Purpose The purpose of this study was to assess how physician assistant (PA) student depression risk, suicidal ideation, and mental health help-seeking behaviors change during didactic training and the relationship between depression risk and demographic factors.Methods Data were obtained through an anonymous online survey sent to didactic students in 7 PA programs during orientation and again at midpoint of the didactic year. Descriptive statistics, independent samples t-testing, and one-way ANOVA analyses were used to assess trends in patient health questionnaire (PHQ-9) scores over the 6month time period. The PHQ-9 is the module of the PHQ that measures severity of depression risk. ResultsThe orientation survey response rate was 82.7% (287/ 347) and the midpoint survey response rate was 62% (217/ 350). Analysis revealed that mean PHQ-9 scores increased significantly from 2.49 to 6.42 (p < 0.001) from orientation to midpoint of the didactic year, with 18.9% of students having scores of 10 or greater at midpoint compared to 4.5% at orientation. Thoughts of self-harm and/or suicidal ideation in the past 2 weeks also increased from 3.5% to 7.4% during the same time frame. Additionally, students' likelihood of seeking mental health help decreased between orientation and midpoint despite the concurrent increases in depression risk and suicidal ideation. ConclusionRising PHQ-9 scores indicated an increased risk of major depression among didactic-year PA students. Further research on early screening methods and factors that encourage help-seeking behaviors may serve to inform programs about how to create learning environments that mitigate depression risk and promote wellbeing during professional training.

Introduction: Medical culture can make trainees feel like there is neither room for mistakes, nor space for personal shortcomings in the makeup of physicians. A dearth of role models who can exemplify that it is acceptable to need support compounds barriers to help-seeking once students struggle. We conducted a mixed-methods study to assess the impact of physicians sharing their living experiences with medical students. Methods: Second-year medical students participated, through synchronized videoconferencing, in an intervention consisting of 3 physicians who shared personal histories of vulnerability (e.g. failure on high-stakes exams; immigration and acculturation stress; and personal psychopathology, including treatment and recovery), followed by facilitated, small-group discussions. For the quantitative component, students completed the Opening Minds to Stigma Scale for Health Care Providers (OMS-HC) before and after the intervention. For the qualitative component, we conducted focus groups to explore the study intervention. We analyzed anonymized transcripts using thematic analysis aided by NVivo software. Results: We invited all students in the class (n = 61, 46% women) to participate in the research component. Among the 53 participants (87% of the class), OMS-HC scores improved after the intervention ( P = .002), driven by the Attitudes ( P = .003) and Disclosure ( P < .001) subscales. We conducted 4 focus groups, each with a median of 6 participants (range, 5-7). We identified, through iterative thematic analysis of focus group transcripts, active components before, during, and after the intervention, with unexpected vulnerability and unarmored mutuality as particularly salient. Conclusions: Sharing histories of personal vulnerability by senior physicians can lessen stigmatized views of mental health and normalize help-seeking among medical students. Synchronous videoconferencing proved to be an effective delivery mechanism for the intervention in a ‘virtual wellness’ format. Candid sharing by physicians has the potential to enhance students’ ability to recognize, address, and seek help for their own mental health needs.

This study of 521 encounters in 25 urban general practices in Australia, compares both patient and doctor reported reasons for encounter (RFE) and diagnoses. Although doctors and their patients generally agreed on the overall distribution of RFE and diagnoses that arose, there was disagreement in at least 30% of paired comparisons within individual encounters. There was better agreement for RFE than for diagnoses. This may have been partly due to differences in the classification systems used. However, it suggests that diagnoses recalled by patients at later household interview are at best only a rough approximation of the diagnoses recorded by the doctor. These findings are important both for patient care and for the conduct of general practice morbidity research.

