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.

Impact of a Longitudinal Medical Spanish Curriculum on Student Communication Skills.

PURPOSE: This study describes and examines the short- and longer-term impact of a required longitudinal medical Spanish curriculum on physician assistant student preparedness and ability to communicate with patients in Spanish during clinical rotations. METHODS: Fifty-eight preclinical students participated in an 80-hour curriculum delivered weekly over 3 semesters. Teaching followed a framework of second-language acquisition and included structured grammar and medical vocabulary practice with didactic, interactive, and group assignments. Vocabulary and grammar were assessed with quizzes. Oral proficiency was assessed by faculty with Spanish Objective Structured Clinical Examination (OSCE) stations at midpoint and end using the Interagency Language Roundtable (ILR), a 6-level scale (immediate outcome). Students self-rated proficiency and confidence and evaluated curriculum effectiveness for preparing them to care for Spanish-speaking patients (longer-term outcomes). RESULTS: All students passed the written and oral quizzes. Faculty-scored ILR verbal proficiency at the OSCEs increased by a mean level of 0.5 over 6 months. Student self-assessed proficiency improved on average by one level from baseline to 24 months later. Students rated highly curriculum effectiveness, preparedness to communicate in Spanish during clinical rotations, ability to judge when an interpreter was needed, and the importance of medical Spanish to future practice. CONCLUSIONS: A required integrated longitudinal medical Spanish curriculum was well received. Physician assistant students demonstrated short-term interval progression in Spanish proficiency, with improvements in both faculty and self-rating scores, and readiness to apply the skill to practice. They valued active learning associated with repeated practice with feedback, role playing, and interval assessments throughout the curriculum.

When less is more: validating a brief scale to rate interprofessional team competencies.

BACKGROUND: There is a need for validated and easy-to-apply behavior-based tools for assessing interprofessional team competencies in clinical settings. The seven-item observer-based Modified McMaster-Ottawa scale was developed for the Team Objective Structured Clinical Encounter (TOSCE) to assess individual and team performance in interprofessional patient encounters. OBJECTIVE: We aimed to improve scale usability for clinical settings by reducing item numbers while maintaining generalizability; and to explore the minimum number of observed cases required to achieve modest generalizability for giving feedback. DESIGN: We administered a two-station TOSCE in April 2016 to 63 students split into 16 newly-formed teams, each consisting of four professions. The stations were of similar difficulty. We trained sixteen faculty to rate two teams each. We examined individual and team performance scores using generalizability (G) theory and principal component analysis (PCA). RESULTS: The seven-item scale shows modest generalizability (.75) with individual scores. PCA revealed multicollinearity and singularity among scale items and we identified three potential items for removal. Reducing items for individual scores from seven to four (measuring Collaboration, Roles, Patient/Family-centeredness, and Conflict Management) changed scale generalizability from .75 to .73. Performance assessment with two cases is associated with reasonable generalizability (.73). Students in newly-formed interprofessional teams show a learning curve after one patient encounter. Team scores from a two-station TOSCE demonstrate low generalizability whether the scale consisted of four (.53) or seven items (.55). CONCLUSION: The four-item Modified McMaster-Ottawa scale for assessing individual performance in interprofessional teams retains the generalizability and validity of the seven-item scale. Observation of students in teams interacting with two different patients provides reasonably reliable ratings for giving feedback. The four-item scale has potential for assessing individual student skills and the impact of IPE curricula in clinical practice settings. ABBREVIATIONS: IPE: Interprofessional education; SP: Standardized patient; TOSCE: Team objective structured clinical encounter.

What and how do students learn in an interprofessional student-run clinic? An educational framework for team-based care.

