Physician Assistant Student Attitudes Toward Gamification of Cardiac Auscultation Instruction.

INTRODUCTION: Current physician assistant (PA) learners have a clear preference for interactive learning that is vibrantly present in new media technologies. At present, there is a paucity of research regarding use or acceptability of gamification in PA education. The purpose of this study was to examine PA students' experience with, attitudes toward, and outcomes of a gamified cardiac auscultation curriculum. METHODS: Faculty at one institution designed an interactive Mobile App Cardiac Auscultation Curriculum (MACAC). The MACAC incorporates independent and group learning using the Littmann Learning mobile app. Author-created surveys as well as knowledge and auscultation assessment tools were delivered to all students. RESULTS: Most of the students recommended the use of the app for future cohorts and reported confidence to accurately identify normal and abnormal heart sounds. Knowledge and auscultation assessment scores demonstrated proficiency in identification of normal and abnormal heart sounds. DISCUSSION: Gamification research is important because blended learning that incorporates new media technologies with traditional approaches can help overcome the limitations of passive learning environments. This study provides evidence that the use of a mobile app can be an effective and innovative method to teach cardiac auscultation to the 21st century PA learners.

Are Physician Assistants Able to Correctly Identify Prescribing Errors? A Cross-Sectional Study.

PURPOSE: (1) To describe how often physician assistant (PA) students correctly identify prescribing errors and (2) examine between-cohort differences on ability to correctly identify prescribing errors. METHODS: This was a cross-sectional study of 2 cohorts of PA students at one institution. Students were presented with 3 hypothetical prescriptions, 2 of which contained a prescribing error. For each prescription, students were asked to (1) identify whether an error occurred and (2) indicate the type of error. A simple Poisson regression model analyzed the data. RESULTS: We received responses from 130 students (72.6% response rate). Approximately 12% (12.3%, n = 16) correctly identified whether all 3 prescriptions were correct. The median number of correctly identified prescriptions was 1 (interquartile range = 1). There was not a statistically significant between-cohort difference identifying the correct number of prescriptions (ß = 0.27, P = .10). CONCLUSION: Physician assistant students' prescribing error identification was similar to previous research in medical and nursing students. Efforts to improve prescribing training are critical to ensure patient safety.

What Physician Assistants Prefer in a Postprofessional Doctorate Program: A Cross-Sectional Rating and Rankings Study.

PURPOSE: The physician assistant (PA) literature has focused on the implications of creating an entry-level doctoral degree; however, there is scant primary literature on postprofessional doctorates, which are becoming more popular as the number of institutions offering them increases. The purposes of this project were to: (1) describe interest and motivation of currently practicing PAs to enroll in a postprofessional doctorate program and (2) identify the most- and least-preferred attributes of a postprofessional doctorate program. METHODS: This was a quantitative cross-sectional survey of recent alumni from one institution. Measures included interest in obtaining a postprofessional doctorate, a nonrandomized Best-Worst Scaling (BWS) exercise, and motivators for enrolling in a postprofessional doctorate. The main outcome of interest was the BWS standardized score for each attribute. RESULTS: The research team received 172 eligible responses (n = 172, response rate = 25.83%). Results indicate that 47.67% of respondents (n = 82) expressed interest in a postprofessional doctorate. The most preferred doctorate program attribute was a clinically based program, ending with a residency, conferring a Doctor of Medical Science (DMSc) degree, with a hybrid course delivery. DISCUSSION: This sample included various interests, motivations, and preferred program attributes. Understanding these factors may help inform the design and redesign of doctoral programs.

American Indian/Alaska Native men are less likely to receive prostate-specific antigen testing and digital rectal exams from primary care providers than White men: a secondary analysis of the National Ambulatory Medical Care Survey from 2012-2018.

