Two Johnson & Wales PA program faculty (Thomas Meehan, PhD, PA-C and Aleko Kimbouris, MPH, PA-C) and a former student (Cameron Adelman, PA-C) presented this content at the recent PA Education Association Forum in Washington, D.C. The following are excerpts from the presentation.

Transgender people face numerous barriers in accessing competent healthcare and fewer than half of PA programs teach students about transgender clinical care. PAs working in all specialties will encounter transgender patients and it is vital for students to be educated about transgender health to reduce poor health outcomes for transgender patients. 

According to Mahowald et al (2020), 18% of transgender (TG) patients were refused care for being TG and 33% had to teach their provider about TG people to get appropriate care.  A study by McPhail et al (2016) demonstrated that many primary care providers (PCPs) are reluctant to prescribe gender-affirming hormone therapy (GAHT), due to a lack of education on TG healthcare and/or lack of experience prescribing GAHT.  Pathoulas, et. al. (2021) conducted a study on improving medical student familiarity with providing GAHT via an optional one-hour lecture on GAHT which students were surveyed before and after. They found a statistically significant increase in medical student comfort and familiarity with GAHT after the focused lecture. Finally, in Rolls et al (2020), a survey of PA programs demonstrated that while 85.6% of programs had at least 1 hour of TG curriculum, only 40.3% included content on GAHT. PA programs that teach TG curriculum have largely focused on social tolerance while few cover topics related to clinical care.  

While a student in the JWU PA program, Cameron Adelman, PA-C, helped PA faculty members identify areas in the curriculum that transgender health content could be integrated. The educational intervention developed was evidence-based and aims to go beyond what other institutions have done in transgender health education.  This transgender clinical medicine curriculum was developed as a blueprint for implementation at PA programs that lack their own transgender health curriculum. A survey to assess the efficacy of the curriculum at improving student knowledge with transgender health topics demonstrated a statistically significant increase across all measured items.  Additionally, the students preferred the integrated curriculum over a one-day approach.

The details of the blueprint were provided to attendees with resources available to any PA program that wants to include enhanced transgender content into their curriculum.

References

Rolls J, Davis J, Backman R, Wood T, Honda T. Curricular approaches to transgender health in physician assistant education. Academic Medicine. 2020;95(10):1563-1569. doi:10.1097/acm.0000000000003464 

Mahowald L, Gruberg S, Halpin J. The state of the LGBTQ community in 2020. Center for American Progress. https://www.americanprogress.org/article/state-lgbtq-community-2020/. Published October 6, 2020. Accessed December 29, 2022. 

McPhail D, Rountree-James M, Whetter I. Addressing gaps in physician knowledge regarding transgender health and healthcare through medical education. Can Med Educ J. 2016;7(2):e70-e78. Published 2016 Oct 18.

Pathoulas JT, Blume K, Penny J, Mansh M, Rubin N, Farah RS. Effectiveness of an Educational Intervention to Improve Medical Student Comfort and Familiarity With Providing Gender-Affirming Hormone Therapy. Fam Med. 2021;53(1):61-64. doi:10.22454/FamMed.2021.612374

Thomas Meehan, PhD, PA-C
RIAPA Board Member

AAPA Leadership and Advocacy Summit 2024
Washington DC
By: Stephanie Slone, PA-C 

I attended the AAPA Leadership and Advocacy Summit in Washington DC last week. I was instantly energized by this group of motivated, passionate individuals who fiercely believe in our profession and work tirelessly to protect it. The AAPA works at the federal level to protect our profession, and this can’t be taken for granted. 

As a PA who is just beginning to understand the effort that goes in to maintaining our ability to practice, I was shocked to learn of the constant challenges that PAs face and the importance of advocacy. One colleague made the comment, “You’re either at the table or you’re on the menu.”

Rhode Island’s CO (constituent organization) RIAPA lobbies to ensure that PAs are not omitted from new legislation. It’s not uncommon for legislation to include the terms “physician” or “licensed independent practitioner”, and not “physician assistant”. As PAs, we need to participate in and support our advocates to ensure we are included in every piece of legislation related to healthcare. Remember, there are several different groups of healthcare providers lobbying for their own interests, and it is a common occurrence for one group to be omitted from legislation. We as PAs need to be as present and as vigilant as other groups to be sure we protect and advance our profession. 

