Research in Physician Assistant Education & Practice

On Thursday, October 27, I flew in with my PA colleague to Winnipeg, a province which I had never been to before in order to take advantage of one of the Pre-Conference Workshops run by the The Canadian Physician Assistant Education Association (CPAEA). My colleague and I have been looking forward to this session as we have presented research posters at previous CAPA conferences but were looking for guidance to get our foot in the door with engaging in more research.

The session was called “Are We Asking the Right Questions? Setting an Agenda for Research in Physician Assistant Education and Practice” run by Joanne Hamilton, RD, MEd, Ed, Dianna Wactel, DHSc, CCPA, David Kuhns, CCPA, MPH, and Ian Jones, MPAS, CCPA (twitter). The session was split into theoretical and practical aspect with experienced researchers circulating the room to give us feedback on research questions we were developing during the workshop.

Research exposure in Canadian PA Programs – Only 1 of the 3 civilian Physician Assistant Programs is offered as a Master’s degree where students must complete a Capstone project in second year. In this project, students select a research topic and are paired with a mentor who advises while they complete a scientific paper and do a presentation (read about Eden’s experience with UofM MPAS Capstone Project experience!). University of Toronto / Consortium of PA Education and McMaster currently offer Bachelor’s degrees, and there is an aspect of research/medical literature interpretation incorporated into their curriculum. Some PAs who have graduated opt to complete a master’s degree with a research component.

• You can understand and engage in Evidence Based Medicine – Going through the process of engaging in PA research exposes you to different research methodologies, you learn to interpret biostatistics and have the ability to critically appraise the medical literature. You exercise that critical thinking and clinical reasoning muscle.
• Expanding our skills beyond our clinical work. In the first 1-2 years of practicing as a Physician Assistant there is a huge learning curve. This tends to plateau as you become more competent in the area of medicine you practice in. When this plateau occurred for me , I was looking for other ways to grow outside of my clinical work. Engaging in advocacy and teaching is one option. Research, is another a great way to grow in your PA career.
• As pioneers of the PA profession in Canada, engaging in research now will allow us to pave the way for clinical practice for future PAs. Engaging in research now gives future generations the groundwork to build up the profession in the future.
• To explain & clarify the PA role: There are some studies that attempt to clarify the PA role, which varies from practice to practice, and across different jurisdictions. If there is not enough understanding of the PA role, there may be reluctance from potential employers to hire PAs. Without understanding, policy decision makers may not understand the necessity of introducing legislation that allows full implementation of PAs in that province.
• To prove the efficacy and need for PAs in the current health care system: Physician Assistants know PAs are effective. However everyone outside of our “PA world” may not. PA research is a great way to reach other health care professionals and stake holders – at conferences, publishing in journals, to convince them of our ability to make a difference in different health care settings. How can we show/justify the need for PAs in health care? How can we demonstrate that PAs are indispensable?
• PA Research in Canada is lacking. This presents opportunities to address a gap or solve a problem within PA education, PA practice and/or in the implementation of PAs. We can create research questions around problems that we see and encounter in practice:
  • Clinical Problems in regard to diagnosis, intervention, investigations, treatment (e.g. Is an Allopatch Graft superior to traditional arthroscopic rotator cuff repairs for massive to large rotator cuff tears)
  • Practice related problems (e.g. How do PAs contribute to organizations to organizations and health systems? How can we reduce ER bounce backs so that patients outcomes are appropriate and PA time is used well? Are PA graduates appropriately trained for entry to practice?)
  • Work-load related problems (E.g. How much time is saved in a physician’s day after a PA is added to practice? How are lengthy wait times reduced when 1-2 PA providers are added to the ER?)
• Replication studies: If a study has already answered your research question, it might be worthwhile to replicate the study – that is using the same method but in a different context. Perhaps the research question is worth answering from your context. One example brought up during the session was an Ontario study that tracked how PAs and NPs introduced into an Emergency Room reduced wait times, but this was only tracked over a period of ~6 days. You could replicate the study at a different site (or even the same site), but track productivity over 3-6 months instead.

How do I learn about the basics of statistics needed to understand/do research?

• Completing a Masters or having research experience is not a pre-requisite for doing PA research. If the opportunity has not been available to you, there is a wealth of online resources or continuing medical education courses you can take to enhance your knowledge, especially in biostatistics. Websites like Coursera offer courses online free for statistics (depending on timing sometimes these stats courses are specific to health care providers, in the past they have offered “Case Based Biostatistics”). Khan Academy offers online tutorials for the Basics of Statistics. Also, a quick google search reveals great Overviews of Biostatistics.
• There are some academic centers that give researchers access to Biostatisticians who may be willing to assist you with data crunching. For example, University of Manitoba’s Biostatistical Consult Unit.

Research conducted by PAs in Canada (will be referred to as PA Research) can be original quantitative or qualitative research about PA economics/utility, PA role, and PA education.

Canadian PA research does appear in Canadian Medical Journals but also in PA journals as well (JAAPA: Official Journal of the American Academy of Physician Assistants) or Elseiver’s Physician Assistant Clinics.

A quick pubmed search demonstrates publications in journals from Canadian PAs (Canadian PAs highlighted in blue):

• Incorporate research formally into Canadian PA Education across all institutions.
• Research funding be made available to Canadian PAs or Canadian PA related research.
• Setting up mentors and advisors for PA research. Advisors can guide you through your research process, help you network with people and resources, applying for grants and funding, and encourage you to present at conferences and publish papers. So find mentors, and ask questions! A research advisor can be anyone who is established doing research. This may include the PA Education Heads (UofT, UofM, McMaster Deans),  physicians with research experience, PhDs, university professors, etc.
• Research CME – There may be Continuing Medical Education Opportunities for PAs to expand their knowledge in research, whether taking CME courses online on research basics / intro to research.
• Network with other PA Researchers – We have a Canadian PA Researchers Facebook group you can join and discuss research.

Doing research as a Practicing Clinical PA: Most Physician Assistants are full time clinicians, not full time researchers and therefore would fall under the category of Scholar-Practitioner. This means we spend our days performing clinical work, and seeing patients and must somehow make extra time. Some PAs have time set aside specifically for research and this may be outlined in their employment contract (this may occur in practice settings affiliated with universities / education centre). In my specific circumstance, I do not have time specifically set aside for research outlined in my contract.  I would have to spend time after work, or if I find I have a few extra hours somewhere in the week I will fit it in then.

• When developing your research question, apart from the 5W’s (Who, What, When, Where, etc.), also consider “Who Cares?” (which also answers the question “Why?”).
• When starting out in PA research, you don’t have to publish to in a big medical journal. Start small. You can start by focusing on a research question or problem that presents in your own small clinical practice.You can start with a small poster presentation, engaging in a talk at an upcoming conference about an interesting case study.
• When thinking about positionally/bias, work collaboratively with other non-PAs, e.g. RNs, NPs, MDs, RDs, etc. If other health care practitioners that are not PAs are contributing to PA research, it can certainly go a long way to elevating the validity of your research findings.

Resources

• Powerpoint: PA’s and Research