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Chalupa RL, Kocher BK, Douglas MS. Using Kern's Model to Redesign a Postgraduate Curriculum for Orthopaedic Physician Assistants. J Physician Assist Educ 2023; 34:54-57. [PMID: 36728326 DOI: 10.1097/jpa.0000000000000478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Postgraduate physician assistant (PA) specialty training expands entry-level education, allowing PAs to work in concentrated fields. The United States Army - Baylor University Doctor of Science in PA Studies Orthopaedics program provides formal education to fill the capability gap caused by surgeon shortages in the military. Based on several sources of feedback, the authors recognized that the curriculum needed modernization and set forth to rewrite the curriculum. This article describes the use of Kern's 6-Step Approach for Curriculum Development for Medical Education to redesign a curriculum for an 18-month postgraduate doctoral program for military orthopaedic PAs. The resulting formal curriculum enables 4 geographically separated sites to execute an orthopaedic PA degree program that addresses a critical specialty care access challenge for the military. Kern's 6-Step approach could be used to design or redesign any PA educational content, from a single course to an entire degree program.
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Affiliation(s)
- Robyn L Chalupa
- Robyn L. Chalupa, DSc, PA-C, is research coordinator for the US Army - Baylor University Doctor of Science in Physician Assistant Studies, Orthopaedics Program, Walter Reed National Military Medical Center in Bethesda, Maryland
- Benjamin K. Kocher, DSc, PA-C, is chief of the Warrior Training Branch at the US Army Medical Center of Excellence Graduate School in Fort Sam Houston, Texas
- Matthew S. Douglas, DSc, PA-C, is dean of the US Army Medical Center of Excellence Graduate School in Fort Sam Houston, Texas
| | - Benjamin K Kocher
- Robyn L. Chalupa, DSc, PA-C, is research coordinator for the US Army - Baylor University Doctor of Science in Physician Assistant Studies, Orthopaedics Program, Walter Reed National Military Medical Center in Bethesda, Maryland
- Benjamin K. Kocher, DSc, PA-C, is chief of the Warrior Training Branch at the US Army Medical Center of Excellence Graduate School in Fort Sam Houston, Texas
- Matthew S. Douglas, DSc, PA-C, is dean of the US Army Medical Center of Excellence Graduate School in Fort Sam Houston, Texas
| | - Matthew S Douglas
- Robyn L. Chalupa, DSc, PA-C, is research coordinator for the US Army - Baylor University Doctor of Science in Physician Assistant Studies, Orthopaedics Program, Walter Reed National Military Medical Center in Bethesda, Maryland
- Benjamin K. Kocher, DSc, PA-C, is chief of the Warrior Training Branch at the US Army Medical Center of Excellence Graduate School in Fort Sam Houston, Texas
- Matthew S. Douglas, DSc, PA-C, is dean of the US Army Medical Center of Excellence Graduate School in Fort Sam Houston, Texas
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Kidd VD. Exploring Motivations and Barriers To Accreditation Adoption Among Physician Assistant and Nurse Practitioner Emergency Medicine and Orthopedic Surgery Residency and Fellowship Programs. Cureus 2023; 15:e36490. [PMID: 36960231 PMCID: PMC10030192 DOI: 10.7759/cureus.36490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 03/24/2023] Open
Abstract
Although there has been a rapid increase in the number of physician assistant (PA) and nurse practitioner postgraduate residency/fellowship specialty training programs in the United States, voluntary accreditation of these programs is a relatively new phenomenon. There is little research examining which factors may be predictors of accreditation adoption among PA and nurse practitioner (NP) postgraduate programs. Therefore, the primary aim of this study was to investigate which motivating factors influence postgraduate programs choice on whether to pursue accreditation. Methodology A descriptive cross-sectional survey consisting of 10 questions was distributed to 56 postgraduate emergency medicine and orthopedic surgery PA, NP, and joint PA/NP residency/fellowship programs via email between November 2022 and February 2023. Descriptive statistics were performed. Results Nineteen postgraduate programs responded to the survey. Two programs submitted incomplete surveys where less than 50% of the total items were completed. The partially completed surveys were omitted from the data analysis. The final response rate was 30% (17/56). Among the responded programs, 47% (8/17) offer dual PA and NP training, and 53% (9/17) are PA only. Although 88% (15/17) of postgraduate programs have discussed accreditation funding with their sponsoring institution only 76% are planning to do so or are in the process of pursuing accreditation. The two most common reasons for pursuing accreditation are program validation and assessment of educational quality 59% (10/17) and competition for applicants 24% (4/17). However, Magnet hospital designation, requirement of the sponsoring institution, or demand from employers were not determining factors of whether to pursue accreditation or not. Reasons for not pursuing accreditation included high costs of accreditation 18% (3/17), lack of perceived value of accreditation 6% (1/17), and lack of protected time to pursue accreditation 6% (1/17). Conclusion Although literature is still lacking on the effectiveness and impact of PA and NP postgraduate program accreditation, the findings of this rare study indicate that postgraduate programs are motivated to pursue accreditation. It is important for accreditors to communicate the utility of program-level accreditation and other value-added benefits to programs and their sponsoring institutions. Further work is necessary to better understand the value of external validation, specific drivers for validation, and barriers that influence accreditation adoption among these postgraduate programs.