There are many ways to help, even if you’re incredibly busy. Please join RIAPA and AAPA. These are the organizations protecting our careers. Consider an additional donation to RIAPA to support lobbying efforts by donating to the Rhode Island Physician Assistant Political Action Committee (RIPAC). Know your legislators and how to reach out, and most importantly, urge your colleagues to join and support RIAPA and AAPA.

 

Stephanie Slone, PA-C

 

By: Chris Ferreira

The 2023 AAPA House of Delegates (HOD) met in Nashville, TN from Friday, May 19 through Sunday, May 21 at the AAPA Conference. The HOD articulates the shared values, beliefs, and professional wisdom of PAs from all corners of the greater AAPA community. Made up of representatives from AAPA’s constituent organizations and Student Academy, the HOD enacts policies and position statements on behalf of the profession.

The HOD consists of voting delegates from 58 chapters representing 50 states, the District of Columbia, U.S. Virgin Islands, Puerto Rico and five federal services, 27 officially recognized specialty organizations, 13 caucuses comprised of individuals sharing a common goal or interest related to health care access or delivery, and the Student Academy; additionally, the current and immediate past House Officers are delegates-at-large and vote.

Your representatives from Rhode Island were RI Chief Delegate Christopher Ferreira, RIAPA Immediate Past President, and RI Delegate Raymond Cord, RIAPA President. While much was discussed, reworked, recommended, and voted upon over three days, here are some highlights.

·         While AAPA now has official policy encouraging its members to become members of State Chapters, Specialty Organizations, Caucuses, and/or Special Interest Groups, a different resolution was rejected which would have recommended that AAPA establish a dues assessment system whereby a member or prospective member of AAPA may make one payment for both dues owed for membership in the AAPA and for a Constituent Organization (CO), like RIAPA. The logistics for managing dues transfers between AAPA and every CO is not currently possible.

·         Policy was adopted supporting equal accessibility of test-taking tools in exam software utilized during PA education, initial certification, and maintenance of certification.

·         Preceptors of accredited PA Programs have already been able to claim Category I CME; the policy was amended to now include preceptors of accredited clinical postgraduate training programs.

·         A resolution was proposed that would have supported the Doctor of Medical Science as the PA-specific doctoral degree. After much discussion regarding potential significant problems with this proposal, this resolution has been referred to committee for further exploration and has not been adopted as policy.

·         AAPA Policy was amended to highlight the importance of PA services being properly tracked to assess the impact of those services on patients on the healthcare system. Additionally, this policy states that claims for services performed by a PA should be submitted under the name/NPI number of the PA, that payers allow for direct payment to PAs, and that payers cover medical and surgical services provided by PAs in all practice settings.

·         Policy regarding medical staff bylaws and the credentialing and privileging of PAs was updated to highlight, among other items, that the duration of medical staff appointments and clinical privileges should be the same for physicians and PAs, that bylaws should give PAs the right to due process when actions taken by the medical staff or governing board adversely affect the PA’s clinical privileges, and that bylaws should include language enabling PAs to provide care during emergency or disaster situations, as well as EMTALA specific provisions as required.  This policy had already underscored that PAs should be voting members of the medical staff and that bylaws should afford PA representation with full voting rights on medical staff committees, including the medical executive committee.

·         Policy was adopted affirming that AAPA opposes restrictions and attempts to restrict the availability of and access to gender affirming healthcare.  Similar policy was adopted further affirming that the inclusion of transgender and non-binary youth athletes in sports consistent with their gender identity promotes overall health and well-being.

·         AAPA promotes equal-opportunity support for aspiring PAs and encourages the efforts of PAs who provide free mentorship and/or coaching.  AAPA strongly encourages equal-opportunity support for aspiring PAs and recognizes the potential negative impact of for-profit pre-PA coaching on diversity in the profession.  The HOD recommends a task force to identify barriers and explore potential opportunities to promote continued inclusion which may include scholarship and/or grant opportunities, pre-PA coaching through AAPA platforms, free AAPA mentorship, and/or additional resources for aspiring PAs.

These are just a few examples of what goes on “behind the scenes” in your profession. Now, more than ever, it is important to maintain active membership in both the Rhode Island Academy of PAs (RIAPA) and the American Academy of PAs (AAPA). As a RIAPA Fellow Member, you have the privilege of voting for your delegates to the HOD and are able to contribute to your profession in other ways both right here at home and also on the national stage.

Wishing all of you a safe and warm holiday season!  Check back often as the RIAPA continues to move forward advancing the PA profession and supporting all that you do!