A National Survey of Quality Improvement Education in Physician Assistant Programs.

PURPOSE: Quality improvement (QI) is emerging as a leadership and career track for physician assistants (PAs). Information on how PA programs teach QI is sparse. This study aimed to define how PA programs are providing education in QI through a national program survey. METHODS: Curriculum survey questions were deployed as a part of the 2014-2015 Physician Assistant Education Association program survey. Questions were grouped into 4 categories: QI champion, pedagogy, integration strategy, and curriculum content. Differences between groups were analyzed, and logistic regression models were built to explore associations. RESULTS: All 194 (100%) PA programs responded to the survey. There were 137 (70.6%) programs that were teaching QI. The median number of total instructional hours was 12 (interquartile range = 16, overall range = 109). There were 37 (27%) programs that were categorized as having a "mature curriculum." Mature curricula were significantly associated with a QI champion who is an expert from an outside department/institution (odds ratio [OR], 5.05; 95% confidence interval [CI], 1.14-22.33) and with programs that have a QI capstone or thesis project (OR, 3.66; 95% CI, 1.14-11.72) whose educational hours correlated more with experiential learning (r = 0.51, P < .01), small group sessions (r = 0.42, P = .01), and web-based modules (r = 0.36, P = .03). CONCLUSION: Quality improvement is an important skill set for PAs, but nearly one-third of PA programs do not have a QI curriculum. Mature curricula were associated with more experiential learning and project-based learning (including capstone/thesis). This study captured many elements of QI education for PAs, which can be used by programs to develop and improve their curricula.

Patient-Centered Medical Home Exposure and Its Impact on PA Career Intentions.

BACKGROUND AND OBJECTIVES: The transformation of primary care (PC) training sites into patient-centered medical homes (PCMH) has implications for the education of health professionals. This study investigates the extent to which physician assistant (PA) students report learning about the PCMH model and how clinical exposure to PCMH might impact their interest in a primary care career. METHODS: An electronic survey was distributed to second-year PA students who had recently completed their PC rotation from 12 PA programs. Descriptive statistics and ordered logistic regression analyses were used to characterize the results. RESULTS: A total of 202 second-year PA students completed the survey. When asked about their knowledge of the new health care delivery models, 30% of the students responded they had received instruction about the PCMH. Twenty- five percent of respondents stated they were oriented to new payment structures proposed in the Affordable Care Act and quality improvement principles. Based on their experiences in the primary care clerkship, 64% stated they were likely to pursue a career in primary care, 13% were not likely, and 23% were unsure. Predictors of interest in a primary care career included: (1) age greater than 35 years, (2) being a recipient of a NHSC scholarship, (3) clerkship site setting in an urban cluster of 2,500 to 50,000 people, (4) number of PCMH elements offered at site, and (4) positive impression of team-based care. CONCLUSIONS: PA students lack adequate instruction related to the new health care delivery models. Students whose clerkship sites offered greater number of PCMH elements were more interested in pursuing a career in primary care.

Primary Care Teams, Composition, Roles, and Satisfaction of PA Students During Primary Care Rotations.

PURPOSE: The goal of t his study was to describe the characteristics of primary care teams, activities, and ro les of physician assistant (PA) students as they encounter various primary care sites. METHODS: An electronic survey was distributed to second year PA students in 12 programs who had completed at least 4 weeks in a primary care rotation. RESULTS: Of the 179 students who responded (response rate 41 %), 88% had completed their primary care rotations in urban settings, mostly in private practices (53%). Physician assistant students reported encountering many types of health care providers on their teams, and the 2 most favored features of the rotations were the interactions with their supervising clinicians and clinical responsibilities. About 68% interacted with other health profession students during their rotation(interprofessional experiential learning). Almost all students completed histories, physical examinations, and treatment plans, but less than 30% reported involvement in billing or care coordination and less than 10% participated in quality improvement projects. More than 60% were satisfied with team-based and interprofessional practices encountered during their primary care rotations, and 39% were more than likely to pursue primary care careers. CONCLUSIONS: Team-based prima ry ca re had a positive impact on students, but more exposure to underserved clinical settings, care coordination, quality improvement, and billing is needed to prepare PA students for the practice of the future. This study is t he first of its kind to explore the relationship between primary care sites and PA training in the era of health care reform.

Patient-centered medical homes and physician assistant education: preparing the PA student for the practice of the future.

PURPOSE: The patient-centered medical home (PCMH) holds promise for improving primary health care delivery, but little is known about its impact on medical education. The purpose of this study was to examine the extent to which physician assistant (PA) students are exposed to elements of the PCMH during the didactic and clinical phases of their education. METHODS: A survey was distributed to clinical coordinators at all accredited PA programs in the United States that met the study inclusion criteria. The survey inquired about curricula central to practice in the PCMH: team-based care, electronic medical record utilization, and principles of care coordination. RESULTS: Of the 211 clinical coordinators that were surveyed, we received responses from 87 (41%), of which 94% stated that they teach principles of interprofessional team-based practice during the didactic phase. Sixty percent or more teach concepts related to physician-directed teams, quality improvement, care coordination, and electronic medical records. Only 25% of respondents provide instruction in payment structures that reward care coordination and high quality care, and 22% stated that their students do not have exposure to the PCMH. Most importantly, less than 25% of respondents utilize designated PCMH clinical sites, and those that do have been doing so for less than two years. CONCLUSION: Many PA programs teach some of the core concepts of PCMH during the didactic phase, but exposure to PCMH during clinical clerkships remains limited. Concerted effort is needed to better prepare PA students to function in these emerging team-based practices.

Career patterns of physician assistants: a retrospective longitudinal study.

OBJECTIVES: A distinguishing characteristic of the physician assistant (PA) profession is career flexibility to move between specialties without further training or certification. The objectives of this study were to characterize the number and type of practice specialties and to explore attitudes towards career flexibility. METHODS: Practice patterns were examined using a survey of AAPA member and non-member graduates from the classes of 1978, 1988, and 1998. RESULTS: Overall, respondents (n = 1,703; 31%) reported practicing in an average of 1.95 specialty practices per decade over the course of their career (range, 1-18; SD, 1.40). Adjusted for the number of decades elapsed postgraduation, the 1978, 1988, and 1998 cohorts practiced in an average of 1.08 (SD, 0.71), 1.51 (SD, 1.02), and 2.41 (SD, 1.49) specialties per decade, respectively (P < 0.0001; all pair-wise comparisons significant, P < 0.001). CONCLUSIONS: Most PAs change specialties during their career, and this trait of the profession is highly valued.