Blue Sky Thinking: Physician Assistant Accreditation and the Potential Impact on the Programs, Faculty, and the Profession.

ABSTRACT: Blue sky thinking references the opportunity to brainstorm about a topic without limits… to consider what things might be like if creative thoughts were unconstrained by current philosophies or other boundaries. This article is a call to our fellow educators to consider how blue sky thinking applied to physician assistant (PA) program accreditation might further advance programs, faculty, and the profession. To develop and maintain a PA program, institutions must voluntarily undergo evaluation by the Accreditation Review Commission on Education for the Physician Assistant. Compliance with accreditation encourages sound educational practices, promotes program self-study, stimulates innovation, maintains confidence with the public, and focuses on continuous quality improvement. In addition, accreditation "can hold institutions accountable for desired outcomes and professional standards." Indeed, while the PA profession has promulgated across the globe, the 50+ years of graduating PAs educated with the highest quality education assures that the United States remains a gold standard. As the 5th edition of the standards are implemented and planning for the 6th edition is underway, in the spirit of continuous quality improvement, we encourage stakeholders of the PA profession to contemplate ways in which accreditation might continue to purposefully advance a desired future state for the profession. In this article, we draw on examples from other health professions which might inform a discussion around the future of PA accreditation. Specifically, the topics of a unified profession title and degree, a specific title and position for program leadership, a modification to how PA programs receive medical direction, and efforts to advance scholarship are addressed.

The Creation of a Massive, Multi-team Organized (MMO) Course.

Instructors and administrators recognize that our world demands graduates who are not only prepared to meet today's challenges but are also equipped to tackle novel problems of the future. This article describes the creation of an interdisciplinary, team-taught course designed using features of collaborative learning and problem-based learning with a focus on the impact of teaching with a large number of faculty. The course was well-received by students with positive feedback about integration of previous curricular content and a low-pressure learning environment. However, the course was not without its challenges. Participation from over half of the program's teaching faculty required a considerable investment of time and resulted in weekly inconsistencies throughout the semester. This article highlights successes, challenges, and recommendations for others seeking to design a course with a similar number of faculty. This course style is referred to as a "massive, multi-team organized (MMO) course."

Creating SPACE to evolve academic assessment.

Universities and research institutions have to assess individuals when making decisions about hiring, promotion and tenure, but there are concerns that such assessments are overly reliant on metrics and proxy measures of research quality that overlook important factors such as academic rigor, data sharing and mentoring. These concerns have led to calls for universities and institutions to reform the methods they use to assess research and researchers. Here we present a new tool called SPACE that has been designed to help universities and institutions implement such reforms. The tool focuses on five core capabilities and can be used by universities and institutions at all stages of reform process.

Ecological factors affecting Infant at Work policies and programs in university settings.

OBJECTIVES: This study identifies the ecological (ie, policy, environment, intrapersonal, and interpersonal) factors affecting the implementation of an Infant at Work program in a university setting. METHODS: Data were collected among faculty, staff, and graduate students at a large Midwestern university from February to July 2020 via focus group (FG) discussions with university employees (n = 22) and semistructured interviews with university administrators (n = 10). We used techniques from expanded grounded theory, allowing for a constant comparative approach to data contextualization and theme identification. RESULTS: Three themes emerged from the FG data: (i) program and policy scope, (ii) employee and employer benefits, and (iii) workplace concerns. Onsite daycares, flexible schedules and participation, and expanded childcare options were some of the programs and policies employees desired. However, barriers to implementing these types of programs include cost, safety, and structure of the work environment. CONCLUSIONS: Findings offer practical recommendations and strategies to improve work/life balance among parents transitioning back to work in a university environment. Findings also provide insight into the feasibility of family-friendly workplace policies and environments. Additionally, findings provide a framework for other organizations to implement similar Infant at Work programs to improve employee work/life balance.

Plastic Surgery amidst the Pandemic: The New York University Experience at the Epicenter of the COVID-19 Crisis.

