Melissa Murfin

Physician Assistant Education Association (PAEA) End of Rotation™ exams are used by programs across the country. However, little information exists on the predictive ability of the exams' scale scores and Physician Assistant National Certifying Exam (PANCE) performance. The purpose of this study was to evaluate End of Rotation exam scores and their relationship with poor PANCE performance (PPP). In an IRB-approved, multi-center, multi-year study, associations between PAEA End of Rotation exam scale scores and PANCE scores were explored. A taxonomy of nested linear regression models with random intercepts was fit at the program level. Fully adjusted models controlled for year, timing of the exam, student age, and gender. Fully adjusted linear models found that 10-point increases in End of Rotation exam scores were associated with a 16.8-point (95% confidence interval [CI]: 14.1-19.6) to 23.5-point (95% CI: 20.6-26.5) increase in PANCE score for Women's Health and Emergency Medicine, respectively. Associations between exams did not significantly vary (P = .768). Logistic models found End of Rotation exam scores were strongly and consistently associated with lower odds of PPP, with higher exam scores (10-point increase) associated with decrements in odds of PPP, ranging between 37% and 48% across exams. The effect estimate for the Emergency Medicine exam was consistently stronger in all models. PAEA End of Rotation exam scores were consistently predictive of PPP. While each End of Rotation exam measures a specialty content area, the association with the overall PANCE score varied only by a change in odds of low performance or failure by a small percentage. Low End of Rotation exam scores appear to be consistent predictors of PPP in our multi-center cohort of physician assistant students.

Pharmacogenetics offers a way to personalize medication prescribing for patients. Through the use of genetic tests that identify variations in enzymes important to drug metabolism, PAs can have patients' genetic information before prescribing a medication. This may reduce the risks of adverse reactions and lost treatment time when patients are given drugs to which they are unlikely to respond. Laboratory testing can identify common genetic variants that alter how the body metabolizes drugs. PAs with knowledge of these variants can choose medications that are more personalized and effective for each patient. Clinical pharmacogenetic guidelines are under development and will help providers identify which drugs are most likely to be affected by genetic variations so they can prescribe for patients based on their specific genetic phenotypes.

The ability for PAs to easily move from one specialty to another without additional formal training is a unique feature of the profession that is valued by PAs and their employers. Specialty certification has been viewed as a threat to this flexibility, yet 73% of PAs are in specialty practice. How can the desire to preserve flexibility be balanced against the desire of specialized PAs to distinguish themselves in their chosen specialty? This article reviews the issue of specialty certification in the context of contemporary PA practice and concludes that although specialty certification remains a threat to the flexibility of the PA model, it may be appropriate in some situations. In particular, specialty certification may be appropriate as a means for promotion within healthcare systems so long as it is not used as a requirement for entry into specialty practice, credentialing, or third-party reimbursement. A portfolio model may give stakeholders an alternative way to assess the experience and competencies of PAs in specialty practice areas.

Treating chronic hepatitis C is crucial to preventing long-term complications such as cirrhosis and liver cancer. New treatments may improve response rates, but the high cost of therapy is a major concern. This article reviews two of these new treatments, sofosbuvir and simeprevir.

Medical smartphone applications (apps) are becoming common as point-of-care references for health professionals and students. There is currently no regulation of the information that is included in the apps or guidelines for recommended use. Judicious review of apps by the user is important before using the information to make treatment-related decisions or as a learning tool in didactic and clinical education.