Acad Psychiatry DOI 10.1007/s40596-015-0322-0
IN DEPTH ARTICLE: COMMENTARY
Assisting Undergraduate Physician Assistant Training in Psychiatry: The Role of Academic Psychiatry Departments Jeffrey J. Rakofsky & Britnay A. Ferguson
Received: 20 October 2014 / Accepted: 5 March 2015 # Academic Psychiatry 2015
Abstract Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PA school accreditation standards provide limited guidance for training PAs in psychiatry. As a result, PA students may receive inconsistent and possibly inadequate exposure to psychiatry. Providing broad and in-depth exposure to the field of psychiatry is important to attract PA students to pursue careers in psychiatry and provide a possible solution to the shortage of psychiatrists nationwide. Additionally, this level of exposure will prepare PA students who pursue careers in other fields of medicine to recognize and address their patient’s psychiatric symptoms in an appropriate manner. This training can be provided by an academic department of psychiatry invested in the education of PA students. We describe a training model implemented at our university that emphasizes psychiatrist involvement in the preclinical year of PA school and full integration of PA students into the medical student psychiatry clerkship during the clinical years. The benefits and challenges to implementing this model are discussed as well. Keywords Interdisciplinary training . Teaching methods
Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PAs take medical histories, perform
J. J. Rakofsky (*) Emory University School of Medicine, Atlanta, GA, USA e-mail: [email protected] B. A. Ferguson Department of Psychiatry and Behavioral Sciences, Grady Health System, 80 Jesse Hill Jr. Drive SE - 13E018, Atlanta, GA 30303, USA
physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling, and make rounds in hospitals and nursing homes. The profession was established in 1965 to address the shortage of medical personnel at the time, and most training programs now average 26 months divided between medical sciences and clinical rotations [1]. Since the 1970s, clinicians have argued for greater psychiatric training for PAs during PA school [2–4] and greater incorporation of PAs into psychiatric practice [5–8]. The most recent edition of the Accreditation Standards for Physician Assistant Education [9] states that “the program curriculum must include instruction in the social and behavioral sciences as well as normal and abnormal development across the life span,” but does not indicate how much time should be dedicated to this nor does it specify who should be teaching the material (e.g., psychiatrists, psychologists, licensed professional counselors, PAs) other than to say it “include individuals with advanced degrees, experience or previous academic background in a field or discipline.” Additionally, PA schools must provide supervised clinical practice experiences with “sufficient patient exposure to allow each student to meet program-defined requirements with patients seeking…care for behavioral and mental health conditions,” and these experiences should occur with preceptors practicing in…behavioral and mental health care.” The accreditation standards provide no other guidance with regard to important items such as the following: the breadth of exposure to the different psychiatric conditions, duration of the supervised clinical experience, nor learning objectives during that experience. This ambiguity may cause some PA students to receive limited or inconsistent exposure to the field of psychiatry. However, a broad and in-depth exposure to the field can be valuable to PAs and society for two reasons: The first is that many PA students will eventually work in primary care practices, where they will encounter large numbers of patients
Acad Psychiatry
presenting with psychiatric symptoms. The more psychiatry they learn during PA school, the better equipped they will be to recognize and address their patients’ symptoms. Secondly, as more patients become insured through the Affordable Care Act, the shortage of psychiatrists in the USA [10] will become more obvious creating a need for mid-level providers. Exposure to psychiatry during PA school will become an opportunity to attract those students that have an interest in working with patients who have mental illness. In this article, we describe a teaching-model that incorporates faculty from an academic psychiatry department during the pre-clinical year and integrates PAs into the medical student clerkship during their clinical year. To our knowledge, only two manuscripts [3, 4], both more than 30 years old have been published describing a model curriculum for teaching psychiatry to PA students. In contrast to those, our model spans across both the pre-clinical and clinical years of PA training, emphasizing department-wide involvement and integrating PA training with that of medical students.