PURPOSE: (1) Identify the proportion of primary care visits in which American Indian/Alaska Native (AI/AN) men receive a prostate-specific antigen test (PSAT)and/or a digital rectal exam (DRE), (2) describe characteristics of primary care visits in which AI/AN receive PSA and/or DRE, and (3) identify whether AI/AN receive PSA and/or DRE less often than non-Hispanic White (nHW) men. METHODS: This was a secondary analysis of the National Ambulatory Medical Care Survey (NAMCS) during 2013-2016 and 2018 and the NAMCS Community Health Center (CHC) datasets from 2012-2015. Weighted bivariate and multivariable tests analyzed the data to account for the complex survey design. RESULTS: For AI/AN men, 1.67 per 100 visits (95% CI = 0-4.24) included a PSATs (or PSAT) and 0 visits included a DRE between 2013-2016 and 2018. The rate of PSA for non-AI/AN men was 9.35 per 100 visits (95% CI = 7.78-10.91) and 2.52 per 100 visits (95% CI = 1.61-3.42) for DRE. AI/AN men were significantly less likely to receive a PSA than nHW men (aOR = 0.09, 95% CI = 0.01-0.83). In CHCs, AI/AN men experienced 4.26 PSAT per 100 visits (95% CI = 0.96-7.57) compared to 5.00 PSAT per 100 visits (95% CI = 4.40-5.68) for non-AI/AN men. DRE rates for AI/AN men was 0.63 per 100 visits (95% CI = 0-1.61) compared to 1.05 per 100 (95% CI = 0.74-1.37) for non-AI/AN men. There was not a statistically significant disparity in the CHC data regarding PSA (OR = 0.91, 95% CI = 0.42-1.98) or DRE (OR = 0.75, 95% CI = 0.15-3.74), compared to nHW men. CONCLUSION: Efforts are needed to better understand why providers may not use PSA and DRE with AI/AN men compared to nHW men.

Exploring the Professional Identity Formation of Racial/Ethnic Minoritized Physician Assistants.

INTRODUCTION: The purpose of this article is to (1) describe how professional identity intersects with physician assistants' (PAs') and PA students' racial and ethnic identities and cultural backgrounds; (2) examine how sociohistorical contexts shape professional identity in racial/ethnic minoritized PAs and PA students; and (3) identify the role of PA program administrators and faculty to address the needs of racial/ethnic minoritized PAs and PA students. METHODS: This study draws on elements of constructivist grounded theory to investigate the professional identity formation (PIF) experiences of 45 PA students and alumni from 3 institutions. Participants were recruited using a snowball method and identified as 23 Black/African American, 12 Hispanic/Latino, 6 mixed race, and 4 Native American/Indigenous. Interview data were analyzed using sociocultural theory as an analytic framework. RESULTS: The results suggest that participants felt that their racial/ethnic identity was an important part of their identity, yet many indicated they experienced frequent micro- and macroaggressions from fellow students, faculty, lecturers, administrators, preceptors, patients, and supervisors. Additionally, they indicated that they need more support from their programs than what is currently provided. DISCUSSION: The results of this study suggest that social experiences before, during, and after PA training strongly influence PIF development in racial/ethnic minoritized PAs. Administrators and professional PA organizations should evaluate methods to support those individuals who identify as a racial/ethnic minority throughout their careers.

Adaptation and factor structure of three psychometric instruments measuring behavioral aspects of medication prescribing in physician assistants.

