested.

Promoting faculty professionalism: a case-based approach.

INTRODUCTION: Professionalism is a key attribute for health professionals. Yet, it is unknown how much faculty development is directed toward skills and behaviours of faculty professionalism. Faculty professionalism includes boundaries in teacher-student relationships, self-reflection, assuring one's own fitness for duty, and maintaining confidentiality when appropriate. METHODS: For five years, we have incorporated faculty professionalism as a routine agenda item for the monthly Physician Assistant Programme faculty meetings, allowing faculty members to introduce issues they are comfortable sharing or have questions about. We also have case discussions of faculty professionalism within faculty meetings every three months. RESULTS: Faculty professionalism is important in the daily work lives of faculty members and including this as part of routine agendas verifies its importance. A faculty survey showed that a majority look forward to the quarterly faculty professionalism case discussions. These have included attempted influence in the admissions process, student/faculty social boundaries, civic professionalism, students requesting medical advice, and self-disclosure. CONCLUSION: A preventive approach works better than a reactionary approach to faculty missteps in professionalism. Routine discussion of faculty professionalism normalizes the topic and is helpful to both new and experienced faculty members. We recommend incorporation of faculty professionalism as a regular agenda item in faculty meetings.

Course on care of patients with chronic illness: patient-centered medical home model.

BACKGROUND: In the United States, the Patient-centered Medical Home (PCMH) is an emerging concept in primary care that is guiding clinical reorganization to meet the needs of patients with chronic illness. We developed a one-semester curriculum to teach the principles and practice of PCMH to medical and physician assistant students during their clinical clerkship year. METHODS: The mini-course on PCMH consists of three 3-h weekend sessions over 16 weeks and a student project to develop constructive planning ideas for an assigned clinical site. In the first two sessions, students receive didactics and engage in project development discussions. Subsequently, participants work with a faculty advisor and clinic site administrative staff to identify and analyze an area of interest for the student and clinic site. In the last session, students present their projects to the larger group. During the first year of implementation, student evaluations were collected after the first and last sessions. RESULTS: At the end of the course, students reported confidence in their understanding of PCMH concepts and practical implementations of it. Completing a student project at their clinical sites posed challenges that were logistical, rather than conceptual, and was difficult to integrate with classroom learning. DISCUSSION: We present an interprofessional PCMH curriculum for medical and physician assistant students during their clinical year. This course provides students a familiarity with principles of the medical home model and practical experience with practice redesign issues in the context of PCMH transformation.

The physician assistant teaching fellowship: A model for faculty recruitment.

PURPOSE: the rapid growth of the number of physician assistant (PA) programs in the last two decades has resulted in a heightened demand for qualified and experienced PA faculty. Barriers to recruitment and retention of faculty include the need for diverse teaching experiences and the lack of available mentors. METHODS: in order to provide a structured experience for training potential faculty for careers as PA educators and to address the barriers to recruitment and retention of new faculty, our institution has offered a PA teaching fellowship since 1998. RESULTS: the teaching fellowship has met its goal of increasing the pool of qualified PA faculty, as nine of the 11 graduates were hired full-time into PA teaching and program administration positions. Curriculum projects developed by the fellows have been incorporated into our curriculum and have been shared with other PA programs. CONCLUSIONS: the PA teaching fellowship is a valuable strategy for developing teaching skills, promoting professionalism among PA educators, increasing the pool of available and qualified PA faculty, and overcoming barriers to retention. This model may be useful to other institutions.