Gerald Kayingo

Patient-centered medical homes and physician assistant education: preparing the PA student for the practice of the future.

Purpose: The patient‐centered medical home (PCMH) holds promise for improving primary health care delivery, but little is known about its impact on medical education. The purpose of this study was to examine the extent to which physician assistant (PA) students are exposed to elements of the PCMH during the didactic and clinical phases of their education. Methods: A survey was distributed to clinical coordinators at all accredited PA programs in the United States that met the study inclusion criteria. The survey inquired about curricula central to practice in the PCMH: team‐based care, electronic medical record utilization, and principles of care coordination. Results: Of the 211 clinical coordinators that were surveyed, we received responses from 87 (41%), of which 94% stated that they teach principles of interprofessional team‐based practice during the didactic phase. Sixty percent or more teach concepts related to physician‐directed teams, quality improvement, care coordination, and electronic medical records. Only 25% of respondents provide instruction in payment structures that reward care coordination and high quality care, and 22% stated that their students do not have exposure to the PCMH. Most importantly, less than 25% of respondents utilize designated PCMH clinical sites, and those that do have been doing so for less than two years. Conclusion: Many PA programs teach some of the core concepts of PCMH during the didactic phase, but exposure to PCMH during clinical clerkships remains limited. Concerted effort is needed to better prepare PA students to function in these emerging team‐based practices.

A longitudinal study of health professional students’ attitudes towards interprofessional education at an American university

ABSTRACT Efforts to improve interprofessional education (IPE) are informed by attitudes of health professional students, yet there are limited US data on student characteristics and experiences associated with positive attitudes towards IPE. A cohort of US medical, nursing, and physician associate students was surveyed in their first and third years, using the Readiness for Interprofessional Learning Scale and Interdisciplinary Education Perception Scale. Information was also collected on demographics and experiences during training. Health professional students differed in their attitudes towards IPE; characteristics associated with having more positive attitudes at both time points included being a nursing student, female, older, and having more previous healthcare experience. Students who participated in interprofessional extracurricular activities (particularly patient-based activities) during training reported more positive attitudes in the third year than those who did not participate in such activities. Based on these findings, schools may consider how student characteristics and participation in interprofessional extracurricular activities can affect attitudes regarding IPE. Building on the positive elements of this interprofessional extracurricular experience, schools may also want to consider service-learning models of IPE where students work together on shared goals.

Primary Care Teams, Composition, Roles, and Satisfaction of PA Students During Primary Care Rotations.

Purpose The goal of this study was to describe the characteristics of primary care teams, activities, and roles of physician assistant (PA) students as they encounter various primary care sites. Methods An electronic survey was distributed to second-year PA students in 12 programs who had completed at least 4 weeks in a primary care rotation. Results Of the 179 students who responded (response rate 41%), 88% had completed their primary care rotations in urban settings, mostly in private practices (53%). Physician assistant students reported encountering many types of health care providers on their teams, and the 2 most favored features of the rotations were the interactions with their supervising clinicians and clinical responsibilities. About 68% interacted with other health profession students during their rotation (interprofessional experiential learning). Almost all students completed histories, physical examinations, and treatment plans, but less than 30% reported involvement in billing or care coordination and less than 10% participated in quality improvement projects. More than 60% were satisfied with team-based and interprofessional practices encountered during their primary care rotations, and 39% were more than likely to pursue primary care careers. Conclusions Team-based primary care had a positive impact on students, but more exposure to underserved clinical settings, care coordination, quality improvement, and billing is needed to prepare PA students for the practice of the future. This study is the first of its kind to explore the relationship between primary care sites and PA training in the era of health care reform.

Collaborating Across Borders in Global Health: Reflections and Lessons Learned.

Feature Editors Note:In this article, the authors, who are part of a unique global health collaborative, outline their challenges and solutions related to global health research. Many, if not all, of their lessons learned are applicable to collaborative research among colleagues from different

Health Policy in Physician Assistant Education: Teaching Considerations and a Model Curriculum.

Abstract Recognition is growing within the medical academic community that future clinicians will need the tools to understand and influence health policy decisions. With the passage of the Patient Protection and Affordable Care Act of 2010, future clinicians will need not only clinical competence for successful practice but also an understanding of how health systems function. Although the fourth edition of the Accreditation Standards for Physician Assistant Education contains provisions and stipulations for the teaching of health topics in general and health policy specifically, physician assistant (PA) educators retain little consensus regarding either learning objectives or specific rubrics for teaching these important concepts. In this article, we discuss approaches for teaching health policy, delineate useful educational resources for PA faculty, and propose a model curriculum.

Do patient-centered medical homes improve clinical performance?

Medical anthropology has extensively critiqued biomedicine’s hegemonic structure that places physicians in control of knowledge and power and casts patients as depersonalized recipients of treatment (not care). Yet in the United States, an increase in collaborative models of healthcare affects not only the types of providers patients see for care but also how that care is delivered. Under the Affordable Care Act, community health centers (CHCs) are at the center of the expansion of accessible and highvalue primary healthcare. One estimate is that CHCs will have added 15,000 new providers to their staffs between 2000 and 2015; most will be PAs and NPs. In this paper, the author explores the providerpatient relationship to include those in collaborative care teams and relationships between the clinic and the community. Analysis of these multiple complex relationships among different types of providers, patients, and communities helps us understand how relationship dynamics and trust infl uence patient care and outcomes in these healthcare settings.1 Commentary by Colette Jeffery: The medical anthropologist looks to understand how relationships outside the immediate physician-patient relationship affect the delivery of healthcare as a whole.1 Henry’s paper takes a broader view of how relationships between PAs, patients, and the community are important factors in PA retention. The study was conducted in rural and urban CHCs in Texas. As PAs’ and NPs’ scope of practice continues to broaden, so will the need for medical anthropologists to study these relationships to assess how they expand patient access to care. The author notes that PAs and NPs spend more time with patients than do physicians, and suggest this could lead to a better provider-patient relationship. Finally, Henry points out that CHCs are growing by leaps and bounds, and that the supply of PAs and NPs also must increase to meet this demand. The number of PAs working in a CHC grew by 13.3% between 2013 and 2014.2,3 Over the same period, the share of recently certifi ed PAs who chose to work in a CHC grew from 3.4% to 4.2%.3 The growth of PAs and NPs in CHCs could be an important piece of the puzzle in solving the primary care shortage the Affordable Care Act’s expansion could bring.