Conflict of Interest

[gabrielled]

Just a general question I have about ethics and conflict of interest.  please post opinions on this.

1.  How can a PA director do research in order to develop a "PA-CAT" test by using as his main data set the accepted students where he is personally involved in the selection process of said students.

2.  If he has recused himself from the acceptance process for prespective students into his program, is this not a serious conflict of interest with the university in which he is under contract with?

[UGoLong]

Just a general question I have about ethics and conflict of interest.  please post opinions on this.
1.  How can a PA director do research in order to develop a "PA-CAT" test by using as his main data set the accepted students where he is personally involved in the selection process of said students.
2.  If he has recused himself from the acceptance process for prespective students into his program, is this not a serious conflict of interest with the university in which he is under contract with?

I don’t know: perhaps he’s trying to quantify his selection methodology and use as the dependent variable how they perform in the program?


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[gabrielled]

reply to yougolong.

not sure what you are getting at but here is the abstract.  the principle of this paper is also setting the selection parameters for acceptance into the very program he runs.  For example, his point system says that an emt basic is equivalent to a full blown licensed paramedic.  also that 5000 hours as a CNA is equivalent to 5000 hrs as a liscensed paramedic.  How is that proper research?  How is that ethical?  Furthermore, if he is setting that sort of standard, then what is the conflict of interest he proports to have with the University he represents?

 

PA-CAT-Research-Protocol-v1.2_11_15_18.pdf

[Febrifuge]

7 hours ago, gabrielled said:

Just a general question I have about ethics and conflict of interest.  please post opinions on this.

1.  How can a PA director do research in order to develop a "PA-CAT" test by using as his main data set the accepted students where he is personally involved in the selection process of said students.

2.  If he has recused himself from the acceptance process for prespective students into his program, is this not a serious conflict of interest with the university in which he is under contract with?

 

Some observations, point by points starting with your opening line: 

This really doesn’t seem like a general question. This seems very specific.

1. If you’re saying you are not familiar with how research about admissions criteria compared to academic performance is done, and you’re wondering how a program director can design and implement a study about which measures best predict student performance in an academic setting, there are qualified people who participate on these boards who can help break it down. But I don’t think you’re asking that. It sounds like you’re starting from the premise that something inappropriate is happening and you’re asking for validation of that. 

2. This doesn’t sound to me like an ethics question. 

So I think the most constructive and useful way to go forward would be to ask you this: please describe what you see as the ethical problems, and why you consider them to be so, and then the group can weigh in on some specific questions. Thanks. Looking forward to a good discussion. 

[ohiovolffemtp]

Are you raising a question that there will be a selection bias in this study, because the principal investigator is using students in whose selection he had a major influence?  Are you asking if there is a bias because the research is being funded by a company who profits by selling tests, so they have a vested interest in an outcome that would tend to support a product they ultimately market?

From reading your attachment, it sounds like there is very little out there which shows much correlation between various quantitative measures, such as test scores, and performance on PANCE.  That's the real goal here: PA schools are graded on 1st time pass rates for students taking the PANCE, so they want to only admit students that will do that.

I didn't see anything in your attachment which spoke to any rating system for prior healthcare experience, only to grades and test scores.  There is a wide variety of practice in how PA school admission processes value prior healthcare experience as well as how they do their interviewing or other assessment of the applicant's interpersonal skills.  There's no data that I'm aware of that correlates any of this to success as a practicing PA.

[gabrielled]

febritruge.

1.  this is in the general discussion section because it is a general discussion.  didnt see a catagory for conflict of interest

2.  look at the date of the abstract.  the administrator involved was hired just shortly before this research.  The director involved was implemental in setting the criteria for new applicants.  essentially weighting it very heavily on GPA

3.  if you read the abstract of the research, it is essentially about the correlation between B.S. GPA, final graduate GPA and Pance results. 

4.  it is the new directors perogative to set the new applicant criteria. However, is it ethical to heavily weigh the new applicant criteria to match the desired research results or is it just bad research.

