AAPA-PAEA Research Fellowship

Dr. Marcia Bouton worked in clinical laboratory science prior to attending Midwestern University’s Physician Assistant Program where she completed a B.S. in Physician Assistant Studies and an M.H.P.E. in 2003. She practiced clinically in surgical oncology and breast surgery for 19 years. In 2022, Dr. Bouton earned her DMSc and joined the faculty of the Midwestern University Physician Assistant Program the same year.

Throughout Dr. Bouton’s career, she has been involved in research related to breast surgery and health professions education. More recently she has focused on topics related to the PA profession such as PA-led research, PA leadership, and equity within the profession. She is a journal reviewer for JAAPA and Quantitative Imaging in Medicine and Surgery. She also reviews submissions for AAPA research grants and AAPA and PAEA conferences. She is currently serving as a member of the AAPA Commission on Research and Strategic Initiatives and is an ASAPA research committee member.

Quincy Jones is an associate professor and clinical coordinator at the Duke PA Program where she has been a PA educator for the last 8 years.  She practices clinically in family medicine at a residential substance use disorder recovery program and in endocrinology in the Adult Gender Clinic at Duke.  Jones is currently pursuing her doctorate in public health with a focus on health, policy, administration, and leadership.  Her academic and research interests include sexual and gender minority health, hepatitis C treatment models for patients with substance use disorders, reducing bias in faculty hiring, student belongingness, and addressing healthcare disparities.

Hayden Middleton, DMSc, PA-C, is a primary care provider, clinical researcher, and instructor of family medicine at Mayo Clinic in Rochester, Minnesota. He earned a neurobiology degree from the University of Texas at Austin and a Master of Science in PA Studies from Bethel University in St. Paul, Minnesota. He most recently completed his Doctor of Medical Science degree at Rocky Mountain University of Health Professions, and as a part of his doctoral studies, he completed a research study focused on dermoscopy education amongst PA students.

As a 2023-2024 AAPA-PAEA research fellow, Dr. Middleton is investigating the utilization of dermoscopy amongst practicing PAs and aims to understand current dermoscopy education, associated barriers, and other factors that influence the use of this diagnostic tool in our profession. Through his research, he hopes that this study will be used to help guide future education of both PAs and PA students in dermoscopy and serve as the first step in determining how dermoscopy can be more widely adopted in PA practice.

Learn more about the three fellows and their research topics.

Bethany Grubb, MPAS, MPH, PA-C, graduated the Physician Assistant program at University of Texas Southwestern Medical Center and subsequently, completed a fellowship program in dermatology at UT Southwestern. In 2014, she earned her Master of Public Health at the UT-Health Science Center Houston. Before joining the UTSW PA faculty, she worked at a busy private dermatology practice and in the Pigmented Lesion Clinic at UT Southwestern.

Professor Grubb and her team are conducting a study to identify quantitative and qualitative measures to characterize leadership within the PA profession, including the most common styles, strategies, and key factors affecting PAs in leadership in healthcare executive, clinical, and academic roles. The goal is to provide a more comprehensive understanding of PA leaders in all sectors to promote future leadership development. In the competitive medical landscape in which PAs provide care and educate students, their involvement in decision-making roles is critical.

Chris Roman, DMS, PA-C, is a medical science liaison at Takeda Pharmaceuticals. He earned a biology degree from Xavier University and a Master of Arts in psychology from the University of Illinois at Chicago, where conducted neuroscience research for several years. He trained as a PA at Midwestern University and later completed a Doctor of Medical Sciences at Butler University. He has practiced in the dermatology and infectious disease, and now treats patients at an urgent care clinic in Indianapolis, Indiana.

In his study, Dr. Roman is investigating the availability of information about provider health programs (PHPs) to support PAs experiencing impairment due to substance use or a physical or mental health issue. He is also looking at the availability of safe haven non-reporting, which allows clinicians to get help without involving the licensing board, as long as patient harm has not resulted from the impairment.

Learn more about the two fellows and their research topics.

Provider Well-Being Curricula and Student Well-Being in PA Education

Dr. Adrian S. Banning has been a physician assistant since 2006 specializing in primary care and focusing on the veteran population. She became a faculty member at Drexel University in 2008. As an associate clinical professor, she teaches the didactic section of PA education which includes evidence-based medicine.

Her previous research has explored the effect of art therapy on medical education and its relationship to communication, ambiguity, empathy, and well-being. Her Fellowship project will investigate associations between PA program curricula and student-reported well-being, in addition to associations between student demographics, program characteristics, and student well-being. Banning hopes that her study will prove valuable to PA programs seeking to meet the new Accreditation Standard B2.20 focused on provider wellness.

