Constance Goldgar

Establishing Essential Physician Assistant Clinical Competencies Guidelines for Genetics and Genomics

The Journal of Physician Assistant Education | 2007 Vol 18 No 2 Establishing Essential Physician Assistant Clinical Competencies Guidelines for Genetics and Genomics Michael Rackover, PA-C, MS, Philadelphia University; Constance Goldgar, PA-C, MS, University of Utah; Chantelle Wolpert, PA-C, MBA, CGC, University of North Carolina; Kristine Healy, PA-C, MPH; Midwestern University; Jennie Feiger, MS, MA, CGC, Red Rocks Community College; Jean Jenkins, PhD, RN, FAAN, National Human Genome Research Institute BRIEF REPORT

An Integrated Evidence-Based Medicine Curriculum in Physician Assistant Training: From Undergraduate to Postgraduate

&NA; Physician assistant educators must equip their students with the skills to competently practice medicine not only today but also in the future. Our graduates are faced with an overwhelming array of new information and it is imperative that they be competent in managing and using this evidence to improve the health of their patients. Future PAs must have the ability to construct answerable clinical questions, develop effective searches of the literature for evidence, appraise the evidence, and ultimately apply it to patients. Evidence‐based medicine (EBM) provides the framework and skill set that enables PAs to efficiently become lifelong learners and critical thinkers. This article is an overview of the University of Utah Physician Assistant Programs (UPAP) EBM curriculum that is focused on clinical relevance and utility. It also outlines how programs can adapt for themselves UPAPs EBM curriculum to satisfy graduate‐level educational requirements, as the masters degree becomes the standard for PA education.

Current Status of Genetics Education And Needs Assessment of Physician Assistant Programs: A Nationwide Survey

Purpose: The explosion of genetic information resulting from the Human Genome Project and related advances has major implications for health care providers, including PAs. In order to assess the current state of genetics education in PA programs and the needs of PA program faculty related to teaching genetics and developing curricula, the authors and the Association undertook a survey of PA programs. Methods: A Web‐based survey containing 18 multiple‐check, Likert scale, and open‐ended questions was sent to the directors of the 134 accredited PA programs in February of 2007. Results: 100 programs responded, for a 75% response rate. Eighty‐one percent of responding programs expressed the need to enhance the quality and extent of genetic and molecular medicine in their curricula, and 62% planned to make changes in the near future. Genetics education is delivered with an assortment of curriculum models and taught with a rich variety of methods. It was surprising to find some salient concepts not being taught in 12‐16% of programs: eg, molecular biology, Mendelian and non‐Mendelian inheritance, pedigree structure, and genetic diagnostic testing. Pharmacogenomics is taught in only two thirds of programs. PA program core faculty play a major role in teaching genetics. PA program respondents indicated the following to be particularly helpful for genetics curriculum development: (1) centrally developed resources, (2) genetic case studies, and (3) up‐to‐date valid resources on the Web for educators and students. Conclusions: PA programs clearly see the importance of genetics in PA education, but have expressed the need for more resources to further develop their curricula. It is hoped that this survey will provide baseline data that will aid in the development of competencies and curricular components in the future.

Evidence-based medicine databases: changing needs along the path from physician assistant student to clinician.

their clinical questions. INTRODUCTION A common question we get from our students is, “What’s the best electronic medical database that will help me answer questions during PA school?” Common to our role as medical educators, our usual response is “it depends.” This conundrum brings to mind the choice we faced as students three decades ago when deciding whether to reach for a voluminous Harrison’s Principles of Internal Medicine or the concise and timely Lange Current Medical Diagnosis and Treatment. In the precomputer era, the choices were perhaps simpler, but less satisfying from an evidence standpoint. A recent study identified more than 30 databases available free or by subscription to students.1 They range from the unscreened, open access breadth of PubMed to carefully appraised and highly clinicianfriendly DynaMed and Essential Evidence Plus. Our noncommittal answer is driven by the need to choose the right tool for the right job. And that job evolves throughout the educational process. The educational and clinical evidence needs of PA students change depending on their stage of training and the depth of their foundational knowledge. The requirements of didactic year students preparing for a gastroenterology final or a problembased learning module differ from those of a student sitting in an examination room with a patient. As a result, it may be prudent for educators responding to this question to be mindful of matching the tool to the student’s stage of training and the setting where the learning takes place.

Demonstrating Evidence-Based Medicine Skills and Comprehension with a Student Capstone Project

Editor’s Note: In this column, the EBM feature editors highlight an example of the capstone project that all students at their institution must complete at the end of the program’s EBM curriculum. The high quality of the student-written paper illustrates the lasting value for the profession of teaching students the principles of searching, evaluating, integrating, and presenting

