Enhancing Physician Assistant Psychiatry Interviewing Skills Using Standardized Patients

INTRODUCTION

The aim of this pilot study was to assess whether supplemental psychiatry training in the didactic year increases the scores on the Physician Assistant Education Association (PAEA) Psychiatry and Behavioral Health End of Rotation examination and psychiatry preceptor evaluation.

METHODS

Data were obtained from the physician assistant (PA) students on PAEA Psychiatry and Behavioral Health End of Rotation examination and psychiatry preceptor evaluation for a single institution. Then, a comparison was performed for PA students who did not participate in supplemental psychiatry/behavioral health training (Cohort 1/historical control group; n = 62) and PA students who participated in supplemental psychiatric and behavioral health training (Cohort 2/experimental group; n = 63) to determine the effects of the groups.

RESULTS

An independent t test demonstrated that the experimental group performed significantly better than the control group on both the Psychiatry and Behavioral Health PAEA End of Rotation examination and preceptor evaluation {control group (M = 83.4) and experimental group (M = 86.3; t [117] = 2.8; P < .05)} and the preceptor evaluation {control group (M = 90) and experimental group (M = 92.6; t [112] = 2.1; P < .05)}. In addition, both analyses demonstrated a moderate effect size (End of Rotation examination, d = 0.51; preceptor, d = 0.62). A multiple regression analysis was used to control for age, sex, grade point average (GPA), and training intervention. Age, sex, and GPA were found not to affect the results. However, treatment intervention was statistically significant for both the End of Rotation examination and preceptor evaluation scores.

DISCUSSION

Supplemental training in behavioral health and psychiatry, which included a standardized patient encounter and an interactive session dedicated to psychiatry interviewing techniques, resulted in students performing better on the Psychiatry and Behavioral Health PAEA End of Rotation examination and preceptor evaluation.

Clinical Faculty Perceptions of Online Learning in Health Professions Education

INTRODUCTION

The purpose of this study was to investigate clinical faculty perceptions of online learning in health professions education.

METHODS

Clinical faculty members from various health professions programs in New York were surveyed to determine whether there was a relationship between clinical faculty members' attitudes toward online learning competencies and their ability to teach online. Additionally, this study explored what type of impact years of teaching experience and online training had on clinical faculty perceptions of online learning.

RESULTS

The study received 60 responses from clinical faculty, most of whom were teaching on Long Island, New York. Although the findings were not significant for most variables, a t -test demonstrated a significant statistical difference between online training and faculty perceptions of online learning. When clinical faculty completed online training, they had a more positive attitude toward online learning. The study also found that clinical faculty members' attitudes toward technology in online learning positively influenced their ability to troubleshoot technical issues in online environments. Years of online teaching experience did not affect how clinical faculty perceived online learning; however, clinical faculty with 1-5 years and 6-10 years of teaching experience rated their attitudes and abilities the lowest out of all the groups.

DISCUSSION

While there appears to be a correlation between faculty perceptions of online learning and online training, more research is needed to objectively determine which specific trainings would be most advantageous.

Integrating Oral Health into Health Professions School Curricula

Oral health is essential to human health. Conditions associated with poor oral health involve all organ systems and many major disease categories including infectious disease, cardiovascular disease, chronic pain, cancer, and mental health. Outcomes are also associated with health equity. Medical education organizations including the Association of American Medical Colleges and National Academy of Medicine recommend that oral health be part of medical education. However, oral health is not traditionally included in many medical school, physician assistant, or nurse practitioner curricula. Several challenges explain this exclusion including lack of time, expertise, and prioritization; we therefore provide suggestions for integrating oral health education into the health professions school curriculum. These recommendations offer guidance for enhancing the oral health curriculum across institutions. We include key organizational and foundational steps, strategies to link oral health with existing content, and approaches to achieve curricular sustainability.

Managing a patient with acute colonic diverticulitis

ABSTRACT

Acute diverticulitis is a common condition in Western society with the potential for substantial patient morbidity. Depending on the severity, the patient's clinical presentation and treatment options vary considerably, leaving uncertainty about optimal management. Traditionally, surgery was recommended to prevent complications, persistent symptoms, and recurrent episodes. Improvements in the understanding of the disease's natural history, diagnostic imaging, and long-term outcomes have prompted changes to diagnosis and treatment guidelines.

Focusing on cultural humility in pharmacy assessment tools

INTRODUCTION

Many pharmacy programs have been reviewing their curricula to ensure that unconscious bias is not interwoven throughout. However, few programs have looked at their assessment tools to determine if unconscious bias exists in them. Since research on unconscious bias in assessment tools is currently limited, this study was developed to explore how race, ethnicity, age, and gender were used in multiple-choice item banks at one pharmacy program.

