Physician Assistant Training in Primary Care > FY 2005 Grant Summaries

California | Illinois | Kansas | New York | Pennsylvania | Virginia | Wisconsin

California

D57HP05124
Betty Ingell, EdD, MHS, PA-C
University of California at Davis
Physician Assistant Program
2516 Stockton Blvd., Ste. 254
Sacramento, CA  95817
Tel: 916-734-3551
Email: betty.ingell@ucdmd.ucdavis.edu

The University of California, Davis Physician Assistant Program has been in existence for 25 years.  Over this time, it has successfully met its mission of educating clinically and culturally competent health care providers who reflect the diversity of California to provide primary care for California’s medically underserved communities.  The Program currently has 93 trainees of whom 49% are underrepresented minority and/or disadvantaged students; 34% are immigrants, and 31% speak English as a second language.

The program emphasizes clinical training of students and placement of our graduates in primary care settings located in Medically Underserved Communities (MUCs).  Specifically: 70% of our students clinical training time takes place in MUCs; 57% of the 2003 graduates work in MUCs; 64% of the 2003 graduates practice in primary care settings; and 87% of the program’s 1151 graduates live and work in California.

As part of a strategic planning effort in cooperation with the Department of Family and Community Medicine in the University of California, Davis School of Medicine, the faculty members have identified two critical areas of need which we propose to address with support from this grant over the next three years.

Objective 1: Over the three year grant period, design, implement, and evaluate a model curriculum to incorporate Improving Chronic Illness Care (ICIC) initiatives and the Chronic Care Model into the PA curriculum.  The curriculum will initially focus on patients with diabetes to improve their quality of life and health outcomes.

Objective 2: Design and implement a Master’s Degree Program for PA students that will 1) meet anticipated professional standards and requirements; 2) maintain the program’s historically high levels of enrollment of ethnically diverse and disadvantaged students, and 3) maintain the program’s historically high levels of graduates practicing in primary and medically underserved settings.

This objective addresses the Healthy People 2010 goal of eliminating disparities of access through provision of adequate numbers of health care providers to work in Medically Underserved Communities, while maintaining the viability of the UC Davis PA Program to train physician assistants in the face of the national trend towards standardization of the culminating entry-level for PAs to a master’s degree.

Illinois

D57HP05121
Geraldine Shangreaux
Malcolm X College Physician Assistant Program
City Colleges of Chicago
1900 W. Van Buren
Chicago, IL  60612
Tel: 312-850-3532
Email: gshangreaux@ccc.edu

The John H. Stroeger, Jr. Hospital of Cook County/Malcolm X College of Physician Assistant Program is fully accredited and accepts 26 new students per year.  The clinical sponsor, John H. Stroger, Jr. Hospital of Cook County, the largest public teaching hospital in Northern Illinois, provides the majority of clinical sites for supervised clinical instruction for students.  The academic sponsor, Malcolm X. College, is one of seven City Colleges of Chicago.  A priority of the college mission concentrates on prospective students that come from educationally and economically disadvantaged situations and are deemed to be in most need of assistance.  Last year’s incoming class had a minority disadvantage enrollment of 62%.  The statistics for the last five years reflects a 42% underrepresented minority representation of students in the program.  In addition, the ongoing trend of enrollees with English as Second Language (ESL) continues.  For this diverse program, the encountered needs this program addresses are in the areas of cultural sensitivities, language barriers, and the need to enhance faculty skills in addressing issues of diversity, and curricula development.

The Physician Assistant Training in Primary Care HRSA grant will assist SHCC/MSC PA Program to continue to attract and graduate minority and disadvantaged students and faculty members.  It will continue to assist in improving the retention rate, through innovative remediation and self assessment programs.  Further it will develop innovative curriculum, and improve our programs computer technology capabilities.

The Program proposes a set of four objectives for the project grant period, 2005-2008:

1. To develop two pre-PA web-based courses that would enhance the cognitive knowledge skills in professional development issues and to increase the problem-solving skills in the medical science of the PA profession targeting at least for 15 pre-PA students for each course;
2. To enable all PA students to pass all unit exams of the Medical Sciences courses and all rotational exams by using an ongoing self-assessment process;
3. To enhance the clinical Geriatric Curriculum by using four indicators from the Healthy People 2010 through Patient Education modules during Community Service Learning activities with at least four sites that serve MUC/Ps;
4. To present 30% of the topics from the didactic (Medical Science course) and the clinical rotation courses in an online lecture format to enhance the management and evaluation process of the PA curriculum.

