Oncology Researcher Joins Rutgers World Health and fitness Institute
Wilfred Ngwa, named a Rutgers Presidential School Scholar and a professor of world-wide wellbeing, advises the Biden Administration’s Most cancers Cabinet
Wilfred Ngwa, a world oncology researcher and clinical physics expert who is creating systems that integrate with radiation therapy to cut down cancer treatment situations and charges, has joined Rutgers World-wide Wellness Institute.
Ngwa, who is a Rutgers Presidential College Scholar and a professor of world wellbeing at the institute, also holds an appointment as a professor in the Division of Radiation Oncology at the Rutgers Most cancers Institute of New Jersey and Rutgers Robert Wood Johnson Healthcare Faculty.
The wide purpose of Ngwa’s study and world wide collaboration is to enhance accessibility to most cancers treatment and lessen wellness disparities, especially in low- and middle-cash flow international locations. He prospects a exploration team that is producing minimal-price tag techniques and systems that can considerably decrease treatment method occasions and expenditures and that can be executed in resource-weak options.
One particular this sort of technologies incorporates artificial intelligence and intelligent radiotherapy biomaterials, these kinds of as nanoparticle drones that can be injected intravenously and will emit missile-like electrons when activated by photon beams in the course of radiation therapy. This process is intended to boost hurt to cancerous tumors while reducing toxic results on human body tissues. This technological know-how also can be programmed to sustainably provide most cancers-battling immunotherapy medicines in resource-powerful and measurable methods. This exploration is supported by the Countrywide Institutes of Overall health and market companions and is in medical translation, with multisite scientific trials on observe to get started in 2023.
Ngwa’s all round study plan is designed to address numerous forms of cancer, and he is major scientific tests similar to managing prostate, breast, and cervical cancers in Nigeria, South Africa, Tanzania and the United States.
“Expanding our multicenter scientific trials to added U.S. and African establishments will be a aim of my exploration at Rutgers. Implementation analysis also will be a priority, so that we can switch understanding into true-world actions that will increase wellness treatment shipping and global wellness,” Ngwa stated. “By creating on my do the job with radiotherapy and the use of highly developed data and interaction technologies in oncology treatment, I glance forward to acquiring a lively exploration plan at Rutgers.”
Ngwa is greatly regarded as an pro on general public well being policy and cancer control in sub-Saharan Africa. Given that 2019, he has been the chair of The Lancet Oncology fee on most cancers in sub-Saharan Africa, which in the spring printed its report about the rapidly escalating cancer load in this resource-poor area of the world. Ngwa is an external adviser to the U.S. presidential administration’s Cancer Cabinet, convened by President Joe Biden to aid build and make progress on the administration’s reignited Most cancers Moonshot initiative, and he is a co-chair of the U.S. Most cancers Moonshot 2. Lancet Oncology commission. He is editor of IOP Publishing’s scientific series in world wide health and radiation oncology and an editorial board member for Journal of International Oncology, Frontiers in Oncology and ecancermedicalscience.
As the founding director of the International Health and fitness Catalyst Summit, Ngwa sales opportunities a collaborative that convenes an once-a-year summit and other activities developed to catalyze significant-effects intercontinental collaborations and initiatives to eliminate health and fitness-related disparities in the United States and globally. An ongoing task that originated by way of a summit is C4: Thorough Cancer Middle in the Cloud, an synthetic intelligence-driven platform that Ngwa is developing with multidisciplinary companions to maximize accessibility to cancer treatment, investigation and training irrespective of geographic location.
Ngwa is originally from Cameroon, exactly where he researched physics and laptop or computer science at the University of Buea, getting a bachelor of science diploma. He gained his master’s and doctoral degrees from University of Leipzig in Germany then completed postdoctoral schooling and instruction in radiation oncology at MD Anderson Most cancers Middle at the University of Texas and at Brigham and Women’s Healthcare facility, Dana-Farber Most cancers Institute and Harvard Health care School.
Ngwa previously was an associate professor of radiation oncology and molecular radiation sciences at Johns Hopkins University’s University of Medicine and Sidney Kimmel In depth Most cancers Middle. He also retains an appointment as a distinguished professor of community health and fitness at the ICT College, based mostly in Cameroon.
“Our goal is… modest: we simply attempt to be fearful when others are greedy and to be greedy only when others are fearful,” wrote Warren Buffett in a 1986 letter to shareholders about the twin contagions of fear and greed in the investment community.
More recently, the real-world Covid-19 contagion drove investment in digital health to record-breaking levels in 2021, roughly double the previous record. Experts gushed (in large part, correctly) about how a silver lining of the contagion was that it had done more to advance telehealth, virtual care and digital health writ large in 10 months than the previous 10 years.
Gravity is a powerful force, however, especially when combined with rising interest rates, continued war and threat of escalation in Ukraine, and fears of a recession. Accordingly, Rock Health recently reported that investment in digital health dropped a whopping 47{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} in 2022.
A quickly emerging consensus has arrived among the early stage investment community, summed up well by the recent JP Morgan healthcare conference: focus on profitability, not growth.
Black rhinoceros are solitary creatures. While current conventional wisdom suggests digital health … [+] startups should focus on profitability, there is enormous opportunity for those willing to stand alone and place longer term bets.
EtienneOutram – stock.adobe.com
The only problem with this perspective? It may well be the dead wrong advice for startups pursuing network effects-driven business models, which underpin four of the five most highly valued companies in the world.
For founders and investors focused on building marketplaces and platforms in digital health, 2023 may be the time to heed Buffett’s counsel: when everybody around seems fearful and focused on playing it safe, it just may be the right time to be audacious (or even a little greedy, using Buffett’s parlance).
Why Platforms and Marketplaces Are Different From (And Outperform) Most Technology Companies
Network effects are often misunderstood, but also fairly easily explained: they occur when the value of a product (or service) increases with the adoption and use of the product by others. There can be “same side” network effects (as in the case of Facebook), or “cross side” network effects (e.g., Uber) in which the presence of one side of users (riders) creates value for the other (drivers) and vice versa.
Both online marketplaces (e.g., Amazon) and multi-sided platforms (e.g., Plaid) take advantage of network effects. Network effects are a simple enough concept, but consider the implications: as more people use the product, more value is created for all, which can in turn attract new users and makes the product itself ‘stickier’ for existing users. As the user footprint itself grows, there are increasing opportunities for monetization. Just one example: from 2007 to 2021 while Facebook grew its user footprint an astonishing 50X (from 58M to 2.9B users), its revenue grew at an even more astonishing 732X (from $153M to $112B).
