To address physician shortages, many have called for medical schools to increase their applicant pool size by broadening their selection criteria. Physician assistants (PAs) are one group that has demonstrated competency and medical knowledge. However, financial and time barriers exist to their applying to traditional four-year programs. The authors designed a three-year accelerated curriculum for PAs to obtain DO degrees. Over the summer, after their first year of didactic instruction, students complete two 4-week primary care clinical clerkships. The second year of didactic study is followed by additional clinical clerkships, for a total of 138 weeks of instruction-82 weeks of didactic instruction, which is identical to that of the traditional curriculum, and 56 weeks of clinical clerkships. The inaugural class of 7 students matriculated in July 2011. In the first three years, 25 students joined the program. Mean age at matriculation is 31.8 years compared with the national mean of 25 years. Mean length of clinical practice before matriculation is 5.4 years. The inaugural class completed the COMLEX-USA Level 1 exam, achieving a 100% pass rate with a mean score 96 points above the national mean. The authors will assess students' residency placements to gauge the medical community's reaction to the accelerated curriculum. They also recommend that alternatives to the existing admission requirements be considered. This program removes many barriers to PAs returning to medical school and expands the applicant pool by adding candidates with clinical experience, helping to address primary care physician shortages.
The purpose of this research was to construct and validate a measure of "intention to stay in academia" for physician assistant faculty members. The 70-item instrument was developed through a literature review, a qualitative investigation of how experienced physician assistant faculty members conceptualized "intention to stay in academia," and an expert review of survey items. The items were pilot tested on a convenience sample of 53 faculty members from 9 physician assistant programs; the revised survey was then administered to all 1002 physician assistant program faculty members in the United States with physician assistant credentials. Rasch analyses were conducted to examine psychometric properties of the measure and collect evidence of validity. The national survey had a 48% response rate, and participants were representative of all physician assistant faculty members. Although the overall instrument demonstrated acceptable construct coverage, good reliability estimates, and adequate fit statistics for the majority of the items, only 36.5% of the variance in the data could be explained by the measure. A subset of 19 items relating to a supportive academic environment ("Supportive Environment" scale) was extracted and met the expectations of the Rasch model. The Supportive Environment scale produced a meaningful progression of indicators of "intention to stay in academia" for physician assistant faculty members and demonstrated characteristics of a linear measure. Administrators can make valid inferences regarding physician assistant faculty intention to stay from the subscale analysis.
Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and Joint Commission, recommend that patients receive transparent communication when a medical error occurs. Recommendations for error disclosure typically consist of an explanation that an error has occurred, delivery of an explicit apology, an explanation of the facts around the event, its medical ramifications and how care will be managed, and a description of how similar errors will be prevented in the future. Although error disclosure is widely endorsed in the medical and nursing literature, there is little discussion of the unique role that the physician assistant (PA) might play in these interactions. PAs are trained in the medical model and technically practice under the supervision of a physician. They are also commonly integrated into interprofessional health care teams in surgical and urgent care settings. PA practice is characterized by widely varying degrees of provider autonomy. How PAs should collaborate with physicians in sensitive error disclosure conversations with patients is unclear. With the number of practicing PAs growing rapidly in nearly all domains of medicine, their role in the error disclosure process warrants exploration. The authors call for educational societies and accrediting agencies to support policy to establish guidelines for PA disclosure of error. They encourage medical and PA researchers to explore and report best-practice disclosure roles for PAs. Finally, they recommend that PA educational programs implement trainings in disclosure skills, and hospitals and supervising physicians provide and support training for practicing PAs.upportive Environment scale produced a meaningful progression of indicators of "intention to stay in academia" for physician assistant faculty members and demonstrated characteristics of a linear measure. Administrators can make valid inferences regarding physician assistant faculty intention to stay from the subscale analysis.
Nurse practitioners and physician assistants can alleviate some of the primary care shortage facing the United States, but their scope-of-practice is limited by state regulation. This study reports both cross-sectional and longitudinal trends in state scope-of-practice regulations for nurse practitioners and physician assistants over a 10-year period. Regulations from 2001 to 2010 were compiled and described with respect to entry-to-practice standards, physician involvement in treatment/diagnosis, prescriptive authority, and controlled substances. Findings indicate that most states loosened regulations, granting greater autonomy to nurse practitioners and physician assistants, particularly with respect to prescriptive authority and physician involvement in treatment and diagnosis. Many states also increased barriers to entry, requiring high levels of education before entering practice. Knowledge of state trends in nurse practitioner and physician assistant regulation should inform current efforts to standardize scope-of-practice nationally.