Safety and Immunogenicity of a monovalent inactivated influenza A/H5N8 virus vaccine given with and without AS03 or MF59 adjuvants in healthy adults.

BACKGROUND: Avian influenza A/H5N8 virus infections have been circulating widely in wild and domestic bird populations with transmission to a few human poultry workers. This phase 1, randomized, blinded trial evaluated the safety and immunogenicity of a monovalent inactivated influenza A/H5N8 virus vaccine (H5N8 IIV) given with and without AS03 or MF59 adjuvants. METHODS: 275 healthy adults, ages 19-64 years, were randomized to one of five groups to receive two doses of 15 µg unadjuvanted influenza A/gyrfalcon/Washington/41088-6/2014(H5N8) (clade 2.3.4.4c) virus vaccine or two doses of 7.5 or 15 µg of vaccine adjuvanted with AS03 or MF59. Immunogenicity was assessed through 21 days following the second dose of vaccine using hemagglutination inhibition (HAI) and microneutralization (MN) assays for the homologous influenza A/H5N8 and three heterologous influenza A/H5 viruses. Safety was assessed through 1 year. RESULTS: The vaccines were well tolerated. Only modest immune responses were seen following receipt of a single dose of vaccine. Seroprotection (HAI titers ≥40) was more common in groups that received AS03 plus 7.5 or 15 µg of vaccine (89% and 93%, respectively) compared to the MF59-adjuvanted groups (56% and 73%), while unadjuvanted vaccine showed a poor response (27%). Higher antigen content resulted in modestly improved immune responses. HAI and MN GMTs and seroconversion rates were low across all study groups for all three heterologous strains of influenza A/H5 virus. CONCLUSIONS: AS03 or MF59-adjuvanted H5N8 IIV generated strong immunogenic responses following two doses. There was poor cross-reactivity for the three antigenically drifted H5N1 strains tested.

Multiple Mini-Interview Utilization in United States Physician Assistant Program Admission Processes.

PURPOSE: Health care program admission processes utilize multi-faceted approaches to evaluate cognitive and noncognitive attributes of applicants. The multiple mini-interview (MMI) was developed in response to the need for a reliable and validated tool to assess noncognitive factors and has been increasingly incorporated into the admissions process by physician assistant (PA) programs. The study's purpose was to explore the current implementation and utilization of the MMI within PA programs. METHODS: The study used a mixed-methods exploratory approach including a telephone survey and semi-structured interview of 11 PA programs using the MMI in their admissions process. Quantitative data collected included demographic information, MMI implementation characteristics, station structure, scoring, feasibility, satisfaction with MMI utilization, and MMI evaluation methods. RESULTS: During the 2015-2016 admissions cycle, the participating programs used from 5 to 10 stations, averaging 7 minutes per station, requiring 8 faculty, 2 staff, and 7 students per interview session. Despite variation in program size, number of applicants, and years of MMI utilization, all participating programs reported that they were satisfied with the format and would continue to utilize the MMI in the admissions process. CONCLUSIONS: While there is substantial literature describing the use of the MMI within health care programs globally, this study represents the first characterization of its use within PA programs on a national level. Although there was variation among PA program implementation of the MMI, our results are comparable to studies within other health care professions. Additional studies are necessary to further describe the MMI and its correlation with PA program educational outcomes and the impact on diversity.

Scholarly Productivity and Occupational Stress Among Physician Assistant Educators.

PURPOSE: Academic scholarship continues to challenge physician assistant (PA) educators in the United States, who typically enter academia with little experience in research or publication. Consequently, difficulty with navigating the promotion process might be expected to impact both job satisfaction and retention of PA faculty. Providing reasonable benchmarks for scholarship is one focus of this project, along with exploration of relationships among publication success, gender, job stressors, program support, and intent to leave academia. METHODS: Deidentified data from the online 2017 Faculty & Directors Survey was obtained from the Physician Assistant Education Association (PAEA), including gender, academic rank, program role, degree, publication numbers, and variables measuring program support, stressors, and intent to leave the institution or academia. Individual response rate was 60.3%, N = 1009. SPSS-v25 was used for data analysis. RESULTS: Respondents were 65% female. The mean number of total publications was 2.7 (down from 4.2 in 2010); the median was zero with 50.6% reporting no publications during their career. Almost half (45.5%) of PA faculty were stressed by research or publishing demands; 53.6% were stressed by the promotion process. Physician assistant educators stressed by promotion were more likely to consider leaving their institution or academia as a whole (Fisher's exact, P < .001 for both). CONCLUSION: This study updates publication benchmarks for PA educators. Scholarship levels have dropped since 2010, likely related to the recent influx of junior faculty. Navigating the promotions process is a significant occupational stressor for PA educators and is associated with faculty intent to leave academia.