Preclinical Year(s) During this period, PA students at our university spend 17 months in a classroom setting learning the basics of clinical medicine. This includes courses in the pathophysiology of disease, pharmacology, ethics, public health, and biostatistics among others. Psychiatry training during this year occurs during the “Behavioral Health” module. This is a 2-week module that is taught by psychiatrists in the department of psychiatry along with PAs, psychiatry fellows, psychologists, licensed professional counselors, and a pharmacist. The lecture topics include an Introduction to the Psychiatric Interview and the Mental Status Exam, Depressive Disorders, Bipolar Disorder, Anxiety and Obsessive-Compulsive Disorders, Personality Disorders, Schizophrenia-Spectrum Disorders, Approach to the Acutely Psychotic Patient, Attention Deficit Hyperactivity Disorder, Post-traumatic Stress Disorder, Substance Use Disorders, Eating Disorders, Somatoform Disorders, and Psychopharmacology. Compared to a medical school course in psychiatry, this course focuses more on diagnosis, phenomenology, basic psychopharmacology and treatment, and less on neurobiology. The effect of society on behavior is examined as well in an effort to appreciate the multiple determinants of mental health and illness.
Clinical Year During this year, students spend 12 months rotating through the different fields of medicine working under the supervision of a preceptor, who may be a PA or a physician. Rotations include internal medicine, pediatrics, family medicine, and obstetrics and gynecology, to name a few. Psychiatric training
during this year occurs most intensely during the psychiatry rotation that lasts for 5 weeks, although there is some psychiatry exposure during primary care rotations, such as family medicine or internal medicine. During the psychiatry rotation, our program fully integrates PA students into the medical student psychiatry clerkship, which is managed by the Director of Medical Student Education within the Department of Psychiatry with the assistance of the clerkship coordinator. As part of this integration, PA students, along with the medical students, attend the same clerkship orientation, are placed at the same clinical sites, have the same patient-care responsibilities, the same “on-call” requirements, and jointly attend the weekly didactics. The goals during this rotation are the same for both medical and PA students: 1) to develop clinical interviewing skills, 2) to learn how to conduct psychiatric safety assessments, and 3) to enhance their psychiatric diagnostic and treatment knowledgebase. Those PA students who voice a strong interest in pursuing a primary care specialty prior to site assignment may be placed at our med-psych clinic or with one of our hospital-based, consultation-liaison teams. Those who voice an interest in emergency medicine may be placed at a site with significant psychiatric emergency room exposure. Otherwise, PA students are randomly assigned to our various inpatient and outpatient clinical sites. Additional required experiences ensure that all PA students (similar to medical students) get at least one half-day exposure to psychiatric emergencies and electroconvulsive therapy and are required to observe an Alcoholics Anonymous meeting. Optional experiences during the clerkship allow students to spend one half-day in our department’s women’s mental health clinic, child psychiatry clinic, child inpatient consultation service, geriatric outpatient clinic, or in the psychiatry residents’ psychopharmacology clinic. At the majority of these sites, the preceptor is the same psychiatry attending that works with the medical students. However, there is a PA at one clinical site who works along with a psychiatry attending to train PA students. This individual plays a unique role in demonstrating the skills and responsibilities of a PA working in a psychiatric setting. In doing so, she is able to provide PA students with a sense of what their responsibilities would entail if they pursued a career in psychiatry. This same PA can also provide mentorship throughout the rest of the student’s enrollment in PA school. Evaluations of PA students are usually completed by the attending, who fills out a structured, summative assessment of the PA’s skills in patientcare, medical knowledge, interpersonal and communication, and professionalism. Though the actual forms are different for medical students and PA students for institutional reasons, medical and PA students are both evaluated on similar competencies. They are also given a multiple-choice exam written by the program’s clinical director and clinical educator. Because of the large total number of PA and medical students rotating through the clerkship at one time, the success of
Acad Psychiatry
such a program depends on a central clerkship coordinator who works with both the medical school and PA school administrators to assign students to clinical sites, manage administrative challenges that may arise, and ensure grades are reported in a timely manner. For those PA students that express a desire for more exposure to clinical psychiatry after they complete their rotation, we provide elective experiences at the same sites that are offered to medical students seeking electives in their final school year.