Evidence-Based Medicine Resources for Physician Assistant Faculty: DynaMed

INTRODUCTION When we took the first tentative steps years ago to develop a new clinical problem-solving curriculum that embraced the concepts of evidencebased medicine (EBM), there was little we could say to students who asked, “But how are we going to do this in the clinic”? The concepts were sound but the immediate application to patients, the only thing that really matters, was stymied by the lack of useful tools. Fortunately, innovation and technology have progressed rapidly and placed a number of devices in the hands of clinician educators that they can use at the bedside and in the exam room. The computer-based electronic health record (EHR) has become ubiquitous. The dog-eared notebook “peripheral brains” of our generation, loaded with clinical facts and held together by a rubber band, have been replaced by sleek and speedy PDAs with instantly accessible voluminous libraries and databases. Many clinicians have become so dependent on these tools that to suffer a system crash, or even to leave them by accident at home, produces instant anxiety. I (DK) have made a mad dash from clinic back to home to retrieve mine more than a few times. Since purchasing Epocrates, a medication database, I have not looked at a Physicians’ Desk Reference text. I’m not even sure the clinic still has one. PDAs have become a necessity for the majority of PA educator/clinicians; however, the choice of software can be overwhelming and is often made with the gut rather than the head. The decision to purchase Epocrates, for example, was made after a brief exposure through a colleague and a free trial. There was no careful weighing of the pros and cons of other products — and this is probably true of many clinical educators. As a new tool is used, we grow familiar and comfortable with the interface and it becomes literally an extension of our bodies. We tend to stay with the same tools not only because they are good, but also because we don’t want to take time to learn a new system. For instance, we have colleagues who swear by LexiComp, another medication database, but we have no interest in investing time to learn a new tool that would replace one that has already become indispensable. Our students often have technology skills that exceed those of faculty. It is important for faculty to become facile with the available resources to support our students’ evidence-based clinical practice. For this reason, the EBM feature in this journal will occasionally review tools that may assist PA educators with their EBM curriculum and help them make choices in a more systematic way. The focus of this review is a computer and PDA database application called DynaMed, which has been designed from the ground up on the principles of EBM.

Evidence for Evidence-Based Medicine

INTRODUCTION As we try to inculcate in our students the value of using evidence-based medicine and refine our teaching of EBM, a fundamental question needs to be posed (and more than one student has asked this!) — what is the evidence that teaching evidencebased medicine actually changes patient outcomes? This question is not new in the medical literature. In fact, one of the chapters in the JAMA Users’ Guides to the Medical Literature posed this question back in 1992,1 and again in 2000,2 noting there was little literature to indicate whether teaching EBM improves patient outcomes. Because we are clearly investing a lot of faculty and student effort in EBM, we need to have a good answer for our students when they ask this question. EBM proponents argue that “it is impossible to design such a randomized study ... because no investigative team or research granting agency has yet overcome the problems of sample size, contamination, blinding, and long-term follow up which such a trial requires.”3 Is it even ethical to consider withholding evidence from clinicians or patients? For this column, we thought we’d try to tackle this question to see if there has been any mounting evidence for EBM improving patient outcomes, especially since it has seemingly become more integrated into clinical practice. Our goal is also to demonstrate the first few steps of the EBM process as we attempt to answer the question in this column.

Physician Assistant Genomic Competencies.

Abstract Genomic discoveries are increasingly being applied to the clinical care of patients. All physician assistants (PAs) need to acquire competency in genomics to provide the best possible care for patients within the scope of their practice. In this article, we present an updated version of PA genomic competencies and learning outcomes in a framework that is consistent with the current medical education guidelines and the collaborative nature of PAs in interprofessional health care teams.

The evidence-based medicine write-up: a tool for EBM skill development and patient-centered evidence application.

INTRODUCTION In 2004, David Keahey and I published a broad overview of the evidence-based medicine (EBM) curriculum delivered at the University of Utah Physician Assistant (PA) Program.1 Over the intervening years, we have shared tools, databases, texts, and various approaches to teaching EBM through this column. In 2010, we published an example of our students’ capstone paper for the master’s curriculum.2 It then occurred to us that we hadn’t des-cribed something we consider to be the lynchpin of this curriculum, the evidence-based medicine writeup (EBMWU). Although the EBMWU has evolved through a number of iterations since we launched our EBM curriculum in 2001, the guiding principle for this endeavor has remained constant: to directly connect the application of evidence to patient care with an active and reflective process. In 2008, after assessment of student evaluations of the EBMWUs, we realized the EBMWU had become cumbersome and weighed down by trying to accomplish objectives outside of the goal of honing EBM skills. After reflection on the essence of what we hoped students were getting from the EBWMU and analysis of the evaluative data, a sleeker and more compact version emerged, which we will describe here.

Recommendations for a Physician Assistant Medical Genetics Curriculum

&NA; Recognizing that genetics is playing a larger role in clinical practice, the challenge for physician assistant (PA) educators is to prepare our students with an appropriate foundation of knowledge, skills, and attitudes. A knowledge base of fundamental genetic principles and approaches is essential, as are the skills that will allow students to apply these principles in the clinic and to exhibit professional attitudes related to genetic information and diagnosis. Such knowledge, skills, and attitudes will be required for common clinical tasks, for example, when assessing familial risk for common diseases as well as ordering, interpreting, and explaining genetic test results to a patient. PA programs need to develop appropriate curricula to meet this dynamic challenge. As a companion piece to recently proposed genetics competencies, a concise outline of recommendations for a PA medical genetics curriculum is offered. The recommendations are designed to assist in teaching PA students the knowledge, skills, and attitudes they require to meet the demands of genomic medicine. A wide variety of teaching and evaluation methods, including didactic lectures, Web‐assisted learning, and clinical experience, are proposed. In addition, specific valid genetics Web resources are presented for teaching, genetic education, primary care clinicians, and students. Teaching should be related to clinical cases and/or experiences whenever possible.