Nonresponse Bias Confounds Self-Reported Mistreatment by Diverse Physician Associate Students Marcia Bouton, Charlotte Bolch, Nicholas Hudak, Dominique Frias-Sarmiento, Bettie Coplan Journal of Physician Assistant Education the Official Journal of the Physician Assistant Education Association, 2025 Introduction This study aimed to evaluate whether physician assistant/associate (PA) students' sociodemographic factors were predictors of risk for mistreatment. A secondary analysis aimed to evaluate whether sociodemographic features were evenly distributed among respondents who answered mistreatment items. Methods Data originated from the PA Education Association End of Program Surveys (2018, 2019, 2021, and 2022). Independent variables were gender, race, ethnicity, and sexual orientation. Using logistic regression, odds ratios were calculated for 2 separate dependent variables: whether respondents experienced mistreatment and whether respondents completed mistreatment items. Results Surveys included 11,461 respondents, 3218 (28.1%) of whom experienced mistreatment; however, 3258 (28.4%) of respondents did not answer any mistreatment items. Analysis showed statistically significant sociodemographic factors for risk for mistreatment, but the model had poor fit (P-value = 0; receiver operating characteristic [ROC] 0.553), possibly related to partial nonresponse bias. Completing mistreatment items was statistically significantly more likely for respondents who indicated they were gay or lesbian (odds ratio [OR] 1.52) or bisexual (OR 1.82) and less likely for respondents who indicated they were male (OR 0.68), sexual orientation “I don't know/prefer not to answer” (OR 0.65), Hispanic (OR 0.79), or not White (OR 0.49). Discussion The sociodemographic factors evaluated were inadequate to predict mistreatment of PA students, but sociodemographic factors were associated with willingness to complete mistreatment questions. Qualitative research is needed to determine why respondents who are male, Hispanic, or not White are reluctant to complete mistreatment questions. Findings could inform survey improvements to more accurately measure health professions student mistreatment.
A pilot study of PAs in leadership: Exploring pathways, barriers, and support systems Marcia Bouton, Robert McKenna, Yolanda Freeman-Hildreth, Theresa Johnson, Ryann Piotrowski, et al. Journal of the American Academy of Physician Assistants, 2025 Objectives: The objectives of this study were to determine pathways, barriers, and support systems experienced by physician associates (PAs) in leadership. Methods: Focus group interviews were conducted with 20 PA leaders. Thematic evaluation revealed inductive themes. Moderate interrater agreement was achieved. Results: Most participants were female, White, and non-Hispanic, with 13 to 23 years of experience as a PA. Participants obtained leadership positions via training, dedication to service, and networking. Participants were motivated to pursue leadership roles by issues related to compensation, time, and autonomy. Biased perception of PA roles and corporate and legal issues were the most common barriers to achieving leadership positions. Participants recommended that PAs interested in leadership self-promote and that they embrace both altruism and a growth mindset. Conclusion: PA leaders achieved leadership positions via dedication, networking, and training. Corporate, legal, and perceptual barriers exist. Employers and PA organizations can support PA leaders with training, compensation, protected time, and autonomy. Celebration of the value of PA leadership is needed.
Physician Associate/Assistant Program Medical Directors Are Important Advocates for the Physician Associate/Assistant Profession: Results From a National Pilot Study Marcia Bouton, Jennifer Wild, Charlotte Bolch, Katherine Mitzel, Tian Zhou Journal of Physician Assistant Education, 2024 Introduction This pilot study aimed to evaluate whether and how physician associate/assistant (PA) program medical directors play a role in advocating on behalf of PAs and what factors correlate with this. Methods The study used a mixed-methods grounded theory approach and was deemed institutional review board exempt. After literature review, a survey was developed and piloted by study personnel and faculty to affirm validity. Recruits with known email addresses were sent a link to a survey that included demographic information and 10 Likert scale questions. There were 69 respondents, and the response rate was 26%. Fisher's exact test and analysis of variance were performed using the R program. A P-value <.05 indicated significance. Thematic analysis of qualitative data was performed using ChatGPT, followed by iterative analysis by the research team. Consensus was achieved for each response. Results Most of the respondents had the following characteristics: MD degree, male, White, practicing clinically, and worked as PA medical directors 8 to 12 hours per week. Participants did not support PA title change, nor had they engaged in legislative efforts to support optimal team practice. Participants were strong PA advocates by promoting PA leadership positions, PA employment, improved attitudes in health care organizations toward PAs, and securing clinical rotations. Many respondents (41%) felt that none of their professional organizations supported them in their role as PA program medical director. Discussion Exploring ways to support continued advocacy by our valued PA program medical directors within PA professional organizations could be advantageous to PA program medical directors' professional growth and the PA profession.
Characteristics of highly prolific PA authors who contributed research to JAAPA and JPAE Marcia Bouton, Michael Halasy Journal of the American Academy of Physician Assistants, 2023 Objective: Highly published physician associate/assistant (PA) researchers were surveyed to quantify experienced support patterns that may inform increased support of PA-led research. Methods: Publication volume of authors of research articles published in JAAPA and the Journal of Physician Assistant Education (JPAE) between 2011 and 2020 was recorded. PAs in the upper quartile were emailed surveys containing demographics and 25 Likert-scale questions. Descriptive statistics and binomial exact test were completed. Results: Sixty-five of the 73 PAs were contacted by email; 26 participated; and 35% were female. Social support measures were high; respondents were mentors and mentees, who work collaboratively. Material support and educational support measures were lower and most reported no funding nor pay for research; they did not learn research skills in PA school. However, they feel recognized, and find joy in research. Conclusions: Successful PA researchers find joy despite low material support regarding funding, pay, and protected time. Women and racial minorities were underrepresented; research is needed to examine potential barriers.