The effect of a well-being curriculum on the mental health outcomes of first year Physician Assistant (PA) students

Stephanie Neary has been a physician assistant since graduating with an MMS in Physician Assistant Studies in 2015. She currently practices inpatient endocrinology in the Diabetes Management Service at the Medical University of South Carolina. She began her career as an adjunct faculty in 2012 and became an instructor at the Yale School of Medicine PA Online Program in 2017. Currently, she serves as an Assistant Professor Adjunct and the Director of Didactic Education.

Stephanie Neary was motivated to study PA student well-being because of her own experiences as a student in two master’s programs paired with her experience advising numerous didactic students. In her Fellowship, she plans to study the effect of a dedicated well-being curriculum on PA student mental health. Neary hopes that her curriculum will erase the idea of white coat infallibility and provide all students foundational skills in positive coping and self-reflection.

Learn more about these two fellows and their research here.

Rigorous and Valid Qualitative Research: African American PA Student Success

Dr. Bester began teaching PA students in the clinical setting in 2007 and transitioned to full-time PA education in 2012, while continuing to maintain her clinical PA practice.

Dr. Bester’s primary research focus is inclusion and diversity within the PA profession and qualitative methodologies. Dr. Bester has published articles related to HIV and infectious diseases, military PAs, and the retention and barriers of minority PAs, faculty, and students. She serves on PAEA’s Diversity and Inclusion Mission Advancement Committee and is also the Primary Investigator for a Minnesota Department of Health Grant to educate students on opiate addiction treatment and expand PA student clinical training opportunities to urban and rural underserved communities in Minnesota.

Physician Assistant Burnout and Fulfillment related to Career Development and Physician Relationship

Dr. Kari Bernard has practiced clinically in cardiac electrophysiology, emergency medicine, urgent care, and occupational medicine since 2004. Dr. Bernard began her research training in 2016 through Walden University. After joining the faculty of the University of Washington MEDEX Northwest PA program as a lecturer at the Anchorage campus, she changed her focus from clinical practice to education and research and was promoted to site director. During her Fellowship, she earned a Doctor of Philosophy in Industrial and Organizational Psychology.

Q: Tell us about your research question for this project and its significance for the PA education and/or health workforce field?

A: I am looking at PA programs that use holistic admissions and have high proportions of underrepresented minority students. The main question is: How are they so successful? For the programs that are doing it well: What are their processes? What kinds of things inform that? And I’m specifically going to look at their culture.

For holistic admissions, you create a mission that articulates the benefits of diversity, and then you link your admissions criteria with that mission. And my hypothesis is that if you don’t have an organizational culture that values diversity, then creating a mission that values diversity will not be nearly as effective.

Q: What kinds of new information or understandings do you hope this research will generate? In what potential ways do you see the results impacting PA education or the workforce?

A: So this is qualitative research in a different way than I think most people are used to. I’m hoping to go into the program, interviewing faculty, staff, and students — learning about the process, the influences, that kind of thing. The research will not be generalizable in the traditional way that quantitative research is generalizable, but the goal is to provide enough detail in the description of the program so that other programs can see how this may or may not work for them and then transfer what they’ve learned from that in-depth analysis into their practices.

Q: What do you think are the most pressing topics for research in the PA field — either education or workforce — right now? 

A: We know that if we have a workforce population that looks more like our patient population that our outcomes may be improved. I think the issue of team practice needs further study. Even though the PA profession is very well established, there are many researchers looking at what the PA’s impact is on the team, what are the outcomes? I think that’s going to influence what we’re doing politically. I think we need to do more research that informs workforce projections. So how many more new programs do we need, because clearly there’s a provider shortage?

Q: What are your goals as a PA researcher? How do you see this fellowship fitting into any type of research agenda or career trajectory you are on?

A: I’ve been a PA educator now for 12 years, and I think at that 5- or 6-year mark you need to decide what you want out of that role. I love teaching — that’s my main thing. But aside from teaching, I want to be able to do research that helps the profession but also helps PA education.

The fellowship is amazing because it’s really going to give me time to focus on research. I think sometimes PA faculty are spread so thin that we can do a lot of things “okay” but we can’t do  a lot of things really well. So I’m hoping to do this really well so that it can be a benefit both to educational programs and to the profession.

Fellowship-Related Publications

• Essary, A. C., K. S. Bernard, B. Coplan, R. Dehn, J. G. Forister, N. E. Smith, and V. L. Valentin. 2018. Burnout and job and career satisfaction in the physician assistant profession. A review of the literature. NAM Perspectives. Discussion Paper. National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201812.
• Coplan B, Evans BC. How organizational culture influences holistic review: a qualitative multiple case study. Adv Health Sci Educ Theory Pract. 2021 Dec;26(5):1491-1517. doi: 10.1007/s10459-021-10055-w. Epub 2021 Jun 12. PMID: 34117962; PMCID: PMC8196269.

