Carl E. Fasser

The Ethics Workup: A Case-Based Approach To Ethical Decision-Making Instruction

&NA; Students need a moral compass to cope with the real ethical dilemmas they face from their earliest training. However, the best way to accomplish this objective is not clear, despite a mandate for such learning experiences in the standards for the accreditation of physician assistant (PA) programs. A structured Ethics Workup has been part of the Baylor College of Medicine PA Program medical ethics course since 2000. Where there is general ethical consensus the work‐up helps students develop a management plan that is ethically justified and consistent with the consensus position. For controversial cases, the work‐up teaches students how to make a well‐reasoned ethically justified argument for a particular course of action. Seven faculty‐facilitated small group sessions provide the context in which the students learn to use the work‐up as a tool for case analysis and decision making. Two case vignettes are addressed in each group session, progressing in complexity from straightforward to more challenging. Students discuss the cases, argue their views based on logic, and defend their reasons for disagreement with the priorities among the appeals. Knowledge gain and capacity to decide when faced by an ethical dilemma is measured using a multiple‐choice exam coupled with the written analysis of a case vignette using the Ethics Workup. Qualitative and quantitative feedback indicates that the Ethics Workup is a helpful tool for analyzing cases bolstered by quality small group case discussions.

Development and Implementation of a Health Behavioral Counseling Curriculum for Physician Assistant Cancer Education

A health behavioral counseling curriculum grounded in Motivational Interviewing and the Transtheoretical Model of behavior change was developed to enhance knowledge and clinical skill among physician assistant (PA) students in managing cancer risk behaviors. A literature and curriculum review informed course content, teaching strategies, and learning activities. The course was evaluated over two pilot years. Students demonstrated increased knowledge and skills regarding the basic principles of the intervention models. The course was integrated into the pre-clinical year of PA training and will be disseminated, beginning with a faculty development workshop for all PA training programs in Texas, USA.

Project-Based Learning for Physician Assistant Students: A Retrospective Assessment of the Master's Paper Project at the Baylor College of Medicine Physician Assistant Program

Background: The accreditation standards for physician assistant (PA) programs require that students be equipped to search, interpret, and apply the results of medical research to patient care, as well as maintain a critical, current, and operational knowledge of new medical findings. This mandate led to the incorporation of the masters paper project (MPP) into the curriculum of the Baylor College of Medicine PA Program. Methods: A retrospective characterization of the 425 MPP projects conducted between January 1990 and December 2007 was carried out. Results: The MPPs encompassed the basic science (6.1%), applied clinical (38.6%), and health services (55.3%) research arenas. Of the 212 faculty involved as mentors, 59 assisted with 198 (46.58%) of the research projects. The projects occurred most often in the areas of internal medicine (20.6%), family medicine (20.1%), pediatrics (18.8%), and surgery (10%). MPPs exploring aspects of PA practice doubled between 2000 and 2007. More than 90% of the MPPs were quantitative in design, involving both prospective (57.03%) and retrospective data collection, using surveys (35.3%) and chart reviews (37.0%). Of the 68 studies employing explanatory designs, cross‐sectional studies were used most often, with longitudinal follow‐up and educational interventions being the next most common. Most analyses used two to six different statistical tools with over half (57.83%) involving Students t‐test or chi‐square, and others using correlations, regression analysis, factor analysis, odds ratios, and survival curves. Conclusions: The research requirement has matured in terms of mentors involved, areas investigated (specifically those exploring aspects of PA practice), and the statistics used for data analysis.

The American Registry of Physiciansʼ Associates— Forerunner of the Association of Physician Assistant Programs

The old adage “success breeds success” describes the rapid proliferation of all types of “physician assistant” programs between 1965 and 1970. This unwieldy growth occurred prior to the development of accreditation standards in 1971 and national certification requirements in 1973. The curriculums for these “generalist” and “specialist” programs ranged in length from a few weeks to over four years, depending on the background of the student and on the role the “new health practitioner” was to play. Programs were located in medical schools, schools of allied health professions, universities, colleges, junior colleges, hospitals, clinics and Federal facilities. In 1970 the Board of Medicine of the National Academy of Sciences classified physician assistants as Type A, B and C according to their degree of specialization, level of clinical decision-making (judgment) and length of training. Several of the Type A universitybased programs, decided that they needed to form an organization to recognize the higher level of education and achievement of their graduates and to provide employing physicians some standard assurance of the graduates’ capabilities.

