Master of Sciences, Case Western Reserve University, 2022, Applied Anatomy

This study evaluates whether academic performance differs when physician assistant (PA) students learn gross anatomy using a mixed-reality (MR) program versus cadaveric dissection. First-year PA student volunteers at Case Western Reserve University enrolled in an anatomy course were divided into two cohorts. During a given unit, each cohort spent laboratory sessions learning through either dissection or MR. At the end of each unit, participants were given a laboratory practical exam on each modality. Differences in exam scores were compared between modalities within the same cohort and between cohorts on the same modality. While students who performed cadaveric dissection within a given unit had less difference between lab exam scores, positive Pearson's correlation coefficients (r>0.80) and Spearman's rho (rs=0.78) indicate that individual students perform equivalently across both exams. Additionally, no difference was found between cohorts on lecture exams (p>0.05), suggesting that MR holds value in a PA gross anatomy curriculum.

Committee: Susanne Wish-Baratz (Committee Chair); Andrew Crofton (Committee Member); Scott Simpson (Committee Member) Subjects: Anatomy and Physiology; Education; Educational Software; Educational Technology; Health Education; Health Sciences; Higher Education; Medicine; Science Education

MS, University of Cincinnati, 2023, Medicine: Genetic Counseling

Health care provider (HCP) continuing education with regard to genomic testing remains an area of concern. Numerous studies have shown the benefits of continuing education for HCPs, including through online modules, in improving confidence for utilizing clinical genomic testing. It remains unclear if these approaches have changed how HCPs perceive their own knowledge. We utilized a modified version of a validated genetic counseling self-efficacy scale to assess what changes in self-efficacy can be observed when comparing HCP response before and after completion of a series of case-based, online, genomic education modules (GEMs). Focusing in on 12 genetic counseling competencies, participants were surveyed before and after completion of online education modules on genomic testing. We also considered whether completion of the GEMs could affect other variables such as changes in practice behavior including referrals to clinical genetics providers and genomic tests ordered. We hypothesized that HCP self-efficacy in the 12 target areas would improve after completion of the modules. Sixteen HCPs, across various specialties, completed the modules and both pre and post-test surveys. Using a paired t-test, we found significant improvements in mean self-efficacy in 8 of the 12 categories for which participants were surveyed (p ? 0.004) after their completion of the online modules. We saw a trend towards increase in both absolute genomic test ordering and referrals to HCPs in genetics though below the established significance threshold. The results of this study suggest improvement in HCP self-efficacy after completion of educational modules and provide an approach to measure HCP self-efficacy for other genomic educational modules. Additional studies involving a larger sample size are needed.

Committee: Laura Ramsey Ph.D. (Committee Chair); Cynthia Prows R.N. M.S.N. (Committee Member); Carrie Atzinger M.S. C.G.C. (Committee Member) Subjects: Health Sciences

Specialist in Education (Ed.S.), University of Dayton, 2023, School Psychology

The Child Find mandate expects local school districts to identify children with suspected disabilities and provide a multi-factored evaluation in a timely manner. However, it is difficult for school districts to be aware of needs in children ages 0-5 before they start school. Although all states must meet the standards for finding children in need for intervention, the number of children with development delays is far higher than the number of children enrolled in intervention services. One way to meet this need is through physicians partnering with their local district to aid in the identification process. The purpose of this study was to determine the relationship between a physician's years of experience and understanding of the referral process, as well as to better understand barriers between physicians and a school district that could limit the referral process. Through a mixed method constructivist design, using surveys and an in-depth interview, ten physicians located within the district provided insight into their understanding of the referral process, barriers to referrals, and strategies to improve the physician/district collaboration. A Pearson Correlation found no correlation between years of experience and understanding of the referral process. Responses to open-ended questions and the in-depth interview indicated perceived barriers due to limited physician/district communication. Collaboration was desired; however, physicians expected the district take the initiative to arrange informative meetings. The results of this study could be used to improve collaboration and communication for the improvement of the referral process.

Committee: Susan Davies (Committee Chair); Deborah Turner (Committee Member); Scott Hall (Committee Member) Subjects: Education; Educational Psychology; Special Education

Doctor of Philosophy, The Ohio State University, 2018, Educational Studies

With the rapid increase in medical knowledge, the ability to use “point of care” information, and the expectation of transparency in working with patients, practitioners are increasingly compelled to use electronic continuing medical education (eCME). However, despite being less effective, pre-digital practitioners often prefer direct contact with faculty lecturers and taking notes on handouts for formal continuing medical education (CME). As the use of technology for learning inevitably evolves, understanding the process of how professionals adopt it for learning will remain meaningful. The research addressed this issue: How have pre-digital physician assistants continued their professional learning in a digital world? Using a lens of the technology acceptance model and its later iterations as theoretical grounding, qualitative interviews were conducted with a bounded group of nineteen physician assistants who graduated from the same training program from 1979 to 1984 using voice over Internet protocol. The understanding of how pre-digital professionals continue their learning in a digital world can be broken into three themes: (a) individuals who demonstrate a willingness to change adapt their learning practices as technology evolves, (b) motivated learners gravitate toward environments that are rich in devices, programs, and people who encourage their continued use of digitally mediated education, and (c) external requirements from medical professional, governmental, and commercial organizations have rendered the use of technology as mandatory to retrieve authoritative information. The implications of this study were to help individual practitioners and employers more effectively integrate technology into professional learning practices and potentially to influence policy decisions regarding continuing education requirements – both for testing and training and to improve patient care.