OBJECTIVES: (1) Present the factor structure of two psychometric instruments for self-efficacy and one for outcome expectations of medication prescribing; (2) evaluate the reliability of the scales, and (3) present preliminary evidence of validity. METHODS: Physician assistants (PA) and PA students completed a survey evaluating three psychometric instruments: (1) Self-Efficacy in Prescribing (SEP), (2) Self-Efficacy in Prescribing-Geriatric (SEPG), and (3) Outcomes Expectations of Prescribing Errors (OEP). Students also evaluated 3 hypothetical prescriptions, two of which contained a prescribing error. Students were instructed to identify (1) if an error occurred and (2) what type of error. The data were analyzed using parallel analysis with a varimax rotation, Cronbach's α, Pearson and Spearman correlations. RESULTS: One hundred eighty five (n = 185) respondents completed the survey (response rate = 63.8%). The parallel analysis found that the SEP had one 7-item factor with α = 0.94 (M = 5.7 (SD = 1.9) out of 10). The SEPG also had one 7-item factor with α = 0.95 (M = 5.5 (1.9). The OEP had one 6-item factor with α = 0.89 (M = 3.5 (SD = 0.8) out of 5). The SEP and SEPG, were correlated to the OEP each other (both p < 0.01). Actively practicing PAs had the highest composite mean SEP and SEPG scores. First-year PA students had the highest mean scores for the OEP. There was a weak association between the mean SEPG score and the number of correctly identified prescriptions (rs = 0.18, p = 0.04). CONCLUSION: The SEP, SEPG, and OEP show preliminary evidence of reliability and structural, construct, and known-group validities using simulated prescriptions. These tools may be able to be used by educators and implementation scientists as one method to show the effectiveness of future interventions to reduce incidence of prescribing errors.

A Cross-Sectional, Mixed-Methods Analysis to Identify the Relative Importance of Factors Students and Providers Evaluate When Making a Job Choice.

Little is known about the relative importance of factors that contribute to job choices among health care providers. A convenience sample of 173 health care providers (N=134) and physician assistant students (N=39) completed a cross-sectional survey. Participants rated the importance of sixteen job- (e.g., work environment), community- (e.g., recreational opportunities), and personal-related factors (e.g., children) and one open-ended item. The highest rated item, on average, was an opportunity to make a difference in patient quality of life (mean (M)=4.57, standard deviation (SD)=0.63) while the lowest rated item was wealth/prestige of living in a certain area (M=2.43, SD=1.05). The average importance rating was similar across types of providers and between providers and students. While personal interest to positively affect patients' quality of life was rated as the most important factor, almost all the studied items were rated as important or very important by the majority of participants.

Job attributes valued by physicians, PAs, and NPs: A cross-sectional survey.

OBJECTIVE: This study evaluated the relative importance of job-, community-, and individual-related factors that contribute to job choice among physicians, physician assistants (PAs), and NPs, to inform policy options to recruit clinicians to rural areas. METHODS: A cross-sectional online survey of PA preceptors from three institutions in two states. Participants were asked to rate the importance of 16 job-, community-, and individual-related factors when choosing a job. RESULTS: We received responses from 45 physicians, 74 PAs, and 15 NPs (24.2% response rate), who rated most job-, community-, and individual-related factors as important; ratings were similar across clinicians. PAs rated loan repayment programs and work hours higher than physicians, though the magnitude of the difference was small. CONCLUSIONS: Clinicians similarly rated many factors as important. A better understanding of the tradeoffs clinicians are willing to make between these factors when making a job choice is critical to increase the attractiveness of rural positions.

Does Learner Self-Efficacy Influence Accurate Identification of Heart Sound Descriptions?

INTRODUCTION: Although physician assistant (PA) training includes cardiac instruction, there is a lack of theory-based research investigating skill and behavioral development in PA students. The objective of this study was to examine the relationship between self-efficacy and ability to correctly identify heart sounds. METHODS: A cross-sectional study was conducted among 2 cohorts of PA students at one institution. Students answered self-efficacy items using 5-point Likert-type answers and identified specific heart sounds from text descriptions. Data from 154 students were analyzed using Cronbach's alpha and bivariate statistical tests. RESULTS: Second-year students identified more heart sounds correctly than first-year students (8 v. 7, Z = -2.64, p = 0.01). Students with more confidence were more likely to correctly identify specific heart sounds. DISCUSSION: Results are consistent with social cognitive theory showing that self-efficacy may be related to outcome performance in PA students. Educational processes that cultivate self-efficacy may increase proficiency in cardiac auscultation.

