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.

<p>The physician -patient relationship is fundamental to medical and healthcare practice. It is value laden. The practice of medicine and healthcare in the traditional sense accentuates a fecund doctor-patient communication. This is considered a necessary step for a proper diagnosis towards an attendant fruitful prognosis. Such a practise eventuates in the recognition of core values within the ambience of a standard medical practise. The values in question refer to issues of commitment and trust, obligations to standard care giving and reception, confidentiality, autonomy, beneficence, non maleficence, justice as well as responsibility. However, the practise of medicine today is criss-crossed by an amazing cast of transformations with the advent of the internet in the medical arena. Medical encounters take place online between doctors and patients even in the absence of pre-existing medical relationships in the hospitals.</p><p>There is today treatments and medical care mediated by the internet, a case of diagnosis and prognosis across distance, and indeed super highway medicine. This instance of hospitals without consulting rooms is morally problematic.</p><p>By the characterization of physician-patient relationship ( especially in the absence of pre-existing relationship) on the internet as virtual, unique, new and problematic, this work assesses the risks associated with such encounters in the light of ethical principles and their implications for moral responsibility.</p>

Thesis (Ph. D.)--Virginia Commonwealth University, 2006. / Prepared for: Dept. of Health Administration. Bibliography: leaves 132-140. Also available online.

Bakgrund: SFOG har tillsammans med SBF, SNS och LÖF upprättat riktlinjer för förlossningsvården som bland annat berör dokumentation av CTG. Dessa har tagits fram genom ”Projekt säker förlossningsvård” och antagits av Blekingesjukhuset Karlskrona år 2008. Syfte: Syftet var att undersöka barnmorskors och läkares följsamhet av CTG-dokumentation, vid aktivt förlossningsförlopp, i förhållande till lokala PM, aktuella riktlinjer och nationella styrdokument på förlossningsavdelningen, Karlskrona. Metod: Retrospektiv journalgranskningmed deskriptiv design har använts.  Datainsamling omfattar tidsperioden 2011-07-01 t.o.m. 2012-03-04. Totalt ingick 748 journaler och 1547 dokumentationer i studien. Dataanalys har skett med hjälp av statistikprogrammet SPSS. Resultat: Av journalerna hade 22% ingen dokumentation om CTG och 46% av dokumentationerna innehöll en klassifikation. Åtgärd har dokumenterats i 80% och dokumentationerna var skriven utan förkortning i 45%. Följsamheten av klassificering och åtgärd tillsammans var totalt 44%medan barnmorskors var 38% och läkares 8%. Konklusion: Följsamheten av CTG-dokumentationbehöver förbättras på förlossningsavdelningen i Karlskrona. Majoriteten av vad som dokumenteras följer inte PM, riktlinjer och nationella styrdokument. / Background: SFOG, SBF, SNS and LÖF have conducted guidelines for obstetric care including documentation of CTG. These have been developed during “Projekt säker förlossningsvård” and adopted 2008 by the hospital in Blekinge, Karlskrona. Aim: The aim of this study was to examine the compliance of CTG documentation by midwives and physician, during active labor, in relation to local PM, current guidelines and national policy at the labor ward Karlskrona. Method: Retrospective study using descriptive design was used. Data collection covers the time period 2011-07-01 to 2012-03-04. Totally 748 records and 1547 documentations were reviewed. Data analysis was progressed in SPSS. Result: Of the total records, 22% did not have any documentation about CTG and 46% of the collected documentations had a classification. Action was documented in 80%, and the documentations were written without an abbreviation in 45%. Compliance of classification and action together was 44%, midwives had  38% and physicians 8%. Conclusion: The compliance of CTG documentation needs improvement in the labor ward in Karlskrona. The majority of documents are not followed by PM, guidelines and national policy documents.

