Exploring the effect of PAs on physician trainee learning

Abstract

Background: Physician assistants (PAs) often have been embedded in academic medical centers to help ensure an adequate patient care workforce while supporting compliance with work-hour restrictions for residents and fellows (also called trainees). Limited studies have explored the effect of PAs on trainee learning. This qualitative study explored, from the perspective of physician faculty and PAs, how PAs working in the clinical learning environment can enhance or hinder trainee learning. Methods: Using purposive sampling, 12 PAs and 12 physician faculty members in one US teaching hospital were selected for semistructured interviews. Data collection and analysis were characterized by an iterative process. Data analysis was informed by principles of conventional content analysis. Results: Participants identified various ways in which PAs may affect trainee learning, intrinsically linked to the roles PAs assume in the clinical learning environment: clinician, teammate, and clinical teacher. Trainee learning may be enhanced because learning time can be optimized by having PAs in the clinical learning environment. Trainees can learn about PAs and how to collaborate with them, and PAs can enculturate and provide clinical instruction to trainees. Trainee learning may be hindered if learning opportunities for trainees go to PAs, trainees feel intimidated by experienced PAs, or trainees become too dependent on PAs. Conclusions: Our findings demonstrate enhancements and hindrances to trainees' learning linked to three key roles PAs perform in the clinical learning environment. These findings can inform how PAs are integrated into teaching services. Further investigation is needed to understand how PAs can balance their professional roles to foster effective collaborative practice and learning.

An act of performance: Exploring residents’ decision‐making processes to seek help

“…Our study suggests that while supervisors seemed to be the gatekeepers of the medical community, other members within the health care team might serve as guides providing practical knowledge and enculturating them into the clinical workplace 11,12,17,20,26,48,49 . Compared to supervisors, other co‐workers afforded the ‘know‐how’ of and guided them through the local norms and practices of the particular workplace 17,20,50 . This knowledge is an essential part of socialisation into the health care team 51 as it helped residents to understand and secure their position as an accepted, legitimate team member.…”

“…Moreover, we also shed light on how help‐seeking as performance does not only occur in the presence of supervisors but also how allied health professionals and fellow residents played a key role in residents’ decision‐making processes to seek help. Our study suggests that while supervisors seemed to be the gatekeepers of the medical community, other members within the health care team might serve as guides providing practical knowledge and enculturating them into the clinical workplace 11,12,17,20,26,48,49 . Compared to supervisors, other co‐workers afforded the ‘know‐how’ of and guided them through the local norms and practices of the particular workplace 17,20,50 .…”

“…Future research should address how to foster learning environments in which the health care team's shared purpose of safe patient care trumps residents’ concerns of negative assessments. We encourage other researchers to consider adopting a perspective that views all health care team members to influence workplace learning interactions 17,20,21,26,50 . Hereto, sociocultural theories can offer guidance 9‐12 .…”

“…Hence, attention for the extent to which residents decide to seek help from other team members is still warranted. Some empirical examples do already touch upon the role of the other health care team members and the workplace environment 2,20,21 . For instance, Kennedy and colleagues, 2 described how residents turned their questions to ‘less powerful’ team members (eg nurses and peers), to maintain their credibility towards supervisors or when supervisors were not available.…”

The wolf you feed: Challenging intraprofessional workplace‐based education norms

“…It allows for “guidance” to be defined with different levels and types of deliberateness ingrained within it. Supported by empirical evidence, the health care team deliberately guides medical trainees for purposes of patient safety 26 and workflow 31 . Furthermore, given their unique perspectives on medical trainees’ knowledgeability within the LoHCP, members of the health care team should be deliberately invited to share their perspectives and to create learning opportunities for individual trainees.…”