Q: Tell us about your research question for this project and its significance for the PA education and/or health workforce field?

A: My research question examines whether there’s a difference between racial and ethnic diversity between PA programs that have standardized testing admissions requirements and programs that don’t. I’m hoping through my research to be able to inform PA education in decision-making in the admissions process and whether the requirement for standardized tests like the GRE or MCAT outweighs the potential benefits of dropping that barrier to racial and ethnic diversity.

Q: What kinds of new information or understandings do you hope this research will generate? In what potential ways do you see the results impacting PA education or the workforce?

A: My research question is pretty well-defined. So if my hypothesis is proven — that is, I believe I will find that there is a lack of diversity in programs that require the GRE or MCAT — then that will give us some information to work with for future research. If PA programs are not satisfied with just that finding, then we need to look further at why that is the case. Is it because students that are applying to the programs consider it a barrier, or is it because cut-off scores after the applications have been submitted are being used by admissions committees to make decisions that prevent students from being interviewed and becoming matriculants? 

Q: What do you think are the most pressing topics for research in the PA field — either education or workforce — right now?

A: Definitely my topic of focus — diversity or lack of diversity and PA student cohorts — because that leads to our graduates and to our workforce. And the fact that our graduates don’t reflect the population that they’re going to be serving is a significant issue that we need to try to find solutions to in the future.

One other topic that I think needs to be looked at critically is the issue of clinical site shortages. With all of the new programs being established and additional students going out onto rotations, we have greater competition for clinical sites, along with the growth in contracting and paying for clinical sites. I think that’s something that needs to be looked into.

I think there’s a connection potentially between the lack of diversity in PA programs and clinical site shortages. If we had more representation from, say, veterans we might have more avenues into veterans administrations rotations and that would open up some clinical site opportunities.

Q: What are your goals as a PA researcher? How do you see this fellowship fitting into any type of research agenda or career trajectory you are on?

A: One aspect of the research fellowship that I’m most excited about is that it will offer me access to mentors who have been in the field for a long time and who are very well-educated in the topics that I’m interested in. This means that they will have insights to offer that I would not otherwise know about, as well as the ability to give me advice about how to develop my research skills, such as literature searching, methodology and design, pathways to publication, and other ways I can get my research out to the public.

Fellowship-Related Publications

• Luck, Morgan EdD, PA-C. Association of Preadmission Factors With Physician Assistant Student Diversity. The Journal of Physician Assistant Education 33(2):p 101-106, June 2022. | DOI: 10.1097/JPA.0000000000000422

Q: Tell us about your research questions for this project and their significance for the PA education and/or health workforce field?

A: I have two research questions. The first is that I’d like to identify factors that may be predictive of PA wages outside of specialties. There may be socio-political demographics or state scope of practice environment factors that help to influence PA wages that are currently not understood or being hidden because of data-reporting techniques and survey methodology. If I can identify some of those variables, it may help to create a more robust understanding of predictors of PA wages outside of specialties.

The second question is an effort to identify predictive factors of permissiveness of state scope of practice laws. Are there factors at the state level that create barriers or allow for permissiveness of state scope of practice laws? And how can we address barriers and augment advocacy efforts to create a more favorable regulatory environment at the state level to produce a more efficient and successful PA workforce?

I think this work will help us better understand the variables that are influencing the workforce and the ability of PAs to practice to the top of their licensure and contribute at the highest level to the health system.

Q: What kinds of new information or understandings do you hope this research will generate? In what potential ways do you see the results impacting PA education or the workforce?

A: As PAs, if we are going to advocate for higher wages in our current position, if we are going to strive for gender equality, if we hope to achieve a level of standardization of wages — within a specialty, within a geographic area, within a practice setting — it’s important to understand the underlying factors that are influencing those wages to guide future policy and advocacy efforts.

The AAPA and state constituent organizations, as well as other stakeholders including PA programs, would benefit from a more robust understanding of the influences that help to shape the PA scope of practice environment.

Q: What do you think are the most pressing topics for research in the PA field — either education or workforce — right now?

A: With respect to PA education, I think we need a better understanding of clinical training models. With the shortage of clinical training sites that all programs are dealing with, and with the difficulty in preceptor recruitment and retention, I think it is vitally important that we have an approach that will allow for new and creative methodology for clinical training. We also need a better understanding of the factors influencing preceptor recruitment and retention. Those factors may be financial; they may be related to the practice environment or incentives. There may be some unique or groundbreaking approaches to clinical education that are not being explored or pursued by programs because of a lack of evidence underlying our understanding of these models.