Potential Benefits The benefits that this training model provide extend to both PA and medical students, psychiatry residents and attendings. PA students gain a rigorous training experience which may draw them into the field of psychiatry. In 2013, only 1 % of surveyed PAs listed psychiatry as their primary practice [11]. It is unknown how this number may change with more PA schools across the country following our model, though we suspect it may increase. An email survey of the 56 PA students graduating from our PA school in December 2014 indicated that 9 % (n=5) were actively pursuing careers in psychiatry, 14 % (n=8) were considering but not actively pursuing a career in psychiatry, 45 % (n=25) were definitely not interested in a career in psychiatry, and 32 % (n=18) did not respond. In comparison, no students in the graduating class of 2013 entered a career in psychiatry upon graduation. Medical students gain comfort working with PA students and may develop the respect for their training that will engender strong working relationships in their future practice settings. Psychiatry residents may get the benefit of hard-working students who are often eager to help with medical procedures and physical exams, thus enabling the resident to complete his work more efficiently. Finally, the attendings gain teaching opportunities that may broaden their teaching portfolio and support their efforts to be promoted within the university.
consistent strong work ethic and comfort working with patients. This comfort is probably the result of their extensive clinical experiences required prior to matriculating into their program. Many have worked as paramedics, sports trainers, emergency room technicians, and some have even worked in mental health settings as mental health technicians or research assistants. Our PA school and others require applicants to complete at least 2000 clinical hours before applying. Another challenge is disinterest in psychiatry among some PA students. However, this is a problem with some medical students as well. Although there may be multiple reasons for this disinterest, as educators, we must help students link the relevance of learning psychiatry to their future professional goals in whichever medical field they may choose. Though we strive to create similar experiences for both medical students and PA students, there are some components of the rotation that are different for these students, for example, preparation for the National Board of Medical Examiners clinical psychiatry shelf exam. Only the medical students take this test. Additionally, some of the mental health laws that we discuss pertain only to psychiatrists and not to PAs. Care must be taken to not induce a feeling of “second-class citizenship” on the part of PA students. Using inclusive terms, such as “future health care providers,” or “clinicians” instead of “medical students” or “physicians” when talking to the students about their experiences may be small ways to mitigate this feeling. The lack of exposure to PAs working in psychiatry means PA students may have a difficult time imagining what their role would be on a mental health care team or what their lifework balance might be. This may be less of a problem as more PAs are recruited to the field of psychiatry and can participate in training PA students in the future. Finally, care must be taken to not oversaturate clinical sites with students given the higher total number of students rotating through the clerkship. The department must be creative and open to converting university clinics into potential rotation sites in order to reduce the congestion.
Challenges Conclusion Though our department’s integrated PA-medical student teaching model has been successful based on student feedback, there have been challenges along the way. One of the first challenges was faculty resistance to teaching PA students because of variability in PA students’ psychiatric knowledgebase relative to medical students. However, with a stronger preclinical training program in place, these students will begin their clinical year with more knowledge than earlier cohorts. While some faculty acknowledge the greater teaching efforts required as a result of some PA students’ smaller knowledgebase, many are also impressed by PA students’
High-quality training during the preclinical and clinical stages of PA school that provides broad exposure to the various psychiatric illnesses, treatment modalities, and treatment settings is crucial for PA students. Many students will choose careers in primary care settings treating psychiatric illnesses, and they will require this training to provide empathic and informed care. Other PA students may discover that treating patients with serious mental illness is their mission and will seek out careers in psychiatry, for which this training will
Acad Psychiatry
serve as the foundation upon which they will build. Psychiatry departments can play an important role in providing this psychiatric training to PA students. Our department’s model emphasizes psychiatrist involvement in the preclinical year and full integration of PA students into the medical student psychiatry clerkship during the clinical year. Exposure to PAs in psychiatry during this clerkship experience may ultimately help with recruitment of PAs into the field of psychiatry and provide one solution to address the shortage of psychiatrists nationwide. Implications for Educators • Physician assistant undergraduate training in psychiatry must be broad and in-depth. • Psychiatry faculty members should be encouraged to participate in their university’s Physician Assistant program preclinical lecture series. • Physician assistant students should be fully integrated into the medical student psychiatry clerkship. • Robust training experiences in psychiatry may inspire more PA students to pursue mental health careers and help address the shortage of psychiatrists nationwide.