Teaching Physician Assistant History: Program Directorsʼ Impressions

The Journal of Physician Assistant Education | 2006 Vol 17 No 3 INTRODUCTION The need to understand the past of the physician assistant (PA) profession and its relationships to the future is embodied within the Standards of the Accreditation Review Commission on Education for the Physician Assistant (ARCPA), which require programs to provide students instruction on the history of the PA profession, as well as on current trends, legal issues, and other regulatory and professional issues.1 In 2003 the Physician Assistant History Center began identifying, collecting, cataloging, and imaging documents, articles, books, films, oral histories, and other artifacts of the history of the PA profession. Much of this information can be used to produce online learning modules on the history of the PA profession for use by programs. While the Society for the Preservation of Physician Assistant History has the expertise to develop, offer, and maintain a Web-based course, the lack of information about where to begin underscored the need for data collection. Understanding what was being taught to PA students about PA history was seen as a primary area for exploration. Funded by a grant from the Association of Physician Assistant Programs (APAP, now the Physician Assistant Education Association), our aim was to identify what was being taught to students about PA history; the methods, resources, and references used in the process; and the manner in which students are judged knowledgeable of the historical, political, and legal issues that impact their chosen profession. The remaining two objectives of this investigation are (1) to achieve consensus regarding the instructional goals, outcome objectives, content areas, and assessment methods essential to students’ understanding of the history, legacy, and political and legal issues affecting their chosen profession; and (2) to beta test the learning modules for a Web-based course on the history of the PA profession. Teaching Physician Assistant History: Program Directors’ Impressions

History Repeats Itself—Another Name Change for The Organization That Represents Physician Assistant Programs

In the wake of the recent vote by the membership of the Association of Physician Assistant Programs to change the organization’s name to Physician Assistant Education Association, it seems timely to look back at some of the other names and changes that PA professional organizations have gone through over the years. Change has been something of a constant in the evolution of our young profession and its representative bodies. Background In the 5 years following the opening of the first physician assistant (PA) program at Duke University in 1965, there was a tremendous proliferation of PA programs, with varying characteristics. Some programs trained graduates to be “generalists” in medicine, while others trained “specialists” to serve in a variety of medical and surgical subspecialties. Programs were located at medical schools, schools of allied health professions, universities, colleges, junior colleges, hospitals, clinics, and federal facilities, and their curricula ranged in length from a few weeks to 4 years. 1 The variations among programs produced PAs who differed greatly in their knowledge base, experiences, skills, and expertise. In 1970, the National Congress on Health Manpower investigated the emerging PA programs at the request of the American Medical Association’s (AMA) Council on Health Manpower and concluded that the generic term “physician’s assistant” was too general to distinguish between them and other health professionals. The council suggested that the term “associate” be used for those PAs trained to work in a direct, responsible, and collegial role with physicians. 2 In a similar attempt to distinguish between these practitioners’ qualifications, the Board of Medicine of the National Academy of Sciences in 1970 began classifying physician assistants as Type A, B, and C, according to their degree of specializatio n, level of clinical decision making (judgment), and length of training. The academy called upon the AMA, the Association of American Medical Colleges (AAMC), and the government to develop uniform standards for education, resolve legal issues, and establish a uniform system of testing and certification for such assistants. 3

The Importance of Teaching Professional History to Physician Assistant Students

Authors desiring to contribute to the “PA History” feature should forward submissions to Reginald Carter, PhD, PA, at: Physician Assistant History Office, DUMC 3848, Durham, NC 27710. Telephone: 919-681-3156; fax: 919-681-3371; e-mail: pahx@mc.duke.edu. Visual media should be accompanied by a brief narrative. Reginald Carter is director of the PA History Office located within the Department of Community and Family Medicine at the Duke University School of Medicine. The office is a joint venture of the Duke University School of Medicine, the American Academy of Physician Assistants, the Association of Physician Assistant Programs, and the National Commission on Certification of Physician Assistants. Additional information can be found on the Society for the Preservation of Physician Assistant History at http://pahx.org. Pam Moyers Scott, MPAS, PA-C; Carl E. Fasser, PA; Reginald Carter, PhD, PA