Date of Award

Spring 5-13-2023

Degree Type


Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

First Advisor

Chloe Ruff

Second Advisor

Brent Thompson

Third Advisor

John Gassler Elizabeth Schmidt William Brooks


The purpose of this study was to examine physician assistant (PA) students’ perceptions of clinical procedure training following completion of didactic and clinical phases within a single program based in eastern Tennessee. The cross-sectional study design utilized two survey instruments to record responses from PA students. Responses were gathered from one cohort following the clinical rotation training phase of their program and from a consecutive cohort prior to beginning rotation training.

Evidence among medical student populations suggest that exposure to common clinical procedures is declining and reports from students indicate lower confidence to perform common procedures. The PA profession has successfully integrated into modern medical practice and is well represented in specialties where procedures are performed. The growth of the profession continues annually. To meet the demand, new programs are expected to open with additional students in need of training within the current medical education system. Exploration of the PA student perspective on their exposure and comfort performing clinical procedures is warranted. The aim of the POST-rotation survey was to gather quantitative measures of exposure to clinical procedures that are observed and performed by PA students on clinical rotation along with their perceptions of comfort to perform them. Evidence of the student experience in the clinical setting can help educators focus didactic training on relevant topics to professional work.

In response to the needs for training physicians, efforts to increase medical students’ exposure to clinical procedures has included cadaver model simulation. When limitations are attenuated, anatomy coursework presents the opportunity to integrate this type of procedure training and benefits to learning are evident. The question persists if this training can be beneficial to the preparation of PA students when included in the didactic phase. The aim of the PRE-rotation survey was to gather students’ perceptions of comfort to perform procedures that had been introduced in the didactic phase with cadaver model simulation prior to beginning clinical rotation training. Additional interest in the student perspective of the effectiveness of training was explored.

Results were analyzed from each survey independently. Thirty-five participants from the post-rotation cohort (N=55) participated in the POST-rotation survey following completion of clinical rotations resulting in a response rate of 63.6%. Frequencies of responses for exposure and perceptions of comfort level and difficulty were analyzed using non-parametric tests for differences and relationships. Qualitative responses indicate lack of exposure to performing procedures is a primary factor that makes procedures difficult to perform. Participants were exposed to all seven procedures on clinical rotation but there were differences in exposure between procedures. Reported comfort levels indicate readiness to perform procedures with live patients with various levels of supervision for all procedures.

Sixty-four participants from the pre-rotation cohort (N=75) participated in the PRE-rotation survey prior to beginning their clinical rotations resulting in a response rate of 85.3%. Responses for exposure, comfort level, perceived effectiveness scales and perceptions of difficulty were analyzed using non-parametric tests for differences and relationships. Qualitative responses indicate volume of practice, training models, and procedure technique are factors that make procedures difficult to learn. Participants had didactic exposure to all seven procedures, but there were differences in exposure between procedures. Perceived comfort level was related with exposure and effectiveness. Training sessions were reported to be effective but include reflection of additional models to cadaver model simulation activities. Most students entering clinical rotation report comfort level to perform 5 out of 7 procedures on a live patient with assistance or supervision while a small percentage report comfort with observation or continued practice with simulation methods.

PA students report experiencing opportunities to observe and perform clinical procedures throughout didactic and clinical training phases and perceive comfort levels to perform procedures on live patients with varying levels of supervision. Didactic training is perceived to be effective. Students at different phases of training have different perceptions of difficulty. Exposure is a primary factor that relates to perceptions of performance and serves as subjective measures of competency development.

Available for download on Wednesday, August 07, 2024