Consider research comparing some of the largest technology companies embracing network effects (marketplaces and platforms) with their equally large pure play technology peers. The data shows that platforms and marketplaces significantly outperform their peers
Grow revenue faster than their pure tech peers (25{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} vs 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Are more scalable, generating substantially higher revenue per employee than their pure tech peers ($891K vs $409K)
Achieve higher levels of profitability than their pure tech peers (22{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} vs 16{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Are accordingly valued more highly their pure tech peers (4.5X to 3.3X EV/Revenue)
If platforms and marketplaces are so powerful and so clearly outperform their ‘pure technology’ peers, why don’t all companies embrace network effects? There are of course many contributing reasons (including that platforms tend to fail at higher rates), but perhaps chief among them: platform thinking requires a different management paradigm and approach to value creation than traditional ‘pipeline’ business models.
The emerging wisdom for digital health – to focus on profitability – applies to one, less so to the other.
Why Is Now The Time To Invest In Platforms And Marketplaces?
Virtually every startup in healthcare winds up offering some type of discount, free offer, or other form of subsidy early on in their lifecycle. Long and painful sales cycles or the lack of proven outcomes are just two reasons why a startup may trade revenue for something in return: a referral customer, a testimonial, partnership to validate the ROI, etc.
The challenge for any early stage investor is to weigh the economic promise of a company against the massive weight of uncertainty and market inertia; demonstration of revenue and attractive unit economics is one way to do so.
For pipeline businesses, especially those in healthcare, this approach makes sense. Achieving product-market fit in any industry is hard work (and most venture backed companies will fail), and healthcare’s regulatory environment, complex financing and payment system increase the risks.
Just above we called attention to how mature marketplace and platform businesses outperform and are more capital efficient than their pure tech counterparts, it’s important to note that the inverse is also true: in the early stages, it takes substantially more effort and capital to start the ‘flywheel’ process, and both revenue and unit economics are a lagging indicator of business prospects.
This makes sense if one considers the nature of network effects: if the platform gains value with more adoption, then early on there is little value to early adopters and little incentive for prospects to adopt. And even less incentive to pay for the product if the intrinsic value is heavily driven by the presence of others.
In the early stages, it takes substantially more effort and capital for platform businesses to start the ‘flywheel’ process, and both revenue and unit economics are a lagging indicator of business prospects.
This is what constitutes the ‘Cold Start’ problem.
But less recognized that the ‘Cold Start’ problem, which focuses on adoption and value, is how founders and investors should think about the Cold Start from a capital and burn rate perspective. Investors in particular tend to invest in and may actively manage a portfolio of companies; they look for patterns both prior to and following investment, and most of these patterns are driven by pipeline thinking, which constitute the majority of dollars and deals in healthcare.
Hence the tension that early stage platform and marketplace founders may face: most investors will have an eye toward short term macro conditions and toward profitability, while founders may understand theirs is a longer term play and a seemingly high rate of cash burn may be entirely appropriate.
For those contrarian founders and investors who can align on vision, strategy and execution plan, however, now may be precisely the right time to invest in platforms and marketplaces in healthcare.
Why? For many reasons.
First, where competition exists, it is likely facing significant challenges. Belts are tightening, and capital is drying up. And, as described above, there is likely significant tension between management and investors around use of resources. The more conservative the approach, the less likely the long term strategy. Further, the current drop in funding means there is likely to be less competition for a period of time. Forward-thinking teams and investors will take advantage.
Second, forward-thinking investors will recognize that, while first mover advantage can frequently be overstated in importance, they can matter a great deal in winner-take-all (or winner-take-most markets). There is perhaps no greater contributing factor to creating ‘winner-take-all’ dynamics than network effects. Timing matters of course. If a platform can begin generating momentum to get the proverbial ‘flywheel’ turning before competitors, it has more than a substantial (and perhaps insurmountable) head start.
Third, aligned understanding of platform strategy between founders and investors can lead to deep structural advantages. Customers whose belts have tightened are likely to be very receptive to adopting technology that yields an immediate return with no upfront or costs in the near term.
Fourth, the longer growth cycles for marketplaces and platform businesses means that exits are likely to occur in a materially different macroeconomic environment.
We can also look to the past for examples. Uber was founded in March 2009, during the Great Recession. Likewise, Airbnb was founded in 2008. Amazon now is one of the biggest companies in the world, but survived in 2000 in large part because it raised significant capital just before the market crashed.
For forward-thinking investors, now may indeed be the right time to invest in marketplaces and platforms. Is there a reason to think about doing so in healthcare?
Why Marketplaces and Platforms in Healthcare?
Three macro trends suggest we’re at a unique period in time for investors in healthcare.
First, it’s hard to overstate the sea change that has occurred – and also the one that has not yet – as a result of 2009’s stimulus bill. Known as the American Recovery and Reinvestment Act, the bill contained massive subsidies to drive physician and hospital adoption and “meaningful use” of electronic health records.
The sea change that happened: EHR adoption shot up to >90{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, from under 10{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} adoption.
The sea change that didn’t happen (yet): meaningful use and interoperability in a manner that would enable improved care coordination, population health management, and researcher accessibility to vast swaths of real world data.
Today, virtually every doctor in the U.S. now practices medicine and interacts with patients while working in an application on a laptop. It is no coincidence that levels of digital health have risen dramatically – and will likely do so again – over the past decade, as investors and entrepreneurs see the opportunity to leverage digitized processes and data, and to deliver on the sea change that hasn’t happened yet.
Second, it’s not news to suggest that healthcare is recession-proof. In fact, recent data suggests that demand for healthcare services actually increases during recessions. In addition, the record $29 billion invested in digital health in 2021 is still tiny compared with the $4T in healthcare spend (of which perhaps 25{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} is wasteful), suggesting there remains enormous opportunity to improve healthcare quality and access while reducing costs.
Third, many of the biggest challenges in healthcare are those best addressed by marketplaces and platforms. Care coordination, provider-payer relationships, care navigation, information asymmetry, and price transparency are all examples of the types of challenges created by a complex, highly regulated and fragmented industry where quality is highly variable and trust between constituents is low.
Platforms and marketplaces create economic value by bringing different constituents / sides of users together and enabling exchange. To do so, they must identify where incentives do or can align, bring uniformity and standardization to transactions, and introduce or increase transparency in order to build trust. Doing so is a business imperative, and one that aligns the platforms’ interest with the broader societal interest in making healthcare more efficient, accessible, and higher quality for all.
Finally, while it’s important to note that healthcare is indeed different, that difference can be rewarding for founders and investors. The highly regulated nature of healthcare, fragmentation, highly educated and trained workforce, and importance of clinical workflow can all lead to greater barriers to entry and higher switching costs for customers. In other words, defensibility for companies and investors.
Six Steps For Founders and Investors To Take Now
What to do with all this information? Get started. Although there is no step-by-step guide for founders or investors interested in building or investing in marketplaces and platforms in healthcare, here are six steps that each can take:
Focus on inefficient interactions that are massive problems: Jonathan Bush has said that healthcare is not a $4T market, but rather thousands of billion dollar markets. But it’s also true that many of the biggest problems involve interactions that involve two or more constituents. One easy place to look, for instance: provider-to-payer interactions. Whether it’s reimbursement, network contracting, utilization management, directory management, or hundreds of other transactions, today’s ‘system’ is rife with inefficiencies and lack of trust in terms of how providers and payers interact.