Kansas

D57HP05123
Richard D. Muma, PhD, MPH, PA-C
Wichita State University
Department of Physician Assistant
1845 Fairmount
Wichita, KS  67260
Tel: 316-978-3011
Email: richard.muma@wichita.edu

According to the Institute of Medicine’s Report, In the Nations Compelling Interest: Ensuring Diversity in the Health-Care Workforce (IOM, 2004) there is a preponderance of scientific evidence supporting the importance of increasing racial and ethnic diversity among health professionals.  This evidence demonstrates that greater diversity among health professionals is associated with improved access to care for racial and ethnic minority patients, greater patient choice and satisfaction, better patient-provider communication, and better educational experiences for all students while in training.  Although many people perceive the Plains States (e.g., Kansas) to be rather homogenous and thus, less challenging by demographic shifts, in fact this part of the country is experiencing an unprecedented influx of first and second generation immigrant families whose health care needs and protective behaviors are yet to be understood.

Therefore, a primary reason for this grant project is to make a major impact in this area by increasing diversity among graduates from Wichita State’s PA Program.  Three goals have been set for this purpose and include:

1. Strengthen and expand both the didactic and clinical curriculum to heighten the training of culturally competent health care providers in primary care medically underserved urban and rural sites;
2. Increase the number of disadvantaged/under-represented minority (RM) faculty who are lecturers, preceptors and faculty; and
3. Increase the number of minority and/or disadvantaged applicants to (and ultimately graduates from) the PA program.

To facilitate these goals, funding is being requested to:

Objective 1: Develop a model curriculum that will focus on specific health problems of minorities and other high risk populations in the community setting, following guidelines presented in Healthy People 2010;

Objective 2: Provide a diverse instructional environment that reflects the diversity of the Wichita community;

Objective 3: Develop and implement a minority/disadvantaged student recruitment plan to increase the number of minority/disadvantaged applicants and enrollees from 12 to 30% by FY09;

Objective 4: Develop and implement a minority/disadvantaged student retention plan to sustain URM enrollment (at least 95%) and provide for successful completion of the program.

New York

D57HP05130
Linda Allison
Le Moyne College Physician Assistant Program
1419 Salt Springs Road
Syracuse, NY 13214
Tel: 315-445-4163
Email: allisolg@lemoyne.edu

The LeMoyne College Physician’s Assistant Program  is request support for our Le Moyne College Cultural Competency Initiative (LMC-CCI), a comprehensive program aimed at assuring culturally competent primary care by our graduates and at enhancing the level of cultural competence in primary health care among our partner agencies.  The LMCCCI brings together university and community groups with long-standing concerns for the promotion of culturally competent healthcare and the elimination of health disparities.  Through these partnerships we propose to develop a problem-based curriculum that can be used in the classroom or online, and that focuses on the linkages between health disparities and cultural competence.  Our partnerships will ensure that students develop skills in the attitudinal, cognitive, and affective domains.

This project will train over 600 trainees during three years, including PA students, PA faculty and preceptors, Upward Bound high school students, and community partner representatives.  In addition, educational materials developed in this project will be made available to all medical, dental, and PA programs via the Internet.

The overall purpose of the project is to meet the Healthy People 2010 goal of reducing health disparities by ensuring that the graduate health care providers have the skills to care for multicultural, multiethnic, multilinguistic populations, and that graduates provide care for populations in underserved communities.  We have reviewed the Healthy People 2010 objectives and local data on the health disparities.  This proposal focuses on the health disparities and special need for culturally competent care in obesity, diabetes, asthma, tobacco, low birth weight, lead poisoning, HIV/AIDS/STDs, hypertension and kidney disease.  There are numerous health conditions that disproportionately affect individuals due to race, ethnicity, geography, or other factors; this project will train PA students who possess the knowledge and skills to provide culturally competent care and to contribute to the reduction of these health disparities.