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Affiliation(s)
- Vasco Deon Kidd
- Orthopedic Surgery, School of Medicine, University of California, Irvine, USA
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Grabenkort R, Hilton G. PA clinical postgraduate training: A half-century of development. JAAPA 2022; 35:57-61. [PMID: 35472035 DOI: 10.1097/01.jaa.0000824952.52796.2f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Clinical postgraduate training (CPGT) for physician assistants (PAs) began in 1971. A half-century later, the United States has 144 programs in 33 specialties. A growing and aging population, specialization in healthcare, and changes in graduate medical education have created new opportunities for PAs to consider this alternative following graduation. Postgraduate training is attractive to PA graduates who desire advanced skills and deeper understanding in a medical or surgical specialty. This article describes the history of CPGT programs, training, and establishment of an accreditation process for educational standardization.
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Affiliation(s)
- Rob Grabenkort
- Rob Grabenkort is the retired codirector of the residency program for NPs/PAs in critical care medicine at Emory Critical Care Center in Atlanta, Ga. Ginny Hilton is the retired director and a guest lecturer at the Norwalk/Yale PA surgical residency in Norwalk, Conn. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Katz PR, Ryskina K, Saliba D, Costa A, Jung HY, Wagner LM, Unruh MA, Smith BJ, Moser A, Spetz J, Feldman S, Karuza J. Medical Care Delivery in U.S. Nursing Homes: Current and Future Practice. THE GERONTOLOGIST 2021; 61:595-604. [PMID: 32959048 PMCID: PMC8496687 DOI: 10.1093/geront/gnaa141] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Indexed: 01/11/2023] Open
Abstract
The delivery of medical care services in U.S. nursing homes (NHs) is dependent on a workforce that comprises physicians, nurse practitioners, and physician assistants. Each of these disciplines operates under a unique regulatory framework while adhering to common standards of care. NH provider characteristics and their roles in NH care can illuminate potential links to clinical outcomes and overall quality of care with important policy and cost implications. This perspective provides an overview of what is currently known about medical provider practice in NH and organizational models of practice. Links to quality, both conceptual and established, are presented as is a research and policy agenda that addresses the gaps in the evidence base within the context of our ever-changing health care landscape.