Develop a thesis about how the world should work: Today’s system is still largely paper- or fax-based. And that’s when it’s not being handled over the phone. If there were a common, trusted platform to facilitate interactions, how would it work? Who would benefit? Why would different constituents use it? Who would pay for it?
First things first – build an atomic network: one of the most important things to remember is that reality will differ from your vision in profound ways. Better to figure those things out, and the difference between what works and what doesn’t, early on when the network is smaller, mistakes are less costly. Andrew Chen recommends building an ‘atomic network’, which is the minimum size for a network to survive on its own (See Musk, Elon, re importance of this lesson).
Invest in understanding platform strategy: As described above, building a platform or marketplace requires a different mindset from building a pipeline business. There’s too little platform strategy expertise and experience in healthcare, but there are resources and good books out there to get started. It’s worthwhile to understand the nuances, since not all network effects are equal.
Align on expectations: Among the most important lessons for both founders and investors is for them both to understand what they’re getting into, what it’s going to take to get there, why it’s worth the effort, and what the process is likely going to look like.
Right metrics: The recognition that platforms build value in a different trajectory and have a different revenue profile than ‘pure technology’ pipeline companies should not be taken to mean that money should be invested willy-nilly. If the payout is larger but longer, it’s even more critical for both sides (management and investor) to hold each other accountable for progress. Developing the right metrics to track, and understanding which ones are most important during which stage of growth, is critical.
Be Mindful of Buffett When Others Are Fearful
Warren Buffett has had a decent streak of success since his 1986 letter to shareholders. This, of course, is putting it mildly.
This author doesn’t believe in advocating for greed (and certainly not greed alone), but in recognizing the attractive and long term investment opportunities that remain right in front of us while most are taking the seemingly safer and certainly more well-traveled path.
Electronic musculoskeletal clinic Hinge Well being released a actual physical therapy home contact support Tuesday, which will complement its virtual treatment abilities.
San Francisco-dependent Hinge Overall health presents bodily treatment for the neck, upper back again, shoulders, elbows, lessen back again and a lot more. Individuals obtain a treatment team, which include physical therapists, health coaches and doctors. Hinge Health functions with overall health options and companies, serving more than 1,250 businesses, which includes Verizon, Volvo and Salesforce. The corporation has raised about $1 billion in funding.
The residence call services is to begin with starting in Chicago, but will ultimately develop nationally in about 18 to 24 months. Customers are equipped to timetable appointments by the Hinge Wellness app, and a actual physical therapist from the firm will come to their house within just a person to two small business times. Each and every appointment is about 45 minutes lengthy. The physical therapist will conduct an assessment that evaluates the member’s bodily capability, adaptability, energy and balance, as effectively as any hazards in the home.
“The [physical therapist], because they’re in the house, can do a drop hazard evaluation, which incorporates analyzing their useful mobility but also evaluating the household. Are there carpets you could excursion above? Are there stairs we require to imagine about?” reported Daniel Perez, co-founder and CEO of Hinge Wellbeing. He will be presenting the news Wednesday at the J.P. Morgan conference in San Francisco.
Whilst virtual treatment has skyrocketed in popularity, quite a few individuals however choose in-human being treatment, specifically when they are starting their health care journey, Perez reported. That is why the organization made a decision to make a hybrid model.
“For a great deal of persons, electronic treatment has expanded accessibility … but there are really a couple of people who like to complement their digital treatment knowledge with in-individual encounters as effectively,” he said in an interview. “This is specifically pertinent for men and women with again, joint and muscle mass ache where by an original in-person analysis can significantly enhance downstream digital care.”
To observe the achievement of the new provider, the firm will be pursuing clinical outcomes, together with ache enhancement, reduction in elective surgical procedures, advancement in practical outcomes and mental health and fitness comorbidities. Hinge Health will also be monitoring affected person engagement, retention, satisfaction and expense reduction, Perez explained.
There is a want for this kind of hybrid treatment method, he included. About one particular in two Us citizens have a musculoskeletal issue, which prices the U.S. about $600 billion on a yearly basis.
“It’s been overlooked for a prolonged time mainly because musculoskeletal problems are not witnessed as killing you,” Perez declared.
The healthcare unit marketplace still has a long way to go when it arrives to ‘going green’, but a wave of adjust is underway with an growing variety of makers shifting towards sustainable and impressive procedures to preserve electricity and decrease their environmental affect.
Sustainable professional medical gear can be beneficial for firms in conditions of charge personal savings, investor attraction, larger model recognition, and attaining a aggressive benefit, in addition to becoming superior for the natural environment and captivating to people. Medical system suppliers must take into account sustainability at the outset of the structure phase and acquire the equipment’s complete lifecycle into account if they are to attain these and other strengths.
Relevant: Why sustainability is additional crucial to pharmaceutical companies now a lot more than ever
In accordance to Hamid Dean Refai, Basic Manager at WebOps World, several international locations are setting targets to help make the earth a more sustainable place by 2050. “Some of these plans and targets are bold but many thanks to the advent of progressive new technological developments, they now have the probable to turn out to be reality. Technological know-how is fundamentally transforming the way we stay and work, and in modern several years, sustainability has been a critical driver of technological development. Currently, as the earth faces a sequence of unparalleled difficulties, technological innovation can engage in a crucial part in creating a extra sustainable long term.”
The health care sector is a sizeable supply of squander and greenhouse fuel emissions, liable for 4.4 per cent of web emissions globally. While some of this is produced instantly by healthcare establishments, more than 70 for each cent of relevant emissions are manufactured across the provide chain. This is notable during the development and disposal of prescribed drugs and health care gadget products and solutions, as properly as the use of power in the course of the complete supply chain and immediate shipping and delivery of treatment.
Relevant: It is really time for environmentally friendly overall health
Moreover, somewhere around 5 million tonnes of garbage are produced annually by hospitals in the US alone. In spite of possessing recycling or reprocessing devices in place, there are several road blocks that prevent eligible content from remaining disposed of responsibly.
“Technological developments in well being, small business, and the environment supply organisations and communities with a prosperity of prospects by means of the introduction of new employment and by creating operational procedures far more streamlined, for instance. Environmental sustainability allows to retain our way of life, as perfectly as social and financial demands. For instance, inexperienced technology these as solar panels and wind turbines can assistance to change tactics and approaches that hurt or deplete all-natural sources with a lot more sustainable and efficient kinds,” says Refai.
Some inexperienced tech innovations have now made their way to the sector. For case in point, the Welch Allyn’s Inexperienced Collection is a person of the to start with clinical test lights in the US to use strength-economical, gentle-emitting diodes (LEDs) instead than halogen lamps. They emit fantastic white mild with a color temperature of 5,500K and have a lifespan of 50,000 several hours without having needing a new bulb.