Can cardiac auscultation accuracy be improved with an additional app-based learning tool?

INTRODUCTION: Many institutions use simulation 'events' to instruct cardiac auscultation. Research shows that these 'one and done' events limit repetition, are costly and do not incorporate learning science techniques, such as spaced learning and retrieval practice. The Littmann Learning™ mobile app, which has unlimited access to a large library of real patient heart sounds, is a cost-effective tool that we considered could be leveraged by educators to provide this training. METHODS: This was a quasi-experimental pre- and post-design consisting of an intervention group (PA22) and a non-equivalent comparator group (PA21). The intervention group used a novel mobile app cardiac auscultation curriculum (MACAC), while the comparator group received standard didactic instruction. One-way analyses of variance were used to analyse the data. RESULTS: A total of 174 PA students participated in the study. There was a significant (p < 0.001) difference in knowledge and auscultation scores between those who did and did not complete the MACAC. PA22 didactic year knowledge scores were 4.11 and 2.96 points higher than PA21 didactic and clinical year knowledge scores (p < 0.001, d = 1.61 and p < 0.001, d = 1.32), respectively. On average, PA22 didactic year auscultation scores were 0.83 points higher than PA21 clinical year scores (p < 0.001, d = 0.6). CONCLUSION: Results indicate that students in their didactic year achieved proficiency in clinically identifying heart sounds, despite not having access to a mannequin simulator and not having an opportunity to identify these sounds bedside. Overall, a MACAC may be an effective method to teach cardiac auscultation to medical learners.

PAs' attitudes about adolescent suicide screening: The Theory of Planned Behavior.

OBJECTIVE: Suicide is an increasing public health problem for adolescents and young adults. The purpose of this study was to identify the frequency of physician assistants' (PAs') self-reported adolescent suicide risk assessments and to elicit salient beliefs regarding behavioral attitudes, norm referents, control factors, and intention to conduct suicide risk assessment with adolescents. METHODS: A convenience sample of PAs completed an anonymous cross-sectional questionnaire. Relationships were assessed using bivariate analyses and qualitative theme analysis. RESULTS: Forty-three PAs completed the questionnaire. Many PAs supported suicide risk assessment screening as a strategy to identify adolescents who are suicidal at an earlier stage of their illness; lack of time during the visit and problematic parental involvement were identified as barriers. CONCLUSIONS: PAs recognized that screening adolescents for suicide ideation may help prevent suicides. Their practice behaviors, however, did not correspond to this belief.

Family Conference Simulation Designed for Physician Assistant Students and Chaplain Residents.

Background: Physician Assistants (PAs) are increasingly likely to work in clinical areas where family conference skills are needed, but there is currently a lack of family conference education in PA program curricula. Objectives: To (1) describe a novel interprofessional education (IPE) event for PA students and chaplain residents; (2) examine whether participating in the IPE event is associated with improvements in attitudes and knowledge regarding interprofessional teams; and (3) describe participant perceptions about the event. Design: Two cohorts of PA students and chaplain residents completed a required interprofessional simulation activity involving a critically ill patient and a family conference. All participants completed pre- and postsimulation activity questionnaires. Bivariate tests were utilized to analyze the quantitative data. Setting/Subjects: Over two years, 171 PA students and 20 chaplain residents completed the activity at a school of medicine in the United States. Measurements: Pre- and postactivity measurements included role-specific questions plus overlapping sections regarding roles and responsibilities of the other discipline, comfort facilitating end-of-life discussions, and the value of IPE. Results: For PA students, there was a statistically significant increase for all questionnaire items. The largest effect size increases were in PA students' confidence in provider-patient communication at the end of life (Cohen's d > 1.1). Chaplain data demonstrated increases in knowledge of the PA role and likelihood of consulting with PAs in the future. Conclusion: This simulation event improved participant attitudes and knowledge relating to interprofessional interactions in the setting of an end-of-life family conference, and may contribute to more effective collaboration between PAs and chaplains in the clinical setting.

