New Research on Challenges PA Students Experience from Application Through Completion

Sense of Belonging, Interpersonal Toxicity Impact PA Students’ Success

December 2, 2022

By AAPA Research

The Journal of the Physician Assistant Education Association (JPAE) recently published two articles about challenges PA students experience. Both papers are based on PA students’ responses to the 2020 AAPA Student Survey, fielded in February 2020.

A Sense of Belonging
Diversity in the PA Pipeline: Experiences and Barriers in Admissions and PA School explores PA student concerns with bias in the application process; and once matriculated, their sense of belonging, desire to leave, and their readiness to care for patients who are racially, ethnically, and socioeconomically diverse. In addition to overall findings, the authors examined the experiences of students who self-disclosed that they are an underrepresented minority in medicine (URM), are a sexual and gender minority (SGM), who grew up in a family of low socioeconomic status (SES), or are a person with a disability (PWD).

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Overall, in 2020, 92% of PA students agreed that they have encountered other students – and 80% agreed that they have faculty or staff – with whom they can identify. These findings no longer look as positive when hearing from PA students from diverse backgrounds. Students who identify as URM, SGM, and PWD were all less likely to agree that they have encountered other students with whom they can identify, and those who identify as URM and PWD were less likely to agree that they have encountered faculty or staff with whom they can identify. Diversity is not just defined by race and ethnicity, and ensuring that students have other students, faculty, and staff with whom they can identify is paramount to creating a sense of belonging. These findings and many more are available in the full article.

Interpersonal Toxicity at School or on Rotations
The Role of Interpersonal Toxicity on Healthcare Students’ Well-Being explores PA students’ feelings of emotional exhaustion, cynicism, low sense of personal accomplishment, compassion fatigue, stress, and experiences with interpersonal toxicity. With data collected in February 2020, this study sets the stage for the experiences of students prior to the start of the COVID-19 pandemic.

One in 10 PA students personally experience – and one in five PA students witness – interpersonal toxicity or abuse at their school or clinical sites at least monthly. They are also emotionally exhausted from school, with 68.2% agreeing or strongly agreeing that it is true of them. Together, PA-students who are experiencing interpersonal toxicity or abuse at their school or clinical sites, no matter the frequency, have significantly higher odds of agreeing that they are emotionally exhausted compared to those that never experience it. These findings and many more are available in the full article.

For PA Students
This research highlights that emotional exhaustion, a hallmark of burnout, was a problem before COVID-19. The ARC-PA accreditation standard B2.20 indicates that PA program “curriculum must include curriculum about provider personal wellness including prevention of a) impairment and b) burnout. The past two years have brought incalculable change and stress to PA education impacting students, faculty, staff, preceptors and more. It is not a sign of weakness to use the resources that your PA program, your school, and your clinic make available. Furthermore, it is part of human nature to want to feel a sense of belonging. Research has shown imposter system can be exacerbated when you are in a minority group, which may then reduce overall success in school. Ensuring that you are at the right program, where you feel like you belong, may reduce unnecessary stressors.

PA school is hard enough! Address your stressors early and effectively so as to prevent them from leading to burnout and/or the desire to leave school.

For Faculty
This research also highlights how interpersonal toxicity amplifies feelings of burnout in PA-students, prior to the COVID-19 pandemic. With 20% of PA students experiencing interpersonal toxicity, and URM, SGM, and PWD more likely to not feel like they have others like them in their program, there is a risk that they will experience burnout and/or leave the program. The ARC-PA accreditation standard A1.11 indicates that institutions with PA programs must demonstrate their commitment to student, faculty, and staff diversity.

Bringing it Together
Time will tell if these standards, as well as the sundry number of interventions and programs addressing both diversity and well-being, lead to greater diversity, stronger feelings of belonging, less interpersonal toxicity, and less emotional exhaustion. Taken together, these two studies show the importance of creating an educational and clinical environment where interpersonal toxicity, regardless of background, is not tolerated. Otherwise, the impact to PA students’ mental health as well as possible retention within their PA program are at risk.

Diversity in the PA Pipeline: Experiences and Barriers in Admissions and PA School is the result of a partnership of PA students, a former AAPA-PAEA Research Fellow, and AAPA research team members. The Role of Interpersonal Toxicity on Healthcare Students’ Well-Being was developed through a collaboration with members of the Joint Task Force on Burnout and AAPA research team members. If you have an idea for a collaboration that aligns with the AAPA Strategic Plan and/or builds upon research AAPA started, please reach out to us.

Noël Smith is Senior Director of PA and Industry Research in Analysis. You can contact her at [email protected].

References
Cuenca JP, Ganser K, Luck M, Smith NE, McCall TC. Diversity in the Physician Assistant Pipeline: Experiences and Barriers in Admissions and PA School. J Physician Assist Educ. 2022;33(3):171-178. doi:10.1097/JPA.0000000000000442.

Sierra T, McCall TC, Brown H, Smith NE. The Role of Interpersonal Toxicity on Healthcare Students’ Well-Being. J Physician Assist Educ. 2022;33(3):198-204. doi:10.1097/JPA.0000000000000440

Accreditation Review Commission on Education for the Physician Assistant, Inc. Accreditation Standards for Physician Assistant Education, 5th ed. Johns Creek, GA: Accreditation Review Commission on Education for the Physician Assistant; 2019.

Chrousos GP, Mentis AA. Imposter syndrome threatens diversity. Science. 2020;367(6479):749-750.

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Diversity in the PA Pipeline: Experiences and Barriers in Admissions and PA School
The Role of Interpersonal Toxicity on Healthcare Students’ Well-Being