The Holst Centre, an impartial open-innovation R&D centre, and the Interuniversity Microelectronics Centre (imec) nanoelectronics investigate division, on the other hand, designed a wi-fi, battery-free, two-channel EEG system in 2008 that is generally powered by system warmth and light.
In addition, the effective and self-contained Neptune 2 squander administration program is just one of Stryker’s eco-friendly products. Due to the dual-canister structure of the system, supplemental containers and repeated cleansing of waste containers are not as required. Furthermore, it cuts down on the time put in by healthcare professionals managing squander.
Purpose: This study describes physician assistant students’ perception toward online didactic education and highlights relationships between student characteristics and their preference for online learning.
Methods: A previously validated survey questionnaire was administered online to physician assistant students enrolled in traditional, in-person training programs across the United States. The survey consisted of five Likert-scale statements measuring perceptions of online learning and was rated on a seven-point Likert scale. Students also reported their age, gender, history of taking an online course, and preferred learning style. Mean scores were reported for agreement with each Likert-scale statement; Pearson correlation coefficients, one-way ANOVA with post hoc Tukey tests, and independent samples t-tests were used to determine relationships between student characteristics and their preference for online learning.
Results: A total of 391 completed surveys met the inclusion criteria for the study and were used in data analysis. The average age of respondents was 25.98 years, 81.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 317) were female, 96.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, (n = 376) reported taking an online course previously, and preferred learning styles were reported as 36.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 141) visual, 7.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 30) auditory, 15.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 61) reading/writing, and 40.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 159) kinesthetic. Nearly a quarter of respondents indicated they preferred online courses, particularly students with a preferred learning style of reading/writing. No relationships were observed between age, gender, or history of taking an online course and preference for online education.
Conclusion: Most physician assistant students prefer in-person learning. However, a substantial number prefer online learning, and a significant number of these students reported a preferred learning style of reading/writing. More research is necessary to give educational institutions the ability to make data-driven, student-centered program development decisions. However, data in this study indicate a need for continued development of online/hybrid physician assistant programs to better align with current student preferences.
Introduction
Since the inception of the profession in 1965, physician assistants (PAs) have learned to practice medicine through a combination of in-person didactic instruction followed by the completion of supervised clinical practice experiences at affiliated hospitals and clinics. Although this is an effective curriculum delivery method, pioneers in the field have also recently demonstrated the feasibility of hybrid PA education [1]. In the hybrid model, students complete the didactic year predominantly online, followed by traditional, in-person clinical training. Anderson summarized some of the benefits of online medical education [2]. These include fostering the development of self-directed learners [3], enhancing student engagement in the classroom [4], expanding opportunities for interprofessional education experiences [5,6], promoting digital literacy with medical technology [7], widening the instructor pool [7,8], removing barriers to attending PA school [9], repurposing time spent commuting [4], allowing students to live in and learn about the communities where they may one day practice, and helping to close the gap of clinician shortages in underserved areas [10]. The ability to teach didactic content online may also prove beneficial considering recent changes to the educational landscape following the severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2)/coronavirus disease 2019 (COVID-19) pandemic. During this time, remote learning in the didactic year across PA programs increased from 6.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} before the pandemic to 96.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} during the pandemic [11]. During this time, there has also been increasing program director support for online didactic education in PA programs [12]. Now that online didactic PA education is possible, innovative PA educators should seek to determine what method of curriculum delivery students prefer, and analyze these preferences to help guide future program development decisions.
A review of the current literature indicates an overall preference for traditional in-person education over online learning among health professions students, both within and outside of the PA profession; however, research specific to the PA community is limited. In a 2006 seminal study, Day et al. concluded that PA students preferred in-person over online curriculum delivery [13], and in 2009, York et al. observed that 78{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of PA students enrolled in a web-based evidence-based medicine course stated they would have preferred in-person lectures instead of, or in addition to, online learning [14]. A review of the literature outside of the PA profession yields similar findings [15-17]. Although video-recorded lectures were found to be of equal or more educational value when compared to in-person instruction, Harvard Medical School students continued to attend traditional lectures if given the choice [15]. Hamilton et al. reported that third-year pharmacy students favored a blended educational approach as opposed to an exclusively online course [16]. A study by Bramer et al. also found that United Kingdom nursing students preferred a balanced mixture of online and face-to-face learning and did not feel that online learning should replace traditional teaching [17].
Further research is needed to explore the current preferences of didactic PA students regarding in-person versus online education to ensure PA program development decisions are student-centered, evidence-based, and data-driven. This is especially important considering the number of new PA programs in development and the number of existing programs that are adapting their curricula to combat current and evolving barriers to medical education. The current study sought to narrow this information gap by determining the curriculum delivery preferences of currently enrolled didactic PA students. Participants were also asked to report their age, gender, history of taking an online course, and preferred learning styles to determine if an association existed between any of these factors and their preference for online education.
Materials & Methods
Study description
This was a cross-sectional survey study. Risks were minimal and consisted of time lost by students to complete the survey and the potential loss of confidentiality among participants. To mitigate these risks, the survey was designed to be completed in fewer than five minutes, participation was a one-time endeavor with no follow-up, and no personally identifiable information was collected. The primary benefit of the study was insight into the preferences of didactic PA students regarding their preferred curriculum delivery method. This could help current and future programs plan the instructional design of their curriculum. The study proposal was reviewed and approved by the institutional review board (IRB) of A.T. Still University, Mesa, Arizona, United States (approval number: 2021-174), and secondary approval was given by Franklin Pierce University, Rindge, New Hampshire, United States (protocol number: 08252021) for exempt status prior to data collection.
Study sample
The Physician Assistant Education Association (PAEA) Program Report 35 reported that the maximum capacity enrollment of didactic students in PA programs across the United States was 11,299 [18]. According to a sample size estimator by Qualtrics (Seattle, Washington, and Provo, Utah, United States), 372 individuals from this population needed to be sampled to adequately represent the target population [19]. Inclusion criteria for participation were as follows: students had to be at least 18 years old, be enrolled in a currently accredited PA Program in the United States, and be in their didactic phase of study. Students at the Yale PA online program were excluded from participation as the principal investigator felt they may reasonably have a favorable bias toward online education. The principal investigator currently works for Franklin Pierce University and has previously been employed by the University of South Alabama; therefore, students from these institutions were also excluded to limit participation bias.
