Polansky Maura N, Govaerts Marjan J B, Stalmeijer Renée E, Eid Ahmed, Bodurka Diane C, Dolmans Diana H J M
Maura N. Polansky is department chair and an associate professor in the PA program at George Washington University in Washington, D.C., and a PhD candidate in the School of Health Professions Education at Maastricht University in Maastricht, Netherlands. In the School of Health Professions Education at Maastricht University, Marjan J.B. Govaerts is an associate professor and Renée E. Stalmeijer is an educational scientist and assistant professor. At the University of Texas MD Anderson Cancer Center in Houston, Texas, Ahmed Eid was an associate professor in the Department of General Oncology at the time of this study and Diane C. Bodurka is vice president of education and a professor in the Department of Gynecologic Oncology and Reproductive Medicine. Diana H.J.M. Dolmans is a professor in the School of Health Professions Education at Maastricht University. The authors have disclosed no potential conflicts of interest, financial or otherwise.
JAAPA. 2019 May;32(5):47-53. doi: 10.1097/01.JAA.0000554742.08935.99.
Physician assistants (PAs) often have been embedded in academic medical centers to help ensure an adequate patient care workforce while supporting compliance with work-hour restrictions for residents and fellows (also called trainees). Limited studies have explored the effect of PAs on trainee learning. This qualitative study explored, from the perspective of physician faculty and PAs, how PAs working in the clinical learning environment can enhance or hinder trainee learning.
Using purposive sampling, 12 PAs and 12 physician faculty members in one US teaching hospital were selected for semistructured interviews. Data collection and analysis were characterized by an iterative process. Data analysis was informed by principles of conventional content analysis.
Participants identified various ways in which PAs may affect trainee learning, intrinsically linked to the roles PAs assume in the clinical learning environment: clinician, teammate, and clinical teacher. Trainee learning may be enhanced because learning time can be optimized by having PAs in the clinical learning environment. Trainees can learn about PAs and how to collaborate with them, and PAs can enculturate and provide clinical instruction to trainees. Trainee learning may be hindered if learning opportunities for trainees go to PAs, trainees feel intimidated by experienced PAs, or trainees become too dependent on PAs.
Our findings demonstrate enhancements and hindrances to trainees' learning linked to three key roles PAs perform in the clinical learning environment. These findings can inform how PAs are integrated into teaching services. Further investigation is needed to understand how PAs can balance their professional roles to foster effective collaborative practice and learning.
医师助理（PAs）常常被安置在学术医疗中心，以帮助确保有足够的患者护理人员，同时支持住院医师和研究员（也称为实习生）遵守工作时间限制。有限的研究探讨了医师助理对实习生学习的影响。这项定性研究从医师教员和医师助理的角度，探讨了在临床学习环境中工作的医师助理如何促进或阻碍实习生的学习。
采用目的抽样法，在美国一家教学医院选取了12名医师助理和12名医师教员进行半结构化访谈。数据收集和分析采用迭代过程。数据分析以传统内容分析原则为依据。
参与者确定了医师助理可能影响实习生学习的各种方式，这些方式与医师助理在临床学习环境中所承担的角色内在相关：临床医生、队友和临床教师。由于临床学习环境中有医师助理可以优化学习时间，实习生的学习可能会得到促进。实习生可以了解医师助理以及如何与他们合作，医师助理可以向实习生传授文化并提供临床指导。如果实习生的学习机会被医师助理占用、实习生对经验丰富的医师助理感到 intimidated（此处原文有误，推测可能是intimidated，意为“胆怯的、受到恐吓的”），或者实习生变得过于依赖医师助理，那么实习生的学习可能会受到阻碍。
我们的研究结果表明，与医师助理在临床学习环境中履行的三个关键角色相关，实习生的学习既有促进因素也有阻碍因素。这些发现可以为医师助理如何融入教学服务提供参考。需要进一步调查以了解医师助理如何平衡其专业角色，以促进有效的协作实践和学习。
