​​​JAAPA is the peer-reviewed clinical journal of the American Academy of Physician Assistants (AAPA). Published for more than 25 years, its mission is to support the ongoing education and advancement of physician assistants (PAs) by publishing current information and research on clinical, health policy, and professional issues.

Published monthly, JAAPA's award-winning editorial includes:

-Clinical review articles (with AAPA-approved Category I CME in each issue)-
Case reports-
Clinical departments-
Original health services research-
Articles on issues of professional interest to PAs

JAAPA (Journal of the American Academy of Physician Assistants) is the peer-reviewed clinical journal of the American Academy of Physician Assistants (AAPA). Published for over 25 years, its mission is to support the ongoing education and advancement of physician assistants (PAs) by publishing current information and research on clinical, health policy, and professional issues. Published monthly, JAAPA's award-winning editorial includes: clinical review articles (with AAPA-approved Category I CME in each issue), case reports, clinical departments, original health services research, and articles on issues of professional interest to PAs.

JAAPA（美国医师助理协会官方期刊）是美国医师助理协会（AAPA）的一本经过同行评审的临床期刊。该期刊已出版超过25年，旨在通过发布关于临床、健康政策和专业问题的最新信息和研究，支持医师助理（PAs）的持续教育和职业发展。JAAPA每月出版，获奖的编辑内容包括：临床综述文章（每期均附有AAPA批准的I类CME）、病例报告、临床部门、原创健康服务研究，以及与PAs专业相关的问题文章。

JAAPA : official journal of the American Academy of Physician Assistants

Pheochromocytoma is a rare catecholamine-secreting tumor. Unless recognized and treated appropriately it can be lethal. Common symptoms include sustained or paroxysmal hypertension associated with headaches, sweating, or palpitations. This article describes a patient with an extra-adrenal pheochromocytoma who presented with symptoms associated with voiding.

Paige Williams

Larry Siref

Mike Feloney

JAAPA

Pheochromocytoma of the bladder

膀胱嗜铬细胞瘤

Attention-deficit/hyperactivity disorder (ADHD) is a common disorder affecting people of all ages, and is characterized by inattention, hyperactivity, and impulsivity. Adults frequently have less hyperactivity or impulsivity but struggle more with inattentiveness and restlessness. Adults also may have comorbid psychiatric conditions and substance use issues that can make ADHD challenging to detect and treat. If left untreated, ADHD may harm the patient's quality of life. This article examines therapies for treating adults with ADHD.

Pamela Ann Melvin Sater

Focus on function

关注功能

Recent research has suggested that ketorolac has an analgesic ceiling effect, meaning that despite increased dosages, the patient obtains no additional pain relief and is more likely to suffer adverse drug reactions. This article describes the outcomes of these studies and the recommendation to use the lowest possible dose for the shortest time when treating patients with acute pain.

Reynold Jaglal

Eric C. Nemec

What is the analgesic ceiling dose of ketorolac for treating acute pain in the ED?

酮咯酸治疗急诊急性疼痛的镇痛上限剂量是多少？

ABSTRACT Wilms tumor, also known as nephroblastoma, is relatively rare but is the most common renal malignancy in children, accounting for about 5% of all childhood malignancies and 90% of all childhood renal malignancies. Advances in the understanding of the underlying cause and pathophysiology of Wilms tumor have significantly improved the prognosis and survival rates for children with Wilms tumor, but cases may occur sporadically and certain affected patients face higher rates of relapse and morbidity. The most common clinical presentation involves the identification of an abdominal mass or swelling without other signs or symptoms. The nonspecific nature of symptoms that can present can delay timely diagnosis and treatment. Numerous predisposing syndromes are associated with an increased risk for the development of Wilms tumor. Clinicians who recognize these syndromes and other conditions and understand the increased risk can provide the appropriate level of anticipatory guidance and use the optimal screening plan.

