The purpose of this study was to examine PA students’ perceptions of their professional training program in relation to stressors imparted by the hidden curriculum of the community of practice during the didactic and clinical years. The cross-sectional study design involved 50 in-person, semi-structured interviews (divided evenly between students in didactic and clinical cohorts) at one Physician Assistant training program in the New York City metropolitan region. Interviews sought to improve understanding about perceptions of stressors, particularly those imparted by the hidden curriculum, and examine mitigating factors within the community of practice. Highlights of results were that daunting stresses in the didactic year were mitigated by faculty support, camaraderie among students, and, at times, students accessing important student services such as psychological counseling. The stressors were exacerbated by disorganized teaching mainly by guest lecturers, including frequent absences, which was perceived by students that their time was not a priority. The stressors of heavy course loads dwindled during the clinical year but were replaced by others related to the hidden curriculum of the medical hierarchy, including occasional depersonalization of patients, teaching by humiliation, and favoritism shown to medical students. The community of practice for Physician Assistant students is highly stressful and psychologically precarious. The culture of PA education would do well to strongly encourage self-care and a greater balance between professional preparation of mental and physical well-being in order to encourage professionalism, improve patient care, and cultivate higher levels of job satisfaction and well-being among students.

Cultural competency training in physician assistant (PA) education may improve patient care outcomes and help reduce health disparities. Research suggests that incorporating cross-cultural communication techniques into healthcare delivery improves provider-patient relationships, patient satisfaction, adherence to treatment, and health outcomes. While PA accreditation standards include mandatory elements regarding cultural competency training of PA students, there is little research on how PA students feel about the effectiveness of this training. This study focused on determining PA students’ perceived levels of preparedness to treat patients of culturally diverse backgrounds. Specifically, the study evaluated PA students’ knowledge, skills, encounters, attitudes, awareness, and abilities regarding cultural competence, as well as students’ evaluations of these components of their education. The study utilized an online cross-sectional questionnaire with quantitative and qualitative components to 239 PA student respondents across eight American professional preparation programs in higher education institutions. The survey used a modified version of the previously validated Self-Assessment of Perceived Level of Cultural Competence Questionnaire (SAPLCC). Descriptive statistics were measured using SPSS software (v. 24). Independent sample t-tests identified significant differences in subscale scores between race and academic year. Qualitative data were hand-coded for common themes. Overall, findings showed that PA students rated their attitudes, awareness, and abilities about cultural competence as significantly greater than their knowledge, skills, and encounters. Specific areas of identified weaknesses in cultural competency education included: knowledge regarding the cultural context of care; skills associated with managing cross-cultural clinical challenges; and encounters related to coping with aggressiveness and bias. Further analysis indicated that second-year students and non-Caucasian students reported higher personal ratings for levels of cultural competence. Qualitative data provided further insight into students’ levels of preparedness, indicating that most surveyed PA students felt well prepared (39%) or moderately prepared (46%), rather than those who did not feel at all prepared (15%). Students indicated that specific classes focusing on cultural topics, discussions about cultural issues, and clinical experiences were the most useful for promoting cross-cultural education. Future investigation might explore the effectiveness of standardized approaches to training, how student perceptions align with actual care outcomes, or examine how diversity within PA programs impacts students’ preparedness to provide cross-cultural care.