BACKGROUND: The student-run clinic (SRC) has the potential to address interprofessional learning among health professions students. PURPOSE: To derive a framework for understanding student learning during team-based care provided in an interprofessional SRC serving underserved patients. METHODS: The authors recruited students for a focus group study by purposive sampling and snowballing. They constructed two sets of semi-structured questions for uniprofessional and multiprofessional groups. Sessions were audiotaped, and transcripts were independently coded and adjudicated. Major themes about learning content and processes were extracted. Grounded theory was followed after data synthesis and interpretation to establish a framework for interprofessional learning. RESULTS: Thirty-six students from four professions (medicine, physician assistant, occupational therapy, and pharmacy) participated in eight uniprofessional groups; 14 students participated in three multiprofessional groups (N = 50). Theme saturation was achieved. Six common themes about learning content from uniprofessional groups were role recognition, team-based care appreciation, patient experience, advocacy-/systems-based models, personal skills, and career choices. Occupational therapy students expressed self-advocacy, and medical students expressed humility and self-discovery. Synthesis of themes from all groups suggests a learning continuum that begins with the team huddle and continues with shared patient care and social interactions. Opportunity to observe and interact with other professions in action is key to the learning process. DISCUSSION: Interprofessional SRC participation promotes learning 'with, from, and about' each other. Participation challenges misconceptions and sensitizes students to patient experiences, health systems, advocacy, and social responsibility. Learning involves interprofessional interactions in the patient encounter, reinforced by formal and informal communications. Participation is associated with interest in serving the underserved and in primary care careers. The authors proposed a framework for interprofessional learning with implications for optimal learning environments to promote team-based care. Future research is suggested to identify core faculty functions and best settings to advance and enhance student preparation for future collaborative team practice.

Interprofessional Education: What Measurable Learning Outcomes Are Realistic for the Physician Assistant Profession?

PURPOSE: To compare physician assistant (PA) students' attitudes regarding interprofessional education by students' seniority, gender, age, and previous experience with interprofessional education. METHODS: The validated 19-item Readiness for Interprofessional Learning Scale and the 12-item Interdisciplinary Education Perception Scale were administered to matriculating and graduating PA students from 2 US institutions (N = 186). Primary outcomes were score differences by subgroup and institution using independent sample t-tests. We also examined scale validity measured by Cronbach's alpha (internal consistency) and Pearson correlation coefficients (concurrent validity). RESULTS: Student demographics at both institutions were similar. Initial comparisons did not demonstrate significant institutional differences. Consequently, data were combined for subsequent analyses. Matriculating students had significantly higher mean Readiness for Interprofessional Learning Scale scores than did graduating students. No significant differences were found by gender, age, or previous interprofessional education exposure for either scale. Both scales demonstrated high internal consistency (Readiness for Interprofessional Learning Scale α = 0.93; Interdisciplinary Education Perception Scale α = 0.84). CONCLUSIONS: Physician assistant student attitudes regarding interprofessional education are very positive at matriculation and are less positive at graduation. Physician assistant student attitudes do not vary by gender, age, or previous interprofessional education exposure. Physician assistant educators should ensure that students' interprofessional education exposure makes full use of the students' initial positive attitudes and focuses on skill development for interprofessional education competencies.

Adapting the McMaster-Ottawa scale and developing behavioral anchors for assessing performance in an interprofessional Team Observed Structured Clinical Encounter.

BACKGROUND: Current scales for interprofessional team performance do not provide adequate behavioral anchors for performance evaluation. The Team Observed Structured Clinical Encounter (TOSCE) provides an opportunity to adapt and develop an existing scale for this purpose. We aimed to test the feasibility of using a retooled scale to rate performance in a standardized patient encounter and to assess faculty ability to accurately rate both individual students and teams. METHODS: The 9-point McMaster-Ottawa Scale developed for a TOSCE was converted to a 3-point scale with behavioral anchors. Students from four professions were trained a priori to perform in teams of four at three different levels as individuals and teams. Blinded faculty raters were trained to use the scale to evaluate individual and team performances. G-theory was used to analyze ability of faculty to accurately rate individual students and teams using the retooled scale. RESULTS: Sixteen faculty, in groups of four, rated four student teams, each participating in the same TOSCE station. Faculty expressed comfort rating up to four students in a team within a 35-min timeframe. Accuracy of faculty raters varied (38-81% individuals, 50-100% teams), with errors in the direction of over-rating individual, but not team performance. There was no consistent pattern of error for raters. CONCLUSION: The TOSCE can be administered as an evaluation method for interprofessional teams. However, faculty demonstrate a 'leniency error' in rating students, even with prior training using behavioral anchors. To improve consistency, we recommend two trained faculty raters per station.

Knowledge and attitude change in physician assistant students after an interprofessional geriatric care experience: a mixed methods study.