5.  Is it a conflict of interest with the university to intentionally ignore high level experience in order to achieve a personal gain?

[UGoLong]

febritruge.
1.  this is in the general discussion section because it is a general discussion.  didnt see a catagory for conflict of interest
2.  look at the date of the abstract.  the administrator involved was hired just shortly before this research.  The director involved was implemental in setting the criteria for new applicants.  essentially weighting it very heavily on GPA
3.  if you read the abstract of the research, it is essentially about the correlation between B.S. GPA, final graduate GPA and Pance results. 
4.  it is the new directors perogative to set the new applicant criteria. However, is it ethical to heavily weigh the new applicant criteria to match the desired research results or is it just bad research.
5.  Is it a conflict of interest with the university to intentionally ignore high level experience in order to achieve a personal gain?

I’m still at a loss why there is anything unethical about seeing if there is a correlation between any two variables, as long as the results are allowed to honestly speak for themselves. If he wants to see if entering grades or hat size correlates with PANCE scores, I personally see no conflict.

Is there another axe being ground here?


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[gabrielled]

ohiovol

the answer to your first 2 questions is yes and yes.  i do know about the rating system because i reviewed an application and the points with the director of health sciences. Pretty sure you will never see this in the public realm.  

As for your last sentence, thank you for saying it.  I would say why not!!!  The entire PA profession was predecatrd on real life experience.  How has that evolved into GPA. 

[gabrielled]

18 minutes ago, UGoLong said:

 

I’m still at a loss why there is anything unethical about seeing if there is a correlation between any two variables, as long as the results are allowed to honestly speak for themselves. If he wants to see if entering grades or hat size correlates with PANCE scores, I personally see no conflict.

Is there another axe being ground here?


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well, when a 22 yr old 3.8 GPA (who doesnt even have a B.S) 1000 hour CNA gets accepted before a 22 yr old 3.6 GPA ( same university, same discipline), 5000 hour paremedic does, i would call that a problem.  when 6 Emt-b (3.7-3.9 GPA-- 1000-1500 hrs) from the same company and 5 are literaly trained by the paramedic, i would call that a problem.  when the 6th emt-b is 30 yrs old with the 6000 hrs and a 3.0 GPA gets in and the paramedic doesnt, I call that a problem.  when the NEW director changes the parameters and is also doing research on those parameters, i call that a problem.  when the entire class of 2018 has the highest health care experience of emt-b, I call that a problem.  when the first of the 2019 class are all CNA and EMT-b, I call that a problem

You talk about about HONEST data.  If it were honest, then the director would be collecting empirical data from programs in which he has 0 influence.  Anything short of that is IS dishonest.  Any more questions about ethics???

[ohiovolffemtp]

Please remember the golden rule: them that has the gold makes the rules.  Because of the position they hold, the program director gets to make the final decisions on who is accepted into their program.  Different directors have different ideas about what sort of students they want in their program.  Since people with all levels of healthcare experience and varying levels of GPA, GRE scores, and interview performance all manage to get into PA school and pass PANCE,  there's no good data to support or reject any particular set of thresholds.  More importantly, there's no data at all measuring who becomes a "good" PA.

For example, my PA school class of 40 ranged from 21 year olds with minimal health care experience doing a combined 3+2 BS and MPAS program to a 53 year old with 30+ years experience in EMS with many years as a paramedic.  39 finished the program, 100% of these passed PANCE on the 1st attempt.  School patted themselves on the back.  I believe 38 of the 39 are still practicing.  Again, no data rating these folks after X years of working.   If the same school had picked a different set of 40 from their pool of applicants for that year would they have had the same results - probably but unknowable.

I can't speak to the decisions made by the people and program you're concerned about.  In particular, I don't know what if any sort of interview process was held and how these applicants performed there.  So, you could be right - or not.  Most likely, all of the applicants were good enough to do well in PA school and pass PANCE if they were above some basic thresholds, so in a way, the school is OK no matter who they pick as long as they avoid those applicants who just aren't ready.