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Affiliation(s)
- Paul R Katz
- Department of Geriatrics, Florida State University College of
Medicine, Tallahassee
| | - Kira Ryskina
- Department of Medicine, University of Pennsylvania,
Philadelphia
| | | | - Andrew Costa
- Department of Clinical Epidemiology and Biostatistics, McMaster
University, Hamilton, Ontario, Canada
| | - Hye-Young Jung
- Population Health Sciences, Weill Cornell Medical
College, New York City, New York
| | - Laura M Wagner
- Healthforce Center, University of California San
Francisco
| | - Mark Aaron Unruh
- Population Health Sciences, Weill Cornell Medical
College, New York City, New York
| | - Benjamin J Smith
- School of Physician Assistant Practice, Florida State
University, Tallahassee
| | - Andrea Moser
- Department of Family and Community Medicine, University of
Toronto, Ontario, Canada
| | - Joanne Spetz
- Healthforce Center, University of California San
Francisco
| | - Sid Feldman
- Department of Family and Community Medicine, University of
Toronto, Ontario, Canada
| | - Jurgis Karuza
- Department of Medicine, University of Rochester,
New York
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Kidd VD, Vanderlinden S, Hooker RS. A National Survey of postgraduate physician assistant fellowship and residency programs. BMC MEDICAL EDUCATION 2021; 21:212. [PMID: 33853588 PMCID: PMC8045993 DOI: 10.1186/s12909-021-02613-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The development of postgraduate programs for physician assistants (PAs) began in 1973 and by 2020 there were approximately 72 programs spread across a broad range of medical and surgical disciplines. PA Post-graduate education programs are voluntary and available to American licensed PAs. Therefore, an assessment of the characteristics of PA post-graduate fellowships and residencies programs was initiated. METHOD A non-experimental, descriptive research study was designed to obtain information on the characteristics of PA postgraduate education programs in the US. The source of information was from surveyed members of the Association of Postgraduate Physician Assistant Programs (APPAP). Questions were drawn from consensus discussions. Directors of postgraduate programs that were operational in 2020 were eligible to participate. RESULTS Seventy-two postgraduate program directors were invited to the survey and 34 program directors replied. These programs are geographically distributed across the US in 13 states. The respondents represent a wide range of medicine: surgery, emergency medicine, critical care, orthopaedics, hospitalist, psychiatry, oncology, primary care, pediatrics, and cardiology. Most programs are associated with an academic medical center and some institutions have more than one postgraduate specialty track. The curriculum includes bedside teaching, lectures, mentorship, assigned reading, procedures, simulation, and conferences. An average program length is 12 months and awards a certificate. Stipends for PA fellows are $50,000-80,000 (2020 dollars) and benefits include paid time off, health and liability insurance. About half of the programs bill for the services rendered by the PA. Over 90% of graduates are employed within 2 months of completing a PA postgraduate training program. CONCLUSION A trend is underway in American medicine to include PAs in postgraduate education. PA postgraduate training occurs across a broad spectrum of medical and surgical areas, as well as diverse institutions and organizations overseeing these programs. Most PA postgraduate programs are in teaching hospitals where the PA resident or PA fellow also serves as a house officer alongside a categorical resident. This study sets the stage for more granular economic and social research on this growing phenomenon in American medicine.
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Affiliation(s)
- Vasco Deon Kidd
- Director of Advanced Practice Providers, The University of California, Irvine, UCI Health, Orange, USA.
| | - Sarah Vanderlinden
- Assistant Director Advanced Practice, APP Critical Care Fellowship Program, Medical College of Wisconsin, Department of MCP Clinical Affairs, Milwaukee, USA
| | - Roderick S Hooker
- Adjunct Professor of Health Policy, Northern Arizona University, Flagstaff, USA
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Tsyrulnik A, Goldflam K, Coughlin R, Wong AH, Ray JM, Bod J, Chekijian S, Della-Giustina D. Implementation of a Physician Assistant Emergency Medicine Residency Within a Physician Residency. West J Emerg Med 2020; 22:45-48. [PMID: 33439803 PMCID: PMC7806319 DOI: 10.5811/westjem.2020.11.49052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/20/2020] [Indexed: 11/17/2022] Open
Abstract
Physician assistants (PA) are an important part of emergency department healthcare delivery and are increasingly seeking specialty-specific postgraduate training. Our goal was to pilot the implementation of a PA postgraduate program within an existing physician residency program and produce emergency medicine-PA (EM-PA) graduates of comparable skill to their physician counterparts who have received the equivalent length of EM residency training to date (evaluated at the end of first year of EM training). The curriculum was based on the Society for Emergency Medicine Physician Assistants (SEMPA) recommendations with a special focus on side-by-side training with EM resident physicians. In reviewing the program, the authors examined faculty evaluations, as well as procedure and ultrasound experience that the trainees received. We found comparable evaluations between first-year EM-PA and physician trainee cohorts. This program serves as a pilot study to demonstrate the feasibility of collocating clinical and didactic programming for physicians and EM-PAs during their postgraduate training. This brief innovation report outlines the logistics of the clinical and didactic curriculum and provides a summary of outcomes evaluated.
