Anita Duhl Glicken

Addressing the hidden curriculum: Understanding educator professionalism

Several authors agree that student observations of behaviors are a far greater influence than prescriptions for behavior offered in the classroom. While these authors stress the importance of modeling of professional relationships with patients and colleagues, at times they have fallen short of acknowledging the importance of the values inherent in the role of the professional educator. This includes relationships and concomitant behaviors that stem from the responsibilities of being an educator based on expectations of institutional and societal culture. While medical professionals share standards of medical practice in exercising medical knowledge, few have obtained formal training in the knowledge, skills and attitudes requisite for teaching excellence. Attention needs to be paid to the professionalization of medical educators as teachers, a professionalization process that parallels and often intersects the values and behaviors of medical practice but remains a distinct and important body of knowledge and skills unto itself. Enhancing educator professionalism is a critical issue in educational reform, increasing accountability for meeting student needs. Assumptions regarding educator professionalism are subject to personal and cultural interpretation, warranting additional dialogue and research as we work to expand definitions and guidelines that assess and reward educator performance.

Neonatal Loss in the Intensive Care Nursery: Effects of Maternal Grieving and a Program for Intervention

This paper describes the reactions of 38 mothers whose infants died in a regional transport neonatal intensive care unit. Most described their infants death as having a major impact on their functioning, although the impact had lessened by 9 months following the loss. In an attempt to help parents whose infant was about to die, a “neonatal hospice program” was implemented. Maternal report indicated that the program had increased staff involvement with families both during and following the infants death and these additional contacts were described as helpful by most of the women interviewed.

Evaluation of Electronic Discussion Groups as a Teaching/Learning Strategy in an Evidence-based Medicine Course: A Pilot Study

BACKGROUND As course directors, we wished to incorporate small group learning into our Evidence-based Medicine course for students to get feedback on the development of a well constructed, researchable clinical question. Scheduling of these groups was problematic. We sought to evaluate computer-mediated communication as an alternative to face-to-face small groups. METHODS Students were randomly assigned to either face-to-face small groups or asynchronous, electronic, small groups. Final examination scores were analyzed with an analysis of variance to determine if there were differences in student performance based on group type. Student survey items were analyzed using Fishers Exact test to determine if there were differences in student attitudes based on group type. RESULTS There were no significant differences found in overall student performance. Significant differences in student attitudes were found to exist with respect to: (1) participation in discussions, with face-to-face groups reporting greater participation; (2) putting more thought into comments, with electronic groups reporting more thought put into comments; and (3) difficulty relating to other students in the class, with electronic groups reporting more difficulty. DISCUSSION We found electronic discussion groups (computer-mediated communication) to be a viable teaching/learning strategy with no adverse effects on student performance or attitudes.

Physician assistants: from pipeline to practice.

For over four decades, physician assistants (PAs) have demonstrated that they are effective partners in a changing health care environment, readily adaptable to the needs of an evolving delivery system. With increased expectations of physician shortages, especially in primary care, PAs will be called on to fill provider gaps and new roles in interprofessional team-based delivery systems. There are over 90,000 certified PAs in the workforce and 173 accredited programs yielding an estimated 6,545 graduates annually, with an estimated 65 new programs seeking provisional accreditation by the end of 2016. New data on the PA pipeline and practice provide key information about the potential of this workforce; however, the overall impact of the PA pipeline on projected shortages remains unclear. Barriers exist to optimal deployment, including faculty shortages, scope-of-practice regulations, and a lack of clinical placement sites. This article brings together data from the Physician Assistant Education Association and the National Commission on Certification of Physician Assistants and its supporting organization, the nccPA Health Foundation. Primary sources include PA candidates, educational programs, students, and certified PAs. Collectively, these data provide a comprehensive picture of PAs’ contributions to the health care workforce. Armed with pipeline and graduate practice data, policy makers and workforce planners will be equipped to design new models of practice that maximize the potential contributions of this growing PA workforce on health care teams.

A neonatal end-of-life palliative protocol--an evolving new standard of care?

IN 1979 THE CHILDREN’ S Hospital, Denver began to address the needs of the unfortunate group of infants who exhibit evidence of poor prognosis and for whom the question is raised whether any more should be done to prolong their lives.1 This program for the NICU was based on concepts first introduced and popularized by the hospice movement.2,3 It was recognized that generally NICU staff are concerned with neonatal survival—a rescue mode of care. Staff are often ill-equipped to provide adequate care to the family of the dying infant. This program proposed a new approach to the very difficult issues involved in the care of these very sick and dying infants. The Neonatal Hospice Program was a comprehensive plan focusing on four main areas: decisionmaking process and shift to palliative care, creation of a home-like, family room setting for the infant and family, involvement of family in the dying process and hospice training for NICU staff. Over the past 20 years, elements of this program have been implemented in many NICUs. However, the adaptation of a comprehensive program for palliative neonatal care has not been universally implemented. NICU staff and families of dying infants continue to seek change in hospital practice. Catlin and Carter have undertaken important research in exploring current trends in the care for the infant from whom life support is withdrawn or withheld.

