Carol A. Hildebrandt

Working effectively with interpreters: A model curriculum for physician assistant students

Background: Effective patient-provider communication is crucial to achieving good health care outcomes. To accomplish this with patients of limited English proficiency, learning to work effectively with interpreters is essential. Aims: The primary goal of this study was to determine if physician assistant students could effectively use interpreters to communicate with Spanish speaking patients after implementation of a cultural competency and Medical Spanish curriculum. Method: In year one of a three year implementation process, a module for teaching students to work effectively with interpreters was developed and implemented in the Wake Forest University School of Medicine Department of Physician Assistant Studies. After four hours of orientation, practice and role play, students were observed and recorded during a standardized patient assessment and evaluated by clinicians as well as by trained, bi-lingual evaluators. Results: In the Class of 2007, 94% (43 students) and in the Class of 2008, 96% (47 students) demonstrated competence. Conclusions: Our findings highlight the feasibility and usefulness of training students to work effectively with interpreters. Evaluation and feedback from students and faculty have been positive. Cost for this curriculum enhancement was reasonable, making it feasible to introduce the training into a wide variety of medical and allied health programs.

Physician Assistant Students Take the Plunge

INTRODUCTION The Department of Physician Assistant Studies at Wake Forest University School of Medicine is a graduate-level program that has a history of curricular innovation using clinical problem-based learning (PBL) strategies that emphasize a small-group approach to learning. Graduates of the program complete a 24-month course of study, and one class of 48 students is enrolled in early June each year. In the spring of 2007, just prior to the clinical year for the students in the class of 2008, the Northwest Area Health Education Center assisted the PA faculty in revising the AHEC’s Community Plunge program, developed initially for primary care interns, for PA students. The faculty felt that the Community Plunge experience would enhance the PA program’s current efforts, which include digitally delivered PowerPoint cases and master’s projects, by providing direct interaction with various community organizations that serve the diverse needs of our community and its members. Such exposure can stimulate ideas and discussion to enrich the clinical expertise and cultural competence of the PA students and aid them in their understanding of patient perspective. The goals of the Community Plunge were:

Physician assistant program characteristics and faculty credentials on physician assistant national certifying exam pass rates.

Purpose: Determination of the ideal terminal degree for physician assistants (PAs) and academic preparedness of PA educators have received much attention in recent years. This investigation, completed in 2009, sought to describe the current state of PA training programs, specifically regarding Carnegie classification, percent conferring masters degrees, number of full‐time faculty, percent of faculty — both principal and other full‐time faculty — with doctoral degrees, student‐to‐faculty ratio, and first‐time graduate Physician Assistant National Certifying Exam (PANCE) pass rates. A secondary aim was to determine if any of these variables predict PANCE pass rates. Methods: This study combined existing data obtained from multiple Internet resources including PA program websites and the PAEA Faculty Directory to determine the number of faculty, faculty credentials, number of students, and PANCE reports. Faculty members were categorized by highest degree attained. Linear regression was used to examine whether any of the programmatic variables were significant predictors of PANCE pass rates. Results: Two of four predictors were significant — whether the program conferred a masters degree (Beta = 0.54, t = 7.25, P = .001) and student‐to‐faculty ratio (Beta = ‐0.21, t = 2.63, P = .01). Mean number of full‐time faculty per training program was eight (SD = 4, range = 2–36). The mean percent of full‐time faculty members with doctorates per training program was 17.6% (SD = 17.7%, range = 0–80%). Conclusions: These results, if replicated, suggest that if a program is seeking to increase its student performance on the PANCE, it may be more helpful to focus resources on improving student‐to‐faculty ratio, regardless of whether or not the faculty are doctoral level.

Standardized Patient Instructors' and Physician Assistant Students' Evaluation of Diabetes Counseling Skills

Purpose: Standardized patient instructors (SPIs) have been used in medical and physician assistant (PA) teaching and have been shown to be a valuable resource for assessing interviewing and clinical skills. This study evaluated the agreement between SPI ratings and student self‐ratings in the assessment of counseling skills. Methods: PA students in three graduating classes (2009‐2011) participated in this study. SPIs received specialized training to simulate a patient with diabetes. SPIs provided feedback during simulated encounters using the Diabetes Risk Factor Interview Scale (DRFIS). The DRFIS provides a criteria‐based scale for student assessment. Students completed the DRFIS as a self‐assessment prior to receiving SPI feedback. Agreement between SPI evaluation and student self‐evaluation using the DRFIS were evaluated. Results: The total DRFIS score was generally comparable between all three graduation classes. SPI ratings of students by individual DRFIS items for all three classes indicate the highest scores occurred for Rapport and Empathy items while the lowest scores were evident for items including Reinforce Effort and Reframing Failure. The percent agreement between SPI and student self‐rating was within one point for greater than 70% for all 12 DRFIS items for the cohort of three graduation classes. Conclusion: PA students rated themselves on average lower on the DRFIS than SPIs but within an acceptable overall percentage range. Using an evaluation scale that is focused around patient counseling skills is a viable teaching tool for students and SPIs. Acceptable agreement between students and SPI was found. The DRFIS provides an effective criteria‐based scale for student assessment. J Physician Assist Educ 2013;24(4):9‐14

Applied Relaxation & Applied Mindfulness (ARAM): A Practical and Engaging Approach for Mind-Body Regulation Training in Medical Education

Mind-body self-regulation techniques, including progressive muscle relaxation, biofeedback, the Relaxation Response, applied relaxation, and meditation, have been employed for the treatment of stress and mental health disorders and for moderating the causes and complications of acute and chronic medical illnesses for many years. More recently, interest has grown in the usefulness of forms of self-regulation training for mitigating the stresses of medical practice along with enhancement of professional performance. Medical schools have begun to include mindfulness training in their required curricula and many make the training available through electives or student health services. In this article, we describe a practical approach to self-regulation training that is a combination of applied relaxation and applied mindfulness (ARAM) designed to be cogent to third-year medical students. Approximately 150 students have practiced this approach and overall feedback has been positive.