Committee: David Stein PhD (Advisor) Subjects: Adult Education; Aging; Continuing Education; Educational Technology; Medicine

Master of Science (MS), University of Toledo, 2018, Pharmaceutical Sciences (Health Outcomes and Socioeconomic Sciences)

Objectives: To determine the development of physician likelihood to refer based off the conceptual meaning of the hierarchical arrangement of items. To examine relationships between predictors* and the likelihood of referring patients to DSME programs. To determine the predictors* of physician likelihood to refer patients to DSME programs. To assess the likelihood of referral to DSME among practice specialties. *Predictors include: age, sex, practice specialty (family/general practitioner, internal medicine, endocrinology, or other), practice setting (hospital, medical group, private practice, or other), percentage of patients with diabetes seen monthly, attitude toward referring to DSME, social norm toward referring to DSME, and perceived behavioral control toward referring to DSME. Methods: Rasch analysis was used to calibrate the survey instrument and asses development of likelihood to refer. Pearson's correlation was performed to assess relationships among predictors and likelihood of physician referral. A linear regression was used to determine predictors of physician likelihood to refer. After analysis and assessing responses, it was determined additional post hoc analysis was needed. One-way ANOVA was conducted to assess the likelihood of referral among provider types and practice settings. Results: Some attitudes and aspects of self-efficacy may be critical antecedents of intention to refer patients with type 2 diabetes to DSME. However, no conceptually meaningful arrangement of items was identified when assessing development of likelihood to refer. Physician intent to refer patients to DSME demonstrated a moderately positive relationship with attitude, subjective norm, and perceived behavioral control (r = 0.369, 0.339, 0.478, respectively, p < 0.001 all). Provider type was found to have a weak negative relationship with intent (r = -.123, p = 0.013) and perceived behavioral control (r = -.153, p = 0.002). Percentage of patients with diabetes had a w (open full item for complete abstract)

Committee: Sharrel Pinto PhD (Committee Chair); Stone Gregory PhD (Committee Member); Puffer Cindy RPh (Committee Member) Subjects: Behavioral Sciences; Behaviorial Sciences; Health; Health Care; Health Care Management; Health Education; Health Sciences; Medicine; Pharmacy Sciences; Public Health Education; Social Research

Ed.D., Antioch University, 2023, Education

Many forms of oppression create barriers for health care, further health disparities, and impact the wellness of physicians. As health disparities, caused by the social determinants of health, complicate the practice of medicine, physicians' risk of burnout increases. The practice of Physician Cultural Responsibility provides a means to overcome health disparities and support physicians while embracing the intersectionality of the populations they serve. Incorporation of Physician Cultural Responsibility into physician professional identity is essential for the practice to be life-long. As there is no standardized curriculum to address teaching the practice of Physician Cultural Responsibility, this study aims to evaluate a proposed curriculum for the adoption of Physician Cultural Responsibility into students' physician professional identity, student experience, and knowledge transfer. Through the transformative research paradigm and transformative learning theory, a mixed-methods study of deidentified qualitative and quantitative data was performed using MaxQDA and SPSS (α = 0.05) analytical software. Results suggest successful adoption of Physician Cultural Responsibility in physician identity development, successful knowledge transfer, as well as improvements in collaboration, belonging, and support in student experiences with within in first year medical students. This curriculum offers best practices for a methodology to address the inequities of practice in cultural competency education requirements within medical education. This includes inclusive and culturally responsive pedagogy aimed at supporting the students' development of skills that improve the patient-physician connection with all patients, limit the impact of personal biases on medical practice, and dismantle the social categorization of medicine. The practice of Physician Cultural Responsibility and it's adoption in physician professional identity yields an opportunity to cre (open full item for complete abstract)

Committee: Lesley Jackson Ph.D. (Committee Chair); Tony Kashani Ph.D. (Committee Member); Warren Jones M.D., F.A.A.F.P. (Committee Member) Subjects: Curricula; Curriculum Development; Education; Health Care; Higher Education; Medical Ethics; Medicine; Minority and Ethnic Groups; Multicultural Education; Public Health Education

MA, University of Cincinnati, 2017, Arts and Sciences: Communication

This study explored medical students' education about physician-patient communication, and if there are gaps between what the students are learning and the published doctor-patient communication literature. Participants were medical students in US medical school programs who completed an anonymous online survey (N = 50). Results indicate that medical students perceived receiving communication skills education, but usually in one course, and they desired more training. Communication theory from the published health communication literature was not a focus. Future research should explore generalizability of the results and seek ways to increase communication theory into US medical school curriculums.