Results of the PAEA 2006 Survey Of PA Program Expansion Plans

INTRODUCTION Forty years ago, the nation faced a projected health care crisis as the number of trained medical professionals was growing at a slower rate than the patient population they cared for. The physician assistant (PA) was created in response to this crisis, an innovative health care professional who could help address the unmet health care needs of a growing population. Echoing publications of the 1960s, recent literature suggests that the nation will again soon face a critical shortage of physicians.1 In response, the Association of American Medical Colleges (AAMC) has recommended a 30% increase in the number of US medical school graduates over the next 10 years.2 Similarly, the Council on Graduate Medical Education has recommended increasing the number of physicians entering residency training from the recent level of 24,000 in 2002 to 27,000 in 2015. Currently, almost 25% of these slots are filled by international medical graduates (IMGs), a fact that has been noted as particularly problematic for the undeveloped donor countries that provide much of this workforce.3 It is clear that our medical colleagues are moving forward with agendas to increase the number of providers in the workforce.1,2 It is also clear that the projected shortage may represent an opportunity for the PA profession. The American Academy of Physician Assistants (AAPA) recently addressed this issue with a 2006 House of Delegates resolution supporting “efforts that promote and foster creative solutions to health care shortages that include expansion and access to physician-PA teams to meet anticipated requirements for health care services.” The AAPA estimates that there are currently more than 63,000 PAs in clinical practice.4 To better understand and inform the Physician Assistant Education Association’s (PAEA’s) participation in the national dialogue on this important issue, in August 2006 PAEA distributed a survey to all accredited PA programs. The survey’s purpose was to gain information about anticipated program growth and projected numbers of PA graduates. The survey also gathered information on participants’ knowledge of new PA programs or allopathic or osteopathic medical schools planned for their areas. It is hoped that data from this survey will inform the ongoing discussion of workforce shortages and the projected unmet need that might be addressed by the PA profession.

The relationship between infant play with inanimate objects and social interest in mother.

This paper discusses the interrelationship between infant play with inanimate objects and social interest in mother from 12 to 18 months of age. This study demonstrates that during unstructured play, with mother available, there are two shifts in play and social behavior. The complexity of play with inanimate objects increases between 12 and 15 months of age. Between 15 and 18 months of age, there is a shift in social interest in mother while the complexity of inanimate object play remains constant. This is probably the result of competition between inanimate object play and interest in mother at 18 months.

The Future of Physician Assistant Education

INTRODUCTION Building foresight about the future is a critical component of planning for growth in any profession. As an essential arm of the profession, physician assistant (PA) education programs prepare competent and qualified practitioners to meet the evolving needs of the US health care system and to an increasing extent, global health care needs. Therefore it is incumbent upon PA educators and their representative organizations to monitor emerging trends, forces, and other factors in the education, health care industry, and clinical medicine arenas that that could potentially affect future health care and the PA profession. The short lag time between the beginning of a student’s education and clinical practice, combined with the speed and amount of change occurring in the many areas that affect health care, challenge faculty to stay ahead of the curve to ensure the relevance of the curriculum. Because it is nearly impossible to predict the future of health care, the key to operating successful programs will be the ability of PA education leadership, equipped with vision and flexibility, to efficiently and rapidly implement the changes required to respond to the needs of students and society. This paper will explore the impact of emerging trends and forces that may affect PA education. Rather than attempt to predict specific outcomes, we present potential opportunities and challenges for PA programs and faculty. The intent is to sensitize PA educators to impending issues and forces and to reinforce our belief that as educators we have an obligation to continually monitor the global and national health care environments in order to prepare practitioners for the future and not just the present.

The Child Heath Associate Physician Assistant Program — An Enduring Educational Model Addressing the Needs Of Families and Children

In contrast to what one might expect, this quote does not come from a recent medical journal. Forty years ago it provided a context for the development of three unique programs designed to address health care disparities and a predicted pediatric workforce shortfall. Henry K. Silver, MD, professor and vice-chairman of the Department of Pediatrics at the University of Colorado Health Sciences Center (UCHSC) addressed the needs of the country’s children by creating an innovative model for health care delivery, in part supported by new pediatric health care professionals who could support and complement the skills and training of their pediatrician colleagues. The first nurse practitioner (NP) program in the country was created in the Department of Pediatrics at the University of Colorado School of Medicine. The Pediatric Nurse Practitioner (PNP) program, launched as a joint venture by Dr. Silver (School of Medicine) and Loretta C. Ford, EdD, RN, PNP (School of Nursing), graduated its first students in 1965. This program, designed to increase the productivity of pediatricians, prepared nurses to assume an expanded role in providing comprehensive health services to children. The PNP was educated to provide almost total care for the well child as well as to manage the problems of the majority of sick and injured children commonly seen in a pediatric practice. The two schools also established a School Nurse Practitioner Program. Most are aware of the long-term impact of these visionary efforts, but few realize that they were also instrumental in the creation of the PA profession. Eugene Stead, MD, in a letter dated November 1, 1981, acknowledged Dr. Silver’s important contributions related to the creation of the NP profession: “Your statement about the chronology is correct. The demonAnita Duhl Glicken, MSW, is professor of pediatrics and interim director of the Child Health Associate/Physician Assistant Program; Gerald Merenstein, MD, is medical director and was director of the CHA/PA program for 12 years; and Mary Arthur, MS, CHA/PA, was a graduate of the second CHA/PA class and a longtime associate director of the CHA/PA program, University of Colorado at Denver and Health Sciences Center, Denver, Colorado.

Best evidence-based practices: a historic perspective.

Neonatologists, neonatal nurses, and others who care for critically ill newborns hope that the care they provide will improve the health and the neurodevelopmental outcome of these neonates. In this progressive era of neonatal medicine, we must pause to look backward even as we look forward, taking full advantage of the opportunity to reflect on our short history and to review several important events in neonatal medicine that have contributed in a meaningful way to the evolution of evidence-based neonatal care. Six interventions highlight why randomized controlled trials are necessary to understand the risks and benefits of our interventions with premature and critically ill infants. We hope this history of the evolving practice of evidence-based neonatal care will enable the reader to have a greater appreciation for the consideration of each and every intervention that we take on behalf of the infants in our care.