Academic dishonesty and cheating abound in universities across the globe, with increased instances of academic dishonesty in many disciplines including medical professional education programs that have high expectations for integrity and ethical conduct. The purpose of this study was to determine how faculty in physician assistant (PA) programs described their experiences, specifically their roles and responsibilities, in addressing incidents of academic dishonesty. The conceptual framework by Nitsch and colleagues, which focused on faculty failure to report conduct violations in dishonesty cases, informed interviews with 10 PA faculty members concerning the role of faculty members in academic dishonesty violations. Interview transcripts were analyzed to identify common themes through a manual coding process. Interviews were followed by a modified Delphi process with 5 of the participants to confirm consensus of the responses obtained in the interviews. Themes from the findings focused on faculty members' high expectations of academic honesty from students in PA programs, the role of university involvement in reporting and managing cases of academic dishonesty, including deterrents to faculty reporting, and program strategies to deter academic dishonesty. Based on findings, a PA faculty development workshop was developed for creating cultures of academic integrity in PA programs and program campuses. Positive social change may result through better management of cases of academic dishonesty in PA programs and on campus, as well as the use of faculty as change agents in promoting a culture of campus integrity.

Palliative care has become an integral part of healthcare throughout the United States. The goals of this discipline are focused on improving patient quality of life during times of illness. These goals are universal throughout medicine and apply to all practicing providers. An interdisciplinary council developed core competencies for this discipline which includes pain assessment and management as a key component. Throughout healthcare, the assessment and management of pain continues to be a challenge for providers. A review of the literature has demonstrated that untreated pain has become an increasing burden on the patient population. Many providers feel training during their medical education is insufficient and they entered the workforce unprepared. An evaluation of current standards put forth by educational governing bodies has shown the regulations regarding palliative care, pain assessment in particular, to be scattered and non-specific. It is apparent a more concise curriculum, dedicated to palliative care and pain assessment is needed for all future medical providers to hone the essential tools needed to properly evaluate and treat pain. The proposed intervention consists of an educational module which combines a didactic session and student role playing module focused on pain assessment. This intervention will focus on Physician Assistant students in particular, as this profession will continue to play a large role in healthcare. Didactic sessions focused on pain assessment, a core competency of palliative care, will be presented to the students. A role playing exercise following these didactics will allow students to practice such pain assessment skills and also explore what it may be like to be a patient in pain and provide them with insight on the importance of adequately assessing related symptoms. The current model of education regarding palliative care has proven to be ineffective, especially regarding pain assessment. A more concise, dedicated module for this essential skill is needed for students to become more efficient, effective providers. With the ability to assess patients more effectively, providers will be able to manage patients’ pain and decrease the burden untreated pain has put on the population as a whole.

BACKGROUND: Service-learning functions as one aspect of the experiential learning continuum, placing equal importance on both service and learning, while emphasizing the reciprocity between the provider and the recipient. Along with reciprocity, the core tenants include engagement, course integration, and reflection. The basis for service-learning arose from philosophical ideas challenging the traditional classroom model and the growing sentiment towards social activism. Today, service-learning has been incorporated into various educational programs, including undergraduate, medical, and various health professions. LITERATURE REVIEW FINDINGS: This thesis contains a comprehensive review of service-learning programs within various educational arenas and their reported benefits and effects on students. Composed of both qualitative and quantitative studies, the literature revealed the increasing trend of incorporating a service-learning experience, largely voluntary, into medical and health science education. Across the different fields, students engaging in service-learning reported high levels of personal and practical gain, including improvements in teaching and communication skills. However, the effects of service-learning within physician assistant curriculum have not been widely explored. PROPOSED PROJECT: This project aims to objectively assess the effectiveness of adding Anatomy Academy, a teaching-based service-learning opportunity, into the curriculum of the Boston University PA program. The study will quantitatively evaluate the effects on students’ skills in patient communication, teaching, and self-perceived confidence, as well as students’ willingness to engage in future service as health care providers. The study will also qualitatively assess student satisfaction with the course and perceived utility in future practice. CONCLUSIONS AND SIGNIFICANCE: The results obtained herein will provide an invaluable assessment of the potential effects of a mandatory service-learning program within a PA curriculum. Beneficial outcomes for the students will serve as motivation and evidence for a larger adoption of service-learning into PA curriculum across the country. For future healthcare providers, service-learning provides an effective framework to train essential skills such as teaching and communication, while forging important community bonds and implementing the principles of preventive medicine.

