PEDIATRIC WOUND CARE: WHAT CAN WE LEARN FROM A SYSTEMATIC REVIEW OF THE LITERATURE? USING A SYSTEMATIC REVIEW AND A CLINICAL CONSENSUS GROUP TO ASSESS THE QUALITY AND CONTENT OF SYSTEMATIC REVIEWS FOCUSING ON PEDIATRIC WOUND CARE. THEN PROVIDING AND ANALYTICAL OUTLINE FOR CREATION OF PEDIATRIC WOUND CARE GUIDELINES FOR EVIDENCE BASED CLINICAL PRACTICE

Background: Wound care practices for neonatal and pediatric patients including the category of products, specific products within each category, and length of application of the products have created lack of standardized evidence-based guidelines for treatments in clinical practices. This dissertation addresses this concern by encompassing three crucial steps in developing evidence-based clinical guidelines for wound care specialists. Using a three-paper method, an expert consensus group was formed, a systematic review of reviews completed and a process for creating clinical decision trees created. Methods: Criteria for selection of the consensus group members included: 1) Research graduate active in Pediatric Wound Care research, 2) Board certified Physicians actively practicing in their aforementioned pediatric general surgery or pediatric plastic surgery subspecialty, and 3) Wound Ostomy Care Nurse actively practicing in Pediatric wound care. An adapted questionnaire was created to address eligibility criteria, information sources, systematic review database search strategy, study selection criteria including keywords, the clinical consensus group’s experience with clinical guideline development, and finally other clinically significant domains that the evidence should be evaluated for. Using domains identified, a systematic review of reviews was completed. PRISMA and AMSTAR were used to assess quality of reporting and quality of the evidence. Results and Conclusions: The consensus group members polled have been proficient in pediatric wound care for several years with the majority of the members practicing for more than 10 years within a hospital setting. Duration and lengths of discussion meetings whether in person or via electronic interface as well as how data collected was reviewed and analyzed, i.e. in person face to face or via conference call, was the driving force in establishing search domains. The articles found in the domain search identified themselves differently, with some identifying themselves as a systematic review, literature review, meta-analysis, or a combination of the two. It was determined that no true “gold standard” for assessing systematic reviews exists. Because this is the first systematic review of systematic reviews in wound care specifically, SRs of SRs in other healthcare related fields were relied upon

Incorporation of Surgical Cadaver Lab Training in a Physician Assistant Fellowship Program

Physician Assistants (PAs) are licensed medical professionals who provide health care under the supervision of and in collaboration with physicians. PAs can specialize in any field of medicine or surgery with additional on-the-job training while some PAs participate in a postgraduate training program in order to increase their knowledge in a certain subspecialty area. This paper describes the incorporation of a cadaver lab curriculum into a postgraduate PA surgical training program. The description of the development, implementation, and evaluation of the cadaver lab experience can assist other programs to implement this hands-on educational experience for a variety of medical providers, including PAs, NPs, medical residents, and fellows

Pediatric wound care: Establishing a consensus group to develop clinical practice guidelines

Introduction. Wound care practices for neonatal and pediatric patients have created a lack of standardized evidence-based guidelines for treatments in clinical practices. Unfortunately, published clinical guidelines for the evaluation and management of wounds in pediatric populations is limited. Consensus groups are used to develop clinical guidelines which define key aspects of the quality of health care, particularly appropriate indications for interventions. The aim of this initiative was to conduct the first two steps of the guideline development process, and to report on the findings from the expert consensus group for pediatric wound care. Methods. The goal was to recruit a multidisciplinary team that consisted of board certified Pediatric Plastic and Pediatric General Surgeons, WOCN, and research specialists active in the International Society of Pediatric Wound Care (ISPEW). All recruited individuals were emailed and invited to participate. For this study, an adapted questionnaire was created to assess eligibility criteria, information sources, systematic review database search strategies, study selection criteria including keywords. Data was collected on the clinical consensus group’s experience with clinical guideline development, and other clinically significant domains for which the the evidence should be evaluated. Results. All six invited individuals agreed to participate. 100% of respondents provided the number of years in their current role within their respective institutions and their length of experience with pediatric wound care management. 17% of respondents had 7 to 10 years in their current role, while 66% had more than 10 years practice in pediatric wound care. Domains identified as important to consider included: Cost of Product/Treatment Duration of Treatment, Ease of Applying Product/Performing Treatment, Accessibility of Product, Storage of Product, Length of Time to Apply Product/Perform Treatment. Discussion. The agreed-upon domains from our study align with previously published consensus group studies. We identified several domains to inform a future systematic review. At this time, no systematic review has been published that has been guided by consensus group domains and search terms for pediatric wound care. Conclusion. Through the use of this consensus group and conducted surveys, we identified the primary domains necessary to complete a practice-informed systematic review, as well as other key domains that are important in clinical pediatric wound care management

Measuring the Quality of Postgraduate Physician Assistant Fellowship/Residency Programs with a Surgical Focus

Introduction Postgraduate programs for PAs provide formal postgraduate training for clinical specialty areas. These programs are intended to provide intense specialty training in various fields, as well as to standardize education beyond the entry level. The purpose of this descriptive study was to determine if there are consistent trends or clear differences in program length, approach to training, validation of learning, and accreditation through the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) for postgraduate programs with a surgical focus in the United States. Methods This study is a non-experimental and descriptive research design. Program directors were mailed a survey consisting of questions about program information, prerequisites, curriculum, training, evaluation, and perspective of graduates after completion of program. Results Of the 29 program directors who were mailed a survey, 62% responded with completed surveys (n=18). 38% of respondents (n=11) stated the annual salary ranged from $40,000 to$60,000. Five programs were accredited by the ARC-PA and four programs were actively seeking accreditation. The majority of program directors believed the attitude of the medical community is higher towards PAs who complete a postgraduate education program. Conclusion As postgraduate programs increase in popularity, it is important to evaluate the standardization of the programs nationally. Papers like this will help drive a consistent approach to PA fellowship development and evolution. As healthcare evolves, there is a need to develop highly specialized physician assistants and place a premium on retaining them within the healthcare systems. Obtaining information on standard practices across postgraduate PA programs helps determine what requirements should be upheld nationally