A Bibliometric Analysis of Scholarly Activity of Authors of Research Articles Published in the Journal of Physician Assistant Education from 2011-2020 Marcia Bouton, Michael Halasy Journal of Physician Assistant Education, 2022 Introduction The purpose of this study was to analyze bibliometric data and trends of author contributions to the Journal of Physician Assistant Education (JPAE) from 2011-2020. Methods Author data were collected from JPAE research articles published from 2011-2020. Publication history and h-index were obtained from Scopus. Data collected included first authors, last authors, and PA authors as well as trends in publications in JPAE. Descriptive statistics, ANOVA, and Wilcoxon rank-sum tests were completed. Results From 2011-2020, 200 research articles were published in JPAE; the volume was constant. Of 698 authors listed, 374 were physician assistants (PAs). Overall, contributing authors had a mean publication number of 19.6 (1-327) compared to 12.1 (1-163) for PAs. First and last PA authors had mean publication numbers of 13.2 and 16.1, respectively, and an average h-index of 3.2 and 4.4, respectively. The overall author h-index was 5.2. The mean number of publications for non-PA last authors was 32.9. Publication to h-index proportion was similar between PAs and other authors. The top 25th percentile of PA authors published >9 indexed documents, 3 times the number published by those in the 1-75th percentile. Discussion PA author articles in JPAE from 2011 to 2020 were fewer than those by non-PAs but were as likely to have a proportionate h-index. PAs listed as first and last author were highly published. Trends suggest that when PA first authors work with PA last authors, there may be a more egalitarian relationship, and mentorship patterns may also exist within these groups. Increasing publication numbers from 2011 to 2020 for PA first and last authors indicates increasing academic contribution.
The feasibility and time required for routine health literacy assessment in surgical practice and effect on patient satisfaction American Surgeon, 2017
Biospecimen sharing among Hispanic women in a safety-net clinic: Implications for the precision medicine initiative Jesse N. Nodora, Ian K. Komenaka, Marcia E. Bouton, Lucila Ohno-Machado, Richard Schwab, et al. Journal of the National Cancer Institute, 2017 Biospecimen donation is key to the Precision Medicine Initiative, which pioneers a model for accelerating biomedical research through individualized care. Personalized medicine should be made available to medically underserved populations, including the large and growing US Hispanic population. We present results of a study of 140 Hispanic women who underwent a breast biopsy at a safety-net hospital and were randomly assigned to receive information and request for consent for biospecimen and data sharing by the patient’s physician or a research assistant. Consent rates were high (97.1% and 92.9% in the physician and research assistant arms, respectively) and not different between groups (relative risk [RR] = 1.05, 95% confidence interval [CI] = 0.96 to 1.10). Consistent with a small but growing literature, we show that perceptions of Hispanics’ unwillingness to participate in biospecimen sharing for research are not supported by data. Safety-net clinics and hospitals offer untapped possibilities for enhancing participation of underserved populations in the exciting Precision Medicine Initiative.
Factors associated with cervical cancer screening in a safety net population Meredith A Heberer, Ian K Komenaka, Jesse N Nodora, Chiu-Hsieh Hsu, Sonal G Gandhi, et al. World Journal of Clinical Oncology, 2016 AIM To identify factors associated with Papanicolaou-smear (Pap-smear) cervical cancer screening rates in a safety net population. METHODS From January 2012 to May 2013, the use of Pap-smear was determined for all patients seen at the breast clinic in a safety net hospital. Health literacy assessment was performed using the validated Newest Vital Sign. The records of patients were reviewed to determine if they had undergone Pap-smears for cervical cancer screening. Sociodemographic information was collected included age, education, monthly income, race/ethnicity, employment, insurance status, and primary care provider of the patient. Logistic regression analysis was then performed to determine factors associated with utilization of Pap-smears. Crude and adjusted odds ratios derived from multivariate logistic regression models were calculated as well as the associated 95%CIs and P-values. RESULTS Overall, 39% had Pap-smears in the prior 15 mo, 1377 consecutive women were seen during the study period and their records were reviewed. Significantly more patients with adequate health literacy underwent Pap-smears as compared to those with limited health literacy (59% vs 34%, P < 0.0001). In multivariate analysis, patients with adequate health literacy, younger patients, and those with later age of first live birth were more likely to undergo Pap-smears. Patients whose primary care providers were gynecologists were also significantly more likely to have Pap-smears compared to other specialties (P < 0.0001). Patients younger than 21 years or older than 65 years underwent screening less frequently (11% and 11%, respectively) than those 21-64 years (41%, P < 0.0001). Race, ethnicity, language, and insurance status were not associated with Pap-smear screening rates. CONCLUSION Patient health literacy and primary care physician were associated with Pap-smear utilization. Development of interventions to target low health literacy populations could improve cervical cancer screening.
Successful repair of the long thoracic nerve after complete transection during axillary lymph node dissection American Surgeon, 2009
Patient comprehension and recall of laparoscopic surgery and outcomes in a non-English speaking population. JSLS Journal of the Society of Laparoendoscopic Surgeons Society of Laparoendoscopic Surgeons, 2007
