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.

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.

The Effects of Social Rank and Neighborhood and School Environment on Adolescent Depression and Suicidal Ideation: A Structural Equation Modeling Approach.

Depression and suicide constitute major public health problems, and their prevalence has been increasing among adolescents in the United States. More research is needed to understand the association between multilevel risk factors and depression and suicidal ideation in adolescents, particularly factors related to perceived social rank and environmental stress. The present study examined relationships among family mental history of mental illness, in-utero and perinatal complications, social rank factors, environmental factors, and depression and suicidal ideation in the past month in a clinical population of adolescents. A cross-sectional survey was administered in outpatient clinics to 197 adolescents ages 12-18 who were primarily Black and female. Findings from structural equation modeling showed the largest effects for the social rank factor on depression and suicidal ideation in the past month. These findings highlight the importance of preventive interventions for coping with social hierarchies to prevent depression and suicidal ideation.

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.

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.

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%.

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.

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.

Moderating Effects of Resilience on Depression, Psychological Distress, and Suicidal Ideation Associated With Interpersonal Violence.

Resilience has been found to attenuate the effects of negative mental health symptomology associated with interpersonal victimization; however, existing research has largely focused on resilience traits, such as individual cognitive and environmental factors that promote resilience. In addition, empirical knowledge on the extent to which resilience mitigates suicidal symptomology associated with interpersonal violence victimization is particularly limited. This study assesses whether the relationship between interpersonal violence (i.e., IPV and nonpartner sexual violence) and mental health symptomology (i.e., depression, psychological distress, and suicidal ideation) is moderated by resilience using a general population sample of women (N = 932). A cross-sectional, observational survey was administered in four U.S. cities (Baltimore, New York City, Philadelphia, and Washington, D.C.). Bivariate results indicated that women exposed to interpersonal violence reported significantly higher rates of suicidal ideation, depression, and psychological distress compared with women without exposure to interpersonal violence. Regression models revealed significant positive associations between interpersonal violence and depression, distress, and suicidal ideation, adjusting for sociodemographics. Resilience did not significantly moderate the relationship between interpersonal violence victimization and any associated mental health outcomes. However, subgroup analyses reveal significant interaction effects between resilience and IPV within specific racial and ethnic minority subgroups, suggesting that attenuating effects of resilience on mental health symptoms (i.e., depression and psychological distress) associated with IPV likely vary across race and ethnicity. Implications for future research and clinical interventions focused on resilience among survivors of interpersonal violence are discussed.

Moderating Effects of Perceived Neighborhood Factors on Intimate Partner Violence, Psychological Distress, and Suicide Risk.

Neighborhood factors such as instability and weakened social ties have been linked to both intimate partner violence (IPV) and poor mental health outcomes; however, research has not yet investigated the relationship between IPV and gentrification-specific change, including whether gentrification-related neighborhood factors affect mental health symptoms commonly associated with IPV. This study aims to determine if (a) perceptions of neighborhood connectedness and recent compositional changes (e.g., residential mobility, crime, and infrastructure) are associated with IPV exposure and (b) perceived neighborhood connectedness and compositional change moderates the relationship between IPV and mental health symptoms (i.e., psychological distress, suicidal ideation, suicide attempts). Data from the 2017 Survey of Police-Public Encounters were used, which is an online, cross-sectional, general population survey administered to male and female adults residing in New York City and Baltimore (N = 1,000). Findings suggest that higher levels of neighborhood disconnectedness were associated with higher levels of IPV, whereas higher levels of neighborhood compositional change were associated with lower levels of IPV. Neighborhood disconnectedness and compositional change worsened psychological distress symptoms and suicide risk most strongly among individuals exposed to IPV. Violence prevention and intervention approaches should consider the extent to which neighborhood instability, related to community connectedness and recent compositional change, impacts the safety and mental health of victims of IPV.

Pathways from health beliefs to treatment utilization for severe depression.

BACKGROUND: Untreated depression is associated with negative behavioral, psychosocial, and physical outcomes leading to socioeconomic costs, disability, and premature mortality. Research has not yet fully developed intervention models to increase the utilization of mental health treatments. The objective of the current study was to characterize the pathways linking health beliefs to treatment utilization among depressed young adults. METHODS: Data were collected in 2017 from 53,760 college students at 54 universities in the United States. Among the respondents, 5,343 screened positive for moderately severe to severe depression. Becker's Health Belief Model (HBM) was the guiding theoretical paradigm. Confirmatory factor analysis and structural equation modeling (SEM) were conducted to elucidate treatment-seeking behavior based on health beliefs (perceived severity, perceived benefit, perceived barriers, self-efficacy, and cues-to-action) while controlling for relevant sociodemographic covariates. RESULTS: Depression treatment utilization was significantly associated with all domains of the HBM. SEM parameter estimates indicated that higher levels of perceived severity, self-efficacy, and cues-to-action were associated with greater depression treatment utilization, whereas perceived benefits and perceived barriers were associated with lower depression treatment utilization. CONCLUSIONS: The HBM may be useful to predict the frequency of seeking treatment by individuals for depression. However, individualized intervention strategies targeting different aspects of the HBM are needed to promote help-seeking behaviors in young adults with depression.

Police Violence among Adults Diagnosed with Mental Disorders.

