Mary L. Warner

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.

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.

Career patterns of physician assistants: a retrospective longitudinal study.

Objectives: A distinguishing characteristic of the physician assistant (PA) profession is career flexibility to move between specialties without further training or certification. The objectives of this study were to characterize the number and type of practice specialties and to explore attitudes towards career flexibility. Methods: Practice patterns were examined using a survey of AAPA member and non-member graduates from the classes of 1978, 1988, and 1998. Results: Overall, respondents (n=1,703; 31%) reported practicing in an average of 1.95 specialty practices per decade over the course of their career (range, 1–18; SD, 1.40). Adjusted for the number of decades elapsed post-graduation, the 1978, 1988, and 1998 cohorts practiced in an average of 1.08 (SD, 0.71), 1.51 (SD, 1.02), and 2.41 (SD, 1.49) specialties per decade, respectively (P<0.0001; all pair-wise comparisons significant, P<0.001). Conclusions: Most PAs change specialties during their career, and this trait of the profession is highly valued.

Physician Assistant Student Peer Evaluation.

Returning to physician assistant (PA) education after a 10-year hiatus, my first assignment was to chair the Professional Role Development course. During the course retreat, one of my colleagues brought up the idea of student peer evaluation of professionalism to be added as a part of the student’s grade. Trained in the military, he explained that peer evaluation was helpful as it kept each person accountable for his or her professional behavior. He wisely stated that there are behaviors that students exhibit outsideof the classroom that facultymight not observe, and that peer evaluationmight provide additional evidenceofbehaviors thatwehaveobserved in the educational setting. His suggestion prompted me to (1) search PA, nurse practitioner (NP), and medical education literature; (2) seek the adviceofcolleaguesaround thecountry; and (3)decidewhether the peer evaluation process should be implemented. Physician assistant professionalism encompasses many attributes such as respect, compassion, integrity, effective communication, positive attitude, self-motivation, timeliness, self-awareness, a balance between humility and confidence, flexibility, and a commitment to lifelong learning. TheARC-PA Standards mandate that we teach and evaluate professionalism; future employers and patients expect our graduates tobeproficient in PAprofessionalism. Professionalism in the classroom setting is well-defined, and most students, because of their previous educational experiences, understand the expectations evenwhenparticipating in small group sessions. The clinical environment poses different challenges because the students are novice learners who remain focused on learning enough medicine to safely care for patients. Even students who have spent a considerable amount of time in the clinical arena in other roles require time to learn PA cultural norms and professionalism and continually adapt to the expectations of various clinical settings.

Initial Practice Patterns of Physician Assistants With Emergency Medical Services Experience

Purpose: This study evaluates the relationship between previous experience in emergency medicine services (EMS), as an emergency medicine technician (EMT) or paramedic, and initial physician assistant (PA) employment in emergency medicine and surgery. Method: Using a cohort of students from four masters degree programs, data were extracted retrospectively from the students admission files and alumni records. Results: There were 283 subjects reviewed for the study. Fifty‐six (19.7%) graduates had emergency medical services (EMS) experience while 227 (80.3%) had no EMS experience. There was no difference between the two groups in the rates of employment in surgery (p=0.4) and when emergency medicine and surgery were combined. (p=0.7). There was a statistically significant difference between the two groups in their rates of initial employment in emergency medicine (p=0.01). Conclusion: While not predictive, there is a statistically significant relationship between prior EMS experience and initial PA practice in emergency medicine.