BACKGROUND: The gender wage gap has existed since women started entering the workforce. Once large, the wage gap narrowed significantly in the 1980’s, and plateaued in the 2000s. Proposed rationales for the wage gap include: gender differences in negotiation, unconscious bias or discrimination, and productivity differences between men and women. Productivity is commonly measured in terms of relative value unit (RVU) generation. RVU assignment to non-clinician providers (NPCs) such as PAs and NPs is inaccurate, contributing to a lack of data regarding their productivity. Little is known about PA productivity in general, particularly gender differences. The purpose of this study is to formulate a standardized definition of clinical productivity and to compare mean productivity of male and female PAs in three specialties. LITERATURE REVIEW FINDINGS: Women are assumed to be poorer negotiators. However, when negotiation, a stereotypically “male” act, is framed in a communal way, gender differences vanish and women are as equally successful. Unconscious bias and discrimination against women have detrimental effects on their salary, job satisfaction, and psychological health. The assumption that women are less productive than their male counterparts arises from the belief that women will drop work obligations to care for the family. After controlling for practice, personal, and productivity differences, women continue to earn significantly less than their male counterparts. The persistent, unexplained wage gap suggests that uncontrolled variables, such as bias or discrimination, are the true cause of the wage gap. PROPOSED PROJECT: The proposed project is retrospective cohort study and secondary database analysis obtained from the NCCPA PA Professional Profile. The data will be utilized to determine average, individual productivity for male and female PAs practicing in three specialties. The mean productivity of male and females will be compared using ANOVA. Confounding variables will be analyzed using a multiple linear regression analysis. CONCLUSIONS: Social constructs regarding gender contribute to stereotypes influencing the definition a “successful negotiator” and provide the foundation for bias and discrimination. Clinical productivity cannot be altered by these stereotypes. If no gender differences in productivity exist, this proposed cause can no longer be used to justify the wage gap. SIGNIFICANCE: Accurately measuring PA productivity has several implications including proper compensation, determination of PA impact on practice efficiency, and comparison of productivity between PAs by gender and specialty type, aiding in the search for the true cause of the gender wage gap in the PA profession.

Physician assistant programs are relatively new academic programs that aim to train and prepare PAs as advanced medical providers. Since their inception less than 60 years ago, multiple changes have been made to the curriculum. Additionally, the introduction of technology in the classroom has allowed further variations in how students learn in PA programs. As a new and growing program, limited research has been done on these PA programs regarding motivation and attendance. This paper aims to evaluate aspects of motivation and attendance that have been previously analyzed in other healthcare programs, then propose a study which explores those variables in Boston University’s physician assistant program. Ultimately, this paper will add to data regarding PA programs that examine motivation and attendance in students. This data is important to maximize student satisfaction, learning, and efficiency in a rapidly growing profession.

BACKGROUND: The ability to disclose bad news to patients is a complex and essential skill for health care providers. Although certain specialties have a higher incidence of engaging in these conversations, this task is done regardless of a provider’s discipline. There are many components to breaking bad news, some of which include finding a private setting, eliciting how much the patient wants to know, providing clear information, and responding to the patients’ emotional needs and reactions. As this task is associated with a large amount of emotional stress, the outcome of this exchange can have lasting impact on both the provider and patient. Unfortunately, patients are dissatisfied with how they receive bad news, and providers admit to lack of comfort and knowledge with this task. LITERATURE REVIEW FINDINGS: Studies show that inadequate education is main area for improvement. Fortunately, the ability to break bad news is a teachable and retainable skill. Didactic sessions, role-play, and small groups are some of the available models used to educate learners. There is promising evidence for the incorporation of SPs into various curricula, because they provide an opportunity for students to learn without compromising patient safety and allow for feedback useful to enhancing skills. PAs are valued health care providers who practice across a variety of specialties. As their education is similar to that of a medical student, and they practice autonomously under the supervision of a physician, it is equally important that they are able to successfully break bad news. However, there are few studies that examine the PA student curriculum for breaking bad news education. Furthermore, there are no studies that examine PA student competency with this skill. PROPOSED PROJECT: The goal of this study is to use a literature review to create a novel curriculum that employs SPs to increase PA students’ competencies for breaking bad news. CONCLUSIONS: An optimal curriculum intervention will include opportunities for feedback, discussion, and practice. SPs can help aid with many of these components, as well as assess interpersonal and technical components of breaking bad news. SIGNIFICANCE: It is expected that the results of this study will parallel those identified for medical students, and PA students’ skills will improve to meet the standards set forth by the ARC-PA. It is the hope that the results of this study will serve as an initial platform for future studies aimed at PAs’ ability to disclose bad news to patients.