David Meni

Wilms tumor and associated predisposing syndromes and conditions

肾母细胞瘤及其相关易感综合征和疾病

FigureFigureFigureFigureThe past decade witnessed a surge in patient demand for healthcare services in the United States, primarily driven by Medicaid expansion in 2015. This surge necessitated enhancing programs for physician associates/assistants (PAs) and advanced practice registered nurses (APRNs; an umbrella term for NPs, certified nurse midwives, and certified registered nurse anesthetists) to ensure that the healthcare workforce could adequately meet the needs of the newly insured population. In response to this challenge, an academic medical center experiencing rapid expansion of its PA and APRN workforce and clinical rotations established a preceptor academy. The goal of the academy was to improve the quality of clinical education provided and support the continuous professional development of preceptors. The term advanced practice provider (APP) is used in this institution to refer to PAs and APRNs. This article reviews the Preceptor Academy's journey, focusing on its development, effect, and future directions. BUILDING EXCELLENCE The Preceptor Academy's success stems from its innovative and comprehensive approach to preceptor development.1 Initially welcoming 20 fellows in 2014, the academy's membership has grown steadily to more than 100 members. A peer-driven governance structure ensures responsiveness to evolving educational needs.2 Technological integration, particularly during the COVID-19 pandemic, facilitated the academy's transition to virtual formats, expanding access and engagement. Committees such as Education, University Liaison, Awards, Membership & Elections, and Marketing play pivotal roles. The Education Committee evolved to deliver virtual educational materials, continuing medical education conferences, grand rounds sessions, and curated articles for newsletters. The University Liaison Committee strengthens partnerships with academic institutions, enhancing rotational experiences. The Awards Committee introduced a Preceptor of the Year recognition, ensuring fairness through a standardized evaluation process. A streamlined electronic system simplified membership application, renewals, fellow participation evaluation, and elections. The Marketing Committee facilitated the transition to virtual platforms and implemented recognition systems. The academic medical center's clinical career ladder offers a structured pathway for professional development, fostering motivation and maintaining high standards (Table 1). Membership in the academy is recognized within the ladder, encouraging participation and enhancing productivity in educational projects.3 TABLE 1. - UPMC clinical career ladder Staff APP Entry level position Senior APP At least 3 years experience or completion of a postgraduate residency or fellowship. At least one advanced level clinical certification (such as advanced cardiac life support or pediatric advanced life support) if practicing in an inpatient setting, or completion of six citizenship grand rounds modules in the past 12 months, as approved by business unit. Must maintain a solid/strong/good performance rating or higher on annual performance evaluation to maintain status. Must have department chair approval for promotion. Completion of a professional development compendium as approved by committee, including supporting documentation, as directed by the senior promotion application. Expert APP At least 5 years experience, including 3 years at UPMC. Postgraduate APP residency or attainment of a certificate of added qualification in a relevant clinical area (if a PA) or doctor of nursing practice attainment (if an NP), or other certificate program that includes coursework of a minimum 50 educational hours and has a test to certify knowledge retention, or a compendium demonstration of advanced practice professional contributions consisting of at least three items from the list below, or a compendium as approved by committee: Evidence of scholarly work (submitted manuscripts, poster or abstract presentation, invited lecturer/guest presenter at either regional or national proceedings, evidence of ongoing research. Attainment of a nonclinical degree (MBA, MS, PhD). Demonstration of clinical precepting of one APP student per calendar year for at least 5 years. Membership in Preceptor Academy. Minimum of 3 years serving on a committee. Must maintain a solid/strong/good performance rating or higher on annual performance evaluation to maintain status. Completion of a peer review committee-approved professional contribution. Must have department chair approval for promotion. DELIVERING EXCELLENCE The Preceptor Academy's initiatives have significantly improved the quality of education, professional development, and retention rates among preceptors. Quality of education The Education Committee's efforts in continuous professional development have led to preceptors reporting higher levels of preparedness and confidence in their teaching abilities. This improvement is reflected in the positive feedback from students, who cite consistent, high-quality clinical rotations.4 Professional development The clinical career ladder has provided a clear pathway for preceptors to advance their careers, encouraging them to achieve higher levels of recognition. Many preceptors have benefited from this structured career advancement, taking on leadership roles in their departments. Retention and satisfaction The academy has significantly contributed to higher retention rates among preceptors. The Membership & Elections Committee, by ensuring a diverse and inclusive membership with a strong sense of community among preceptors, has contributed to increased job satisfaction through the combination of professional growth opportunities, recognition, and support.5 SUSTAINING AND EXPANDING THE ACADEMY Looking ahead, the Preceptor Academy aims to sustain its effect by expanding the scope of the clinical career ladder, creating new modules focused on emerging medical technologies, and increasing research activities to inform the wider educational community. These initiatives will ensure that the academy remains at the forefront of educational innovation, supporting the professional development of healthcare learners and clinicians alike.6 Ultimately, the academy's comprehensive approach serves as a model for effective preceptor education evolution in clinical settings, with far-reaching implications for the healthcare sector. CONCLUSION The Preceptor Academy's evolution over the past decade reflects its commitment to enhancing the quality of clinical education and supporting the professional development of preceptors. Through innovative programming, peer-driven governance, and strategic initiatives, the academy has made significant strides in transforming the educational landscape for PAs and APRNs. As it continues to adapt and expand, the Preceptor Academy remains a central asset in shaping the future of healthcare education and delivery.