Antipsychotic use is an important issue in long-term care (LTC) homes due to their widespread use, the potential for serious adverse events and limited evidence about their efficacy in treating behavioural and psychological symptoms of dementia. Rates of antipsychotic use vary across LTC homes, but little is known about the contribution of physicians to this variation. This study documented the characteristics of physicians who regularly treated residents in Ontario LTC homes and examined variation in antipsychotic prescribing across physicians. In a population-based retrospective cohort of LTC residents, 637 (52.8%) of 1,207 LTC physicians cared for 46,365 (90.4%) of all residents. Overall, 27.3% of residents received antipsychotic therapy, but extremely high prescribers prescribed antipsychotics to 42.8% of their patients. Variation in physician antipsychotic prescribing persisted after controlling for clinical and behavioural resident characteristics. This variation was reduced by 47.1% when LTC homes were accounted for in multilevel cross-classification logistic regression models.

Antipsychotic use is an important issue in long-term care (LTC) homes due to their widespread use, the potential for serious adverse events and limited evidence about their efficacy in treating behavioural and psychological symptoms of dementia. Rates of antipsychotic use vary across LTC homes, but little is known about the contribution of physicians to this variation. This study documented the characteristics of physicians who regularly treated residents in Ontario LTC homes and examined variation in antipsychotic prescribing across physicians. In a population-based retrospective cohort of LTC residents, 637 (52.8%) of 1,207 LTC physicians cared for 46,365 (90.4%) of all residents. Overall, 27.3% of residents received antipsychotic therapy, but extremely high prescribers prescribed antipsychotics to 42.8% of their patients. Variation in physician antipsychotic prescribing persisted after controlling for clinical and behavioural resident characteristics. This variation was reduced by 47.1% when LTC homes were accounted for in multilevel cross-classification logistic regression models.

The physician -patient relationship is fundamental to medical and healthcare practice. It is value laden. The practice of medicine and healthcare in the traditional sense accentuates a fecund doctor-patient communication. This is considered a necessary step for a proper diagnosis towards an attendant fruitful prognosis. Such a practise eventuates in the recognition of core values within the ambience of a standard medical practise. The values in question refer to issues of commitment and trust, obligations to standard care giving and reception, confidentiality, autonomy, beneficence, non maleficence, justice as well as responsibility. However, the practise of medicine today is criss-crossed by an amazing cast of transformations with the advent of the internet in the medical arena. Medical encounters take place online between doctors and patients even in the absence of pre-existing medical relationships in the hospitals. There is today treatments and medical care mediated by the internet, a case of diagnosis and prognosis across distance, and indeed super highway medicine. This instance of hospitals without consulting rooms is morally problematic. By the characterization of physician-patient relationship ( especially in the absence of pre-existing relationship) on the internet as virtual, unique, new and problematic, this work assesses the risks associated with such encounters in the light of ethical principles and their implications for moral responsibility.

Little is known about how people evaluate credence attributes, that is, those attributes which the consumer often cannot fully evaluate even after purchasing and consuming the product. And yet consumers struggle to evaluate quality in several important product categories dominated by credence attributes such as food safety, medical services, legal services, and pharmaceuticals, among others. The dissertation explores the processes by which people form quality evaluations of services high in credence attributes and the consequences of those evaluations. Drawing on the service quality, dual-process social information processing, expert-novice and risk literatures, I develop a conceptual model to illustrate how skill and motivation moderate the ways people seek and integrate observable information to infer unobservable quality. The influence of quality evaluations on outcome, satisfaction, value, and loyalty is mapped. The model is tested in the context of a classic credence service, health care services with two large datasets using structural equation modeling. Study 1 draws on an existing patient satisfaction database (6,280 records) to measure the sources and consequences of quality evaluations. Study 2 validates Study 1 findings and extends those findings to show the moderating roles of product expertise and perceived risk on quality evaluation processes. The second study is tested with 1,379 consumers (patients) drawn from an online consumer panel. The research suggests service quality in this context refers narrowly to the attributes of the core product (here, the physician‘s medical competence); interpersonal and organizational quality are associated with value, satisfaction and loyalty, rather than overall quality. Two paths to quality evaluations appear to exist. In the first, consumers integrate evidence of the physician‘s capabilities, practices, and prior outcomes to reach evaluations of technical quality. In the second path, consumers rely on a trust heuristic in which observed interpersonal and organizational quality signals are used to build trust in the physician; that trust, in turn, influences perceptions of technical quality. The trust heuristic appears to be used when the stakes are low and, counterintuitively, when the stakes are high, just when superior evaluations are most needed.