BACKGROUND: Substance use disorders are highly prevalent and highly stigmatized. They are defined as conditions in which the use of one or more substances, in spite of negative consequences, leads to a clinically significant impairment or distress. Stigma is a characteristic deemed undesirable by society. Stigma is dependent on the relationship between the specific discrediting or undesirable characteristic and the social context. LITERATURE REVIEW FINDINGS: The various manifestations of stigma include public or external stigma, provider stigma, and internal stigma. External stigma is the negative beliefs that society holds about people in stigmatized groups, for example patients with substance use disorders or HIV. Another type of stigma is provider stigma, referring to the negative beliefs that providers hold about patients belonging to these stigmatized groups. Internal stigma is defined as the devaluation that people in stigmatized groups hold about themselves in relation to society. Stigma is continued when there is a lack of familiarity and education with a stigmatized condition or group. PROPOSED PROJECT: The proposed project aims to address and decrease provider stigma in physician assistant trainees before they begin their clinical training through an educational intervention. This thesis will propose the development and evaluation of a new curriculum to educate physician assistant students on substance use disorders and their treatments, frame substance use disorders as chronic diseases, and aid physician assistant student trainees on recognizing their attitudes and biases, or prejudices, toward working with patients with substance use disorders. The project will assess attitudes before and after the education intervention to analyze if attitudes toward patients with substance use disorders have changed as a result of the educational intervention. The goal of the educational curriculum is to improve physician assistant student attitudes toward working with patients with substance use disorders before they encounter this population in clinical practice. SIGNIFICANCE: Physician assistants are clinicians who diagnose illness, develop treatment plans, manage their own patients, and often serve as the primary clinician for patients. Physician assistants will encounter a number of patients with substance use disorders throughout the course of their careers. Addressing provider stigma in this group will help improve treatment outcomes in this patient population and give the students the confidence and knowledge to manage patients with substance use disorders. As a result of completing this curriculum, physician assistant students will have decreased stigma and better attitudes toward working with patients with substance use disorders.

The flipped classroom structure is a new concept designed to accommodate current students in place of the traditional classroom structure. Instead of in-class lectures, students do the majority of learning outside of class and use in-class time to participate in interactive activities with peers and with educators. Most out-of-class learning materials involve use of lecture videos, online games, or lecture notes. Recent studies found success with flipped classrooms in a variety of settings and students. However, there are no studies regarding whether current students better retain information when providing lectures in digital media as opposed to traditional media. This study compares the mean difference of pretest and post classroom scores for pharmacology using NBME exams of PA students given study materials in digital form and those given study materials in traditional paper form. We hope the study can contribute to effective teaching for future students.

INTRODUCTION: The demand for healthcare services is expected to increase significantly faster than the rate of growth of healthcare providers in the United States. One method for meeting the demand is the utilization of physician assistants in the management of patient care. Medical doctors and residents have traditionally provided radiation oncology patient care. It was not until recently that the use of physician assistants in radiation oncology became common practice. However, the most effective utilization of physician assistants in radiation oncology has not been fully elucidated at this time. REVIEW OF THE LITERATURE: The demand for radiation oncology services is expected to increase in part because people are living longer; there is increased cancer survivorship, and better treatment modalities. Physician assistants are capable of providing high quality patient care comparable to medical doctors and improving patient satisfaction. The need for Physician assistants in radiation oncology is expected to increase significantly by 2020. Effective models of team-based care are becoming increasingly important as the demand for radiation oncology services increases. PAs can be used in a variety of different models including shared, independent, and mixed models of team-based care. The utilization of physician assistants in radiation oncology is maximized when physician assistants provide care that otherwise could only be performed by a medical doctor. For example, when radiation oncology centers use a mixed model of team-based medicine, the practice can bill services provided by a physician assistant at 100% of the medical doctor service fee rate thus maximizing the cost effectiveness of physician assistants. METHODS: This study is aimed at determining the statistical difference in terms of new patient and established patient visits within an academic medical center radiation oncology unit before and after the addition of a physician assistant. A pre- and post-physician assistant analysis of new and established patient visits will be analyzed using a paired T-test. CONCLUSION: This study is unique in that it is focusing on a single radiation oncology center. A significant limitation of the study will be the small, single center, sample size. However, the results of this study can be used in the future as a reference for the expected impact of a physician assistant on a radiation oncology center.