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Affiliation(s)
- Alina Tsyrulnik
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Katja Goldflam
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Ryan Coughlin
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Ambrose H Wong
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Jessica M Ray
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Jessica Bod
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - Sharon Chekijian
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
| | - David Della-Giustina
- Yale University School of Medicine, Department of Emergency Medicine, New Haven, Connecticut
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Characteristics of Effective Continuing Medical Education for Physician Assistants and Nurse Practitioners in Hospital Medicine. J Physician Assist Educ 2020; 31:2-7. [PMID: 32004252 DOI: 10.1097/jpa.0000000000000285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to describe participant characteristics and effective teaching methods at a national continuing medical education (CME) conference on hospital medicine for physician assistants (PAs) and nurse practitioners (NPs). METHODS In this cross-sectional study, participants provided demographic information and teaching effectiveness scores for each presentation. Associations between teaching effectiveness score and presentation characteristics were determined. RESULTS In total, 163 of 253 participants (64.4%) completed evaluations of 28 presentations. Many of the participants were younger than 50 years (69.0%), had practiced for fewer than 5 years (41.5%), and worked in nonacademic settings (76.7%). Teaching effectiveness scores were significantly associated with the use of clinical cases (perfect scores for 68.8% of presentations with clinical cases vs. 59.8% without; P = .04). CONCLUSION Many PAs and NPs at an HM CME conference were early-career clinicians working in nonacademic settings. Presenters at CME conferences in hospital medicine should consider using clinical cases to improve their teaching effectiveness among PA and NP learners.
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Specialty certification and clinical flexibility. JAAPA 2019; 32:43-48. [PMID: 30817480 DOI: 10.1097/01.jaa.0000553385.82884.f1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The ability for PAs to easily move from one specialty to another without additional formal training is a unique feature of the profession that is valued by PAs and their employers. Specialty certification has been viewed as a threat to this flexibility, yet 73% of PAs are in specialty practice. How can the desire to preserve flexibility be balanced against the desire of specialized PAs to distinguish themselves in their chosen specialty? This article reviews the issue of specialty certification in the context of contemporary PA practice and concludes that although specialty certification remains a threat to the flexibility of the PA model, it may be appropriate in some situations. In particular, specialty certification may be appropriate as a means for promotion within healthcare systems so long as it is not used as a requirement for entry into specialty practice, credentialing, or third-party reimbursement. A portfolio model may give stakeholders an alternative way to assess the experience and competencies of PAs in specialty practice areas.
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Kraus CK, Carlisle TE, Carney DM. Emergency Medicine Physician Assistant (EMPA) Postgraduate Training Programs: Program Characteristics and Training Curricula. West J Emerg Med 2018; 19:803-807. [PMID: 30202490 PMCID: PMC6123089 DOI: 10.5811/westjem.2018.6.37892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 06/19/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction A growing number of formal postgraduate training programs have been established to provide emergency medicine physician assistants (EMPA) with the unique skills and knowledge to work in the emergency department (ED). The objective of this study was to provide an overview of the current state of EMPA postgraduate training and to describe program characteristics and curriculum components. Methods We conducted a cross-sectional study of EMPA postgraduate training programs using data from websites and contacting individual programs to provide program characteristics and curriculum components. Variables collected included length of program, curriculum (e.g., clinical rotations, didactic experience, and research opportunities), size of program/number of trainees, affiliation with emergency medicine (EM) residency, geographic location, and salary. Results We identified 29 EMPA postgraduate training programs in 17 states, with at least one additional program in development. The mean length of EMPA training programs is 15 months (range 12-24 months). The most common non-ED/elective rotations are orthopedics, ultrasound, anesthesiology, and trauma. The mean number of trainees per class is 3.46 (median 3, range 1-16 trainees); 27 of 29 (93%) programs were in institutions that also had an EM residency program. The mean annual salary is $58,566 (range $43,000-90,000). Conclusion EMPA postgraduate training programs have common characteristics and curriculum components despite a lack of a specialty-specific accrediting organization or certifying examination. The overall growth and current number of these programs merits further research focusing on whether standardized curricula, formal recognition, and accreditation should be developed.
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Affiliation(s)
- Chadd K Kraus
- Geisinger Health System, Department of Emergency Medicine, Danville, Pennsylvania
| | - Terry E Carlisle
- University of Missouri-Columbia, Department of Emergency Medicine, Columbia, Missouri
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