Objective 1: Develop and implement a model problem-based curriculum in cultural competence that can be offered via distance learning or in the classroom;

Objective 2: Develop community-based linkages to enhance the placement of students into agencies serving a diverse population to provide students with an opportunity to develop cultural competence skills within the context of multicultural communities and populations;

Objective 3: Increase ethnic and cultural diversity within the faculty, staff, and student bodies through active recruitment and support.

D57HP05125
Kathleen Roche, MPA, PA-C
Pace University
One Pace Plaza
New York, NY  10038
Tel: 212-346-1503
Email: kroche@pace.edu

The Pace University – Lenox Hill Hospital Physician Assistant Program proposes to develop innovative curriculum to address chronic disease management in primary care and to meet national goals of improving access to quality health care by improving access to a diverse and culturally competent health professional workforce.  The expected outcome is increased numbers of graduates choosing primary care practice as a result of an improved comfort and confidence level in managing diverse patient populations with chronic conditions and the realization that they can make a difference in these patients’ lives.  The specific, measurable objectives of this project are:

1. Increase students’ knowledge and skills in dealing with the medical and sociological issues facing persons living with chronic disease by developing a 2 unit course to be offered to students in the clinical (senior) year.  The developed curriculum, including learning objectives and an on-going chronic disease case used as the base of the curriculum will be distributed to all PA programs in the United States;
2. Extend efforts to recruit and enroll minority and disadvantaged students and decrease attrition from the current 12% to 7% by the third year of the grant;
3. Develop a data collection system template for longitudinal data, identifying characteristics and trends of the applicant pool, matriculated students and program completers.  The collection system will relate interventions and elements of the didactic and clinical training to outcomes, including graduate choice of practice sites and percent of patients with chronic disease cared for at the practice site.

Methods to accomplish the objectives include development of an on-going case involving one patient with chronic disease; introduction of a care model involving shared management with other health care professionals and patient self-management; a health literacy training and project and the development of new urban primary care sites whose practice emphasizes chronic disease management with diverse patient populations.

D57HP05127
Llewellyn Adrian, PA-C
City College of New York
Sophie Davis School of Biomedical Education
Physician Assistant Program at Harlem Hospital Center
138^th Street and Convent Avenue
Harris Hall, Suite 15
New York, NY  10031
Tel: 212-650-7745
Email: allewellyn@ccny.cuny.edu

Over 70% of the students at the City College PA Program at Harlem Hospital are ethnic minorities, as opposed to 20% nationally.  Seventy-five percent of our students, versus 25% nationally, prefer primary care practice in the inner city; and 94% intending to practice in a medically underserved area, compared to just 38% nationally.  This historical data provides the strength of the program to eliminate health disparities.  This requires the Harlem PA Program to expend more resources in interactive computer teleconferencing, innovative electronic interventions, cultural enrichment and mentoring healthcare workforce to access, distribute and assure quality rural and urban healthcare for all.  The PA program using generalist primary care faculty is currently enthusiastic in setting up more primary care rural training sites and also developing exportable technologies for national acceptance of rural Healthy People 2010 curricula.  These innovative enhancements are solely designed to facilitate training of minority preceptors, faculty and students in rural and urban primary care practice.  This project will have national impact when URM preceptor training materials, URM retention/recruitment innovations and rural site articulations are exported nationally to any PA Program for administration and adoption at their respective locations.  The PA Program trainees, graduates and faculty have all been trained and certified by Harlem Hospital for HIPAA regulations, ADA regulations and Cultural Competency regulations.  The proposed project will use cutting edge management protocols to optimize on all available resources and institutional support to achieve BHPr goals through the three objectives required to maintain and improve on specific targets.

Objectives:

1. To provide clinical preceptors with faculty development and training at two of three culturally diverse sites and disseminate this information nationally;
2. To provide innovative electronic interventions exportable to underrepresented minority (URM) trainees during recruitment and training phases thus increasing the retention rate and to maintain above national pass-rates on the Physician Assistant National Certifying examination;
3. To expand the clinical articulations with clerkship sites by 25% per year utilizing trainees to explore new urban and rural primary care sites, both within and outside of New York State.