SUMMARY: The coronavirus disease of 2019 pandemic became a global threat in a matter of weeks, with its future implications yet to be defined. New York City was swiftly declared the epicenter of the pandemic in the United States as case numbers grew exponentially in a matter of days, quickly threatening to overwhelm the capacity of the health care system. This burgeoning crisis led practitioners across specialties to adapt and mobilize rapidly. Plastic surgeons and trainees within the New York University Langone Health system faced uncertainty in terms of future practice, in addition to immediate and long-term effects on undergraduate and graduate medical education. The administration remained vigilant and adaptive, enacting departmental policies prioritizing safety and productivity, with early deployment of faculty for clinical support at the front lines. The authors anticipate that this pandemic will have far-reaching effects on the future of plastic surgery education, trends in the pursuit of elective surgical procedures, and considerable consequences for certain research endeavors. Undoubtedly, there will be substantial impact on the physical and mental well-being of health care practitioners across specialties. Coordinated efforts and clear lines of communication between the Department of Plastic Surgery and its faculty and trainees allowed a concerted effort toward the immediate challenge of tempering the spread of coronavirus disease of 2019 and preserving structure and throughput for education and research. Adaptation and creativity have ultimately allowed for early rebooting of in-person clinical and surgical practice. The authors present their coordinated efforts and lessons gleaned from their experience to inform their community's preparedness as this formidable challenge evolves.

A Game of Adaptability: Reflecting on the Highlights and Challenges of Applying for Surgical Residency During the COVID-19 Pandemic.

Virtual recruitment of candidates applying into General Surgery residency during the COVID-19 pandemic presented a number of benefits and challenges. Notable benefits for candidates included financial and resource cost savings, the ability to conduct multiple interviews within short time frame, and the ability to meet more faculty members on virtual interview day. Challenges included technological difficulties, difficulty assessing culture and authenticity of in-program relationships, zoom fatigue, and inability to form relationships with co-applicants. After assessing our experiences with these benefits and challenges, the authors recommend that future recruitment cycles maintain virtual interview days with optional, nonevaluative open house days for revisit and second look opportunities.

Gender disparities in academic dermatology in Japan: Results from the first national survey.

BACKGROUND: A wide gender gap exists in many fields in Japan, including the academic society of dermatology. Women are substantially underrepresented in the highest academic ranks. OBJECTIVE: We aimed to clarify the possible factors contributing to the current gender gap in the field of academic dermatology and to recommend necessary measures to decrease the gender gap. METHODS: We performed a cross-sectional study of faculty members' academic productivity at the dermatology departments of all the educational institutions in Japan in 2019. RESULTS: Women had significantly lower academic productivity than men. A significant gender difference in academic productivity was found in lecturers and assistant professors but not in associate professor and professor positions. This gender difference was still significant after normalizing the productivity for career length. CONCLUSION: Our findings suggest the need to encourage women lecturers and assistant professors to improve their academic achievement to decrease the gender gap in academic dermatology.

Faculty and programmatic influences on the percentage of graduates of color from professional physical therapy programs in the United States.

The physical therapy profession in the United States suffers from a shortage of providers of color. This is unlikely to change with newly graduating students, as 2.6% of 2017 graduates were African American and 5.7% were Hispanic or Latino. Faculty mentorship has a more profound influence on the retention of underrepresented minority students as compared with students from privileged backgrounds, according to undergraduate literature. The influences of faculty characteristics on physical therapy graduates of color are unknown. The purpose of this study was to determine faculty and programmatic characteristics that could influence the percentage of physical therapy graduates of color. This study implemented the theory of academic capitalism to inform the results of a retrospective panel analysis, which used accreditation data from 2008 to 2017. Data from 231 programs was used to create fixed effects and random effects models to estimate the effects that faculty and program characteristics had on the percentage of graduates of color that a program produced. There was a statistically significant positive relationship between faculty of color and graduates of color (p < 0.001), but faculty must be sufficiently diverse before a program can expect a meaningful change in their percentage of graduates of color. Academic capitalist principles suggest that competition between programs for resources could negatively influence the proportion of graduates of color. Cause and effect associations between variables cannot be established. The authors concluded that professional physical therapy programs appeared to have increases in the percentages of graduates of color when they had more core faculty members of color.

Using a Diagnostic OSCE to Discern Deficit From Disability in Struggling Students.