Physician Assistant (PA) students undergo a rigorous educational curriculum consisting of both clinical and didactic instruction to prepare them for their role as a general health care provider. In order to complete training as a general health care provider PA students must learn a wide array of general medical knowledge and clinical skills so that they are able to use their judgment and skills in any area of practice or specialty. More specifically, PAs are expected to identify and effectively treat pediatric disorders that are within the knowledge and skills obtained during their qualified education. In medicine, perhaps the most important diagnostic tool is the ability to properly perform an effective physical examination. Historically, within PA program curricula, methods to optimize performance of a pediatric physical examination have been poorly represented. The pediatric population is unique in that the approach to the patient, as well as the techniques used to gain cooperation from the patient, may change drastically through normal child development. Having a wide array of techniques and skills to comfort and engage the pediatric patient is critical in performing the physical exam. Formal training in this area will better prepare PA students for any setting in which a pediatric patient will be encountered and enable them to deliver effective pediatric care. The objective of this project is to develop a curriculum that will focus on a mastery of skills needed to successfully perform a pediatric physical exam. The proposed curriculum will educate PA students in an understanding of age-appropriate strategies to be used while examining pediatric patients from birth through to mid-childhood (8-years old) that will meet the expectations of current pediatric practices. A literature review provides the basis for the curriculum. The curriculum will be integrated at the end of the PA student’s didactic curriculum, prior to beginning their clinical rotations. Assessment will include a needs assessment for the curriculum, gauging the comfort of students performing the pediatric physical exam, and preparedness of the students for their pediatric clerkship. Student success will be evaluated through a pre and post-test comparison, clinical skills evaluation, as well as a questionnaire surveying student comfort level and knowledge of strategies with the standard curriculum in comparison to student comfort level and knowledge of strategies after specialized training with the newly developed curriculum. It is predicted that the new curriculum will better prepare PA students for their pediatric clerkship and practice.

In 2009, a local physician assistant (PA) program lost accreditation due to decreased success in licensure pass rates on the Physician Assistant National Certification Examination (PANCE). In response, the program's admissions committee required additional metrics for accepting quality candidates more likely to pass the licensure examination on the first attempt. The purpose of this study was to gain a better understanding of these metrics, specifically the relationship between demographics, prerequisite admission requirements, and PANCE success. The theoretical framework and conceptual model shaping this study was Bordage's illumination and magnify framework and Swail's geometric model of student persistence and achievement. The purpose of this nonexperimental quantiative study was to investigate the relationhip between the demographic variables, preadmission requirements, and their relationship to predict first-time PANCE success. Using archival data, total sampling (N = 107) included all students who took the PANCE from 2012 to 2016. Binary logistic regression results showed that The Graduate Record Examination quantitative reasoning score was statistically significant (p < .01), and a poor predictor of success, secondary to not having a significant effect on the odds of observing PANCE success. The overall results did not provide admission predictors of student success on the first-time attempt to pass PANCE. The study has significance for social change in the area of admissions policy development that supports a nonbiased process for the identification and selection of quality PA candidates.

BACKGROUND: In recent years, medical and physician assistant (PA) education has moved towards a competency based model. This model encourages teaching students to “know how” to use what they learn in practice rather than simply gain a large knowledge base. This allows students to garner a deeper understanding of the material. Active learning strategies such as flipped classroom and interactive learning, have gained great support in recent years. These models have helped further the ability of universities to move towards these competency based education models. At the core of these newer teaching and learning modalities are the instructors themselves. They play a vital role in not only what a student learns, but how well they learn it. LITERATURE REVIEW: A literature review highlights both the importance of hiring quality instructors as well as the importance of their ability to fulfill these new teaching models. There have been numerous studies on how effective teaching influences a student’s performance in the classroom. To date, there has not been any research on how to increase the probability of hiring an effective instructor from day one. PROPOSED PROJECT: The objective of this study is to develop a tool that would help employers screen for potentially less qualified candidates. The proposed tool is a questionnaire that would be filled out by potential employees and would raise a red flag if a potentially concerning answer choice was selected. The validity of this questionnaire will be tested by comparing current physician assistant didactic and clinical instructors’ scores on the questionnaire, to their respective student evaluations. CONCLUSION: It is predicted that a “red flag” score on/this questionnaire will correlate with poor instructor scores on student evaluations. Successful validation and deployment of this tool would allow students to be instructed by the best possible instructors, bettering their education.

The Affordable Care Act (ACA) was passed by Congress in 2010 as a health policy initiative to improve the effectiveness of the United States healthcare system. Policies and regulations under the ACA include provisions to improve the quality and cost-effectiveness of medical services which has resulted in a transition of payment systems from fee-for-service (FFS) reimbursement models to value-based reimbursement (VBR) models. Policies under the ACA also encouraged the formation of affordable care organizations (ACOs) which endorse new models of healthcare delivery, specifically team-based care models, to increase the efficiency, quality and accessibility of medical care while at the same time controlling costs. Although physician assistants (PAs) have been a proposed method for addressing the growing demand for high quality, cost-effective healthcare, research that explores the economic value and financial impact of physician assistants is limited. Currently, productivity metrics are used to determine the economic value of physicians and PAs. Current methods of measuring productivity include volume-based metrics and claim based data. Although these methods may be sufficient for measuring physician productivity, they fail to account for PA practices. Current productivity metrics also fail to account for a vast majority of PA productivity due to current billing policies that do not capture all services provided by PAs. In this study, we will explore the financial impact associated with the addition of PAs to ten different physician-owned family medicine practices by measuring the percent increase in net annual practice revenue one year after the employment of a PA. Net practice revenue is defined as the total revenue generated per provider per year minus overhead costs associated with provider employment.