Pennsylvania

D57HP05122
Albert F. Simon
Saint Francis University
Department of Physician Assistant Services
117 Evergreen Drive
Loretto, PA  15940
Tel: 814-472-3131
Email: BSimon@francis.edu

This project will provide investments needed to develop curricula in public health, specifically to expand the current offerings in oral health and provide clinical experiences in oral cancer screening, prevention of dental caries and good dental hygiene programs for children.  Didactic curricula and clinical experiences will be developed also to equip students with the tools to combat obesity, diabetes and heart disease through an active preventive approach. An additional focus of this project will be to increase the enrollment of underrepresented minorities in the PA program at Saint Francis University.

The specific goals and objectives are as follows:

1. Eliminate barriers to care by increasing the number of program completers practicing in medically underserved areas or who are serving in primary care disciplines.  To accomplish Goal I, we will focus on recruitment of additional rotation sites in underserved areas and increase the number of required student experiences in primary care and medically underserved areas.  This includes support activities such as assisting with travel expenses and placement strategies.
2. Improve the training in addressing key 21^st century health issues affecting the United States by developing innovative curricula in public health and oral health.  To achieve Goal II, we will develop an oral health didactic curriculum to be delivered as part of the health promotion series.  Students will then be placed at a clinic assignment to perform screening examinations under the supervision of a dentist.  Students will also perform dental screening exams and oral hygiene promotion to underserved populations under the supervision of a dentist.  An innovative curriculum on healthy lifestyles will be developed that integrates directed readings with an actual twelve week practical experience where each student participates in lifestyle modification and coaching of a fellow student.  A six hour bio-terrorism and disaster response module will be developed and added to the existing public health course curriculum.
3. Eliminate health disparities by increasing the number of underrepresented minority/disadvantaged program enrollees.  Goal III will be accomplished by obtaining a recruiter who will work in partnership with the SFU Graduate and Professional Studies Office to increase the enrollment of underrepresented minority students through attendance at college fairs located at minority institutions.  This objective will also create a minority ambassador program to provide support for potential applicants in the process of applying and matriculating. 

Virginia

D57HP05129
Anthony A. Miller, MEd, PA-C
Shenandoah University
Division of Physician Assistant Studies
190 Campus Blvd., Suite 430
Winchester, VA  22601
Tel: 540-545-7257
Email: amiller@su.edu

Shenandoah University is a non-profit, private comprehensive university located on a 6-acre main campus located in Winchester, Virginia.  The Program’s physical plant includes two dedicated classrooms, a skills lab, faculty offices, computer lab, and several areas dedicated to student use.  Clinical education takes place in a variety of locations within the region.  Currently, the Program has clinical affiliations with 85 hospitals, clinics and physicians’ offices yielding over 125 clinical placement sites.

This project is an enhancement and continuation of recruitment, educational, placement and evaluation activities for a relatively new physician assistant program.  These objectives are specifically designed to enhance an existing program that is self-sufficient, to develop innovative instructional and evaluation components that can be disseminated to other programs, and to meet the legislative purposes of Title VII.

Objectives:

I. Encourage the placement of SU PA program graduates in rural and inner-city primary care based health professions shortage areas.

1a. At least 25 percent of the graduates in each class over three years (2006-2008) will be placed in medically underserved communities;

1b. All students (100%) will complete at least one clinical experience in a rural or inner-city setting designated as a designated medically underserved community state or federal;

1c. A recruiter/placement coordinator will be hired, oriented and begin activities as outlined in the job description;

1d. On-line resources will be developed and implemented using Blackboard platform as well as through the SU PA Program web site to provide candidates and students with the opportunities and tools to enhance their awareness of the opportunities available in medically underserved communities and the benefits of practicing in these areas.  This will be supplemented with guest speakers during end-of-rotation seminar days;

1e. A majority of graduates will be placed in primary care practices: 74% in year one, 76% in year two, and 81% in year three.

II. Develop and implement required and elective curriculum components to increase PA students’ knowledge and skills in the areas of: Care of Patients with Chronic Conditions and Special Topics in PA Practice to include: Medical Spanish, Leadership in Health Care, HIV/AIDS Issues, Improving Care for Vulnerable Populations, and Global Health Issues in Health Care.

III. Maintain and enhance a computerized data base system for clinical planning and evaluation, overall program evaluation, and tracking graduates.