Acknowledgments We would like to thank Carolyn Knight for her careful review and feedback of the manuscript. Disclosures There are no relevant disclosures.
References 1. Carter R. Physician assistant history. Perspect Physician Assist Educ. 2001;12(2):130–2. 2. Shea KC, Pechacek M. Why teach mental health topics to physician assistants and other allied healthcare professionals? US Army Med Dep J. 2008:52–3. 3. Ilk CR, Goldstein EH. An educational program in psychiatry for physicians’ assistant students. P A J. 1975;5(2):109–11. 4. Petrusa ER, Taylor CB, Simmons R, Cabe W. A three-component course in psychiatry for primary care physician’s assistants. J Med Educ. 1978;53(9):770–2. 5. Sharma TR, Nicely MD. Physician assistants in mental health. South Med J. 2011;104(2):87–8. 6. Shanks CS. PAs in psychiatry: improving care for the underserved. JAAPA: Off J Am Acad Physician Assist. 2007;20(4):14. 7. Pollack DA, Ford SM. Is there a role for physician assistants in community mental health? Community Ment Health J. 1998;34(2): 209–17. 8. Mathews WA, Yohe CD. PAs in psychiatry: filling the gap. Physician Assist. 1984;8(6):26–8. 9. Accreditation Review Commission on Education for the Physician Assistant Inc. Accreditation Standards for Physician Assistant Education. 4th edition. Johns Creek, GA. Available from: http:// www.arc-pa.org/acc_standards. Last Accessed 29 Sept 2014. 10. US Department of Health and Human Services. Shortage Designation: Health Professional Shortage Areas & Medically Underserved Areas/Populations [updated June 19, 2014]. Available from: http://www.hrsa.gov/shortage/. Last Accessed 29 Sept 2014. 11. National Commission on Certification of Physician Assistants. 2013 Statistical Profile of Certified Physician Assistants: An Annual Report of the National Commission on Certification of Physician Assistants 2014. Available from: http://www.nccpa.net. Last Accessed 29 Sept 2014.
IN DEPTH ARTICLE: COMMENTARY
Assisting Undergraduate Physician Assistant Training in Psychiatry: The Role of Academic Psychiatry Departments Jeffrey J. Rakofsky & Britnay A. Ferguson
Received: 20 October 2014 / Accepted: 5 March 2015 # Academic Psychiatry 2015
Abstract Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PA school accreditation standards provide limited guidance for training PAs in psychiatry. As a result, PA students may receive inconsistent and possibly inadequate exposure to psychiatry. Providing broad and in-depth exposure to the field of psychiatry is important to attract PA students to pursue careers in psychiatry and provide a possible solution to the shortage of psychiatrists nationwide. Additionally, this level of exposure will prepare PA students who pursue careers in other fields of medicine to recognize and address their patient’s psychiatric symptoms in an appropriate manner. This training can be provided by an academic department of psychiatry invested in the education of PA students. We describe a training model implemented at our university that emphasizes psychiatrist involvement in the preclinical year of PA school and full integration of PA students into the medical student psychiatry clerkship during the clinical years. The benefits and challenges to implementing this model are discussed as well. Keywords Interdisciplinary training . Teaching methods
Physician assistants (PAs) are medical professionals who practice medicine with the supervision of a physician through delegated autonomy. PAs take medical histories, perform
J. J. Rakofsky (*) Emory University School of Medicine, Atlanta, GA, USA e-mail: [email protected] B. A. Ferguson Department of Psychiatry and Behavioral Sciences, Grady Health System, 80 Jesse Hill Jr. Drive SE - 13E018, Atlanta, GA 30303, USA