With respect to the PA profession, we need to continue to grow the body of literature that investigates the impact of PAs on our health care system — whether that be the impact of PAs on the health of populations, the cost of care, or the safety and quality of care that’s provided.

Q: What are your goals as a PA researcher? How do you see this fellowship fitting into any type of research agenda or career trajectory you are on?

A: Through this fellowship, I hope to gain exposure to policymakers and thought-leaders, in the profession and outside of the profession, who can help me identify some of those factors and variables that may be influencing PA education and the profession more globally. I hope to gain skills, not only related to my own research, but to better integrate and coordinate PA education and practice research with funding agencies, policymakers, and other decision-makers at the federal level, which could lead to new and exciting research initiatives in the future.

Fellowship-Related Publications

• White, Ryan MS, MPH, PA-C; Keahey, David PA-C, MSPH; Luck, Morgan MS, PA-C; Dehn, Richard W. MPA, PA-C, DFAAPA. Primary care workforce paradox: A physician shortage and a PA and NP surplus. Journal of the American Academy of Physician Assistants 34(10):p 39-42, October 2021. | DOI: 10.1097/01.JAA.0000791476.25727.d9

Dr. Alicia Quella has a doctorate in epidemiology and is a PA in emergency medicine. Dr. Quella is an Associate Professor and Epidemiologist. She publishes on PA workforce, global health and medical error. She has served as the brief/abstract editor at JPAE and one of the clinical editors at JAAPA. She currently practices as a PA and epidemiologist at a Federally Qualified Health Center in Minneapolis, MN.

Her consulting projects include collaboration with the Ministry of Health in the Lao PDR to build the PA profession. She currently teaches emergency medicine, epidemiology, and global health. Her passion is developing medical curriculum that encourages hands-on and active learning.

Fellowship Related Publications

• Quella, Alicia K. PhD, MPAS, PA-C; Hooker, Roderick S. PhD, MBA, PA; Zobitz, John M. PhD. Retention and change in PAs’ first years of employment. JAAPA 34(6):p 40-43, June 2021. DOI: 10.1097/01.JAA.0000750972.64581.b0

Dr. Christina Hanson has been a PA for nine years and has worked in family practice, orthopedic surgery, and urology. For the past five years, she has been a full-time faculty member at Bethel University PA program in St. Paul, Minnesota. In 2015, she began taking courses toward a Doctor of Education in Leadership in Higher Education degree and successfully defended her dissertation in 2018.

Her research is focused on the current lack of diversity in the PA profession by analyzing data collected by national PA organizations. She will compare the responses of underrepresented minority applicants to non-underrepresented minority applicants with regard to factors that impacted their decision to pursue the PA profession. She hopes this research will shed light on how and why people are choosing to become PAs, so that recruitment and retention efforts can be improved — particularly to increase the proportion of underrepresented minority PAs.

Virginia Valentin has been a PA educator since 2012, having previously taught at the University of Kentucky. Dr. Valentin is the chair and director of the Physician Assistant Studies department in the University of Kentucky’s College of Health Sciences. Virginia earned a Doctorate of Public Health with a focus in epidemiology from the University of Kentucky in May 2017. She brings nearly two decades of clinical experience to her teaching.

Her primary research interest is improving patient outcomes and access to care through identification of patient, provider, and contextual barriers (e.g. organizational and regulatory) to care. Her publications to date have focused on the PA workforce, as well as understanding the utilization of PAs and the barriers to PAs providing patient care. Her dissertation increased the understanding of patient factors that influence the stage of melanoma diagnosis and treatment through analysis of physician density, as well as individual, social, and geographic factors within the state.

Fellowship-Related Publications

• Valentin, Virginia L. DrPH, PA-C; Najmabadi, Shahpar PhD, MPH; Jones, Jeffery PhD; Everett, Christine M. PhD, MPH, PA-C State Scope of Practice Laws: An Analysis of Physician Assistant Programs and Graduates, The Journal of Physician Assistant Education: December 2020 – Volume 31 – Issue 4 – p 179-184 doi: 10.1097/JPA.0000000000000331
• Valentin VL, Najmabadi S, Everett C. Cross-sectional analysis of US scope of practice laws and employed physician assistants. BMJ Open 2021;11:e043972. doi: 10.1136/bmjopen-2020-043972
• Valentin VL, Najmabadi S, Honda TJ. Associations between state scope of practice laws and US physician assistant wages from 1997 to 2017: a longitudinal analysis. BMJ Open. 2021;11(8):e052849. Published 2021 Aug 18. doi:10.1136/bmjopen-2021-052849