Survey design and distribution
A previously validated survey instrument from O’Malley et al. [20] regarding perceptions of online education was adapted for use in the study, with the author’s permission. The adapted survey consisted of two questions to identify eligibility criteria, five Likert-scale questions regarding student perception of online education, and four student characteristic/demographic questions: (i) age, (ii) gender, (iii) history of taking an online course previously, and (iv) preferred VARK (visual, auditory, reading/writing, kinesthetic) learning style [21]. An alphabetical list of currently accredited PA programs by state from the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) website was used to determine which programs to target for student recruitment [22]. The program director for the first accredited program listed for each state was sent a recruitment email asking whether they would offer participation to their didactic students. Those who agreed were asked to forward a standardized student-specific recruitment email to their currently enrolled didactic students that described the study’s purpose, risks, and benefits, and informed students that participation was voluntary, and completion of the survey was considered their consent to participate. The email also provided a link to the survey should they wish to complete it. If no response was received from a program director after one week, the recruitment email was sent for a second and final time. At the end of every two-week period, the next accredited program listed on the ARC-PA website for each state was contacted. This process continued, every two weeks, until the needed sample size of 372 qualified surveys was completed.
Data collection, storage, and analysis
Data were collected from September through December 2021. Both ordinal and nominal (categorical) data were collected and stored on the SurveyMonkey platform (Momentive Inc., Waterford, New York). Following data collection, descriptive (frequencies, percentages, means, standard deviations, and confidence intervals) and comparative statistics were conducted using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021, Armonk, New York). To determine if a correlation existed between age and preference for online education, a Pearson correlation coefficient was calculated for each Likert-scale statement; p-values less than .05 were used to determine statistical significance. A one-way ANOVA test was used to compare means among Likert-scale statements according to the four different preferred learning styles of participants; p-values less than .05 were used to determine statistical significance. Post hoc Tukey tests were then conducted to determine pairwise differences between the preferred learning styles for each Likert-scale statement; p-values less than .05 were used to determine statistical significance. Independent samples t-tests were used to determine if there was a significant difference in mean Likert-scale scores between genders or between those who had taken an online course previously versus those who had not; because multiple t-tests were conducted, the criterion for statistical significance was adjusted downward to a p-value less than 0.1 to control for alpha inflation in accordance with the Bonferroni correction.
Results
PA program participation and student characteristics
The researchers did not directly access the study sample (didactic PA students), which instead had to be recruited to the study by PA program directors of invited programs. Therefore, the total number of student participants who received the survey was unknown and an accurate response rate could not be calculated. Approximately 35{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (50/141) of PA programs invited to the study responded to the email request, and 32{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (45/141) opted to participate. These programs represented didactic PA students across 31 states. At the conclusion of data collection, 472 surveys were received, of which 391 were complete, met inclusion criteria for the study, and were subsequently used for data analysis. The average age of the study sample was 25.98 years (range = 21-51 years). Gender was reported as 18.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 72) male, 81.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 317) female, 0.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 1) gender non-binary, and 0.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 1) preferred not to answer. Most participants (96.2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, n = 376) reported taking an online course previously. The distribution of preferred learning styles of the sample was 36.1{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 141) visual, 7.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 30) auditory, 15.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 61) reading/writing, and 40.7{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 159) kinesthetic (hands-on).
Participant preferences for online education
Table 1 reports the study participants’ agreement and disagreement with statements pertaining to their perception of online education. Most students disagreed to some degree (strongly disagreed, disagreed, or somewhat disagreed) with four out of the five Likert-scale statements studied; 76.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 299) disagreed with the statement “Most people believe that online learning is more effective than traditional methodologies”, 72.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 283) disagreed with the statement “In a course with both traditional and online methodologies, I learn better through the online portion”, 69.4{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 271) disagreed with the statement “I prefer online courses to traditional courses”, and 59{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 231) disagreed with the statement “I believe that I can learn the same amount in an online course as in a traditional course.” In contrast, most students (56.5{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, n = 221) agreed to some degree (strongly agreed, agreed, or somewhat agreed) with the statement “I believe that I can make the same grade in an online course as in a traditional course.”
Likert-scale Statement
Strongly Disagree, n ({08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Disagree, n ({08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Somewhat Disagree, n ({08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Neither Agree nor Disagree, n ({08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Somewhat Agree, n ({08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Agree, n ({08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Strongly Agree, n ({08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f})
Most people believe that online learning is more effective than traditional methodologies.
96 (24.6)
125 (32.0)
78 (19.9)
29 (7.4)
39 (10.0)
14 (3.6)
10 (2.6)
In a course with both traditional and online methodologies, I learn better through the online portion.
104 (26.6)
117 (29.9)
62 (15.9)
35 (9.0)
29 (7.4)
27 (6.9)
17 (4.3)
I prefer online courses to traditional courses.
116 (29.7)
96 (24.6)
59 (15.1)
27 (6.9)
41 (10.5)
25 (6.4)
27 (6.9)
I believe that I can learn the same amount in an online course as in a traditional course.
74 (18.9)
83 (21.2)
74 (18.9)
22 (5.6)
55 (14.1)
48 (12.3)
35 (9.0)
I believe that I can make the same grade in an online course as in a traditional course.
41 (10.5)
48 (12.3)
42 (10.7)
39 (10.0)
67 (17.1)
101 (25.8)
53 (13.6)
Table
1: Levels of Agreement with Likert-scale Statements Regarding Perception of Online Education
n, number of participants
Relationships between participant characteristics and their preferences for online education
Age
One survey respondent was omitted from analysis due to an erroneous input of their age (“2t”) which could not be validated. As reported in Table 2, no significant correlation was observed between age and preference for online education.
Likert-scale Statement
What is your current age?
n
Pearson Correlation
p-value
Most people believe that online learning is more effective than traditional methodologies.
390
0.02
0.66
In a course with both traditional and online methodologies, I learn better through the online format.
390
0.09
0.07
I prefer online courses to traditional courses.
390
0.06
0.23
I believe that I can learn the same amount in an online course as in a traditional course.
390
0.03
0.56
I believe that I can make the same grade in an online course as in a traditional course.
390
0.01
0.79
Table
2: Correlation of Likert-scale Statements with Age
n, number of participants
Gender
Only male and female genders were used in the analysis as these categories made up 99.49{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the sample. As reported in Table 3, no significant relationship existed between gender and preference for online education.
Statement
Gender
n
Mean
Standard Deviation
t
df
Two-sided p-value
Mean Difference
95{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} Confidence Interval of the Difference
Lower Bound
Upper Bound
Most people believe that online learning is more effective than traditional methodologies.
Male
72
2.64
1.50
-0.16
387
0.87
-0.03
-0.43
0.37
Female
317
2.67
1.56
In a course with both traditional and online methodologies, I learn better through the online format.
Male
72
2.72
1.68
-0.31
387
0.76
-0.07
0.23
-0.52
Female
317
2.79
1.75
I prefer online courses to traditional courses.
Male
72
2.89
1.84
-0.09
387
0.93
-0.02
-0.51
0.47
Female
317
2.91
1.92
I believe that I can learn the same amount in an online course as in a traditional course.
Male
72
3.58
2.07
0.59
387
0.56
0.15
-0.36
0.66
Female
317
3.43
1.95
I believe that I can make the same grade in an online course as in a traditional course.