Pay for performance programs are being used more and more extensively nowadays. The proponents of incentives claim that money is an important motivator for better performance, while the opponents insist that incentives can never bring lasting performance improvement, which is driven by intrinsic motivation. It has been born out that monetary reward has detrimental effects on intrinsic motivation. However, the results come mostly from experiments on school children, whether the result can be replicated in work settings is still a question needs to be examined. This study examined whether performance based pay has detrimental effect on physicians¡¦ intrinsic motivation and what effects other non-monetary rewards may have on intrinsic motivation. It is found that the intrinsic motivation of Attending Physician is significantly higher than Resident Physician, which implies that the motivational property of the work itself is a very important factor of intrinsic motivation. Physicians from privatized public hospitals have higher intrinsic motivation than those from public hospitals, of which the causes may need to be further explored. In terms of different positions, productivity-based pay, organizational performance based pay and recognition are found to have positive influence on Attending Physicians¡¦ intrinsic motivation, while career development opportunities and research-teaching based pay are found to have positive influence on Resident Physicians¡¦ intrinsic motivation. As to the effects of performance-based pay, it is found that physicians having performance-based pay do feel more controlled by pay; however, their intrinsic motivation is not negatively affected. It seems to imply that organizational workers are able to separate intrinsic reward and extrinsic reward and thus their intrinsic motivation is not affected by extrinsic rewards. This result is similar to what Fisher found in 1978. The moderating effect of individual difference is not significant in this study due to the homogeneity of physicians.

BACKGROUND¡GWork plays an important role in everyone¡¦s health and happiness. However, facing the rapidly changing medical environment, physicians feel even more stress than ever. PURPOSE¡GThe purpose of this study was to find the current stressors among physicians who worked in hospitals in southern Taiwan, and to evaluate the correlations among demographics, type A behavior pattern(TABP) and the perception and approach-avoidance intention (AAI) of the stressors. METHOD: Structured questionnaires were mailed to physicians who worked in hospitals in Ping tong and Kaohsiung. Data were coded and analyzed with factor analyses, £q2 test, Pearson¡¦s correlation, partial correlation, Student t test, ANOVA and multiple regression when appropriate. RESULTS: The effective response rate was 7.9% and there was no true difference between the samples and population in demographic characteristics. Six factors were extracted from stressors by factor analyses with the cumulative percentage of total variance explained around 64.7%. The overall Cronbach¡¦s £\ was .917. The extent of stress perception and the AAI of the factors of stressors, namely ¡§patient management (PM)¡¨, ¡¨interpersonal relationship (IR)¡¨, ¡¨work load (WL)¡¨, ¡¨medical environment (ME)¡¨, ¡¨organizational structure (OS) and ¡§research and teaching (RT)¡¨, were used as dependent variables during comparisons between different demographic variables and TABP. The mean TABP score was 4.47, mean perceived stress was 3.13 and the mean AAI of the stressors was 3.5. The most stressful factor of stressors was PM and the least was IR. The AAI of the factor of the stressors revealed that RT was most likely to use approach as the coping strategy whereas the OS was the least. The correlation between the extent of the stress perception and AAI of the stressors varied. Significant correlation was found only in moderate stress zone. TABP significantly correlated to stress perception with Pearson¡¦s r = .227 ( P < .05 ). There was significant difference in overall stress perception on TABP and the position of the physicians. Physicians with TABP perceived more stress than Type B did. Residents were more likely to report their job as stressful than attending physicians did. However, the correlation between TABP and the AAI of the stressors (overall and all 6 factors) were not significant. The attribute of the hospital was the only factor that has the moderator effect on AAI of the stressors. Physicians who worked in public hospitals use approach as the coping strategy to the stressors more likely than physicians who worked in private hospitals did. The correlation between the stress perception and AAI to the factors of the stressors, and the moderator effect of physicians demographics and TABP on stress perception and AAI to the factors of the stressors will be discussed in detail in the text.