[ohiovolffemtp]

Another point, not all program directors value paramedics as good candidates for PA.  If I recall correctly, one program director who posts on these forums stated that he felt paramedics tended to narrow their differential diagnosis too quickly and consequently he felt that they were more difficult to teach.  Whether or not that belief is true globally, I believe his statements represent what he's come to believe based on his personal experiences.  Therefore, that figures into his decision making.

[thinkertdm]

It looks like this is taking data from a number of study sites, not just one.  There is no information in the research protocol about actively using any particular data for admissions criteria.

As noted above, many PA programs have different entrance criteria; some value prior experience, some value education, some value shadowing hours.  I see the prior note about particular experience being admitted; unless you have input into the admissions interview, it is difficult to come to a conclusion on the basis of experience alone.

If you are using this to justify why you weren't selected, its the incorrect path.  If you are bemoaning the fact that PA school admissions criteria is less on experience and more on other things...

[CAAdmission]

On 9/13/2019 at 2:03 PM, ohiovolffemtp said:

 he felt paramedics tended to narrow their differential diagnosis too quickly and consequently he felt that they were more difficult to teach. 

It can also be very difficult to teach them to write a comprehensive H&P. They like to write little snippets of things that look like ambulance run reports. 

[CAAdmission]

On 9/12/2019 at 10:53 PM, gabrielled said:

You talk about about HONEST data.  If it were honest, then the director would be collecting empirical data from programs in which he has 0 influence.  Anything short of that is IS dishonest.  Any more questions about ethics???

Admissions criteria are so disparate it would be almost impossible to generate a comprehensible data set. There have been a few very small studies looking at the effect of experience on PA school success and they concluded there was no effect. 

[ohiovolffemtp]

Even more important, are there any studies evaluating the effect of prior experience on success as a practicing PA?  Not sure who would be interested, because that's not how schools grade themselves.  I can tell how much my prior experience as a firefighter/paramedic has helped me as an EM PA.  However, 25% my graduating class from PA school went into EM.  None of the rest of them had EMS experience.  I also have no data on how well they're doing, what accuities they see, etc.

[gabrielled]

TRUE STORY

so at the er, the doctor asks the PA to perform an intabation, the ER PA says he is not comfortable with that procedure. So the doctor asks the paramedic that is present to do it who completes it with no problem.  saying how much easier it is to do in a trauma room with a scope as opposed to bouncing down a dirt road in the back of the ambulance

[GetMeOuttaThisMess]

Even more important, are there any studies evaluating the effect of prior experience on success as a practicing PA?  Not sure who would be interested, because that's not how schools grade themselves.  I can tell how much my prior experience as a firefighter/paramedic has helped me as an EM PA.  However, 25% my graduating class from PA school went into EM.  None of the rest of them had EMS experience.  I also have no data on how well they're doing, what accuities they see, etc.

And I bet none of them had tubed a patient during training.


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[gabrielled]

15 hours ago, CJAdmission said:

It can also be very difficult to teach them to write a comprehensive H&P. They like to write little snippets of things that look like ambulance run reports. 

That is the most ignorant and prejudicial response i have seen yet.  But i'm sure a CNA can right a much more comprehensive report.  After all, they have never had to go to court for a police shooting, a murder or a vehicle accident.  All of which paramedics have to do all the time. 

But, if that is the prevailing sentiment of PA's, then it explains a lot.

[gabrielled]

29 minutes ago, GetMeOuttaThisMess said:

And I bet none of them had tubed a patient during training.


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my point exactly.  question is " why not?  it is a simple procedure.  the whole profession was originated around medics. specifically vietnam era medics with the extensive untapped health knowledge they bring. now you are telling me that the vast experience that paramedics obtain are somehow disqualifying. 

From what i have seen so far, i'm pretty sure that PA's who have no experience in EM other than a 6 week rotation should educate themselves.

 

[CAAdmission]

4 hours ago, gabrielled said:

That is the most ignorant and prejudicial response i have seen yet.  But i'm sure a CNA can right a much more comprehensive report.  After all, they have never had to go to court for a police shooting, a murder or a vehicle accident.  All of which paramedics have to do all the time. 