Retention of Physician Assistants within a Specialty after Completion of a Postgraduate Training Program

Background: The advantages of a specialized training program have led to over 84 postgraduate training programs for Physician Assistants (PAs) covering over 25 specialties. Employee lateral mobility is more prevalent within the PA profession, which allows PA providers to switch between medical specialties. The versatility of PAs promotes higher turnover rates compared to physician counterparts. These high turnover rates can result in increased institutional burden. Postgraduate PA programs provide pre-employment exposure to more in-depth medical training, enabling a well-rounded knowledge base of the PA’s roles and responsibilities, minimizing turnover rates. Purpose: The goal of this survey study is to identify PA graduates’ perceptions of their retention rate, job satisfaction within a given specialty, factors influencing a PA’s decision to change their specialty, and specialty preparation provided by postgraduate training programs and specific educational training. Methods: A mixed method design was utilized to survey both program directors and graduates of PA postgraduate training programs. Results: Of the 398 postgraduate program graduates, 196 (49%) accepted a job within the institution where they trained. Across all postgraduate training programs, 87% of graduates have not changed their specialty since program completion. Ninety-six percent of respondents felt their postgraduate training gave them an accurate preview of employment in their specialty of interest, and all postgraduates would recommend a postgraduate training program to a new PA graduate

Survey Analysis of Overall Job Satisfaction of Physician Assistants

Background: Over the last three decades, the physician assistant (PA) profession has seen an increase in the number of women in the profession, a decline in the age of new PA graduates, a movement toward specialty practice, and an exponential growth in the workforce as a whole. Historically, surveys reveal the majority of PAs are satisfied with their career choice and current job. Although a majority of PAs report high job satisfaction, career burnout is still significant within the profession. Career burnout among health care providers continues to rise due to the strains of the US healthcare system, growing patient populations, and increased administrative burden. Purpose: The purpose of this study is to examine overall career satisfaction and retention rates among physician assistants with 10 years of clinical experience or more versus less than 10 years of clinical experience. The results of this study will provide a means to analyze the various aspects of a PA’s career which contribute most significantly to long term job satisfaction and will ultimately serve to improve retention rates among all institutions. Methods: A survey addressing job characteristics, overall career satisfaction, and retention rates was sent to program directors of 254 varying PA programs across the country. The participants were split into two groups: Group A (participants with \u3c 10 years of clinical practice experience) and Group B (participants with \u3e 10 years of clinical practice experience). Results: Group A contained 127 participants (20 males, 107 females). The majority of the participants were aged 20-39 years old, began their PA career at 25-30 years of age, and had been working as a PA for 2-5 years. Group B contained 71 participants (26 males, 44 females, 1 undisclosed gender). The majority of the participants were 30-49 years old, began their PA careers between the ages of 25-30, and had been working as a PA for more than 15 years. Discussion: Overall, the majority of the participants in the study were females currently practicing in a surgical subspecialty at a non-academic institution in an outpatient setting, which correlates with national data from the American Academy of Physician Assistants (AAPA). Both groups rated job satisfaction a 4 out of 5. Autonomy from supervising physicians differed between Group A and Group B; these differences are likely due to an expansion of knowledge, refined clinical skills, and increasing rapport with the supervising physician that develops over years of clinical practice

Utilization and Workforce Integration of Physician Assistants

Background: The healthcare field is experiencing rapid growth in the number of advanced practice providers (APPs) with projections that demonstrate that this trend will only continue. Even though the number of APPs is growing, the development of facility-specific APP management infrastructure often grows at a slower pace. Specific policies and procedures on APP utilization and clinical efficiency metrics are lacking. This can lead to deficiencies in the understanding of the education and practice boundaries of APPs. Objective: Our study aimed to analyze the growth and utilization of physician assistants (PAs) in several hospitals located within Texas Medical Center (TMC) in Houston, Texas. We investigated potential factors influencing PA utilization and professional growth and information on the workflow structure, perceived barriers to the efficient utilization of PAs, and the integration of PAs into clinical teams and practice. Methods: We used a mixed methods design to investigate the trends of PAs in hospitals within a large urban medical center. Eight clinical managers at eight different TMC institutions were invited to participate in an email survey and qualitative phone interview. Results: The survey response rate was 62.5% (n=5). Analysis of interviews and survey responses identified five major themes regarding the utilization of the PA within the organizations: 1) the majority of locations employ PAs in team-based workflow structures with the main goal of creating increased access to care, 2) PAs provide an important degree of continuity and consistency for healthcare services, 3) most locations attempted to measure PA clinical efficiency, but struggled in regards to the best methods to do so, 4) hospitals have a favorable trend in retention rates of PAs and offer research opportunities and professional growth resources to their advanced practice providers, and 5) institutions encountered difficulty when it came to optimal billing practices for PAs. Conclusions: The primary focus of a PA’s job responsibility has shifted from providing physician satisfaction to an increased focus on providing quality patient care and increased patient access. PAs help facilitate coordination of care and create a solid foundation for continuity of care. There is a need for an updated method to measure PA clinical efficiency and a need for standardized PA billing practices