Development and Evaluation of a Research Extension Experience in Directed Studies (REEDS) for Physician Assistant Students Tiffany Kindratt, MPH Department of Physician Assistant Studies Texas Society of Allied Health Professionals Conference September 21, 2017 Houston, Texas

Background Efforts have been made to equip allied health professionals with clinical research knowledge and skills Few curriculum models have been developed to train research skills to allied health students, in particular physician assistant (PA) students Master’s programs require completion of graduate project yet have limited time for teaching research methodology in already packed curriculum

Literature Review Reasons for lack of research training in PA curriculum: Lack of curriculum requirements for accreditation Lack of curriculum models published Lack of faculty expertise

Literature Review Lack of curriculum requirements for accreditation ARC-PA requires that PA programs educate students how to search and critically appraise medical literature in order to apply it to patient care No curriculum requirements for teaching research methods Lack of curriculum models published in scientific journals Cipher and colleagues (2003) reported on research agenda used at the University of North Texas PA program Curriculum focused on educating PA students how to develop research questions, conduct literature reviews, read and review literature, write a final research paper and give an oral presentation of results No evaluation of student baseline or post-curriculum outcomes reported

Background Lack of PA faculty expertise Swanchak and colleagues (2013) evaluated whether PA educators were prepared to facilitate master’s level research projects Found a lack of preparedness and deficits in research training among PA faculty Ways to address barriers Development of research training programs Collaboration with departments with established research programs and mentors

Purpose To develop, implement and evaluate the Research Extension Experience in Directed Studies (REEDS) online curriculum designed to train PA students how to conduct research during their clinical year of training Original goal was to enroll PA students into an online program to learn the entire research process throughout their clinical year based on Community Health Fellowship Program and Research Methods Course

Specific Aims Conduct annual needs assessment of PA student research knowledge and skills (phase 1) Develop a set of online modules to train PA students how to conduct primary and secondary research studies (phase 2) Track online module completion and satisfaction (phase 3)

Methodology: Phase 1 Setting: University of Texas Southwestern School of Health Professions Subjects/Students: Master of Physician Assistant Studies (n=201) Class of 2015 (n=34) Class of 2016 (n=29) Class of 2017 (n=42) Class of 2018 (n=43) Class of 2019 (n=53) Measures Students answered 23 questions on research knowledge, confidence in skills and attitudes 5-point Likert scales 1=strongly disagree to 5=strongly agree Check questions

Methodology – Phase 1 Measures Knowledge Institutional review board (IRB) procedures Importance of Human Subjects Protection and HIPAA Research Steps of the research cycle Community-based participatory research methods Basic research designs Basic statistical terms (i.e. t-test, chi square, ANOVA) Advanced statistical terms (i.e. logistic regression) Components of research articles Methods for creating oral and poster presentations Modes of dissemination for research studies

Methodology – Phase 1 Measures Confidence in Skills (Self-Efficacy) Formulate research questions Design a descriptive or exploratory study Perform literature search using MEDLINE/PubMed Critical appraisal of research articles Develop survey instruments Collect data and create databases Analyze and interpret data Write formal research manuscript Develop and deliver formal research presentations

Methodology – Phase 1 Measures Attitudes Research is important to the PA profession Interested in working on projects with faculty Interested in presenting project results by poster at local or national conferences Interested in presenting project results by oral presentation at local or national conferences

Methodology – Phase 1 Measures Statistical Analysis Methods Responses dichotomized Strongly disagree/disagree/undecided Strongly agree/agree Proportions of strongly agree/agree presented

Methodology – Phase 2 Curriculum Development Seven (7) online modules were developed based on PA students’ self-assessed research needs, previous literature and interests including: Responsible conduct of research Research project development Database creation and analysis Analysis and interpretation using SPSS Analysis and interpretation using STATA Secondary data analysis using SAS Dissemination Online modules were made available to medical students in the UTSW Community Health Fellowship Program and Research and Scholarly Activity rotations

Methodology – Phase 3 Track online module completion and satisfaction Total number of PA and medical students who viewed online modules 7-item online lecture evaluation on Survey Monkey to provide feedback on ways that the online curriculum can be improved (1=strongly disagree to 5=strongly agree).

Methodology – Phase 3 Online Lecture Evaluation Identify what online lecture was completed Rate level of agreement with the following: The online presentation was organized. The examples provided were helpful in the development of my research project. The content provided in the online presentation met my learning needs. Overall, I was satisfied with this online presentation. This education format suits my learning style. Please provide any additional feedback to enhance the online presentation

Results: Phase 1 – Knowledge (%Agree/Strongly Agree)

Results: Phase 1 – Skills (%Agree/Strongly Agree)

Results Phase 1 – Attitudes (%Agree/Strongly Agree)

Results: Phase 2 - Curriculum Objectives Curriculum Module Learning Objectives Developing Research Questions and Objectives Define “research questions” Describe ways to develop research questions based on general topic Explain characteristics of good research questions List examples of previous research questions Develop research objectives from research questions Developing Survey Instruments Describe 11 step process for developing surveys Visualize research question Review literature for existing surveys Select specific topics for questions Choose question types (open or close ended) Choose response types (nominal or ordinal) Review wording Check order of questions Format layout Pilot test Revise Implement Discuss tips for survey development

Results: Phase 2 - Curriculum Objectives Curriculum Module Learning Objectives Database Creation and Coding Visualize your data as you develop your research question Discuss 6 steps for data management and control Describe ways to annotate your data for future reference Develop database and codebook for entry and analysis Reporting and Writing Identify 5 principles of scientific writing Draft a manuscript using these principles using “The Recipe” Create tables and figures to describe your methods and results

Results: Phase 2 - Online Curriculum

Results: Phase 3 - Online course enrollment and tracking 18 students enrolled in online course 10 online lecture evaluations completed 50% viewed database creation and coding module 40% viewed reporting and writing module 10% viewed developing survey instruments

Results: Phase 3 - Lecture Evaluations, N=10 (means)

Limitations Although positive attitudes towards research, no PA students were interested in completing entire online program Future interest may be higher if a distinction in research is offered Limited faculty time required modules to be developed on “as-needed” basis

Next Steps Transition from Moodle to D2L Brightspace Modules will be included in UTSW new medical school curriculum’s 12-week Research and Scholarly Activity rotation Develop data analysis specific modules for using STATA and SAS Develop section for quality improvement methods Contact: Tiffany Kindratt, MPH Tiffany.Kindratt@utsouthwestern.edu

References 1. Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). Accreditation Standards for Physician Assistant Education. September 2014 2014. 2. Harding KE, Stephens D, Taylor NF, Chu E, Wilby A. Development and evaluation of an allied health research training scheme. J Allied Health. 2010;39(4):e143-148. 3. Cipher DJ, Lemke, H., Coleridege, S.T.,. Establishing a Research Agenda in Master’s- level Physician Assistant Studies Programs. Perspective on Physician Assistant Education. 2003;14(2):84-87. 4. Swanchak LE, Walters H. Are physician assistant educators prepared to facilitate master's level research among their students? J Physician Assist Educ. 2013;24(2):42-43. 5. Dehaven MJ, Gimpel NE, Dallo FJ, Billmeier TM. Reaching the underserved through community-based participatory research and service learning: description and evaluation of a unique medical student training program. J Public Health Manag Pract. 2011;17(4):363-368.