Medical students attitudes toward and intention to work with the underserved: a systematic review and meta-analysis.

BACKGROUND: Experts in the field of medical education emphasized the need for curricula that improve students' attitudes toward the underserved. However, some studies have shown that medical education tends to worsen these attitudes in students. We aimed at systematically reviewing the literature assessing the change in medical students' attitudes toward the underserved and intention to work with the underserved throughout medical education, the sociodemographic and educational factors associated with favorable medical student attitudes toward and/or intention to work with the underserved and the effectiveness of educational interventions to improve medical student attitudes toward and/or intention to work with the underserved. METHOD: We conducted a systematic review on MEDLINE, Scopus, and Web of Science databases. Three investigators independently conducted the electronic search. We assessed the change in medical students attitudes toward the underserved by computing a weighted mean effect size of studies reporting scores from validated scales. The research team performed a meta-analysis for the sociodemographic and educational factors associated with medical students attitudes toward and/or intention to work with the underserved. RESULTS: Fifty-five articles met the inclusion criteria, including a total of 109,647 medical students. The average response rate was 73.2%. Most of the studies were performed in the USA (n = 45). We observed a significant decline of medical students attitudes toward the underserved throughout medical education, in both US and non-US studies. A moderate effect size was observed between the first and fourth years (d = 0.51). Higher favorable medical students attitudes toward or intention to work with the underserved were significantly associated with female gender, being from an underserved community or ethnic minority, exposure to the underserved during medical education and intent to practice in primary care. Regarding educational interventions, the effectiveness of experiential community-based learning and curricula dedicated to social accountability showed the most positive outcome. CONCLUSIONS: Medical students attitudes toward the underserved decline throughout medical education. Educational interventions dedicated to improving the attitudes or intentions of medical students show encouraging but mixed results. The generalizability of our results is impeded by the high number of studies from the global-North included in the review.

Training Physician Assistants to Use Medical Interpreters Effectively.

PURPOSE: To examine the internal consistency of a validated instrument for physician assistant (PA) communication skills with interpreters and evaluate a training activity focused on effectively working with interpreters during a standardized patient assessment. METHODS: Six cohorts of PA students completed training on how to communicate with patients who required an interpreter. Students then completed an assessment with a limited English-proficient patient and interpreter. Student competency was assessed using a previously validated measure. Data were analyzed using a multivariable Poisson regression model. RESULTS: There were usable data on 439 PA students. The median number of areas that students performed/partially performed was 10 out of 12 (inter-quartile range: 3). The Poisson regression model revealed significant differences between cohorts. Areas for further training include using Teach-Back (n = 203) and thanking the interpreter (n = 170). CONCLUSIONS: Although the PA students performed well, there is considerable room for improvement in certain communication techniques.

Development of an Innovative Career Development Program for Early-Career Women Faculty.

OBJECTIVE: Our institutional Women in Medicine & Science Program (formerly the Office of Women in Medicine and Science) developed the Early Career Development Program for Women to promote the careers of women faculty. At 6 monthly sessions, participants learn relevant content (imposter syndrome, strengths, change style, career management, assertive communication, feedback, personal influence, conflict management, negotiation, importance of mentors, resilience, and self-care); exchange ideas; and expand their professional networks. Here, we report changes in participants' career skills/knowledge, confidence, and perceptions of the current environment after attending the program. METHOD: Between 2014 and 2017, participants (N = 65) completed pre- and post-program surveys that assessed career knowledge and skills, confidence, and perceptions of the current environment and provided program feedback. RESULTS: Most skills showed pre-post significant improvement. The greatest increases occurred in knowing paths to promotion, tailoring communication style, ability to manage conflict, and ability to handle personal-professional role balance. Women reported a significant increase for all items measuring confidence. Among these items, establishing networks, understanding institutional culture, providing feedback, motivating others, strategic planning, delegating, and conflict management had the largest increases. Overall, 89.3% of respondents rated the program impact as very strong/profound, 98.5% rated the concepts as essential, 95.2% rated the skills as essential, and 90.8% rated the sense of community with women in their class as very/extremely close. CONCLUSIONS: Work-related skills/knowledge, confidence, and perceptions of the current environment increased significantly among program participants. These early-career women faculty indicated that the program augmented the skills needed to develop their careers in an academic medical center.

