Below are some example past capstone projects:
How prevalent is low-value prostate cancer screening in primary care clinics? A pilot study using the National Ambulatory Medical Care Survey from 2013-2018
By Chris Gillette, Sarah Garvick, Nathan Bates, Courtney Martin, MMS, PA-C, Amresh Hanchate, Daniel Reuland
Introduction
There has been an increasing focus on improving value in health care and de-implementing the use of low-value services, such as prostate cancer (PC) screening for men aged >70 years. It is unclear whether utilization of low-value PC screening has changed over time nationally. The objectives of this study are to: (1) identify the proportion of primary care visits at which low-value PC screening is ordered, and (2) identify predisposing, enabling, and health care need characteristics that are associated with low-value PC screening in the United States.
Methods
This was a secondary analysis of the National Ambulatory Medicare Care Survey (NAMCS) datasets from 2013-2016 and 2018. Andersen’s Behavioral Model of Health Services Use guided independent variable selection. Weighted multivariable logit models were used to analyze the data. Results from the regression models are presented with odds ratios (OR) and 99.5% confidence intervals (CI).
Results
There were 6.71 low-value PSAs per 100 visits (95% CI=5.19-8.23) and 1.65 low-value DREs per 100 visits (95% CI=0.91-2.38). For each additional service ordered by PCPs, the odds of ordering a low-value PSA increased by 49% (OR=1.49, 99.5% CI=1.33, 1.67) and the odds of performing a low-value DRE increased by 37% (OR=1.37, 99.5%=1.15, 1.63). For e:ch additional increase of number of previous visits, the odds of performing a low-value DRE decreased by 8% (OR=0.92, 95% CI=0.85-0.996).
Conclusions
The use of low-value PSA and DRE was sizable during the observed time period. Organizations who want to reduce low-value PSA and DRE may want to focus interventions on providers who order a high number of tests.
Publication
Dual Process Clinical Reasoning Assessment: Quantifying the Qualitative
By Caroline B. Sisson, Joshua Waynick, Chris Gillette
Introduction
Clinical reasoning is a vital skill for every patient provider, yet theory behind clinical reasoning and assessment remain difficult to define. Dual process theory is a potential theoretical model to better understand teaching and assessing clinical reasoning development in physician associates (PA) trainees.
Objectives
(1) Describe the development of a standardized clinical reasoning assessment for preclinical PA students; (2) describe the assignment of student grades based on a standardized checklist, clinical faculty judgment with a global rating scale, and faculty panel review; and (3) evaluate interrater reliability between grading performed by individual faculty members and grading conducted by the faculty panel.
Methods
Three clinical faculty members created a checklist to assess preclinical PA students’ clinical reasoning on a standardized patient assessment. Individual faculty graders and a panel of faculty graders evaluated student performance. Interrater reliability between individual faculty members and the faculty panel was assessed using Cohen’s kappa.
Results
The study participants included 88 PA students (n=88) and 12 faculty evaluators (n=12). The faculty panel changed 11 grades (12.5%) from individual faculty members. Cohen’s kappa indicated substantial agreement (k=0.698, 95% CI: 0.54-0.85) between the individual faculty members’ grades and the faculty panel’s grades.
Conclusions
The process of conducting a comparison of a checklist, the global rating scale, and a panel review improves the standardization of clinical reasoning assessment.
Publication
Dual Process Clinical Reasoning Assessment: Quantifying the Qualitative - PubMed (nih.gov)