METHODS

A total of 27 pharmacy test banks, including examinations from first-, second-, and third-year pharmacy curricula, were examined. The exams administered in the 27 courses provided 3621 questions for review and coding based on reference to race, ethnicity, age, and gender.

RESULTS

Of the total 3621 exam items reviewed, 40 referenced race. Of those 40, it was determined that race was only applicable/relevant to two (5%) of the questions, linked to Whites. Gender breakdown was 56% male and 45% female, with no mention of transgender. Gender was central to 72 of the 426 questions. Age was mentioned in 381 of the questions and was central in only 46. Ethnicity was not mentioned in any of the questions. In none of the questions were these variables self-identified.

CONCLUSIONS

The routine mention of race in preparation of materials such as question banks, with no specified goal, risks contributing to racial bias. The goal of all pharmacy educators is to graduate pharmacists that possess sound academic knowledge, clinical skills, and the cultural humility to provide quality care to their patients.

Hypogonadism in men: Updates and treatments

ABSTRACT

Hypogonadism is a clinical syndrome of testosterone deficiency that presents with nonspecific symptoms of sexual dysfunction, fatigue, and decreased strength or muscle mass. Men with obesity, diabetes, and other comorbidities are at higher risk for hypogonadism. Patients presenting with symptoms should be tested for low testosterone and treated with testosterone replacement. Testosterone therapy carries risks and must be closely monitored. Patients treated for hypogonadism may experience improvement of symptoms and quality of life.

A Call to Action for Cultural Humility in Pharmacy Education Student Assessments

An important topic in the conversation on the education of pharmacy students evolves around methods of pedagogy and assessment and attention to diversity and inclusion. Well-intentioned educators may introduce bias into their teachings and assessment tools by focusing on diseases with a higher rate of presentation in minorities without engaging in conversations about why these health disparities exist. When considering the content and structure of a curriculum, it is also important to review its assessment tools, with attention to cultural humility in multiple-choice examinations, case-based presentations, and even observed structured clinical examinations. Disregarding this component of the conversation may lead students to have an unconscious impression that social constructs are biological markers for a disease. Students may recall not only what they learned in a classroom setting, but often the content included in their assessments as well. By writing test items that are culturally responsible, unconscious bias can be reduced and test items can better measure the knowledge that educators intend to assess. As pharmacy educators perform programmatic reviews, attention should be directed toward unconscious bias, not only in the curricula but also in evaluation and assessment tools.

Examining the Impact of Implicit Bias Education in Healthcare Students

Implicit bias is prevalent in healthcare, possibly because of the practices employed during healthcare education. However, the impact of healthcare education on student beliefs and attitudes has not been well studied. Students entering healthcare careers have the unique opportunity to become educated on their biases and to be given tools to actively avoid implicit bias. By having an awareness of the impact that implicit bias can have on the future interactions of healthcare students, educators can make a profound difference on the experiences of not only the student, but also the patients they will treat. In this commentary, we explore current research on the impact of implicit bias education on healthcare student beliefs and clinical practice. Additionally, we review a framework to assist faculty in designing curricula to implement implicit bias education.

Call to Action: Addressing Social Determinants of Health in Pharmacy Practice

Social determinants of health (SDOH) are conditions in which individuals are born, live, work, learn, play, and age that affect health, risks, functioning, and outcomes. SDOH are recognized barriers to care, risk factors for certain diseases, and associated with poorer health outcomes. Screening for SDOH in physician practices and hospitals is reportedly low. The accessibility of pharmacists and established relationships with patients make pharmacy settings ideal for identifying and mitigating social needs. An evaluation of the impact of SDOH on health outcomes and opportunities for pharmacists to embed screening into practice is warranted.

Childhood Immunization and COVID-19: An Early Narrative Review

The COVID-19 pandemic has evolved into arguably the largest global public health crisis in recent history—especially in the absence of a safe and effective vaccine or an effective anti-viral treatment. As reported, the virus seems to less commonly infect children and causing less severe symptoms among infected children. This narrative review provides an inclusive view of scientific hypotheses, logical derivation, and early analyses that substantiate or refute such conjectures. At the completion of a relatively less restrictive search of this evolving topic, 13 articles—all published in 2020, were included in this early narrative review. Directional themes arising from the identified literature imply the potential relationship between childhood vaccination and COVID-19—either based on the potential genomic and immunological protective effects of heterologous immunity, or based on observational associations of cross-immunity among vaccines and other prior endemic diseases. Our review suggests that immune response to the SARS-CoV-2 virus in children is different than in adults, resulting in differences in the levels of severity of symptoms and outcomes of the disease in different age groups. Further clinical investigations are warranted of at least three childhood vaccines: BCG, MMR, and HEP-A for their potential protective role against the SARS-CoV-2 virus.