Male
72
4.33
2.06
-0.44
387
0.66
-0.11
-0.61
0.39
Female
317
4.44
1.93
Table
3: T-test Comparison of Likert-scale Scales by Gender
n, number of participants; t, independent sample t-test; df, degrees of freedom.
History of Taking an Online Course Previously
As reported in Table 4, no significant relationship existed between taking an online course previously and preference for online education.
Statement
Online Course Previously
n
Mean
Standard Deviation
t
df
Two-sided p-value
Mean Difference
95{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} Confidence Interval of the Difference
Lower Bound
Upper Bound
Most people believe that online learning is more effective than traditional methodologies.
Yes
376
2.66
1.53
-0.74
14.58
0.47
-0.41
-1.59
0.77
No
15
3.07
2.12
In a course with both traditional and online methodologies, I learn better through the online format.
Yes
376
2.77
1.71
-0.79
14.56
0.45
-0.50
-1.85
0.86
No
15
3.27
2.43
I prefer online courses to traditional courses.
Yes
376
2.90
1.88
-0.61
389
0.54
-0.30
-1.29
0.68
No
15
3.20
2.31
I believe that I can learn the same amount in an online course as in a traditional course.
Yes
376
3.44
1.96
-1.86
389
0.06
-0.96
-1.98
0.06
No
15
4.40
2.20
I believe that I can make the same grade in an online course as in a traditional course.
Yes
376
4.38
1.94
-2.74
15.53
0.02
-1.22
-2.17
-0.27
No
15
5.60
1.68
Table
4: T-test Comparison of Likert-scale Statements by History of Taking an Online Course Previously
n, number of participants; t, independent sample t-test; df, degrees of freedom.
Preferred Learning Style
As reported in Table 5, the highest mean score (most agreement) for each Likert-scale statement was observed with those who selected reading/writing as their preferred learning style; four out of the five differences in means reached statistical significance. There were also statistically significant findings on the pairwise analysis of the different learning styles (Table 6).
Likert-scale Statement
Visual
n
Mean
Standard Deviation
95{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} confidence interval for mean
p-value
Lower Bound
Upper Bound
Most people believe that online learning is more effective than traditional methodologies.
Visual
141
2.75
1.49
2.50
3.00
0.04
Auditory
30
2.70
1.70
2.06
3.34
Reading/Writing
61
3.08
1.80
2.62
3.54
Kinesthetic
159
2.44
1.44
2.21
2.67
In a course with both traditional and online methodologies, I learn better through the online format.
Visual
141
2.84
1.71
2.56
3.13
0.02
Auditory
30
2.77
1.87
2.07
3.46
Reading/Writing
61
3.33
2.07
2.80
3.86
Kinesthetic
159
2.53
1.56
2.29
2.78
I prefer online courses to traditional courses.
Visual
141
3.01
1.83
2.71
3.32
0.01
Auditory
30
2.73
1.91
2.02
3.45
Reading/Writing
61
3.56
2.25
2.98
4.13
Kinesthetic
159
2.60
1.75
2.32
2.87
I believe that I can learn the same amount in an online course as in a traditional course.
Visual
141
3.57
1.99
3.24
3.90
0.55
Auditory
30
3.57
1.96
2.83
4.30
Reading/Writing
61
3.66
2.06
3.13
4.18
Kinesthetic
159
3.30
1.94
3.00
3.61
I believe that I can make the same grade in an online course as in a traditional course.
Visual
141
4.43
1.97
4.10
4.75
0.04
Auditory
30
4.47
2.13
3.67
5.26
Reading/Writing
61
5.03
1.75
4.58
5.48
Kinesthetic
159
4.19
1.93
3.89
4.49
Table
5: One-way ANOVA of Likert-scale Statements with Preferred Learning Styles
n, number of participants
Likert-scale Statement
Preferred Learning Style (a)
Preferred Learning Style (b)
Mean difference
(a-b)
95{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} confidence interval for mean
p-value
Lower Bound
Upper Bound
Most people believe that online learning is more effective than traditional methodologies.
Visual
Auditory
0.05
-0.75
0.85
1.00
Reading/Writing
-0.33
-0.94
0.28
0.50
Kinesthetic
0.31
-0.15
0.77
0.30
Auditory
Visual
-0.05
-0.85
0.75
1.00
Reading/Writing
-0.38
-1.27
0.50
0.68
Kinesthetic
0.26
-0.53
1.05
0.83
Reading/Writing
Visual
0.33
-0.28
0.94
0.50
Auditory
0.38
-0.50
1.27
0.68
Kinesthetic
0.64
0.04
1.24
0.03
Kinesthetic
Visual
-0.31
-0.77
0.15
0.30
Auditory
-0.26
-1.05
0.53
0.83
Reading/Writing
-0.64
-1.24
-0.04
0.03
In a course with both traditional and online methodologies, I learn better through the online format.
Visual
Auditory
0.08
-0.82
0.97
1.00
Reading/Writing
-0.48
-1.17
0.20
0.26
Kinesthetic
0.31
-0.21
0.82
0.41
Auditory
Visual
-0.08
-0.97
0.82
1.00
Reading/Writing
-0.56
-1.55
0.43
0.46
Kinesthetic
0.23
-0.65
1.12
0.91
Reading/Writing
Visual
0.48
-0.20
1.17
0.26
Auditory
0.56
-0.43
1.55
0.46
Kinesthetic
0.79
0.12
1.46
0.01
Kinesthetic
Visual
-0.31
-0.82
0.21
0.41
Auditory
-0.23
-1.12
0.65
0.91
Reading/Writing
-0.79
-1.46
-0.12
0.01
I prefer online courses to traditional courses.
Visual
Auditory
0.28
-0.69
1.25
0.88
Reading/Writing
-0.54
-1.28
0.20
0.23
Kinesthetic
0.42
-0.14
0.98
0.22
Auditory
Visual
-0.28
-1.25
0.69
0.88
Reading/Writing
-0.82
-1.90
0.26
0.20
Kinesthetic
0.16
-0.83
1.10
0.98
Reading/Writing
Visual
0.54
-0.20
1.28
0.23
Auditory
0.82
-0.26
1.90
0.20
Kinesthetic
0.96
0.23
1.69
0.00
Kinesthetic
Visual
-0.42
-0.98
0.14
0.22
Auditory
-0.14
-1.10
0.83
0.98
Reading/Writing
-0.96
-1.69
-0.23
0.00
I believe that I can learn the same amount in an online course as in a traditional course.
