Validation of a Novel Statistical Method to Identify Aberrant Patient Logging: A Multi-Institutional Study.

INTRODUCTION: Student patient encounter logging informs the quality of supervised clinical practice experiences (SCPEs). Yet, it is unknown whether logs accurately reflect patient encounters, and the faculty resources necessary to review for potential aberrant logging are significant. The purpose of this study was to identify a statistical method to identify aberrant logging. METHODS: A multi-institutional (n = 6) study examined a statistical method for identifying potentially aberrant logging behavior. An automated statistical Mahalanobis Distance (MD) measurement was used to categorize student logs as aberrant if they were identified as probable multivariate outliers. This approach was validated using a gold standard for aberrant logging behavior with manual review by 4 experienced faculty ("faculty consensus") and then comparing interrater agreement between faculty and MD-based categorization. In secondary analyses, we compared the relative accuracy of MD-based categorization to individual faculty categorizing data from their own program ("own program" categorization). RESULTS: 323 student logging records from 6 physician assistant (PA) programs were included. Compared to "faculty consensus" (the gold standard), MD-based categorization was highly sensitive (0.846, 95% CI: 0.650, 1.000) and specific (0.766, 95% CI: 0.645, 0.887). Additionally, there was no significant difference in sensitivity, specificity, positive predictive value, or negative predictive value between MD-based categorization and "own program" categorization. DISCUSSION: The MD-based method of identifying aberrant and nonaberrant student logging compared favorably to the more traditional, faculty-intensive approach of reviewing individual student logging records. This supports MD-based screening as a less labor-intensive alternative to individual faculty review to identify aberrant logging. Identification of aberrant logging may facilitate early intervention with students to improve clinical exposure logging during their SCPEs.

Patient satisfaction with physician assistant/associate care: an international scoping review.

BACKGROUND: As the role of the physician assistant/associate grows globally, one question is: what is the level of patient satisfaction with PAs? Driven by legislative enactments to improve access to care, the PA has emerged as a ready and able medical professional to address workforce shortages. The aim of this study was to review the literature on patient satisfaction of PAs. OBJECTIVES: The basis for this review was to clarify working definitions, synthesize the evidence, and establish conceptual boundaries around the topic of patient satisfaction with PAs. The intent was to identify gaps in the literature and offer suggested undertakings for more clarification on the subject. METHODS: A scoping review was undertaken. Literature from 1968 to 2019 was searched and filtered for eligibility. Those that met criteria were categorized by date, method, geography, themes, and design. RESULTS: In total, there were 987 papers or reports that were identified through bibliography database searching. Additional articles found through snowball methodology-reviewing references (n = 11). Only English language articles emerged for analysis. From this effort, 25 articles surfaced from the filtering process for final inclusion. Most (72%) of the articles came from the United States of America, three from the United Kingdom, and one each from Ireland, the Netherlands, and New Zealand. Most articles were descriptive in nature. Some variations in methods emerged. CONCLUSION: PAs are operational in 15 nations; their acceptance appears successful and satisfaction with their care largely indistinguishable from physicians. Findings from this analysis highlight one theory that when patient's needs are met, satisfaction is high regardless of the medical provider. Areas for further research are identified.

PAEA End of Rotation™ Exams Accurately Identify Students at Risk of Physician Assistant National Certifying Exam Failure.

PURPOSE: Physician Assistant Education Association (PAEA) End of Rotation™ exams are used by programs across the country. However, little information exists on the predictive ability of the exams' scale scores and Physician Assistant National Certifying Exam (PANCE) performance. The purpose of this study was to evaluate End of Rotation exam scores and their relationship with poor PANCE performance (PPP). METHODS: In an IRB-approved, multi-center, multi-year study, associations between PAEA End of Rotation exam scale scores and PANCE scores were explored. A taxonomy of nested linear regression models with random intercepts was fit at the program level. Fully adjusted models controlled for year, timing of the exam, student age, and gender. RESULTS: Fully adjusted linear models found that 10-point increases in End of Rotation exam scores were associated with a 16.8-point (95% confidence interval [CI]: 14.1-19.6) to 23.5-point (95% CI: 20.6-26.5) increase in PANCE score for Women's Health and Emergency Medicine, respectively. Associations between exams did not significantly vary (P = .768). Logistic models found End of Rotation exam scores were strongly and consistently associated with lower odds of PPP, with higher exam scores (10-point increase) associated with decrements in odds of PPP, ranging between 37% and 48% across exams. The effect estimate for the Emergency Medicine exam was consistently stronger in all models. CONCLUSIONS: PAEA End of Rotation exam scores were consistently predictive of PPP. While each End of Rotation exam measures a specialty content area, the association with the overall PANCE score varied only by a change in odds of low performance or failure by a small percentage. Low End of Rotation exam scores appear to be consistent predictors of PPP in our multi-center cohort of physician assistant students.

Collaboration versus competition: an interprofessional education experience.

BACKGROUND AND OBJECTIVES: Our purpose was to assess student, preceptor, and patient satisfaction with a phased pilot project to introduce interprofessional education teams into a clinical setting. METHODS: Focus groups with students and preceptors were used to evaluate acceptability with interprofessional education teams. We assessed pairings of second-year physician assistant students (PAS2) with both first- and second-year medical students (MS1, MS2) for three to eight clinic sessions in a university-based primary care clinic, over a period of 2 years. RESULTS: Twenty students and seven preceptors participated in paired clinical placement. All students agreed that the pairing was helpful for their learning. MS felt that they benefitted from the clinical experience of the PAS, whereas PAS felt that MS brought depth of information from their didactic learning. All students wished that the clinic sessions could have been more frequent. Preceptors did not feel precepting two students was more burdensome than precepting one student but did feel it was important to choose appropriate students who were interested in working together and teaching each other. Preceptors felt that the MS2/PAS2 pairing was optimal. CONCLUSIONS: Students and preceptors were all satisfied with interprofessional teams in the clinical setting. This model provides one solution to the dilemma of multiple learners requiring training in a limited number of clinical placement sites.

To teach or not to teach: 2011 national survey of physician assistants and preceptor experiences.

PURPOSE: The availability of clinical preceptors is essential for education and workforce planning. The purpose of this study is to describe the proportion and the characteristics of physician assistants (PAs) involved as preceptors. It also aims to identify the most important incentives and barriers for PAs to precept students. METHODS: A cross-sectional study was conducted with certified PAs in the United States from March 2011 to May 2011. An anonymous survey was sent via email to the 76,527 PAs in the National Commission on Certification of Physician Assistants' database. A total of 11,722 unique responses was received, yielding an overall response rate of 15.3%. RESULTS: Only 25% of clinically active PAs self-identified as current preceptors of PA students in 2011. The most common characteristics of current preceptors were male gender, practicing full-time, working in a teaching hospital, providing inpatient care, and having more than 6 years of clinical practice. The most important incentives to consider precepting more students among all respondents were the quality of the students and the ability to earn CME category I credit. In contrast, the most important reported barriers were lack of support by either supervising physician or administrators. Preceptors and nonpreceptors ranked certain incentives and barriers differently. CONCLUSIONS: The proportion of PAs who are clinical preceptors is low. Knowing the differences in the characteristics and attitudes between PA preceptors and nonpreceptors will help inform future recruitment and retention efforts. Qualitative research is underway to further explore quantitative study findings.