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Purpose The coronavirus (COVID-19) pandemic has presented physician assistant (PA) educators with unprecedented challenges in delivering content remotely with minimal time to develop new pedagogical strategies. We surveyed faculty about their experience during the early weeks of adapting to these new instructional techniques. Methods An anonymous quantitative and qualitative survey was distributed to all individuals registered by programs as Physician Assistant Education Association members. Results The survey response rate was 22.3% (667/2991) with 32% of program directors (PD), and 23.7% of faculty reporting they had taught online synchronous content prior to COVID-19 adaptations. Prior experience with technology was associated with significantly lower levels of faculty stress during the pivot to online instruction. A majority of the respondents felt educational quality had remained consistent despite the transition to online teaching, and a majority of both faculty and program directors anticipate only minor changes to program structure once they are able to return to traditional classroom learning. Concerns about technology were most commonly cited as stressors and as causes of decreased quality of instruction. Conclusion Educational challenges and stress during the pandemic were most prominently associated with unfamiliar technology. It remains to be seen what changes persist when the pandemic subsides.

Objective: Negative stigma related to mental health diagnoses is common in both clinicians and the public. Questions about physical and mental conditions on licensure applications often are overly broad and may violate the Americans with Disabilities Act (ADA). This study investigated state physician assistant (PA) licensing applications relating to physical and mental health, and their consistency with the ADA. Methods: We collected PA state licensure applications from all 50 states and the District of Columbia. To be considered consistent with the ADA about physical conditions, an application had to only contain questions about a current (within the past year) physical health condition that impaired the applicant's ability to practice as a PA, or not include any questions about physical health. Questions that asked for speculation about possible future situations were considered inconsistent with the ADA. Results: Nearly 57% of state PA licensing applications were consistent with ADA guidelines on physical conditions; 51% were consistent for mental health conditions. Conclusions: Many state PA licensing boards include questions about physical and mental health conditions that are not limited to current impairment. These licensure questions could violate the ADA, and may reduce PAs' willingness to seek help for mental health issues. Balancing public safety with clinician health is a challenge. Further research and action are needed to optimize PA licensure questions on physical and mental health.

Purpose We tested the hypothesis that physician assistant (PA) students can benefit from exposure to senior PAs who share their living experiences with mental illness.Methods First-year students from 5 PA programs were asked to participate in this mixed methods study. After completing a pre-activity survey, students from 3 programs participated in an intervention consisting of senior PA faculty sharing their mental health experiences, including treatment and recovery. A facilitated discussion followed, and students not exposed to the intervention served as controls. The qualitative component of the study was based on transcripts from 3 focus groups of students in the exposed group. ResultsWe recruited 167 students from 5 PA training programs, 112 of whom (67%) completed baseline and endpoint assessments (37 in the exposed group, 75 in the control). The intervention resulted in significant improvements on the Opening Minds to Stigma (OMS-HC, p = 0.002, Cohen's d = 0.38) and Self-Stigma of Seeking Help (SSOSH, p = 0.006, d = 0.31) scales. Change in the OMS-HC was driven by its social distance (p = 0.003) and disclosure (p = 0.02) subscales. No comparable changes were found in the control group. We identified 3 overarching themes: 1) active elements of the intervention; 2) mutuality; and 3) peer relationships.Conclusions Senior PAs sharing their lived experiences with mental illness proved to be an effective anti-stigma intervention for PA students. A candid, intimate, and confidential virtual learning space was feasible through synchronized videoconferencing. Our findings can inform programmatic interventions to address stigma, self-stigma, help-seeking behaviors, and the overall mental health of PA students. METHODS Participants, Synchronized Videoconferencing Delivery, and Ethics ApprovalParticipants were first-year PA students enrolled in 5 programs across the United States (one public and 4 private; 3 in the The authors declare no conflict of interest.

Objective: This study built on a recent publication to explore physician assistant (PA) licensure renewal applications, as well as PA likelihood to seek help for physical or mental health conditions. Methods: We were able to obtain licensure renewal applications from 47 states. A national survey was then conducted to explore the connection between licensure questions and help-seeking behavior. Results: Only 18 states were consistent with the Americans with Disabilities Act (ADA) in their approach to initial and renewal applications. Thirty-fi ve percent of PAs expressed reluctance to seek help for a mental health issue due to concerns about licensure repercussions. States with applications that were inconsistent with the ADA were signifi cantly more likely to express these concerns. Conclusions: Considerable stigma exists among PAs regarding seeking help for mental health issues. Problematic licensure questions increase this reluctance. Advocacy is needed to reduce stigma of mental health and substance use, and to modernize licensure applications.