physical examinations, diagnose and treat illnesses, order and interpret lab tests, perform procedures, assist in surgery, provide patient education and counseling, and make rounds in hospitals and nursing homes. The profession was established in 1965 to address the shortage of medical personnel at the time, and most training programs now average 26 months divided between medical sciences and clinical rotations [1]. Since the 1970s, clinicians have argued for greater psychiatric training for PAs during PA school [2–4] and greater incorporation of PAs into psychiatric practice [5–8]. The most recent edition of the Accreditation Standards for Physician Assistant Education [9] states that “the program curriculum must include instruction in the social and behavioral sciences as well as normal and abnormal development across the life span,” but does not indicate how much time should be dedicated to this nor does it specify who should be teaching the material (e.g., psychiatrists, psychologists, licensed professional counselors, PAs) other than to say it “include individuals with advanced degrees, experience or previous academic background in a field or discipline.” Additionally, PA schools must provide supervised clinical practice experiences with “sufficient patient exposure to allow each student to meet program-defined requirements with patients seeking…care for behavioral and mental health conditions,” and these experiences should occur with preceptors practicing in…behavioral and mental health care.” The accreditation standards provide no other guidance with regard to important items such as the following: the breadth of exposure to the different psychiatric conditions, duration of the supervised clinical experience, nor learning objectives during that experience. This ambiguity may cause some PA students to receive limited or inconsistent exposure to the field of psychiatry. However, a broad and in-depth exposure to the field can be valuable to PAs and society for two reasons: The first is that many PA students will eventually work in primary care practices, where they will encounter large numbers of patients
Acad Psychiatry
presenting with psychiatric symptoms. The more psychiatry they learn during PA school, the better equipped they will be to recognize and address their patients’ symptoms. Secondly, as more patients become insured through the Affordable Care Act, the shortage of psychiatrists in the USA [10] will become more obvious creating a need for mid-level providers. Exposure to psychiatry during PA school will become an opportunity to attract those students that have an interest in working with patients who have mental illness. In this article, we describe a teaching-model that incorporates faculty from an academic psychiatry department during the pre-clinical year and integrates PAs into the medical student clerkship during their clinical year. To our knowledge, only two manuscripts [3, 4], both more than 30 years old have been published describing a model curriculum for teaching psychiatry to PA students. In contrast to those, our model spans across both the pre-clinical and clinical years of PA training, emphasizing department-wide involvement and integrating PA training with that of medical students.
Preclinical Year(s) During this period, PA students at our university spend 17 months in a classroom setting learning the basics of clinical medicine. This includes courses in the pathophysiology of disease, pharmacology, ethics, public health, and biostatistics among others. Psychiatry training during this year occurs during the “Behavioral Health” module. This is a 2-week module that is taught by psychiatrists in the department of psychiatry along with PAs, psychiatry fellows, psychologists, licensed professional counselors, and a pharmacist. The lecture topics include an Introduction to the Psychiatric Interview and the Mental Status Exam, Depressive Disorders, Bipolar Disorder, Anxiety and Obsessive-Compulsive Disorders, Personality Disorders, Schizophrenia-Spectrum Disorders, Approach to the Acutely Psychotic Patient, Attention Deficit Hyperactivity Disorder, Post-traumatic Stress Disorder, Substance Use Disorders, Eating Disorders, Somatoform Disorders, and Psychopharmacology. Compared to a medical school course in psychiatry, this course focuses more on diagnosis, phenomenology, basic psychopharmacology and treatment, and less on neurobiology. The effect of society on behavior is examined as well in an effort to appreciate the multiple determinants of mental health and illness.