Visual
Auditory
0.00
-1.03
1.03
1.00
Reading/Writing
-0.09
-0.87
0.69
0.99
Kinesthetic
0.27
-0.33
0.86
0.65
Auditory
Visual
-0.00
-1.03
1.03
1.00
Reading/Writing
-0.09
-1.23
1.05
1.00
Kinesthetic
0.26
-0.75
1.28
0.91
Reading/Writing
Visual
0.09
-0.69
0.87
0.99
Auditory
0.09
-1.05
1.23
1.00
Kinesthetic
0.35
-0.42
1.12
0.64
Kinesthetic
Visual
-0.27
-0.86
0.33
0.65
Auditory
-0.26
-1.28
0.75
0.91
Reading/Writing
-0.35
-1.12
0.42
0.64
I believe that I can make the same grade in an online course as in a traditional course.
Visual
Auditory
-0.04
-1.04
0.96
1.00
Reading/Writing
-0.61
-1.37
0.16
0.17
Kinesthetic
0.24
-0.34
0.81
0.72
Auditory
Visual
0.04
-0.96
1.04
1.00
Reading/Writing
-0.57
-1.68
0.55
0.56
Kinesthetic
0.28
-0.72
1.27
0.89
Reading/Writing
Visual
0.61
-0.16
1.37
0.17
Auditory
0.57
-0.55
1.68
0.56
Kinesthetic
0.84
0.09
1.60
0.02
Kinesthetic
Visual
-0.24
-0.81
0.34
0.72
Auditory
-0.28
-1.27
0.72
0.89
Reading/Writing
-0.84
-1.60
-0.09
0.02
Table
6: Tukey Post Hoc Pairwise Analysis of Preferred Learning Styles
Discussion
Purpose and major findings
The PA educational community has endured many challenges and evolved significantly over the last few years. Due to the unfortunate COVID-19 global pandemic, almost every PA program across the country quickly discovered its ability to implement didactic curriculum online and continue the education of PA students at a time when clinicians were crucially needed [23]. Academic administrators, faculty, students, and other stakeholders must now decide what role hybrid PA programs have in the future of PA education. Perceptions of PA students toward online learning should be considered in this discussion; determining these perceptions was the purpose of this study.
Most pre-COVID-19 studies show that health professions students generally prefer in-person over online education [13-17], and the results of the current study align with those findings. However, the current study also reveals a significant number of PA students who do prefer learning in an online environment. Despite the majority of participants (69.31{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, n = 271) preferring traditional courses, the survey nevertheless identified 23.79{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 93) who preferred online learning. Furthermore, as the sample population did not include students from programs that currently use online programming as a major component of their curriculum [2], the preference for online education of the entire PA student population may be slightly higher than reported here. The current study also provides insight into the type of student who may prefer learning online. Interestingly, data analysis showed no correlation between age and students’ preference for online education. Similarly, there were no significant relationships between gender or having previously taken an online course and preference for online education. However, a statistically significant relationship did exist between self-reported preferred learning styles and preference for online learning. Although only 15.6{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} (n = 61) of the sample reported their preferred learning style as reading/writing, this group had the most agreement with all Likert-scale statements favoring online education; four out of five of these results were statistically significant.
Relevance of findings
A substantial interest among PA students in online didactic education is not surprising considering other recent studies of medical students in a post-COVID-19 educational environment. Stoehr et al. collected cross-sectional data from 3,286 medical students across 12 countries [24]. In their study, 91{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of participants agreed that lecture-style education was a suitable teaching concept for online learning, 97{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} indicated they had the devices required for online learning, 80{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} felt comfortable using the software required for online learning, 76{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} felt well prepared for online learning, and 62{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} reported being happy with the quality of online courses [24]. Another post-COVID-19 study of 64 medical students at a United States-based allopathic medical school that moved the entire pre-clinical curriculum to a virtual format during the pandemic demonstrated that 70.3{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of students reported an unchanged or improved overall medical education in a virtual course module compared to a previous module that was taught in a traditional face-to-face setting [25]. Furthermore, a recent systematic review of 24 studies measuring medical student satisfaction with e-learning during the pandemic indicated that 51.8{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the 15,473 medical students studied were satisfied [26].
Study limitations
A potential limitation to this study is that it was conducted during the COVID-19 pandemic and perceptions of online education may have been influenced by either positive or negative experiences encountered during this turbulent time in medical education. Furthermore, the study was not experimental in nature and, therefore, could not control for other variables that may have influenced student perception of online PA education, such as the quality of instructional design and the types of resources made available to students at different institutions. Another limitation was that students were asked to self-report their VARK [21] learning style instead of completing the VARK questionnaire, and students were limited in their selection to only a single preferred learning style. Other limitations to this study are those inherent to survey-based research, including an inability to clarify study questions if needed and not allowing respondents to further explain their answers beyond predetermined survey selections.
Conclusions
Most didactic PA students (69.31{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) prefer traditional in-person education over online learning. However, the number of didactic PA students that do prefer online learning (23.79{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}) is also substantial. If we generalize these findings to the 11,299 maximum enrollment slots available per the last PAEA Program Report, there are potentially 2,689 students who may benefit from online/hybrid PA education. Despite these findings, only three out of the 282 currently accredited PA programs are designed to offer a significant portion of their curriculum in an online/hybrid format. Although more research is needed regarding hybrid PA education, based on the findings of this study, the researchers recommend more institutions consider exploring and/or piloting this type of program delivery. Future studies may consider determining the characteristics and preferred learning styles of students who decide to apply to online/hybrid PA programs and how a student’s preferred learning style relates to their satisfaction with, and success in, an online PA educational environment.
Anna Sutton was stunned when she acquired a letter from her husband’s work-based mostly health strategy stating that Humira, an pricey drug made use of to treat her daughter’s juvenile arthritis, was now on a lengthy record of medications deemed “nonessential gains.”
The July 2021 letter said the household could possibly take part in a new hard work overseen by a firm identified as SaveOnSP and get the drug absolutely free of demand or be saddled with a regular copayment that could major $1,000.
“It genuinely gave us no selection,” reported Sutton, of Woodinville, Washington. She additional that “every single solitary Fda-permitted medicine for juvenile arthritis” was on the list of nonessential rewards.
Sutton had unwittingly come to be element of a tactic that companies are making use of to offer with the substantial value of medication prescribed to handle ailments this sort of as arthritis, psoriasis, most cancers, and hemophilia.
Those people businesses are tapping into dollars presented through programs they have formerly criticized: patient money guidance initiatives established up by drugmakers, which some gain administrators have complained encourage individuals to continue to be on highly-priced manufacturer-title prescription drugs when significantly less highly-priced possibilities might be obtainable.
Now, nevertheless, employers, or the sellers and insurers they retain the services of specially to oversee these types of endeavours, are looking for that revenue to offset their individual prices. Drugmakers object, declaring the income was supposed largely for patients. But some advantage brokers and organizations like SaveOnSP say they can assist trim employers’ paying on coverage — which, they say, could be the distinction concerning an employer presenting coverage to personnel or not.
It really is the hottest twist in a very long-working dispute concerning the drug market and insurers in excess of which group is additional to blame for soaring expenditures to patients. And individuals are, yet again, caught in the center.
