Anthony A. Miller

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.

Value Added: Graduate-Level Education in Physician Assistant Programs

INTRODUCTION Statement of the Problem For many reasons, physician assistant (PA) educational programs have been moving over the past two decades toward offering exclusively the master’s degree, through a variety of curricular models and with a number of different types of master’s degrees. This movement has accelerated in recent years. At this writing, more than 90 of the 136 accredited PA programs offer a master’s degree or master’s option. But there has been little uniformity in how institutions sponsoring PA programs either transitioned existing programs to the graduate level or created new graduate-level programs, because no nationally developed standards or guidelines were available. In 2003 the membership of the Physician Assistant Education Association (then the Association of Physician Assistant Programs) charged the board of directors to commission a group to define the content and configuration of PA graduate preparation. The Graduate Education Commission (GEC), composed of senior PA educators and leaders, was charged with examining the emerging structures, content, and patterns of PA graduate education and curricula and with developing recommendations for educational institutions desiring guidance on making the transition to the graduate level. The specific charges to the group were as follows:

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.

Family Cultural Portrait and Cultural Perspectives of Death and Dying: Two Models of Cultural Competence Learning Experiences

Helping physician assistant (PA) students move toward cultural competence is an ongoing challenge for PA educators. The pressures of addressing all of the curricular components needed to produce a competent clinician in an average time frame of two years may result in a dilution of topics that may not be apparent on the certifying examination or perceived to be integral to the day-to-day practice of medicine. But educators are also challenged to provide effective instruction that addresses the affective domain, where the measures do not lend themselves to multiple-choice examinations or other objective measures. In particular, consideration of cultural differences evokes anxiety in some and is viewed as a topic to be avoided. Nonetheless, we can agree with Locke that “the need for new and different models for working with culturally different populations in the United States is imperative. We must be aware of the many values that each culturally diverse group adds to the quality, vitality, and the strength of the nation.”1 We have found that often students do not recognize the cultural richness and diversity present in their own families. Having students develop a family cultural portrait can be an excellent way to begin the exploration of cultural diversity in a relatively safe yet personal manner. In addition, student consideration of death and dying from a cultural perspective has proven to be an enlightening experience for all concerned. Over the past four years, Tony Miller’s course “Humanities for the PA Profession,” has required students to develop a twoto three-page cultural portrait of their families. The required components include: (1) racial and ethnic roots, (2) socioeconomic profile, (3) general values and beliefs, (4) artifacts, and (5) values, beliefs, and traditions regarding health care. Summaries are shared in class. Similarly yet independently, Rena Bass at the Downstate Medical Center Physician Assistant Program has encouraged students to consider issues of chronic care and reaction to death and dying from a cultural perspective. In the course “Gerontology and LongTerm Care,” students research views, reactions, and approaches to aging and death and dying from a cultural perspective and share their findings in an informal educational arena, generally on the great lawn of the campus.

Expansion of Physician Assistant Education.

Abstract Physician assistant (PA) educational programs were created in the 1960s to prepare a new type of health care practitioner. Physician assistant programs began as experiments in medical education, and later, they proved to be highly successful in preparing capable, flexible, and productive clinicians. The growth of PA educational programs in US medical education—stimulated by grants, public policy, and anticipated shortages of providers—has gone through 3 distinct phases. At present, such programs are in the midst of the third growth spurt that is expected to continue beyond 2020, as a large number of colleges and universities seek to sponsor PA programs and attain accreditation status. Characteristics of these new programs are described, and the implications of the current expansion of PA education are examined.

Reinventing the Hospital Handoff for Clinical Education.

Health care providers and hospital administrators have continually looked to enhance hand-off processes and communications to help avoid discontinuity of care and potential errors. “Handoff” describes the communication process and information exchange used by providers when the responsibility for patient care is transferred from one provider to another, from emergency department to inpatient, from one hospital service to another, and from inpatient tooutpatient or to rehabilitation. Breakdown in these types of communication was identified as the leading cause of sentinel events in the United States. The literature is rich with examples of specialty-specific, profession-specific, and setting-specific tools used for handoffs. And research has demonstrated that patient safety and better outcomes are related to standardization of the hand-off procedures. Concern for patient safety has led to hand-off recommendations by The Joint Commission and the World Health Organization. Both the American Board of Pediatrics and the Association of American Medical Colleges define handoffs as a core “entrustable professional activity.” “I-Pass” is one mnemonic used in some settings, particularly in graduate medical education, to help standardize handoffs and decrease the incidence of preventable adverse events. The I-Pass mnemonic stands for: • Illness severity • Patient summary • Action list (to-do items) • Situation awareness and contingency plans • Synthesis by receiver