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Health disparities

What are health disparities? According to Unequal Treatment, health disparities are the differences in the incidence, prevalence, mortality, and burden of diseases and other adverse health conditions that exist among specific population groups. Disparities in health care exist even when controlling for gender, condition, age, and socioeconomic status. After decades of improvements in preventive health care and significant declines in disease mortality for many Americans, disparities…

Research and the physician assistant

Introduction Most physician assistant (PA) students choose to study to become PAs because they want to care for patients. If they had wanted to study for a research-oriented degree, they would have applied for MS or PhD programs in biochemistry, biology, public health, or experimental psychology. Nevertheless, PAs cannot avoid research. To provide high-quality, evidence-based patient care, PAs need to consult research daily. PAs who are…

Evidence-based medicine

Learning outcomes After carefully reading this chapter, the physician assistant student will be able to: 1. Provide an overview of the history of evidence-based medicine. 2. Describe the steps to evidence-based practice. 3. Write a foreground (“PICO”) question for a given clinical vignette. 4. Differentiate experimental from observational study designs. 5. Describe the key design elements of randomized controlled trials, cohort, case control, and cross-sectional studies,…

Interprofessional practice and education

Introduction Physician assistant (PA) students who train in the early 21st century are being prepared as never before for interprofessional practice (IPP) via interprofessional education (IPE) ( Box 40.1 ). IPE is a newer concept in medical education; therefore PAs who graduated a decade ago may not have had the same experience in IPE as current students and physicians. Working as part of a team with…

Stress, burnout, and self-care for physician assistants

Learning outcomes The reader of this chapter will be able to: 1. Describe the concepts of burnout, resilience, compassion fatigue, depersonalization, wellness, and self-care. 2. Understand the current models of burnout and wellness, including the individual and external factors that affect clinician wellness. 3. Describe the effects of burnout as it relates to the physician assistant student, practicing clinician, and patient. 4. Discuss potential strategies for…

Postgraduate clinical training programs for physician assistants

Introduction Employment opportunities and clinical roles for physician assistants (PAs) have rapidly expanded to include positions in a wide variety of specialty areas. Postgraduate curricula are designed to build on the knowledge and experience acquired in PA school, enabling individuals to assume roles as well-prepared PAs on specialty health care teams more rapidly than those without formal training or prior specialty experience. Many postgraduate programs have…

Medical malpractice and risk management

Introduction A physician assistant‘s (PA’s) medical practice deals in a world of gray. There are few clinical situations a PA encounters that clearly and unequivocally present themselves so that a ready diagnosis and treatment plan can be implemented. The vast majority of patient encounters will result in the most common “gray” component of your practice: the differential diagnosis. Through a differential diagnosis, the PA sorts out…

Clinical ethics

Introduction Every clinical and public health decision has ethical components that are at times difficult to recognize and process. As John Glaser noted, there are “no ethics free zones.” , In the context of clinical care, ethical awareness is as essential as pathophysiology to bringing about a successful patient outcome. For the physician assistant (PA), the stage is set for complex ethical dilemmas, given their role…

Professionalism

Introduction Trust between the patient and clinician is central to the therapeutic relationship. Without this requisite level of trust, patients will not reveal information about themselves nor will they follow treatment recommendations. Trust builds from the belief that the clinician possesses expert knowledge (which will be applied to the benefit of individuals and society) and will avoid self-interest while acting on behalf of those served. Growing…

International clinical rotations

Introduction The purpose of this chapter is to provide physician assistant (PA) students interested in international clinical education with an overview of international clinical rotations (ICRs) to facilitate decision making about participation and to provide guidance on how to maximize the learning experience. This chapter emphasizes several guiding principles for student participation in ICRs: alignment of student goals with learning experiences; informed decision making toward participation;…

Other surgical subspecialties

Introduction Patients who require subspecialty surgical care may be referred to the surgeon by a primary care provider (PCP), a medical specialist, or another surgeon. Physician assistants (PAs) now work in nearly all surgical subspecialties. The need for PAs in the subspecialties continues to grow as resident work hours decrease, fewer surgical residency spots are available, and patient demand for these services increases. According to the…

Other medical subspecialties

Introduction This chapter aims to prepare students for clinical rotations in medical subspecialties, such as rheumatology, endocrinology, neurology, pulmonology, nephrology, infectious disease, and gastroenterology. Patient approach Typically, a patient is referred to one of these specialists by his or her primary care provider (PCP) for assistance with a condition that is out of the scope of the PCP’s practice or has been suboptimally managed in primary…

Oncology

Introduction to oncology Cancer remains a leading cause of death in the United States despite a steady decline in overall cancer mortality from 1999 to 2016. This downward trend in mortality is likely because of improvements in early detection and dramatic advances in our understanding of cancer pathobiology. These advances have fueled the unprecedented development of novel immunotherapies and targeted pharmacotherapeutic agents; however, traditional cytotoxic chemotherapeutic…

Orthopedics

Introduction Orthopedic medicine offers physician assistants (PAs) unique opportunities to practice team-based medicine at a high level. As a result of the opportunities in orthopedics, as well as the value PAs bring to the orthopedic care team, in 2018 more than 1 in 10 PAs in the United States practiced in orthopedic surgery. Musculoskeletal complaints are common in all medical settings; therefore a quality orthopedic experience…

Dermatology

Introduction Dermatology became a distinct medical subspecialty at the end of the 18th century; however, many dermatologic disorders were first described more than 2000 years ago. When confronted with a dermatologic complaint, you may recall the old adage, “If it’s wet, dry it, and if it’s dry, wet it.” This treatment approach has been ascribed to Hippocrates. During the third century BC, his Hippocratic Collection, also…

Cardiology

Cardiology and approach to the patient Cardiology is the internal medicine specialty of heart and vascular diseases and treatments. The primary goals of cardiology are to reduce morbidity and mortality and improve quality of life. This is accomplished by stabilizing patients with life-threatening emergencies, treating acute conditions, managing chronic diseases, and providing primary and secondary disease prevention. Methods of prevention and treatment include lifestyle modification, medication…

Emergency medicine

Patient approach Emergency medicine practitioners have one overarching goal for each patient: to answer the question, “Does my patient have a threat to life, limb, or sight today?” Emergency departments (EDs) are structured to provide life-saving services to patients in acute need. Determining which patients are in acute need, however, can be less than obvious. A woman with a classic presentation of gastroesophageal reflux may have…

Surgery

In cognitively demanding fields, there are no naturals. Nobody walks into an operating room straight out of a surgical rotation and does world-class neurosurgery. MALCOLM GLADWELL Patient approach Whenever a surgical provider approaches a patient, there are certain questions that should be considered, such as (1) “Will this patient benefit from surgery?”, (2) “Is surgery the most appropriate next step?”, and (3) “Is this patient a…

Behavioral science and medicine: Essentials in practice

Introduction Throughout history, many cultures have viewed mental illness as a form of religious punishment or demonic possession. In ancient Egypt, Greece, and Rome, mental illness was categorized as a religious or personal problem. During the Middle Ages, people believed mentally ill individuals were possessed or in need of religion. Negative attitudes toward mental illness persisted into the 18th and 19th centuries in the United States,…