Amy Haller

Autumn Groscost

Hayley Quigley

Benjamin Reynolds

The evolution and effect of a preceptor academy for PAs and APRNs

PA和APRN导师学院的演变与影响

ABSTRACT Major depressive disorder (MDD) is a common psychiatric condition that causes considerable morbidity and disability. MDD is characterized by recurrent depressive episodes that can result in loss of productivity, job insecurity, social isolation, and suicidality. Primary care providers frequently provide the initial management of MDD; however, some patients do not respond to first- or second-line treatments, a condition called treatment-resistant depression (TRD). Understanding how to accurately diagnose and manage TRD is important for clinicians.

Cyrus Ma

Brittany Strelow

Recognition and management of treatment-resistant depression

难治性抑郁症的识别与管理

ABSTRACT Objective: This study investigated educational debt, repayment strategies, and other factors potentially related to recently certified physician associates/assistants' (PAs') choice or preference for primary care versus all other specialties. Methods: A national dataset from 2023 of recently certified PAs was used to conduct quantitative and qualitative analyses. Analyses were conducted separately for PAs who had accepted a clinical position and those who had not accepted a clinical position. Results: Overall, 88% of respondents reported having educational debt, with 13.5% owing $200,000 or more. PAs from backgrounds underrepresented in medicine had accrued higher educational debt than their counterparts. Educational debt was significantly associated with specialty choices/preferences: PAs with higher debt were more likely to opt for nonprimary care specialties. Qualitative analyses revealed that PAs rely on different strategies for repaying their loans, depending on whether they choose or prefer primary care or nonprimary care specialties. Conclusions: These results suggest that educational debt plays a role in specialty selection, but other factors also are significant.

Andrzej Kozikowski

Mirela Bruza-Augatis

Dawn Morton-Rias

Kasey Puckett

Colette Jeffery

Alicia Quella

Sheila Mauldin

Joshua Goodman

The effect of education debt on PAs' specialty choice or preference

教育债务对执业医师专业选择或偏好的影响

ABSTRACT Objective: This study examined the characteristics and effect of a doctoral degree on career metrics of physician associate/assistant (PA) graduates. Methods: This was a comparative analysis study of doctor of medical science (DMSc) program graduates. Characteristics from this survey were compared with program data and the National Commission on Certification of Physician Assistants Statistical Profile of Board Certified PAs for 2022. Results: Graduates self-reported that the DMSc degree was beneficial for receiving raises, promotions, and new leadership positions. Conclusions: The DMSc degree was considered a positive career benefit by graduates.

James R Kilgore

Thomas Colletti

Jenna Rolfs

James A Shuler

Elyse Watkins

Jeremy M Welsh

Stephen Lewia

Characteristics and career effect on PA graduates of a doctor of medical science program

医学科学博士项目毕业生的特征及其对职业的影响

Abbreviation	JAAPA.
Journal Impact	0.74
Quartiles(Global)	MEDICINE, GENERAL & INTERNAL(Q3)

ISSN	0893-7400, 1547-1896
h-index	27

Publication Information	Publisher: Lippincott Williams and Wilkins Ltd.，Publishing cycle: ，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1999，Proportion of original research papers: 84.38%，Self Citation Rate:12.50%， Gold OA Rate: 1.85%

JAAPA : official journal of the American Academy of Physician Assistants

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Pheochromocytoma of the bladder

Focus on function

What is the analgesic ceiling dose of ketorolac for treating acute pain in the ED?

Wilms tumor and associated predisposing syndromes and conditions

The evolution and effect of a preceptor academy for PAs and APRNs

Wilms tumor and associated predisposing syndromes and conditions

The evolution and effect of a preceptor academy for PAs and APRNs

Recognition and management of treatment-resistant depression

The effect of education debt on PAs' specialty choice or preference

Characteristics and career effect on PA graduates of a doctor of medical science program