BACKGROUND: Problem-based learning (PBL) is a pedagogy commonly used in medical education which utilizes small discussion groups led by a facilitator to learn by discussing a problem or case study. Some research suggests that relative to conventional teaching, PBL is more effective in knowledge acquisition and retention due to its emphasis on contextualization and linking concepts, rather than memorization of facts. OBJECTIVES: The objective of this study is to compare PBL to lecture-based learning (LBL) module in pre-clinical PA and medical students. METHODS: This is a quasi-experimental crossover interventional study to be conducted with a 1st year PA class and a 2nd year medical school class from Boston University. The students will be assigned to either a control group who will take a LBL module or the interventional group who will take a PBL module. After completing the module the groups will crossover to take the opposing treatment and will be reassessed. The students will take a test at the start of the study, 1 week later before taking either the intervention or control treatment, another 1 week later prior to the cross treatment and a final test 1 week later. Each test will consist of 20 multiple-choice questions with a corresponding Likert scale question assessing the student level of confidence in their answer choice. RESULTS: The mean score, standard deviation, confidence interval and variance will be calculated for each test with the medical student and PA student scores combined. The level of knowledge acquisition will be separated between each group and by whether the student is a PA or medical student. The confidence values will be analyzed to determine if there is a relationship with knowledge acquisition in either of the treatments. DISCUSSION: This study will provide evidence as to whether PBL is superior to LBL in teaching ACS and chest pain to PA and medical students.

abstract: More underrepresented minority (URM) healthcare professionals are needed to improve health equity. Although holistic review in admissions has the potential to increase URM participation in health professions, recent data suggest that its impact varies substantially. The purpose of the dissertation research described here was to identify interventions to increase diversity among healthcare professionals and explore holistic review use in physician assistant (PA) program admissions to advance understanding of effective practices. PA programs were selected as an important prototype for exploratory studies since the extent of holistic review use in PA programs was unknown; at the same time, URM representation among PA students has decreased over the last 15 years. A critical review of the literature revealed that various holistic review practices have been used by several health professions programs to successfully increase URM enrollment and that organizational culture may be a factor that promotes success. Following this, 2017 Physician Assistant Education Association survey data were analyzed to assess the frequency of holistic review in PA programs and examine its association with URM matriculation. Results from 221 of the 223 PA programs accredited at the time showed that 77.5% used holistic review, and its use modestly correlated with proportion of first-year students identified as ethnic minorities (rs = .20, p < .01). Of particular interest, some programs using holistic review had substantially higher proportions of URM students than others. This finding laid the foundation for a qualitative multiple case study to explore the role of organizational culture as a hypothesized antecedent to effective holistic admissions processes. Survey study responses were used to select two PA program ‘cases’ that met criteria consistent with a proposed conceptual framework linking organizational culture that values diversity (or ‘diversity culture’) to holistic admissions associated with high URM enrollment. Directed content analysis of data revealed that diversity culture appears to be a strong driver of practices that support enrolling diverse classes of students. Overall, this mixed methods program of research advances understanding of holistic review, its utility, and the influence of organizational culture. The research generated important insights with ramifications for current practice and future studies within PA and across health professions programs. / Dissertation/Thesis / Doctoral Dissertation Nursing and Healthcare Innovation 2019

Objective: This dissertation analyzed one state's physician assistant (PA) workforce focusing on recruitment and retention. The goal was to identify factors associated with Indiana PAs working in medically underserved, rural, and primary-care medicine. The study evaluated characteristics of PAs who chose initially to work in rural versus urban areas and who have continued to do so. From the literature and as a result of study outcomes, a framework was developed, upon which recommendations were made for effective methods of increasing and retaining the number of PAs in primary care within rural areas. Subjects: Data were obtained from applications for PA licensure submitted to the Indiana Professional Licensing Agency between the years 2000 and 2010. Additionally, PAs working in Indiana who graduated during this period were surveyed. Methods: Descriptive statistics quantitatively defined the Indiana PA workforce. Survey questions to this population focused on provider upbringing, education, and specialization interest, as well as recruitment and retention to rural, primary-care, or underserved areas. Chi Square tests and logistic regression were used, where appropriate, to examine the influence of independent variables on the choice of practicing in rural, primary-care, and medically underserved areas. Based on these responses, recommendations were developed for strategies to increase the supply of physician assistants in rural areas. Findings: Among applicants for PA licensure in Indiana from 2000 to 2010, there were more females (70%) than males (30%), and the median age of applicants was 35 years. Respondent PAs predominantly worked in counties that were designated by the United States Department of Agriculture as metropolitan (91.3%) and largely in areas designated as Code 1 according to Rural-Urban Continuum Codes, the highest level of urbanicity. Additionally, more PAs worked in a specialty area (79%) than in primary care (21%). Chi Square analyses revealed significant relationships (p < .05) between primary care and gender; educated outside of Indiana and working in an underserved area; and being born in a rural area and choosing to practice in a rural area. Binary logistic regression identified that female gender was predictive of the decision to practice in primary care, and birth in a rural area was predictive of current rural practice. In reflecting upon their first employment following training, 70 percent of respondents believed that the job offer was neither directly nor indirectly a result of having completed a clinical rotation at that particular site, or having worked with a particular preceptor, during their experiential training. A relationship was found between the respondents' initial job location being urban and living in a metro location at the time of high school graduation. Finally, educational debt influenced males' initial practice location and specialty but did not similarly affect choice of practice among females. Conclusions: There were several important characteristics of recently licensed PAs in Indiana that were identified in this study. Educational institutions, policymakers, and communities may increase recruitment and retention of PAs to rural and primary-care practice by actively identifying PAs who possess selected characteristics for the area of interest and providing incentives to reduce educational debt.