Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
Department of PA Studies, College of Health Sciences, University of Kentucky, Lexington, KY, USA.
Med Educ Online. 2024 Dec 31;29(1):2312713. doi: 10.1080/10872981.2024.2312713. Epub 2024 Feb 7.
Effective communication is critical in patient care. Multilingual medical providers, including Physician Assistants (PAs) can contribute to improved health care among patients with limited English proficiency; however, this is contingent upon matriculating multilingual providers. In this study, the association between prospective applicants' self-reported English as second language (ESL) status and their likelihood of matriculation into a PA program was investigated.
Participants included applicants to five admission cycles of the Centralized Application Service for Physician Assistant from 2012 to 2020. Logistic regression was utilized to investigate association between applicant ESL status and odds of program matriculation in both bivariate and multivariable regression models. Models were adjusted for citizenship status, undergraduate grade point average, gender, age, race/ethnicity, number of programs applied to, and patient care hours.
In unadjusted and adjusted models, ESL status was associated with a significantly lower odds of matriculation to a PA program across all study years. In adjusted multivariable models, associations were strongest for 2014-2015 where ESL status was associated with a 35% lower odds of matriculation (odds ratio 0.65, 95% confidence interval 0.56, 0.76) when controlling for demographics, citizenship status, patient care experience, and academic achievement. In sensitivity analyses restricting to (a) those with TOEFL scores ≥ 100, and (b) restricting to those ESL applicants without TOEFL scores, we did not observe important changes in our results.
Results indicated that non-native English-speaking applicants have lower odds of PA program matriculation. Decrements in matriculation odds were large magnitude, minimally impacted by adjustment for confounders and persistent across the years. These findings suggest that PA program admission processes may disadvantage non-native English-speaking applicants. While there are potential explanations for the observed findings, they are cause for concern. Matriculating and training PAs who have language concordance with underserved populations are important means of improving patient outcomes.
有效的沟通在患者护理中至关重要。包括医师助理（PA）在内的多语言医疗提供者可以帮助提高英语水平有限的患者的医疗保健水平；然而，这取决于多语言提供者的入学。在这项研究中，调查了未来申请人自我报告的英语作为第二语言（ESL）状态与他们进入 PA 项目的可能性之间的关联。
参与者包括 2012 年至 2020 年期间五个医师助理集中申请服务入学周期的申请人。使用逻辑回归调查申请人 ESL 状态与项目入学几率之间的关联，包括在双变量和多变量回归模型中。模型调整了公民身份、本科平均绩点、性别、年龄、种族/民族、申请的项目数量以及患者护理时间。
在未调整和调整后的模型中，ESL 状态与所有研究年份 PA 项目入学率显著降低相关。在调整后的多变量模型中，2014-2015 年的关联最强，在控制人口统计学、公民身份、患者护理经验和学业成绩的情况下，ESL 状态与入学几率降低 35%相关（比值比 0.65，95%置信区间 0.56，0.76）。在敏感性分析中，限制条件为（a）那些托福成绩≥100 的人，以及（b）限制为那些没有托福成绩的 ESL 申请人，我们没有观察到我们的结果有重要变化。
结果表明，非英语母语申请人的 PA 项目入学几率较低。入学几率的降低幅度较大，在调整混杂因素后影响较小，且多年来保持不变。这些发现表明，PA 项目入学流程可能对非英语母语申请人不利。虽然对于观察到的发现有潜在的解释，但这令人担忧。录取和培训与服务不足人群语言一致的 PA 对于改善患者预后非常重要。