Clinical Year During this year, students spend 12 months rotating through the different fields of medicine working under the supervision of a preceptor, who may be a PA or a physician. Rotations include internal medicine, pediatrics, family medicine, and obstetrics and gynecology, to name a few. Psychiatric training
during this year occurs most intensely during the psychiatry rotation that lasts for 5 weeks, although there is some psychiatry exposure during primary care rotations, such as family medicine or internal medicine. During the psychiatry rotation, our program fully integrates PA students into the medical student psychiatry clerkship, which is managed by the Director of Medical Student Education within the Department of Psychiatry with the assistance of the clerkship coordinator. As part of this integration, PA students, along with the medical students, attend the same clerkship orientation, are placed at the same clinical sites, have the same patient-care responsibilities, the same “on-call” requirements, and jointly attend the weekly didactics. The goals during this rotation are the same for both medical and PA students: 1) to develop clinical interviewing skills, 2) to learn how to conduct psychiatric safety assessments, and 3) to enhance their psychiatric diagnostic and treatment knowledgebase. Those PA students who voice a strong interest in pursuing a primary care specialty prior to site assignment may be placed at our med-psych clinic or with one of our hospital-based, consultation-liaison teams. Those who voice an interest in emergency medicine may be placed at a site with significant psychiatric emergency room exposure. Otherwise, PA students are randomly assigned to our various inpatient and outpatient clinical sites. Additional required experiences ensure that all PA students (similar to medical students) get at least one half-day exposure to psychiatric emergencies and electroconvulsive therapy and are required to observe an Alcoholics Anonymous meeting. Optional experiences during the clerkship allow students to spend one half-day in our department’s women’s mental health clinic, child psychiatry clinic, child inpatient consultation service, geriatric outpatient clinic, or in the psychiatry residents’ psychopharmacology clinic. At the majority of these sites, the preceptor is the same psychiatry attending that works with the medical students. However, there is a PA at one clinical site who works along with a psychiatry attending to train PA students. This individual plays a unique role in demonstrating the skills and responsibilities of a PA working in a psychiatric setting. In doing so, she is able to provide PA students with a sense of what their responsibilities would entail if they pursued a career in psychiatry. This same PA can also provide mentorship throughout the rest of the student’s enrollment in PA school. Evaluations of PA students are usually completed by the attending, who fills out a structured, summative assessment of the PA’s skills in patientcare, medical knowledge, interpersonal and communication, and professionalism. Though the actual forms are different for medical students and PA students for institutional reasons, medical and PA students are both evaluated on similar competencies. They are also given a multiple-choice exam written by the program’s clinical director and clinical educator. Because of the large total number of PA and medical students rotating through the clerkship at one time, the success of
Acad Psychiatry
such a program depends on a central clerkship coordinator who works with both the medical school and PA school administrators to assign students to clinical sites, manage administrative challenges that may arise, and ensure grades are reported in a timely manner. For those PA students that express a desire for more exposure to clinical psychiatry after they complete their rotation, we provide elective experiences at the same sites that are offered to medical students seeking electives in their final school year.
Potential Benefits The benefits that this training model provide extend to both PA and medical students, psychiatry residents and attendings. PA students gain a rigorous training experience which may draw them into the field of psychiatry. In 2013, only 1 % of surveyed PAs listed psychiatry as their primary practice [11]. It is unknown how this number may change with more PA schools across the country following our model, though we suspect it may increase. An email survey of the 56 PA students graduating from our PA school in December 2014 indicated that 9 % (n=5) were actively pursuing careers in psychiatry, 14 % (n=8) were considering but not actively pursuing a career in psychiatry, 45 % (n=25) were definitely not interested in a career in psychiatry, and 32 % (n=18) did not respond. In comparison, no students in the graduating class of 2013 entered a career in psychiatry upon graduation. Medical students gain comfort working with PA students and may develop the respect for their training that will engender strong working relationships in their future practice settings. Psychiatry residents may get the benefit of hard-working students who are often eager to help with medical procedures and physical exams, thus enabling the resident to complete his work more efficiently. Finally, the attendings gain teaching opportunities that may broaden their teaching portfolio and support their efforts to be promoted within the university.
consistent strong work ethic and comfort working with patients. This comfort is probably the result of their extensive clinical experiences required prior to matriculating into their program. Many have worked as paramedics, sports trainers, emergency room technicians, and some have even worked in mental health settings as mental health technicians or research assistants. Our PA school and others require applicants to complete at least 2000 clinical hours before applying. Another challenge is disinterest in psychiatry among some PA students. However, this is a problem with some medical students as well. Although there may be multiple reasons for this disinterest, as educators, we must help students link the relevance of learning psychiatry to their future professional goals in whichever medical field they may choose. Though we strive to create similar experiences for both medical students and PA students, there are some components of the rotation that are different for these students, for example, preparation for the National Board of Medical Examiners clinical psychiatry shelf exam. Only the medical students take this test. Additionally, some of the mental health laws that we discuss pertain only to psychiatrists and not to PAs. Care must be taken to not induce a feeling of “second-class citizenship” on the part of PA students. Using inclusive terms, such as “future health care providers,” or “clinicians” instead of “medical students” or “physicians” when talking to the students about their experiences may be small ways to mitigate this feeling. The lack of exposure to PAs working in psychiatry means PA students may have a difficult time imagining what their role would be on a mental health care team or what their lifework balance might be. This may be less of a problem as more PAs are recruited to the field of psychiatry and can participate in training PA students in the future. Finally, care must be taken to not oversaturate clinical sites with students given the higher total number of students rotating through the clerkship. The department must be creative and open to converting university clinics into potential rotation sites in order to reduce the congestion.
