Redesigning Physician Assistant Education to Promote Cognitive Diversity, Inclusion, and Health Care Equity

Academic leadership in physician assistant/associate medical education: a cross-sectional analysis of the association with doctoral degree, gender, and minority status

BACKGROUND

There is a critical need for a diverse pool of academic leaders to increase the number and diversity of the medical workforce. Physician Assistant/Associate (PA) is a growing medical profession. Although the master's degree is the terminal degree for PAs, a growing number of PAs obtain a variety of doctoral degrees. However, there is no standardized training for academic PA leaders. The purpose of this study was to identify factors associated with PA academic leadership. Specifically, this study explored the following factors: doctoral degree credentials, gender and underrepresented minority status.

METHODS

Using the 2019 Physician Assistant Education Association Faculty and Directors survey, we assessed the relationship between academic leadership groups [Program Director (PD), Academic Director (AD), and Clinical Director (CD)] doctoral degree, gender, and underrepresented minority in medicine (URIM) status. Multivariable logistic regression models were used to determine the predictors of being in a leadership role. Results with p < 0.05 were considered statistically significant.

RESULTS

Of the 956 participants, 71% were female, 4% Hispanic, 86% White, 4% Black, 2% Asian, and 1% Native Hawaiian/Pacific Islander/American Indian/Alaska Native. Overall, 9% were URIM. Mean age was 45.6 (SD = 10.2) years. Average time in PA education was 2.9 years (SD = 1.4). Approximately 50% (n = 472) had a leadership role (PD-24%, AD-10%, CD-16%). Of all leaders, 68% were female, 9% were URIM, and 19% had a doctoral degree. Having a doctoral degree increased the odds of being a PD [AOR 2.38, CI [1.57-3.59], p = < 0.0001, AD and CD = non-significant]. More time in PA education increased the odds of being a PD [AOR 1.10, CI [1.07-1.12, p = < 0.0001] and AD [AOR 1.06, CI [1.03-1.09], p = < 0.0001], but not a CD. Gender and URIM status were not significantly associated with leadership roles. URIMs had doctorate degrees at higher rates than non-URIMs.

CONCLUSION

PA academic leaders differ by doctoral degree attainment but not by gender and URIM status. URIM faculty are grossly underrepresented in the PA professorate, but disproportionately have doctoral degrees. Academic training opportunities for all PA academic leaders and strategies to increase URIM faculty are needed.

Assessing and benchmarking equity, diversity, and inclusion in healthcare professions

ABSTRACT

Healthcare professions are among the fastest growing careers in the United States, but the issues of equity, diversity, and inclusion remain a challenge. The percentage of underrepresented minority groups is disproportionately small despite many efforts to increase workforce diversity over the past several decades. As the demographics in our nation are rapidly changing, increasing racial, ethnic, and cognitive diversity is crucial to achieving a workforce with the capacity to provide accessible and equitable healthcare. Given the growing evidence that a diverse workforce improves healthcare outcomes, fosters unique perspectives (cognitive diversity), and helps to reduce health disparities, there is an urgent need to address perennial barriers such as structural racism, biases, and stereotypes. Educational institutions should be held accountable to integrate equity, diversity, and inclusion in all aspects of healthcare professions education and practice. This article discusses potential areas for innovation and opportunities that can be leveraged in assessing and benchmarking equity, diversity, and inclusion in healthcare professions. The ability to thoroughly assess the PA profession's culture in relationship to diversity, equity, and inclusion provides an opportunity to determine how well the profession is performing, and to strategically plan for what else need to be done.

An assessment of physician assistant student diversity in the United States: a snapshot for the healthcare workforce

BACKGROUND

The Physician Assistant (PA) workforce falls short of mirroring national demographics mainly due to a lack of diversity in student enrollment. Few studies have systematically examined diversity across PA programs at the national level, and little is known about best practices for consistently graduating a diverse group of students. We descriptively characterized the extent to which PA programs are graduating a diverse group of students and identified top performing PA programs.

METHODS

Data from the Integrated Postsecondary Education Data System (IPEDS) were used to calculate the number and proportion of racial or ethnically diverse graduates. The study sample included 139 accredited PA programs that had graduated a minimum of five cohorts from 2014-2018. Within each of the United States Census Divisions, programs were ranked according to the number and proportion of graduates who were underrepresented minority (URM) race, Hispanic ethnicity, and of non-white (URM race, Hispanic, and Asian).

RESULTS

Amongst PA programs in the United States, a large disparity in the number and proportion of racial and ethnic graduates was observed. Of 34,625 PA graduates, only 2,207 (6.4%) were Hispanic ethnicity and 1,220 (3.5%) were URM race. Furthermore, a large number of diverse graduates came from a small number of top performing programs.

CONCLUSION

Despite the abundance of evidence for the need to diversify the healthcare workforce, PA programs have had difficulty recruiting and graduating a diverse group of students. This study provides empirical evidence that PA programs have not been able to attain the level of diversity necessary to shift the lack of diversity in the PA workforce. Based upon this study's findings, the top performing PA programs can be used as role models to establish benchmarks for other programs. The results of this descriptive study are currently being used to guide a qualitative study to identify the top performers' strategies for success.