But, if that is the prevailing sentiment of PA's, then it explains a lot.

Important, helpful hint: with this attitude, don't apply to a program where I'm on the admissions committee, sweetheart. 

[thinkertdm]

18 minutes ago, CJAdmission said:

Important, helpful hint: with this attitude, don't apply to a program where I'm on the admissions committee, sweetheart. 

It could be a dude.  Of course, the sentiments still apply.  It seems to me that if one gets rejected from a program, maybe blaming the program director isn't the best way to go.  

[PickleRick]

Anyone ever see those outtakes from American Idol, where they show these people that are terrible singers, and are basically told such by the whole panel?  Then they go off on Simon Cowell, and scream and yell that he doesn't know talent when he sees it.

[GetMeOuttaThisMess]

my point exactly.  question is " why not?  it is a simple procedure.  the whole profession was originated around medics. specifically vietnam era medics with the extensive untapped health knowledge they bring. now you are telling me that the vast experience that paramedics obtain are somehow disqualifying.  From what i have seen so far, i'm pretty sure that PA's who have no experience in EM other than a 6 week rotation should educate themselves.

 

 

The reason why is because in most settings there isn’t an opportunity for one to do one. EM attendings-> anesth>EM residents->med students, etc. Sure, you can understand the concept and go through the motions of intubating a mannequin but nothing beats real life experience and in my training setting back in the stone age those opportunities didn’t present themselves because of the med school hierarchy.

 

When it’s all said and done, admissions are determined based on GPA, sGPA, experience/shadowing, and personal interaction skills at the time of the interview. As I’ve previously noted in the past, I lived dangerously during my interview by telling the faculty that I clearly demonstrated that I would be a steady as she goes provider based on my schooling track record and prior EMS experience. I couldn’t promise them that I would be an all-star like maybe a 4.0 GPA brainiac applicant that couldn’t tie their shoes without experience would but at least they would know going in what they were going to get from me at a minimum. It must’ve worked and I would like to think that I’ve been better than average. Not an all-star, but better than average.

 

BTW, those in EM, as well as other settings, never know it all. It’s always a learning process.

 

 

 

 

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[ohiovolffemtp]

@GMOTM - my PA program very briefly went over intubation as opposed my paramedic training that went over it in depth, including required anesthesiology rotations and required numbers of field intubations.  I don't know about the whole class, but I did intubate during my OR rotation.  Since I was and am a medic I asked the anesthesiologist who graciously let me intubate on a case I was already part of.

@everyone:

General comments on paramedics becoming PA's.  Every program director has their own perspective based on their personal experiences.  It's a natural tendency to generalize based on those.  However, there's really no data to confirm that generalization.

My personal experience: my years of experience as a medic was very helpful in certain similar portions of my training, especially cardiology, where I'd probably already had 90%+ of what was taught.  It also was very helpful on the interpersonal aspect of dealing with patients, especially upset or seriously ill ones during my clinicals.  However, there were large portions of the program that covered areas new to me.  That's why I went to PA school.  The consistent story I hear from preceptors and also physicians I work with in EM is that PA's who are or were medics are much more comfortable and eager to dive into complicated procedures and to manage sicker patients.

My take away: prior experience is very helpful to a PA - in my case that was paramedic to EM.  I have a classmate that did nuclear medicine who's now doing IR - she's clearly the square peg for the square hole.  However, ability to learn and interpersonal skills, which are far more difficult for an admission process to judge, are also very relevant.   Because of their position, each admission team gets to pick in their own way.  

My reco for the OP: try to find a program that attaches particular importance to prior healthcare experience, possibly particularly to EMS and or military experience.  I've heard there are some that do.  There are posters here who have better data that I do on that.  Also, look at how you present yourself, especially when you're angry or disappointed.  For better or worse, people hear how you say things much louder than what you're saying.

[UGoLong]

My biggest paramedic lesson was that you go with what you and your crew have, even if you don’t know the answer to every question, and to be comfortable with that.


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