A Description of Physician Assistant Postgraduate Residency Training: the Resident’S Perspective
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Research Article A Description of Physician Assistant Postgraduate Residency Training: The Resident’s Perspective David Asprey, PhD, PA-C; Lelia Helms, PhD, JD Note: This study was sponsored in part by a grant from the APAP Research Institute. Purpose: Postgraduate residency training is an optional form of education that has existed within the physician assistant profession since 1971. Despite almost three decades of experience, there are no comprehensive data regarding PA residents’ opinions about their residency training. At the time of this study, there were 17 residency programs in 10 different states. This study was undertaken to characterize PA residency training in the United States from the perspective of participants. Methods: This study utilizes a non-experimental, descriptive research design to describe residents’ perspectives of various characteristics, activities and opinions regarding PA postgraduate residency training. Data were collected from a survey instrument reviewed by a select group of residency directors for design and clarity. Standard procedures for gaining approval and clearance for studies involving human subjects were followed. Forty-six (59%) of the 78 enrolled residents responded. Data were entered into a relational database. Descriptive statistical analyses utilized a standard statistical software package. Results: Results from the survey data collected from the PA residents are reported. Data are categorized as follows: resident demographic information, entry-level PA program information, pre-residency program information, residency program information, residency curriculum data, residents’ perceptions of changes in knowledge and skills and residents’ opinions regarding residency. Conclusions: PA postgraduate residency education provides an important educational vehicle for training graduate PAs in specialty care. A substantial proportion of residents proceed directly from entry-level to postgraduate training. Residents report satisfaction with their programs generally and specifically in terms of knowledge and skills acquired. More information comparing the differences between academic and internship models of residency education is needed as is consideration of greater standardization in program record-keeping and support for research into the longitudinal outcomes associated with postgraduate education. (Perspective on Physician Assistant Education 2000;11(2):79–86) Introduction education beyond the entry level and ing specialization and autonomy has for increased specialty training.1,2 If led greater numbers of PAs to seek for- Physician assistant residency educa- the PA profession follows the pattern mal postgraduate training prior to tion has developed in response to a of physicians and several other health- entering the specialty of their choice or perceived need for standardization of care professions, postgraduate residen- transferring from one specialty to cy education may become an expecta- another. David Asprey is the program director and an associ- tion for practitioners. There are two basic types of PA ate professor for the Physician Assistant Program, The The role of the PA has expanded postgraduate residency programs: College of Medicine, University of Iowa, Iowa City, dramatically over the past 30 years. internship and academic model pro- Iowa. Lelia Helms is a professor of Planning, Policy 5 and Leadership, The College of Education, University Today PAs are practicing medicine grams. Internship model programs of Iowa, Iowa City, Iowa. with substantial autonomy in virtually include a modest, practically oriented, every specialty area of medicine.3,4 didactic curriculum combined with Correspondence should be addressed to: Increased autonomy and specialization intensive clinical rotations and educa- David Asprey, PhD, PA-C have resulted in a need for practical, tional experiences. They lead to a cer- Program Director and Associate Professor postgraduate, specialty education. To tificate of completion. Academic model Physician Assistant Program The College of Medicine date, most PAs accomplish specialty programs combine a highly structured University of Iowa education through extensive on-the- and formalized didactic education Iowa City, IA 52242 job training with one-on-one educa- (through courses taken for graduate Voice: 319-335-8920 Fax: 319-335-8923 tion from physicians practicing the credit) with clinical rotations and lead e-mail: [email protected] specialty.3 The trend towards increas- to a master’s degree (or credit towards PERSPECTIVE ON PHYSICIAN ASSISTANT EDUCATION, VOL. 11, NO. 2, SPRING 2000 79 A DESCRIPTION OF P HYSICIAN A SSISTANT P OSTGRADUATE R ESIDENCY T RAINING a master’s degree) upon completion. this study at its general membership sis generally consists of summary statis- Because of the different foci of these meeting in May 1997. tics for each parameter reported. two models of residency programs, this In May 1998, surveys were sent to study reports findings by these two cat- residency program directors for distrib- Results egories as appropriate for identifying ution to all their enrolled residents. The important differences between them. surveys were accompanied by a cover Findings are presented in the follow- letter signed by the study author and co- ing general categories: demographics, Purpose signed by the president of APPAP. To information about entry-level PA pro- provide residents with some measure of gram, pre-residency information, pro- This study reports findings from confidentiality in reporting unfavorable gram selection and enrollment, program the second in a two-part comprehen- comments and to add to the integrity of curriculum, and opinions about residen- sive study inventorying PA postgradu- responses, each resident received an cy training. When appropriate, findings ate residency programs. The first part, envelope in which to seal and, thereby, are subcategorized into respondents in “A Description of Physician Assistant secure the completed survey prior to internship and academic model pro- Postgraduate Residency Training: The returning it to the program director. grams. A total of 46 surveys were Director’s Perspective,”5 inventoried After one month, residency directors returned. Occasionally, respondents did residency programs from information who had not returned surveys from cur- not complete all fields of the question- provided by program directors. This rently enrolled residents were contacted. naire and thus the identified number of study, conducted contemporaneously Problems identified through this proce- responses for the data will vary. in May 1998 with the first, sought dure were addressed and assistance in information from currently enrolled, completing the surveys was provided as Resident Demographic Information postgraduate residents about their appropriate. The method of administer- backgrounds, professional history, and ing the survey via the program directors Currently enrolled residents were opinions regarding the value of their was utilized with the assumption that almost evenly divided between males training. This study does not rely or the directors could more effectively (n=23, 51%) and females (n=22, 49%). build upon on either existing descrip- coordinate the distribution and collec- Respondents (n=44) were predomi- tive information or on well-formulated tion of the survey from busy residents nantly white (86%) with the remainder educational theory as its foundation. and thus improve the response rate. being African-American (14%). No Instead, its purpose is to develop an The method of administering the other ethnic identity was represented in initial inventory of baseline informa- surveys for residents resulted in some this group of respondents. The mean tion about PA postgraduate residency limitations in response rates. In the age reported was 34.4 years (n=44, training as described by PA residents companion study, 16 of the 17 directors SD=8.4, range 24–57). enrolled at the time of this study. of postgraduate residency programs returned their inventories. Of these 16, Entry-Level PA Program Information Methods only 14 directors returned surveys col- lected from residents enrolled in their As presented in Table 1, 45 (98%) of A survey instrument requesting programs. The two programs that the residents provided the name of their information about residents’ back- returned information from directors, entry-level PA program. The most com- grounds and experiences was devel- but not from residents, enrolled six res- monly reported entry-level PA programs oped and reviewed by a select group of idents. Of the 14 programs that did attended were Alderson-Broaddus PA residents and residency directors to return surveys from their residents, 46 College, George Washington University, identify problems of design and clarity. (64%) of the residents (n=72) enrolled University of Southern California, and The study employed a non-experimen- in May 1998 completed inventories. Western Michigan University. tal, descriptive research design. It uti- These responses comprise the database Residents were asked what creden- lized a questionnaire to ask residents for the information about residents’ per- tial(s) they were awarded from their about their various characteristics, spectives on their postgraduate pro- entry-level PA program. More than one backgrounds, activities, and opinions grams in this analysis. choice could be selected. All respon- regarding PA postgraduate residency Data collected from the survey were dents