Direct and Indirect Effects of Fibroblast Growth Factor (FGF) 15 and FGF19 on Liver Fibrosis Development

Farnesoid X receptor (FXR) induces fibroblast growth factor 15 (FGF15; human ortholog FGF19) in the gut to potently inhibit bile acid (BA) synthesis in the liver. FXR activation in hepatic stellate cells (HSCs) reduces liver fibrosis (LF). Fgf15^-/- mice develop attenuated LF, but the underlying mechanisms for this protection are unclear. We hypothesized that FGF15/19 functions as a profibrotic mediator or mitogen to HSCs and increased BAs in Fgf15^-/- mice leads to enhanced FXR activation in HSCs, subsequently reducing fibrogenesis. In this study, complimentary in vivo and in vitro approaches were used: (1) CCl₄ -induced LF model in wild type (WT), Fgf15^-/- , and Fgf15 transgenic (TG) mice with BA levels modulated by feeding cholestyramine- or cholic acid-containing diets; (2) analysis of primary HSCs isolated from WT and Fgf15^-/- mice; and (3) treatment of a human HSC line, LX-2, with FXR activators and/or recombinant FGF19 protein. The results showed that Fgf15^-/- mice had lower basal collagen expression, which was increased by BA sequestration. CCl₄ induced fibrosis with similar severity in all genotypes; however, cholestyramine increased fibrosis severity only in Fgf15^-/- mice. HSCs from Fgf15^-/- mice showed increased FXR activity and reduced expression of profibrotic mediators. In LX-2 cells, FXR activation increased peroxisome proliferator-activated receptor gamma activity and reduced proliferation. FGF19 activated both signal transducer and activator of transcription 3 and c-Jun N-terminal kinase pathways and reduced nuclear factor kappa-light-chain-enhancer of activated B cells signaling without increasing fibrogenic gene expression or cell proliferation. Conclusion: FGF15/19 does not act as a direct profibrotic mediator or mitogen to HSCs in our models, and the protection against fibrosis by FGF15 deficiency may be mediated through increased BA activation of FXR in HSCs.

Fluctuations in Stress Over Time During the First Year of Health Science Programs

PURPOSE

Psychological adjustment can impact individuals at various points during the formative years of their educational process. Health science programs can be highly stressful and potentially negatively impact physical and psychological health. This study intended to explore the fluctuations in stress levels in health science students during their first year of graduate school.

METHODS

Study participants included students enrolled in four graduate health sciences programs: Doctor of Physical Therapy (DPT), Occupational Therapy (OT), Speech-Language Pathology (SLP), and Physician Assistant (PA). Students completed the Brief Symptom Inventory (BSI) during the first week of graduate school (time 1), during the last 2 weeks of semester 1 (time 2), and at mid-semester for semester 2 (time 3). Subscales on the BSI included anxiety, depression, obsessive compulsive, phobia and somatization.

RESULTS

A total of 79 students completed the scale at all three time points. Mean anxiety scores changed over time from time 53 at time 1, 57 at time 2, to 54 at time 3. At the three time points, mean depression scores were 53, 56, and 53; mean obsessive-compulsive scores were 57, 63, 59; mean phobia scores 51, 50, and 50; and mean somatization scores 49, 54, and 51.

DISCUSSION

There are notable fluctuations in anxiety levels in health science students, and therefore, it is necessary to assist students in developing effective stress management techniques to help moderate the negative consequences of stress.

Examination of Executive Function and Social Phobia Among Female College-Aged Students With Celiac Disease

Celiac disease (CD) is a T-cell mediated genetically inherited autoimmune disease affecting approximately 1% of the population. Research suggests that CD impacts executive functioning (EF) and social phobia (SP). However, most of the literature in this area focuses on age groups outside of the traditional college age range and has never measured EF and SP together. This descriptive study compared traditional age female college students with CD to age- and sex-matched college students without CD on measures of EF and SP. Participants completed the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), the Social Anxiety Questionnaire for Adults-Short Form (SAQ-A30), and a demographic questionnaire. Results indicated that participants with CD reported lower grade point averages; scored lower on BRIEF-A measures of working memory, planning/organization, and organization of materials; and scored higher on SAQ-A30 measures involving interactions with the opposite sex and strangers. Implications for nursing practice are discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(2), 25-34.].