Positive Value of a Women's Junior Faculty Mentoring Program: A Mentor-Mentee Analysis.

BACKGROUND: Recently appointed women faculty in academic medicine face many challenges during their careers and can become overwhelmed managing their multiple faculty roles as teacher, scholar, and clinician, in addition to their roles in personal life. Although a mentor can be invaluable in assisting a woman junior faculty member to adjust to faculty life and providing critical career guidance, not all medical institutions have faculty mentoring programs. We created a mentoring program specifically for our women junior faculty to address this issue at our own institution. MATERIALS AND METHODS: To assess the value of this program, we conducted a novel mentor-mentee paired-data analysis of annual surveys collected from 2010 to 2015. Of the 470 responses received, 83 were from unique mentees and 61 from unique mentors. RESULTS: Career development, research, and promotion were the top topics discussed among the mentoring pairs, followed by discussions of institutional resources and administration/service. There was high congruency among the mentoring pairs that they thought these discussions, as well as other conversations about mentee professional development and well-being, had been helpful. However in some instances, mentors felt they had not been helpful to their mentee, whereas their mentees felt otherwise; this finding speaks to the value and importance of mentees providing positive feedback to their mentors. Overall, both mentees and mentors thought that the mentees had significantly benefited from the mentorship. Unexpected outcomes of these relationships included promotion, grant applications/awards, articles, presentations, and professional memberships. The use of a Mentee Needs Assessment Form to individualize the mentoring relationship for each mentee may explain the high overall satisfaction and participant recommendations of the program. CONCLUSIONS: Our findings demonstrate the value in establishing mentoring programs specifically for women faculty, especially in environments in which other mentoring opportunities do not exist.

Innovative Strategies for Clinical Microscopy Instruction: Virtual Versus Light Microscopy.

PURPOSE: The purpose of the study was to compare virtual microscopy with light microscopy to determine differences in learning outcomes and learner attitudes in teaching clinical microscopy to physician assistant (PA) students. METHODS: A prospective, randomized, crossover design study was conducted with a convenience sample of 67 first-year PA students randomized to 2 groups. One group used light microscopes to find microscopic structures, whereas the other group used instructor-directed video streaming of microscopic elements. At the midpoint of the study, the groups switched instructional strategies. Learning outcomes were assessed via posttest after each section of the study, with comparison of final practical examination results to previous cohorts. Attitudes about the 2 educational strategies were assessed through a postcourse questionnaire with a Likert scale. RESULTS: Analysis of the first posttest demonstrated that students in the video-streamed group had significantly better learning outcomes than those in the light microscopy group (P = .004; Cohen's d = 0.74). Analysis of the posttest after crossover showed no differences between the 2 groups (P = .48). Between the 2 posttests, students first assigned to the light microscopy group scored a 6.6 mean point increase (±10.4 SD; p = .0011), whereas students first assigned to the virtual microscopy group scored a 1.3 mean point increase (±7.1 SD; p = .29). The light microscopy group improved more than the virtual microscopy group (P = .019). Analysis of practical examination data revealed higher scores for the study group compared with 5 previous cohorts of first-year students (P < .0001; Cohen's d = 0.66). Students preferred virtual microscopy to traditional light microscopy. CONCLUSION: Virtual microscopy is an effective educational strategy, and students prefer this method when learning to interpret images of clinical specimens.