Wisconsin

D57HP05126
Jeff Nicholson, MEd, PA-C
University of Wisconsin-Madison
Department of Medicine – Physician Assistant Program
1050 Medical Sciences Center
1300 University Avenue
Madison, WI  53706
Tel: 608-263-5620

The program seeks to increase the number of students from underserved areas and minority groups, expand its clinical sites in underserved areas and expand training in cultural competency.  The need for the project is high.  The minority population in Wisconsin has grown rapidly since 2000 with significant increases in the Hispanic and Southeast Asian populations.  The program’s distance education option offers new opportunities for minority candidates, but needs help with recruitment, mentoring and online resources.  The current clinical competency curriculum includes only limited experiences with the Hispanic culture.  The program has a long history of success in maintaining clinic sites in urban and rural areas that have contributed to the distribution of graduates to non-metropolitan areas in a proportion will above the national average.  Now the program would like to use that strategy to establish new clinical sites in underserved/minority areas to aid in placing graduates in those areas.  The program believes it can attain a 50% increase in graduates MUC employment through strategies supported by this grant.

Measurable objectives:

1. Increase the number of clinical training sites in medically underserved communities (MUCs) and settings that serve Wisconsin’s minority populations by six each year so that all clinical year trainees will complete a four or eight week clinical experience at those sites;
2. Increase the number of students from medically underserved communities to comprise 30% of total enrollees by year three of the grant cycle;
3. Increase the number of underrepresented minority students to enroll a minimum of three such students in year one, four in year two, and five in year three;
4. Expand the cultural competence of preceptors, faculty and students.

With grant support, the program will employ recent program graduates with ties to underserved and minority communities to help recruit minority students, mentor them and help develop new clinical sites.  The program will expand cultural competency training to include other cultures in the state (African American, Southeast Asian, Native American) through semi-annual workshops and will develop a web-based training module that will meet the needs of both distance and campus based students as well as statewide faculty and preceptors.  The distance education enrollment will be expanded.

D57HP05128
Timothy R. Gengembre, MS, MBA, PA-C
Department of Physician Assistant Studies
Marquette University
1700 W. Wells Street
Milwaukee, WI  53233
Tel: 414-288-7180
Email: tim.gengembre@marquette.edu

This project proposes to help address the gap in service to underserved populations in Milwaukee by exposing students to the unique needs of these populations and fostering a comfort level and an interest in serving these diverse populations upon graduation, with the clear intention of placing more graduates in medically underserved communities.  The Department of Physician Assistant Studies at Marquette University will augment the current curriculum by creating simulated clinical scenarios throughout the professional phase of training, which will allow students to practice clinical skills competency and cultural competency in the areas targeted by Healthy People 2010 goals and objectives.  Standardized patients will be used in carefully designed clinical scenarios to create a variety of experiences for students that mirror real-life psychosocial encounters with patients from culturally and socio-economically diverse backgrounds and in sensitive areas of patient care, e.g. eliciting a sexual history, questioning patients about substance abuse, or broaching the subject of domestic violence.  The intent of these experiences is to establish student comfort in discussing these subjects with patients.  Our outcomes will show that by creating a level of comfort in difficult interviewing experiences and by increasing students’ cultural competence, students will be more likely to initiate dialogue and increase the chance of effecting real change in racial and ethnic disparities in patient care.  In addition, this level of comfort may increase the numbers of graduates who choose to practice in areas that are underserved or disadvantaged.

Objectives:

This project will add SP encounters throughout the second and third years of training so as to increase the number of standardized patient experiences for students from six to eighteen.  By creating standardized patient experiences which combine clinical knowledge with cross-cultural knowledge and experience with addressing delicate issues with patients we will increase our students’ abilities in effective interpersonal skills and comfort in communicating with patients from diverse backgrounds and/or with various barriers to access.  In addition, exercises will be designed to increase the students’ abilities in self-reflection and metacognition related to their interpersonal interactions with the SPs, cultural biases and personal discomfort in raising certain issues with patients.  In order to accomplish these objectives, an SP coordinator will train standardized patients to accurately depict historical clues and physical exam findings in a uniform experience for all students.  SPs will assume the role of patient by following carefully scripted patient encounters which will be designed to depict cultural and/or psychosocial issues, as well as depict signs and symptoms of common medical illness.  Healthy People 2010 goals and objectives will be used as a basis for selecting topics for these scenarios.