Effect of Applicant Gender on Multiple Mini-Interview Admissions Score.

PURPOSE: Admissions criteria for physician assistant (PA) schools vary considerably, but they often involve a combination of academic measures, noncognitive "humanistic" qualities, and mission-related items. To address noncognitive attributes, some PA schools have implemented the multiple mini-interview (MMI) format developed at McMaster University in Canada. This research project looked at differences in interview scores by gender over 3 consecutive admissions cycles at one PA program. METHODS: Three years of pre-existing de-identified data gathered as part of the routine admissions process were analyzed retrospectively using SPSS-v25. RESULTS: Data were available for all interviewees for 2015, 2016, and 2017 (N = 350 total). Between-group differences were not statistically significant by gender. Reliability (Cronbach's α) was 0.865 for academic scoring and 0.694 for MMI scoring. DISCUSSION: Analysis of 3 years of admissions data from a single program did not show evidence for gender bias in MMI scores. Although this result is reassuring, it requires continued monitoring and replication.

Reliability and Validity of National End of Rotation Examinations: An Update.

PURPOSE: This study sought to evaluate the reliability of the PAEA End of Rotation™ exam scores used as a combined scale. The study also investigated how closely the individual exam scores and the combined scale correlate with Physician Assistant National Certifying Exam (PANCE) performance to validate their use as tools for assessing physician assistant (PA) students during their clinical training. METHODS: Deidentified PAEA End of Rotation examination and PANCE scores were used to calculate Pearson correlations, Cronbach's alpha, and value of Cronbach's alpha if individual exams were removed from the analysis. A linear regression model was generated to predict certification exam scores. RESULTS: End of Rotation examinations are a reliable predictor of certification examination performance independent of PA program or test version, with Cronbach's alpha at 0.847. CONCLUSIONS: The mean of all 7 examinations may be used, but the mean of just 4 examinations (Emergency Medicine, Family Medicine, General Surgery, and Internal Medicine) is also a valid predictor of certification examination performance.

Does previous healthcare experience increase success in physician assistant training?

OBJECTIVE: Healthcare experience is used by many physician assistant (PA) programs to rank applicants. Despite a large healthcare literature base evaluating admissions factors, little information is available on the relationship of healthcare experience and educational outcomes. We aimed to test whether previous healthcare experience is associated with increased success during the clinical portion of the PA educational process. METHODS: Hours of direct healthcare experience reported on Central Application Service for Physician Assistants applications for 124 students in the classes of 2009 through 2013 were associated with a calculated average preceptor evaluation score for each student and with average standardized-patient examination scores for a subset of students. RESULTS: Average student age was 28.7 years and median healthcare experience was 2,257 hours (range 390-16,400). Previous healthcare experience was not significantly correlated with preceptor evaluations or standardized-patient examination scores. CONCLUSIONS: This 5-year single institution pilot study did not support the hypothesis that healthcare experience is associated with improved clinical year outcomes.

Reliability and Validity of PAEA End of Rotation™ Examination Scores for Predicting Performance on the Physician Assistant National Certification Examination.