Patient advocates say the phrase “nonessential” stresses clients out even while it does not suggest the medicine — typically identified as “specialty” medications due to the fact of their large prices or the way they are made — are needless.
Some advocates anxiety the new approaches could be “a way to weed out all those with pricey health care requirements,” mentioned Rachel Klein, deputy government director of the AIDS Institute, a nonprofit advocacy team. Employees who rely on the medicines might truly feel pressured to improve insurers or employment, Klein reported.
Two variations of the new approach are in perform. Equally are used largely by self-insured businesses who seek the services of sellers, like SaveOnSP, which then get the job done with the employers’ pharmacy profit supervisors, these as Categorical Scripts/Cigna, to put into practice the strategy. There are also smaller sized sellers, like SHARx and Payer Matrix, some of which operate straight with companies.
In a person method, insurers or businesses go on to go over the medications but designate them as “nonessential,” which lets the health options to bypass once-a-year boundaries set by the Economical Care Act on how a lot sufferers can shell out in out-of-pocket expenses for drugs. The employer or hired seller then raises the copay required of the employee, normally sharply, but presents to significantly lower or eliminate that copay if the affected individual participates in the new exertion. Personnel who concur enroll in drugmaker economical support applications intended to protect the drug copays, and the seller monitoring the exertion aims to capture the highest volume the drugmaker gives per year, according to a lawsuit filed in May well by drugmaker Johnson & Johnson in opposition to SaveOnSP, which is primarily based in Elma, New York.
The employer need to nonetheless protect part of the charge of the drug, but the amount of money is decreased by the volume of copay support that is accessed. That aid can change extensively and be as considerably as $20,000 a calendar year for some medications.
In the other strategy, companies you should not hassle naming medications nonessential they basically fall coverage for specific medicines or classes of medication. Then, the exterior seller assists people deliver the monetary and other information and facts desired to utilize for no cost medicine from drugmakers via charity programs meant for uninsured individuals.
“We are seeing it in each individual point out at this stage,” said Becky Burns, main running officer and chief money officer at the Bleeding and Clotting Issues Institute in Peoria, Illinois, a federally funded hemophilia treatment method centre.
The approaches are largely staying employed in self-insured employer well being programs, which are ruled by federal rules that give wide versatility to businesses in developing wellbeing benefits.
However, some client advocates say these courses can guide to delays for clients in accessing drugs even though apps are processed — and at times unpredicted charges for buyers.
“We have patients get billed following they max out their aid,” said Kollet Koulianos, vice president of payer relations at the National Hemophilia Basis. The moment she gets concerned, distributors often assert the payments had been sent in error, she claimed.
Even though only about 2{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f} of the workforce requires the medications, which can expense 1000’s of dollars a dose, they can guide to a significant economic liability for self-insured employers, reported Drew Mann, a gains consultant in Knoxville, Tennessee, whose clientele features businesses that use variations of these plans.
Prior to employer health and fitness plans took benefit of this kind of assistance, people typically signed up for these applications on their own, receiving discount coupons that protected their share of the drug’s cost. In that circumstance, drugmakers normally compensated a lot less than they do under the new employer techniques due to the fact a patient’s out-of-pocket charges have been capped at decreased amounts.
Brokers and the CEOs of corporations providing the new applications say that in most cases people carry on to get their medications, usually with tiny or no out-of-pocket charges.
If personnel do not qualify for charity mainly because their income is much too high, or for a different motive, the employer may possibly make an exception and shell out the declare or glimpse for an alternative answer, Mann claimed. Client teams mentioned that some specialty medicine might not have any alternate options.
How this apply will enjoy out in the very long operate remains uncertain. Drugmakers present each copay assistance and charity treatment in part since they know many individuals, even people with insurance policy, simply cannot manage their products and solutions. The programs are also excellent general public relations and a tax create-off. But the new emphasis by some businesses on maximizing the amount of money they or their insurers can collect from the plans could lead to some drugmakers to get problem with the new tactics or even reconsider their systems.
“Even while our customer, like most producers, offers billions in discounts and rebates to health insurers as element of their negotiations, the insurers also want this further pool of resources, which is intended to aid individuals who are unable to fulfill the copay,” mentioned Harry Sandick, a attorney representing J&J.
J&J’s lawsuit, filed in U.S. District Courtroom in New Jersey, alleges that individuals are “coerced” into taking part in copay assistance programs following their medicines are considered “nonessential” and hence are “no more time subject matter to the ACA’s yearly out-of-pocket greatest.”
The moment patients enroll, the money from the drugmaker goes to the insurer or employer approach, with SaveOnSP retaining 25{08cd930984ace14b54ef017cfb82c397b10f0f7d5e03e6413ad93bb8e636217f}, in accordance to the lawsuit. It promises J&J has misplaced $100 million to these efforts.
None of that funds counts toward patients’ deductibles or out-of-pocket maximums for the year.
In addition to the lawsuit in excess of the copay aid software efforts, there has been other reaction to the new employer methods. In an Oct letter to doctors, the Johnson & Johnson Patient Aid Foundation, a different entity, mentioned it will no for a longer time present free of charge prescription drugs to clients with insurance coverage setting up in January, citing the rise of these kinds of “choice funding courses.”
Still, J&J spokesperson L.D. Platt claimed the drugmaker has ideas, also in January, to roll out other help to sufferers who could be “underinsured” so they will not likely be impacted by the foundation’s decision.
In a statement, SaveOnSP explained that employers item to drug companies’ “applying their employees’ ongoing need to have for these medicines as an justification to retain climbing the drugs’ charges” and that the agency simply “advises these businesses on how to battle back again versus soaring rates when acquiring employees the drugs they will need at no cost to the workforce.”
In a court filing, SaveOnSP reported drugmakers have a different solution if they never like attempts by insurers and employers to max out what they can get from the courses: lower the sum of guidance offered. J&J, the filing stated, did just that when it recently reduce its allotted quantity of copay aid for psoriasis medicine Stelara and Tremfya from $20,000 to $6,000 for each participant on a yearly basis. The submitting famous that SaveOnSP individuals would nevertheless have no copay for these prescription drugs.
For Sutton’s portion, her spouse and children did participate in the plan provided by means of her husband’s operate-dependent insurance plan program, agreeing to have SaveOnSP check their enrollment and payments from the drugmaker.
So significantly, her 15-calendar year-previous daughter has ongoing to get Humira, and she has not been billed a copay.
Even so, “the total course of action appears variety of slimy to me,” she said. “The individuals are caught in the middle between the drug market and the insurance field, each and every hoping to get as a lot funds as feasible out of the other.”
KHN (Kaiser Well being News) is a national newsroom that provides in-depth journalism about wellbeing issues. With each other with Plan Evaluation and Polling, KHN is 1 of the 3 major running programs at KFF (Kaiser Loved ones Foundation). KFF is an endowed nonprofit business delivering information on health and fitness difficulties to the nation.