Committee: Stephen Haas Ph.D. (Committee Chair); Nancy Jennings Ph.D. (Committee Member); Shaunak Sastry Ph.D. (Committee Member) Subjects: Speech Therapy

Doctor of Philosophy (Ph.D.), University of Dayton, 2016, Educational Leadership

The purpose of this study was to assess the perceptions of graduating physician assistant students about the importance on topics of health policy, reform and public health as well as their perception of their preparedness in these areas. PA accrediting bodies have broadened the scope of program standards by requiring PA educators to expand curricula to include these content topics. Physician assistants are important players in the U.S. healthcare system, which is undergoing systematic reform. The question to be answered was: Do PA students identify these topic areas as important and, for each topic area, do they feel adequately prepared with sufficient knowledge for clinical practice? Participants in the study included 352 PA students from 14 PA programs randomly selected from 4 geographic regions of the continental U.S. The programs were all single campus, non-probation, master's level and fully accredited for at least 5 years. A 20-item instrument, the Health Policy Perception Tool, was developed and validated for data collection. In general, the majority of PA students rated content items high on the importance scale. However, they displayed a wide range of ratings on their perceived preparedness in each content area. Findings were aggregated into 3 areas: health policy and reform, health system structure/function and public health. Health policy/reform items demonstrated the highest disparity, with students indicating that they were least prepared on areas relating to the Affordable Care Act, newer concepts such as Patient Centered Medical Homes and Accountable Care Organizations. They also rated health system structure/function items as moderately important, but they indicated they were ill prepared. PA students did indicate that public health topics were very important to them and they rated their level of preparedness on these items moderately high. The findings from this study have implications for PA education leaders. PA programs appear to (open full item for complete abstract)

Committee: Carolyn Ridenour Ed.D (Committee Chair) Subjects: Educational Leadership; Health Care; Health Education; Health Sciences; Higher Education

MS, University of Cincinnati, 2009, Education : Health Promotion and Education

Human papillomavirus (HPV) was one of the most common sexually transmitted infections (STIs) in women of child-bearing age in the U.S. It was estimated that nearly three out of every four Americans between the ages of 15 and 49 would be infected with genital HPV over the course of their lifetime. Human papillomavirus was present in almost 100% of cervical cancers. Despite this growing epidemic, there was little knowledge and awareness of HPV among the general public. HPV was most often detected in abnormal Pap test results. However women undergoing Pap tests lacked basic knowledge about testing, abnormal results, and follow-up procedures. The purpose of this study was to determine women's knowledge of HPV and their perceptions of the education they received from their physician regarding the purpose of a Pap test, explanation of Pap test results, and how effectively the physician explained associations between HPV and cell abnormalities, cervical cancer, risk factors, and preventive measures. This study was needed due to the increased number of Human Papillomavirus infections and the lack of knowledge regarding testing, treatment, risk factors, and preventive measures. This study focused on the educational efforts of physicians and the knowledge levels of patients. This study was different from other studies in that it scored physicians' education efforts as perceived by their patients and measured patients' understanding of such efforts. This study was designed to identify and fill a possible void in the literature regarding HPV and physician education efforts. The results of this study benefited health education professionals and health care professionals by targeting potential gaps in education for future health promotion efforts. Information from this study could be used to help increase and promote dialogue between physicians and their patients. A survey containing 33 questions was completed by 109 women at a social service agency in the summer of 2008. Based (open full item for complete abstract)

Committee: Randall Cottrell PhD (Committee Chair); Judy Murnan PhD (Committee Member) Subjects: Health Education

Master of Gerontological Studies, Miami University, 2004, Gerontology

As the older population rapidly grows, the shortage of physicians trained in geriatrics will become more critical. Physicians trained to understand the complexities that can accompany the aging processes will become increasingly important for a high-quality health care system in an aging society. This report explores this problem known as the geriatric imperative, and suggests training the “gerontological physician” as a solution. Data from the AAMC's Graduate Questionnaire was analyzed for trends in perceptions of geriatrics education and training from 1978 to 2003. Results indicate increasing trends in student perceptions of adequate geriatrics training; increasing enrollment in geriatrics electives; and greater confidence in geriatric knowledge and skills. This analysis and the geriatrics literature demonstrate that we have begun to address the geriatric imperative, but more work is needed to ensure all elders received effective, high-quality health care.

Committee: Suzanne Kunkel (Advisor) Subjects: Gerontology