Assessing Harmful Bias and Celebrating Strength Through the Narratives of Black/African American Physician Assistant Students

INTRODUCTION

Two national crises, the COVID-19 pandemic and systemic racism, have drawn nationwide attention to the disparities that exist in our society today. The American healthcare system, including physician assistant (PA) education, is not exempt from the impact of harmful bias and discrimination. The purpose of this study was to explore narratives recounting the experiences of Black/African Americans who have successfully completed their PA education in an attempt to understand how PA educators can better support students of color.

METHODS

Qualitative, semi-structured interviews, guided by a critical race theory framework, were conducted with 6 Black/African American PAs who had graduated within the last 5 years. Trustworthiness was ensured through member checking, triangulation, peer debriefing during the coding and analysis process, and autoethnographic reflection.

RESULTS

Themes of mentorship and cultural capital, including aspirations, family, social support, and resistance to an oppressive system, highlight the strengths present in Black/African American students. Additional themes surrounding stress related to race, including a pressure to prove, isolation and anxiety, and imposter phenomenon, all pointed toward the need for honest and safe dialogue among individuals with racial differences.

DISCUSSION

This research article presents key findings and opportunities for PA educators to emphasize cultural capital to enable Black/African American PA students to thrive. Communicating across racial differences and intentional engagement are imperative for PA educators to successfully support Black/African American students.

Understanding Early Admission Processes: Implications for Physician Assistant Workforce Diversity and Healthcare Equity

PURPOSE

Increasing diversity in the physician assistant (PA) workforce has been identified as a key priority by national PA organizations and PA programs alike. This study aimed to understand why certain applicants did not progress in PA program admissions by exploring common reasons for nonprogression and identifying any demographic trends.

METHODS

We conducted a retrospective review of applicants over the last 5 consecutive admission cycles at the University of California Davis Physician Assistant program.

RESULTS

The most common reasons for denial, starting with the most prevalent, were low application score, bachelor's GPA <3.0, missing prerequisite(s), late application, and science GPA <2.7. Several associations between demographic groups and reasons for nonprogression were identified.

CONCLUSIONS

The findings from a multicohort study might help programs consider these issues in their own programs and identify interventions to support underrepresented applicants.

Does Community College Attendance Affect Matriculation to a Physician Assistant Program? A Pathway to Increase Diversity in the Health Professions

PURPOSE

To explore whether community college (CC) applicants were a significant contributor to the diversity of matriculants to physician assistant (PA) programs and whether CC applicants were less likely to matriculate to PA programs than non-CC applicants.

METHOD

The authors used national data from the 2016-2017 application cycle. They categorized applicants to PA programs into 5 pathways: HS-CC (applicant attended CC while in high school), first-CC (applicant attended CC before a 4-year university), 4Y-CC (applicant attended CC while at a 4-year university), post-CC (applicant attended CC after graduating from a 4-year university), and no-CC (applicant never attended CC). The authors used Pearson chi-square and Kruskal-Wallis H tests and the appropriate post hoc tests to assess whether applicants in the 4 CC pathways were more diverse in terms of their race, ethnicity, gender, rurality, and socioeconomic status than those in the no-CC pathway. They used logistic regressions to assess associations between the CC pathways and matriculation to a PA program.

RESULTS

Among the 8,577 matriculants in the 2016-2017 application cycle, more than 75% attended a CC at some point. First-CC and post-CC matriculants were more likely to be Black (P < .001) or Hispanic (P < .001) and come from a disadvantaged background (P < .001) than no-CC matriculants. After adjusting for applicant demographics, academic performance, rurality and socioeconomic status, and application strategy, first-CC applicants had 17% lower odds of matriculating to a PA program than no-CC applicants (P < .001).

CONCLUSIONS

CCs are an important pathway to the PA profession, with 3 of 4 matriculants having a CC background. However, lower matriculation rates among similarly qualified applicants who transferred from a CC to a 4-year university than among applicants with no-CC background suggest that PA programs are missing important opportunities for increasing student diversity and thereby the profession.

Predicting Physician Assistant Program Matriculation Among Diverse Applicants: The Influences of Underrepresented Minority Status, Age, and Gender

PURPOSE

Health professions schools can foster a diverse medical workforce by ensuring equal educational access for students of varied backgrounds. This study examined how physician assistant (PA) applicants' demographic characteristics and prior academic history affected likelihood of PA program matriculation.

METHOD

The authors used national application data from the 2015-2016 PA application cycle to investigate associations between applicants' underrepresented minority (URM) status, age, and gender, and likelihood of matriculating into a PA program. Effects were examined alone and after adjusting for other demographics and potential confounders (number of applications submitted, patient care hours, academic achievement). The authors tested whether odds of matriculation differed among demographic subgroups with and without current Graduate Record Examinations (GRE) scores.

RESULTS

In univariate models, likelihood of matriculation was lower among URM, older, and male applicants. In fully adjusted models, the URM effect became nonsignificant and the gender effect reversed, while older applicants remained less likely to matriculate. URM and age, but not gender, effects differed by GRE status; only URMs and older applicants without current GRE scores were less likely to matriculate than non-URMs and younger applicants.

CONCLUSIONS

Findings that URMs, older individuals, and men had lower matriculation odds changed when controlling for academic achievement and GRE status, indicating the importance of these components in the admissions process. URM and age findings were contingent on GRE status such that odds of matriculation decreased among URM and older applicants without GRE scores, suggesting that standardized test requirements may be a barrier to PA workforce diversity.