PHYSICIAN ASSISTANT (PA) PRODUCTIVE FAILURE: THE EFFECTS OF PRODUCTIVE FAILURE IN PA EDUCATION

Abstract

AbstractIntroduction Physician assistants (PAs) need highly developed critical thinking and problem-solving skills, along with the ability to adapt to diverse clinical situations. The current highly structured nature of curricular activities in medical and PA training often fails to effectively transfer knowledge and skills to the clinical practice environment. This study proposes the implementation of Productive Failure (PF) in PA education through simulation-based clinical patient experiences. Productive failure is an instructional approach where learners attempt to solve complex problems before receiving formal instruction. Productive Failure aims to enhance critical thinking, problem-solving skills, learner motivation, and resilience among PA students. However, there is a lack of research evaluating the impact of PF in PA education. Methodology This study uses high-fidelity simulation scenarios to create realistic and challenging clinical situations, allowing learners to engage in problem-solving and experience initial failure in a controlled setting. All clinical phase students enrolled in the Oklahoma City University Physician Assistant program were invited to participate in this study. Voluntary participants were stratified based on an emergency medicine rotation completion, then randomly assigned to either a control or intervention group in a randomized control trial (RCT). Both groups participated in an observed structured clinical experience (OSCE) simulation activity. Immediately before and after the OSCE simulation, both groups completed pre-simulation and post-simulation surveys to assess self-efficacy (confidence) and emotional stress responses. Participants' clinical competency in decision-making was also evaluated during the simulation. The intervention group experienced productive failure during their OSCE simulation as the sole intervention. This involved a progressive decline in the patient’s clinical status despite appropriate medical interventions initiated by participants. Immediately following the OSCE simulation, each group participated in a debriefing session. Following this, only the intervention group took part in focus group discussions to reflect on learning from OSCE activities that incorporated PF in the patient scenario. Pre-simulation and post-simulation self-efficacy, pre-simulation and post-simulation emotional stress responses, and competency scores were analyzed to assess the effects on participants and the effectiveness of PF in PA education. Conclusion This study highlights the impacts and potential benefits of integrating productive failure into PA education through OSCE simulation, suggesting that this approach can better prepare students for the complexities of clinical practice. Future research is needed to explore the long-term effects and benefits of PF and its applicability across different PA education contexts.