At the conclusion of this chapter, the reader should be able to:
Describe the transition from physician assistant (PA) student to early career PA.
Discuss how reflection-in-action assists the novice PA in recognizing learning needs.
Outline the self-directed learning process used by the new graduate PA to address gaps in knowledge and skills.
Discuss tips for maximizing a successful student-to-clinician PA role transition.
Throughout life, a person experiences many transitions. Although transitions are a normal and necessary part of personal growth, significant transitions, like professional role transitions, can be stressful. These transitions often disrupt a person’s sense of self. , As Meleis notes, “Role transition is the process of learning behaviors necessary to carry out a new role effectively.” The ease of the role transition process is affected by the congruity of past and future roles and the preparedness of the transitioner for his or her new role and responsibilities.
The transition from physician assistant (PA) student to practicing PA is a significant role transition. Although all PA graduates are rigorously prepared for patient care as they are mentored and supervised by expert clinicians, the learning curve upon entry to professional practice is steep. Upon entering the workforce, it will be assumed, to a certain degree, that the newly graduated PA will know what he or she is doing and will no longer require constant supervision. Orders will be implemented, prescriptions will be filled, and all this will happen without anyone looking over the novice PA’s shoulder.
The purpose of this chapter is to give the new PA graduate perspective and insight into what to expect during the role transition process from PA student to practicing PA. The chapter summarizes the PA literature on what to expect during role transition and ends with tips on how to ensure a successful transition.
What to expect during role transition
A few studies have been conducted on the student-to-clinician transition for PAs, and their findings can help new PA graduates anticipate what to expect during their professional role transition. What follows is a brief summary of the key conclusions from each study, including specific information regarding job orientation/onboarding, emotions experienced, and sources of support during the role transition process.
A study by Forister and Chlup in 2017 focused on how novice PAs transfer learning from formal training to clinical practice. The authors found three common social perspectives concerning transfer of learning during the transition to practice: (1) partnership perspective, (2) self-reliant perspective, and (3) insecure perspective. The study concluded that novice PAs who held the partnership perspective experienced the smoothest transition. These PAs worked closely and collaboratively with their supervising physicians to build their knowledge and skills and were noted to be highly motivated and goal oriented. Study participants holding the self-reliant social perspective also experienced a mostly positive transition. They acquired new knowledge and skills necessary for their work without the assistance of others by harnessing their intrinsic motivation for learning and engaging in reflective practice. Lastly, novice PAs who held the insecure perspective had difficulty during role transition because of suboptimal environmental support from employers/supervising physicians and the influence of negative emotions (e.g., feeling insecure, anxious, or overwhelmed).
A national survey of new graduate PAs published by Polansky in 2011 explored how workplace learning occurs for PAs during their first 2 years of employment. In this study, three effective workplace learning methodologies were identified :
Accessing learning opportunities through direct patient care
Self-assessing learning gaps pertinent to patients’ health care needs
Having opportunities to observe and be observed in practice
Herrmann conducted a qualitative study in 2016 to characterize the student-to-clinician transition experience among PAs in their first 6 months of practice. Study participants worked in multiple areas of medicine (i.e., primary care, internal medicine, cardiothoracic surgery, psychiatry, rheumatology, urology, and emergency medicine). This study found that new PA graduates:
Had an immediate sense of increased responsibility in clinical practice compared with when they were students
Worried about not knowing answers, not knowing what to do, and looking and feeling incompetent
Found the support received from supervising physicians, other health professionals, other new graduates, and their PA programs to be essential to the transition process
Gained a sense of comfort, confidence, and clarity with their new roles and responsibilities within the first 3 months of professional practice
All three PA transition studies collected information on job orientation/onboarding from their study populations. Relevant findings from the studies are broken down into subtopics on the orientation/onboarding experience.
Length of orientation/onboarding and learning methods used
Herrmann found that job initiation onboarding/orientation ranged from 1 hour to 6 months for the study participants (see Table 56.1 for quotes related to job orientation/the onboarding process). Polansky found that 60% of study participants reported participating in a structured orientation period ranging from 4 to 8 weeks before assuming full patient care duties. Forister and Chlup reported an average observational period of 36 days for participants sharing the partnership perspective, 3.8 days for the self-reliant perspective, and 5.5 days for the insecure social perspective. All three studies reported that orientation/onboarding activities included observing physicians and other clinicians, conducting shared visits with physicians, or seeing patients independently at a decreased volume.
|Most participants initially functioned much like a PA student.||The first week or two, it was very similar to being a student. . . . People want to know where you’re at and what you’re capable [of]. But now . . . it’s more of [a] check-in regarding major treatment decisions. . . . If I wanted to move someone to the ICU and put them on pressors, I’d probably check in first (Participant 5).|
|The period of onboarding or job orientation varied for the participants.||After 6 months, I start seeing my own patients and [the supervising physicians will] kind of like “cut me loose” [laugh] (Participant 10).|
|Many of the new PA graduates were allowed to see a reduced patient load.||Right now I’m on 30-minute appointments, and eventually it will be 15 [minute appointments] (Participant 1).|
|Many were not yet engaged in their full responsibilities.||Once I’m fully trained, they’ll do . . . a weekend where they have me work with someone doing a weekend of overnight shifts (Participant 9).|
|A few participants had no orientation or a concise orientation period.||When I first started, the nurse practitioner was on maternity leave still, and so it was just me and the doctor. And so when he was in the operating room and we had people to discharge or consult, yeah I was kind of really just thrown into it (Participant 7).|
Preparation for full clinical responsibilities
Polansky asked participants to rate their level of preparedness for clinical practice after PA school. Most felt prepared: 53% felt somewhat prepared, and 34.6% felt well prepared. Once on the job, 48% of participants reported being able to perform the full range of their clinical responsibilities within 6 months of practice. PAs in primary care were performing all clinical duties by 3 months of practice, whereas PAs in medical and surgical specialty practice took longer to achieve their full scope of practice. In the Herrmann study, roughly half of the study participants were engaged in their full clinical responsibilities within the first 6 months. Those who were not were often in specialty practice or not yet caring for a full panel of patients daily.
The range of emotions experienced by early career PAs during the transition process was broad and highly dependent on the work environment. In two of the three PA transition studies, , negative emotions such as stress, anxiety, fear, insecurity/uncertainty, and feeling overwhelmed were present during the role transition process. Relevant quotes about general fears and vulnerabilities, as well as specific insecurities (i.e., insecurities about the electronic medical record [EMR] and prescribing), from the Herrmann study can be found in Table 56.2 .