PURPOSE: To examine changes in physician assistant (PA) student attitudes and knowledge about interprofessional education (IPE) after participation in a longitudinal community-based curriculum. METHODS: Second-year PA students participated in an interprofessional geriatrics curriculum. Faculty-facilitated IPE teams met three times and assessed one adult patient longitudinally over 8 months. Attitudes of student participants and their nonparticipating peers (comparison group) were assessed pre- and postcurriculum using the validated Readiness for Interprofessional Learning Scale (RIPLS). Reflections submitted by participants after each session were analyzed thematically. RESULTS: No significant differences in RIPLS scores were found compared with baseline for either group; participating students had significantly higher baseline scores compared with nonparticipating students. Qualitative analysis of participant reflections revealed two major themes: "roles and scope of practice of other health professions"; and "applicability of team-based care to practice" with a temporal change in theme pattern over one year. CONCLUSION: Volunteer student participants had a more positive attitude toward interprofessional learning than nonparticipants. Primary learning occurred about roles of other professions and the value of team-based care. The mixed evaluation methodology allowed examination of attitudes, knowledge, and underlying ("informal" or "hidden") learning.

A comparison of two scales for assessing health professional students' attitude toward interprofessional learning.

RATIONALE: The validated 19-item Readiness for Interprofessional Learning Scale (RIPLS) is often used for assessing attitudes toward interprofessional education (IPE). The 12-item Interdisciplinary Education Perception Scale (IEPS), also used for this purpose, has not been validated among the professions of medicine, pharmacy, and physician assistants (PAs). The discriminatory ability of the two scales has not been directly compared. Comparison of the two will aid educators in selecting the optimal scale. OBJECTIVE: To compare psychometric properties of the RIPLS and IEPS and to examine the ability of each scale to discriminate mean scores among student subgroups (gender, profession, seniority, and prior IPE exposure). METHOD: We conducted a cross-sectional (Qualtrics(©)) survey (RIPLS and IEPS) of junior and senior students in medicine (n=360), pharmacy (n=360), and the PA profession (n=106). Descriptive statistics were used to report aggregate mean scores of subgroups. The internal consistency of each scale was assessed using Cronbach's α. Concurrent validity was measured by Pearson's correlation coefficients. Independent-sample t-tests and analysis of variances (ANOVAs) were performed to assess the discriminatory ability of each scale. Cohen's d effect sizes were calculated for all significant pair-wise comparisons. RESULTS: Response rate was 82%. Cronbach's α was 0.85 (RIPLS) and 0.91 (IEPS). The RIPLS discriminated scores by gender among junior students only, and scores by IPE exposure among all students. The IEPS distinguished score differences for the three professions among junior students and by prior IPE exposure for all three professions. Neither scale detected differences in mean scores by profession among all students or by level of training among the three professions. CONCLUSIONS: Neither the RIPLS nor the IEPS has greater discriminatory ability for detecting attitude differences among the student subgroups. Reason for differences may be explained by slightly different scale constructs. The RIPLS is designed to assess students' own attitude toward interprofessional learning, while the IEPS discerns perceived attitudes about team collaboration for students' own professions and may be more appropriate for more advanced students.

Physician assistant students' views regarding interprofessional education: a focus group study.

PURPOSE: The purpose of this study was to identify and report physician assistant (PA) student experiences, learning, and opinions regarding interprofessional education (IPE). METHODS: A series of open-ended questions was constructed and designed to solicit PA students' opinions about the need for IPE, preferred teaching strategies, and implementation methods, using focus group methodology. We used two sets of questions, one for students who had participated in a formal geriatrics IPE experience (n = 12), the other for students who did not have the experience (n = 10). Focus group sessions were audiotaped and transcripts coded. Key themes were identified and ranked. RESULTS: Twenty-two students participated in four focus groups. Theme saturation was reached and six overlapping themes emerged: (1) PA students learned the most about occupational and physical therapist roles; (2) They were surprised at other professions' lack of knowledge about the PA profession; (3) They strongly expressed that IPE should be required early in training; (4) They expressed preference for direct patient care with other health professions students, with trained faculty oversight; (5) They requested diverse clinical settings; and (6) They identified the optimal number of different students in a single IPE experience as four/five. The group exposed to geriatrics IPE noted the critical importance of faculty training for facilitation, while the nonexposed group emphasized the challenge of limited curricular time. CONCLUSION: PA students recognize the importance of IPE and request early, required clinical experiences led by well-trained interprofessional faculty with the option to choose clinical sites. Student preferences should be considered in IPE curriculum design.

Anthrax exposure--stay alert, act swiftly.

Initiating appropriate antibiotic therapy as soon as anthrax infection is suspected is not only acceptable but is also justified by the outcomes of the 2001 anthrax cases.