Police violence is reportedly common among those diagnosed with mental disorders characterized by the presence of psychotic symptoms or pronounced emotional lability. Despite the perception that people with mental illness are disproportionately mistreated by the police, there is relatively little empirical research on this topic. A cross-sectional general population survey was administered online in 2017 to 1,000 adults in two eastern U.S. cities to examine the relationship between police violence exposure, mental disorders, and crime involvement. Results from hierarchical logistic regression and mediation analyses revealed that a range of mental health conditions are broadly associated with elevated risk for police violence exposure. Individuals with severe mental illness are more likely than the general population to be physically victimized by police, regardless of their involvement in criminal activities. Most of the excess risk of police violence exposure related to common psychiatric diagnoses was explained by confounding factors including crime involvement. However, crime involvement may necessitate more police contact, but does not necessarily justify victimization or excessive force (particularly sexual and psychological violence). Findings support the need for adequate training for police officers on how to safely interact with people with mental health conditions, particularly severe mental illness.

Sexual orientation and mental health among adults in four U.S. cities.

Sexual minorities have higher risk for psychological distress than heterosexual populations. However, this disparity remains under-studied in urban settings, and there likewise has been minimal prior research of potential interactions with gender and race/ethnicity. The present study aimed to examine mental health correlates of sexual minority identification in conjunction with gender and race/ethnicity. A community sample of 1,615 adults from four eastern cities in the United States was used. A series of regression analyses were conducted to examine differences in psychological distress and suicidal ideation across different sexual orientation populations. The results showed that only bisexual individuals had significantly higher psychological distress and risk for suicidal ideation than heterosexual individuals even after adjusting for age and income. The associations were consistent across gender and race/ethnicity. No significant differences between homosexual and heterosexual individuals were found. Health professionals working with people of bisexual orientation in urban settings should attend to potential psychological distress and recent suicidal ideation.

Paranoid beliefs and realistic expectations of victimization: Data from the survey of police-public encounters.

BACKGROUND: The anticipation of threat or victimization is a core feature of paranoia. Cognitive theories of paranoia suggest that paranoid thoughts may arise as a psychological response to trauma exposure, which likewise may lead to greater anticipation of subsequent victimization. Little is known, however, about the relation between paranoid beliefs and anticipated victimization when accounting for past victimization experience. The present study aimed to address whether the experiences of past victimization contribute to the link between paranoid beliefs and the anticipation of threat or victimization, with a particular focus on exposure to police violence. METHODS: Data were collected through the Survey of Police-Public Encounters (N=1615), a cross-sectional, general population survey study conducted in four Eastern U.S. cities. Associations between paranoia and anticipated victimization were assessed using linear regression models, with and without adjustment for past victimization exposure. RESULTS: Paranoid beliefs were positively associated with police victimization expectations (ß=0.19, p<0.001), but these associations were statistically better explained by past exposures to similar victimization such that paranoia was no longer associated with anticipated victimization in adjusted models (ß=0.02, p=0.451). To assess for the specificity of past exposures to victimization, adjusting for past exposure to intimate partner violence (as a control condition) did not eliminate the association between paranoia and expected police victimization. CONCLUSIONS: The overall findings are consistent with cognitive theories of paranoia in which paranoid beliefs may be a severe but normative reaction to past victimization exposures in some cases.

Association of Exposure to Police Violence With Prevalence of Mental Health Symptoms Among Urban Residents in the United States.

Importance: Police violence is reportedly widespread in the United States and may pose a significant risk to public mental health. Objective: To examine the association between 12-month exposure to police violence and concurrent mental health symptoms independent of trauma history, crime involvement, and other forms of interpersonal violence exposure. Design, Setting, and Participants: This cross-sectional, general population survey study of 1221 eligible adults was conducted in Baltimore, Maryland, and New York City, New York, from October through December 2017. Participants were identified through Qualtrics panels, an internet-based survey administration service using quota sampling. Exposures: Past 12-month exposure to police violence, assessed using the Police Practices Inventory. Subtypes of violence exposure were coded according to the World Health Organization domains of violence (ie, physical, sexual, psychological, and neglectful). Main Outcomes and Measures: Current Kessler Screening Scale for Psychological Distress (K6) score, past 12-month psychotic experiences (World Health Organization Composite International Diagnostic Interview), and past 12-month suicidal ideation and attempts. Results: Of 1221 eligible participants, there were 1000 respondents (81.9% participation rate). The sample matched the adult population of included cities on race/ethnicity (non-Hispanic white, 339 [33.9%]; non-Hispanic black/African American, 390 [39.0%]; Hispanic/Latino, 178 [17.8%]; other, 93 [9.3%]), age (mean [SD], 39.8 [15.2] years), and gender (women, 600 [60.0%]; men, 394 [39.4%]; transgender, 6 [0.6%]) within 10% above or beyond 2010 census distributions. Twelve-month prevalence of police violence was 3.2% for sexual violence, 7.5% for physical violence without a weapon, 4.6% for physical violence with a weapon, 13.2% for psychological violence, and 14.9% for neglect. Police violence exposures were higher among men, people of color, and those identified as homosexual or transgender. Respondents reported suicidal ideation (9.1%), suicide attempts (3.1%), and psychotic experiences (20.6%). The mean (SD) K6 score was 5.8 (6.1). All mental health outcomes were associated with police violence exposure in adjusted logistic regression analyses. Physical violence with a weapon and sexual violence were associated with greater odds of psychotic experiences (odds ratio [95% CI]: 4.34 [2.05-9.18] for physical violence with a weapon; 6.61 [2.52-17.36] for sexual violence), suicide attempts (odds ratio [95% CI]: 7.30 [2.94-18.14] for physical violence with a weapon; 6.63 [2.64-16.64] for sexual violence), and suicidal ideation (odds ratio [95% CI]: 2.72 [1.30-5.68] for physical violence with a weapon; 3.76 [1.72-8.20] for sexual violence). Conclusions and Relevance: Police violence was commonly reported, especially among racial/ethnic and sexual minorities. Associations between violence and mental health outcomes did not appear to be explained by confounding factors and appeared to be especially pronounced for assaultive forms of violence.