Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2005. / "A dissertation in nursing." Advisor: Steve Krantz. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed June 23, 2006. Includes bibliographical references (leaves 138-159 ). Online version of the print edition.

Thesis (Ph.D.)--RAND Graduate School, 2006. / Includes bibliographical references.

abstract: Health care providers (HCPs) are an important source of physical activity (PA) information. Two studies were conducted to qualitatively and quantitatively examine nurse practitioners'(NPs) and physician assistants' current PA counseling practices, knowledge and confidence to provide PA counseling and providers' perceptions about their current PA counseling practices. The specific aims for these two studies included quantitatively and qualitatively identifying the prevalence of PA counseling, perceived counseling knowledge and confidence, and educational training related to counseling. In study 1, survey respondents were currently practicing NPs and physician assistants. Participants completed a modified version of the Promotion of Physical Activity by Nurse Practitioners Questionnaire either online or in person during a population specific conference. The majority of both NP and physician assistant respondents reported routinely counseling patients about PA. There were no differences in perceived knowledge or confidence to provide PA counseling between the two populations. Approximately half of all respondents reported receiving training to provide PA counseling as part of their educational preparation for becoming a health practitioner. Nearly three-quarters of respondents reported interest in receiving additional PA counseling training. In study 2, five focus groups (FGs), stratified by practice type, were conducted with NPs and physician assistants. Both NPs and physician assistants reported discussing PA with their patients, particularly those with chronic illness. Participants reported that discussing lifestyle modifications with patients was the most common type of PA counseling provided. Increased confidence to counsel was associated with having PA knowledge and providing simple counseling, such as lifestyle modifications. Barriers to counseling included having more important things to discuss, lack of time during appointments, the current healthcare system, lack of reimbursement and perceived patient financial barriers. PA recommendation knowledge was highly variable, with few participants reporting specific guidelines. FG participants, while not familiar with the American College of Sports Medicines' "Exercise is Medicine" initiative indicated interest in its use and learning more about it. The findings of these two studies indicate that while NPs and physician assistants are knowledgeable, confident and currently providing some amount of PA counseling to patients, additional training in PA counseling is needed and desired. / Dissertation/Thesis / Ph.D. Exercise and Wellness 2011

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.

Legal liability of a physician in graduate medical training and its practical consequences Abstract From both legal as well as practical point of view, a physician in training (i.e. without specialist qualification for performing the medical profession of physician) finds himself in a unique position, differing from those of any other medical staff. Having completed a medical degree, a physician starts his journey towards obtaining an unrestricted license to practice medicine. However, up until a successful ending of his graduate training, he is required to practice medicine under direct or indirect supervision of an attending physician, with a sole exception of those procedures explicitly permitted to be done unsupervised. With regard to the above mentioned, the aim of this thesis is to deliver a complex picture analysing legal liability of a physician in graduate medical training. Further on, it aims to critically assess current legislation concerning this topic on the grounds of relevant case law as well as outcomes of a survey among physicians without specialist qualification for performing the medical profession of physician. First part of the thesis analyses mainly the legal framework a physician in training has to work in, i.e. Act. No. 95/2004 Coll. Following part of the thesis then covers the issue...

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

Background: Emergency Department (ED) overcrowding is a national healthcare problem, and despite awareness and efforts to alleviate excessive patient volume, it continues to be an epidemic. One improvement technique proposed is to increase employment of independently licensed APRNs in the ED. Objective: The objective of this study was to determine if LMC and USACS physicians are willing and ready to implement and collaborate with NPs in the ED. Design and Methods: A non-experimental descriptive study design was employed, and sixty emergency medicine providers were surveyed. Eighteen participants (14 MDs, 4 DOs) completed an online questionnaire which consisted of 21 Likert-style questions, an open-ended question, and six demographic questions. Research questions: 1) What are physician perceptions regarding the tasks and resources required for NPs to practice in emergency medicine? 2) What are physician perceptions regarding the need, importance, and benefits of NPs in the ED? 3) What are physician perceptions of contextual factors regarding NPs’ working in the organization? Results: Entire Questionnaire: Mean = 2.02 (SD = .35); Subscale 1: Mean = 2.13 (SD = .33); Subscale 2: Mean = 1.79 (SD = .48); Subscale 3: Mean = 2.06 (SD = .49). Conclusion: This study concludes that, overall, there is a readiness to change among the USACS physicians. Evaluation of subscale 2 and 3 from this study indicates that USACS physicians are willing and ready to implement an NP service in LMC's ED. Furthermore, while discrepancies occurred in subscale 1, these differences can be mitigated through education, credentialing requirements, and policy development.

Despite a wealth of literature on the aetiology of somatic distress or somatization, somatic theory has failed to expand beyond a dualistic epistemology of causation. Within the primary health context where medically unexplained symptoms are characteristically articulated as literal, symbolic gestures of internal psychological processes, individuals' subjective accounts of somatic distress are reduced to objective phenomena and thus articulated on the grounds of absence. Within this context, the body as a lived, meaningful, perceiving subjectivity is silenced in favour of the corpse, thus rendering the somatizing individual's lived and subjective experience, expression and knowledge of somatic distress inaccessible. Instead, the somatizing individual is positioned within a domain of perturbed silence - a domain in which the professional's turning away or retreat from engaging somatization on the grounds of unique, subjective and corporeal experience, positions the patient/client as a passive, silent recipient whose somatic expressions as lived are overlooked. This study attempts to initiate a theoretical focus of departure from existing articulations of somatic distress through the development of a theoretical and epistemological framework that addresses some of the tensions inherent to contemporary somatic theory. In so doing, it employs embodiment philosophy and narrative methodology as a basis for a preliminary and critical investigation into a relatively neglected area of somatization research. / KMBT_363 / Adobe Acrobat 9.54 Paper Capture Plug-in

This research study explores in general the nature of a private general medical practice [PGMP] and whether analysis of the PGMP as a social system can lead the Group Dynamics Practitioner towards developing interventions that will enhance group effectiveness in the PGMP support staff group. The main assumption is that, through the application of a framework of analysis based on that of G. C. Homans and the AGIL functional prerequisites developed by T. Parsons, a structured analysis of the external and internal variables that impact on the PGMP as a social system can be undertaken. The findings of the analysis would lead to the formulation of interventions that would improve the performance effectiveness of the PGMP as a social system. Following a two-questionnaire survey of 17 practices that provided demographic information as well as soft skills training needs, a single PGMP was identified for the case study. Data pertaining to the group as a social system were collected, and by using direct observation, content analysis and a sociometric test, the practice support staff sub-system, being the main focus of this research, could be analysed. By linking the findings to the elements of the framework of analysis, areas of ineffective group functioning could be identified and interventions suggested. This research indicates that the choice of soft skills is associated with the nature and size of the practice, as well as the dynamics of the sociometric patterns characteristic of the relations within the practice support staff subsystem; that while some practice support staff have preferences for sociometric task and socio-emotional relations outside their work clusters, these seem to serve as a buffer against clique forming, thus enhancing the function of integration within the social system as a whole; and that the physical practice layout, and the interaction dynamics that it creates, tend to hinder integration between the members of the practice support staff group, as a social subsystem.