Challenges Conclusion Though our department’s integrated PA-medical student teaching model has been successful based on student feedback, there have been challenges along the way. One of the first challenges was faculty resistance to teaching PA students because of variability in PA students’ psychiatric knowledgebase relative to medical students. However, with a stronger preclinical training program in place, these students will begin their clinical year with more knowledge than earlier cohorts. While some faculty acknowledge the greater teaching efforts required as a result of some PA students’ smaller knowledgebase, many are also impressed by PA students’
High-quality training during the preclinical and clinical stages of PA school that provides broad exposure to the various psychiatric illnesses, treatment modalities, and treatment settings is crucial for PA students. Many students will choose careers in primary care settings treating psychiatric illnesses, and they will require this training to provide empathic and informed care. Other PA students may discover that treating patients with serious mental illness is their mission and will seek out careers in psychiatry, for which this training will
Acad Psychiatry
serve as the foundation upon which they will build. Psychiatry departments can play an important role in providing this psychiatric training to PA students. Our department’s model emphasizes psychiatrist involvement in the preclinical year and full integration of PA students into the medical student psychiatry clerkship during the clinical year. Exposure to PAs in psychiatry during this clerkship experience may ultimately help with recruitment of PAs into the field of psychiatry and provide one solution to address the shortage of psychiatrists nationwide. Implications for Educators • Physician assistant undergraduate training in psychiatry must be broad and in-depth. • Psychiatry faculty members should be encouraged to participate in their university’s Physician Assistant program preclinical lecture series. • Physician assistant students should be fully integrated into the medical student psychiatry clerkship. • Robust training experiences in psychiatry may inspire more PA students to pursue mental health careers and help address the shortage of psychiatrists nationwide.
Acknowledgments We would like to thank Carolyn Knight for her careful review and feedback of the manuscript. Disclosures There are no relevant disclosures.
References 1. Carter R. Physician assistant history. Perspect Physician Assist Educ. 2001;12(2):130–2. 2. Shea KC, Pechacek M. Why teach mental health topics to physician assistants and other allied healthcare professionals? US Army Med Dep J. 2008:52–3. 3. Ilk CR, Goldstein EH. An educational program in psychiatry for physicians’ assistant students. P A J. 1975;5(2):109–11. 4. Petrusa ER, Taylor CB, Simmons R, Cabe W. A three-component course in psychiatry for primary care physician’s assistants. J Med Educ. 1978;53(9):770–2. 5. Sharma TR, Nicely MD. Physician assistants in mental health. South Med J. 2011;104(2):87–8. 6. Shanks CS. PAs in psychiatry: improving care for the underserved. JAAPA: Off J Am Acad Physician Assist. 2007;20(4):14. 7. Pollack DA, Ford SM. Is there a role for physician assistants in community mental health? Community Ment Health J. 1998;34(2): 209–17. 8. Mathews WA, Yohe CD. PAs in psychiatry: filling the gap. Physician Assist. 1984;8(6):26–8. 9. Accreditation Review Commission on Education for the Physician Assistant Inc. Accreditation Standards for Physician Assistant Education. 4th edition. Johns Creek, GA. Available from: http:// www.arc-pa.org/acc_standards. Last Accessed 29 Sept 2014. 10. US Department of Health and Human Services. Shortage Designation: Health Professional Shortage Areas & Medically Underserved Areas/Populations [updated June 19, 2014]. Available from: http://www.hrsa.gov/shortage/. Last Accessed 29 Sept 2014. 11. National Commission on Certification of Physician Assistants. 2013 Statistical Profile of Certified Physician Assistants: An Annual Report of the National Commission on Certification of Physician Assistants 2014. Available from: http://www.nccpa.net. Last Accessed 29 Sept 2014.