Towards Earlier Identification: Physicians Assistants' Perceptions of their Ability to Identify, Diagnose, and Refer Patients with Autism Spectrum Disorder

Early detection is imperative for children with autism spectrum disorder (ASD) to achieve optimal functioning. Knowledge of early signs of ASD, as well as open communication, can mitigate delayed diagnosis. This study explored physician assistants' (PA) abilities to diagnosis ASD as well as gathered information on their training. A majority of respondents who see pediatric patients received training on developmental milestones, but far fewer received training to identify red flags for ASD. Few PAs are talking with every patient's caregivers about a variety of behavioral health conditions, not just ASD. Overall, PAs rated their current skills working with patients with ASD lower than their desired level, suggesting a desire to become more adept at meeting their patients' needs.

The effect of fibroblast growth factor 15 deficiency on the development of high fat diet induced non-alcoholic steatohepatitis

Non-alcoholic steatohepatitis (NASH) is a form of non-alcoholic fatty liver disease (NAFLD) characterized by steatosis, inflammation, and fibrosis often associated with metabolic syndrome. Fibroblast growth factor 15 (FGF15), an endocrine factor mainly produced in the distal part of small intestine, has emerged to be a critical factor in regulating bile acid homeostasis, energy metabolism, and liver regeneration. We hypothesized that FGF15 alters the development of each of the listed features of NASH. To test this hypothesis, four-week old male Fgf15^-/- and their corresponding wild-type (WT) mice were fed either a high fat diet (HFD) or a control chow diet for six months. The results confirmed that HFD feeding for six months in WT mice recapitulated human NASH phenotype, including macrovesicular steatosis, inflammation, and fibrosis. Whereas FGF15 deficiency had no effect on the severity of liver steatosis or inflammation, it was associated with decreased liver fibrosis. Furthermore, FGF15 deficiency resulted in abnormal bile acid homeostasis, increased insulin resistance, increased HFD-induced serum triglycerides, decreased inductions of hepatic cholesterol content by HFD, and altered gene expression of lipid metabolic enzymes. These data suggest that FGF15 improves lipid homeostasis and reduces bile acid synthesis, but promotes fibrosis during the development of NASH.

Creating an IPE infusion plan: from foundation to implementation

Today's health care system has embraced the model of collaborative interprofessional efforts among health care professionals to achieve desired patient health outcomes. The Academy can offer the foundational experiences needed to support and develop interprofessional patient-centered plans of care for health professional students. This paper explores one institution's approach to the creation of an infusion plan which the authors have termed a "structured immersion approach" (SIA) to interprofessional education (IPE). The SIA supports "Core Signature IPE" experiences within existing silo-based curriculums that allow for interprofessional education experiences and the appreciation of the importance of interprofessional practice in today's health care.

Stress Management Strategies For Students: The Immediate Effects Of Yoga, Humor, And Reading On Stress

Background: Health science programs can be demanding and difficult for many students, leading to high levels of stress.  High levels of stress can have a negative effect on students and subsequently the practicing clinician.  Research suggests that yoga, humor, and reading are simple, effective methods to help reduce stress. To date no research compares the acute effects of yoga, humor, and reading in doctor of physical therapy and master’s of occupational therapy students.  Additionally, it is undetermined if one technique is more effective than the other in reducing stress.  Purpose: The purpose of this study was to compare the immediate effects of yoga, humor, and reading on acute stress in students enrolled in doctor of physical therapy and master’s of occupational therapy programs. It was hypothesized that following a 30-minute yoga, humor, and reading intervention session, students would demonstrate a reduction of stress on the Daily Stress Inventory (DSI) and a decrease in blood pressure and heart rate. Subjects: Twenty-two students from the School of Graduate Medical Education Doctor of Physical Therapy (DPT) program (n=14) and Master’s of Science in Occupational Therapy (OT) program (n=8) volunteered to participate in the study.  Methods: At baseline subjects completed a demographic survey.  All subjects participated in a yoga, humor, and reading intervention session, once a week on the same day and at the same time for a total of three weeks. Intervention sessions were randomized and counterbalanced across subjects. Before and after each intervention session, stress was measured using the Daily Stress Inventory, systolic blood pressure (SBP), diastolic blood pressure (DSP), and heart rate (HR).  Results: A repeated one-way ANOVA indicated that all three interventions significantly decreased  SBP, DBP, and HR and no one intervention was more effective than the other in reducing these dependent variables (p = . 058, p = .315  and p= .180 respectively).  There was no significant main effect or interaction of the yoga, humor, or reading intervention session on the DSI scores (p = .362). Conclusions: The results of this study indicate that one 30-minute session of yoga, humor, and reading had similar effects in decreasing acute stress in health science students. This finding is important since these interventions resulted in a significant reduction in stress in a relatively short amount of time, allowing educators to begin to consider different stress management strategies to offer to students.