PROBLEM: When medical students with disabilities fail, identifying the underlying cause is challenging. Faculty unfamiliar with disability-related barriers or accommodations may falsely attribute academic struggles to disability. Fear of legal action may prompt inappropriate promotion of students with disabilities who are struggling to meet competencies. Therefore, a clear understanding of the origin of difficulty is critical to determining an appropriate response to the student's failure, including revision of accommodations, academic remediation, probation, and dismissal. APPROACH: A large Midwestern medical college created an innovative approach to differentiate between disability-related barriers and academic deficits by creating a diagnostic objective structured clinical examination (OSCE). The goal of this OSCE was to determine the need for additional or refined accommodations versus clinical remediation, and to guide future decision making about a student on academic probation. Using 3 simulated cases that drew on a cross section of clinical knowledge, a team of clinical and disability specialists observed a disabled student to determine the origin of that student's difficulties in a clinical rotation. OUTCOMES: Using the diagnostic OSCE, the team quickly identified clinical reasoning and fund of knowledge deficits, and need for further accommodations. As a result, the team was able to remediate the clinical deficits, augment the current accommodations in vivo, and determine the potential impact on performance. The team approach was documented and facilitated the legally required interactive process for determining additional barriers, efficacy of existing accommodations, and need for additional reasonable accommodations. All parties reported a positive experience. The collective knowledge and expertise of the team helped confirm the origin of the deficit: a fundamental lack of knowledge and reasoning skills versus a disability-related barrier. NEXT STEPS: The next step is to formalize this process to ensure appropriate evaluation of students with disabilities.

Evaluating Core Clerkships: Lessons Learned From Implementing a Student-Driven Feedback System for Clinical Curricula.

PROBLEM: Medical schools have implemented various ways to engage students in improving medical curricula. These systems, however, usually focus on the preclerkship curriculum, perhaps because medical students move through this phase of medical education synchronously, making it easier to collect student input. In contrast, clerkship and postclerkship curricula often lack similar levels of student engagement in program evaluation. APPROACH: To increase communication among students, faculty, and administration during the clinical years of medical education, the Student Curricular Board (SCB) at the University of Illinois College of Medicine's Chicago campus (UICOM-Chicago) developed a student-driven feedback model in 2016 that aimed to parallel the system previously implemented in the preclerkship years. Interested fourth-year students were selected by their peers to represent individual core clerkships, and they communicated regularly with clerkship directors about concerns from current clerkship students. Third-year students applied and were selected to represent their cohort of peers moving through clerkship tracks. Proposed changes and improvements were tracked via novel, student-driven SOAP-Education (SOAP-Ed) progress notes written throughout the academic year. OUTCOMES: In response to a program evaluation survey conducted after implementation of this pilot, third-year students said they felt that their feedback was taken seriously by faculty and administration. Furthermore, student feedback led to meaningful changes in core clerkship curricula and in the system used to gather clerkship feedback. Clerkship directors expressed appreciation for this partnership, and students said they gained valuable leadership experience and knowledge of curricular development. NEXT STEPS: Current SCB members and curricular leadership plan to assess student and faculty perceptions of this system and its efficacy and work toward expansion to all UICOM campuses. Lessons learned from this student-driven model of feedback in third-year core clerkships will likely add to the conversation on how to better engage medical students as active stakeholders in their own education.

A strategy for empowering clinicians and increasing innovation: the Magic Wand Initiative.

Clinicians play a critical role in recognizing, initiating, and adopting innovative solutions to clinical problems. Increasing clinician involvement in problem-based innovation will help identify and solve unmet medical needs. The overall objective of our program was to increase clinician involvement in problem-based innovation. We pioneered and piloted the "Magic Wand" Initiative (MWI) at Massachusetts General Hospital Department of Dermatology, by inviting clinical faculty to voluntarily participate in problem-driven innovation. The primary outcome was the number of unmet clinical needs identified and pursued by clinicians, who were 'activated' to initiate problem-based innovation. Other objectives were to enhance clinician-to-clinician dialogue and to develop specific strategic framework for clinician-led, problem-driven research. This pilot MWI was started in 2013 with an announcement at dermatology faculty meeting inviting all clinical faculty to participate on volunteer basis. Academic dermatologists were the main participants in this program. They also contacted, collaborated and worked with research faculty, industry experts and lawyers. Out of 30 unmet needs identified by clinicians participating in MWI, eight are actively being pursued by clinicians. Three of those cases presented here have achieved publications, grant funding, prototype devices and product for patient use. In conclusion, MWI is an innovative approach that educates and equips clinician to identify and solve problems and engages them as leaders in their healthcare ecosystem. MWI has achieved concrete measurable success, affirming that if clinicians are empowered and supported to identify and solve existing unmet medical problems, new and innovative solutions can be invented to improve patient care.