PURPOSE: In 2013, the Physician Assistant Education Association (PAEA) launched its End of Rotation™ examinations for student assessment of core clinical rotation content. Although being similar to the National Board of Medical Examiner's subject examinations ("shelf exams"), these examinations have not been characterized for reliability or validated against outcomes such as the Physician Assistant National Certification Examination (PANCE). This study's objective was to determine whether a composite scale based on all 7 PAEA End of Rotation examinations can be used as an effective measure of comprehensive medical knowledge for physician assistant (PA) students in their clinical year. METHODS: This study was a retrospective analysis of deidentified data gathered by 3 PA programs. Scores for all 7 PAEA End of Rotation examinations and for the PANCE were available for all students in the class of 2014 for all programs, with an overall N = 134. SPSS version 21 was used for descriptive and inferential data analysis. RESULTS: The overall Cronbach alpha for the 7 End of Rotation examination scores was 0.871. Pearson correlation coefficients for the End of Rotation examinations and the PANCE ranged from 0.47 to 0.68 and were statistically significant. Simple regression of a composite 7-item End of Rotation examination average gave an R of 0.810 and an adjusted R = 0.654 (P < .0005), explaining 65% of the variance in PANCE scores. CONCLUSIONS: This study provides solid evidence for the reliability of the composite 7-item End of Rotation score and the validity of using this composite score for the purpose of predicting whether the medical knowledge base in clinical PA students is adequate to pass the PANCE.

Outcomes of a nationwide mentoring program for physician assistant educators.

PURPOSE: Physician assistant (PA) program faculty recruited from clinical practice encounter many barriers to success in academia, contributing to high attrition rates. METHODS: In response, the PAEA Research Institute developed a nationwide mentoring program for junior PA educators in 2010-2011, focused on scholarship. The program was not well-utilized; more than half of the 33 early-career faculty originally enrolled in the program failed to contact their volunteer mentors despite signing formal agreements. RESULTS: Neither confidence levels nor actual scholarly productivity differed significantly between the initially matched and wait-list groups. Time devoted to scholarship at the midpoint and end of the program correlated significantly with number of papers produced during the mentorship year (Pearson 0.830 and 0.823, respectively, P < .0001). A separate qualitative follow-up survey identified lack of time, communication issues, and lack of structured expectations for scholarly output as significant barriers. CONCLUSION: These results suggest lack of time may interfere with mentoring relationships and scholarly success for early-career PA educators.

Snapshot of anatomy teaching in physician assistant education.

PURPOSE: Cadaver dissection has been a defining part of the culture of medical education for centuries. Currently there is an active debate regarding the advantages of dissection versus other forms of teaching anatomy. METHODS: De-identified data from the 2010 Curriculum Survey were obtained from the Physician Assistant Education Association, with 82 PA programs responding to anatomy curriculum questions. SPSS 21 was used for descriptive statistics, t-tests, and Mann-Whitney tests. RESULTS: Programs reported a mean of 102.4 and median of 91 contact hours in anatomy (range 4-270). The "average" PA program anatomy course used 57.4% lecture, 4.6% simulation, 25.9% dissection, and 12.1% prosection. Private programs had significantly fewer total and lab contact-hours than public programs. DISCUSSION: Teaching anatomy through cadaver dissection poses many challenges for health professions educators. Based on the results presented, PA programs are addressing this challenge in a variety of ways in their curricula.

Benchmarking the scholarly productivity of physician assistant educators: an update.

PURPOSE: Success in scholarship has long challenged physician assistant (PA) educators, most of whom enter academia with little experience in research or writing. Since most PA programs grant a professional graduate degree, and expectations for PA faculty typically focus on teaching and service rather than research, it is reasonable for promotion and tenure decisions to be based on comparisons from within the PA education realm. Providing such benchmarks is the focus of this report. Predictors of successful publication and trends over time are also explored briefly. METHODS: De-identified data from the 2010 Faculty Survey were obtained from the Physician Assistant Education Association (PAEA), including basic demographics, faculty rank and program role, degree, and number of peer-reviewed publications. PAEA distributed the online survey in March 2010 to all faculty associated with member programs. The response rate was 35%, N = 425. SPSS version 19 was used for data analysis. RESULTS: Respondents were 58.1% female. The mean number of publications reported by respondents over their entire career was 4.2, and over the last 3 years was 1.7. The respective median numbers of publications were one and zero. Logistic regression analysis identified three significant predictors of publication success: number of years in PA education, previous publications, and highest degree attained. CONCLUSIONS: This study seeks to provide rational benchmarks for PA program faculty seeking promotion or tenure. Previous publications and highest degree attained are key factors predicting successful publication. There is a continuing need for faculty development activities to help PA educators publish successfully.