Sr Research Scholar, Medicine - Family & Community Medicine
Director, Primary Care Associate Program, Family Medicine (1974 - 2005)
Director of Evaluation, California Statewide AHEC Emergency Preparedness Program (2003 - 2008)
Executive Advisor and Evaluation Director, California Statewide AHEC Program (2005 - Present)
Associate Director, Center for Education iadn Research n Family and Community Medicine (2002 - 2010)
Honors & Awards
Recognition award, California Healthcare Workforce Policy Commisstion (2006)
MHS, University of California,Davis, Health Services (1980)
FNP, University of California,Davis, Family Medicine (1979)
BS, Duke University, Nursing (1964)
Community and International Work
Evaluation and development
California Statewide AHEC Program
Opportunities for Student Involvement
Community-based training for PAs/NPs
Opportunities for Student Involvement
External Evaluator, Botswana, Africa
Evaluation of National Nurse Practitioner Program
Opportunities for Student Involvement
Current Research and Scholarly Interests
Evaluation of academic-community programs for health professionals in medically underserved areas
Training of health professionals for medically underserved areas/populations
Program development in medical education (Family Medicine and (AHECs)
National and state policy workforce development
Forging successful academic-community partnerships with community health centers: the California statewide Area Health Education Center (AHEC) experience.
2014; 89 (1): 33-36
Increased access to insurance under the Affordable Care Act will increase demands for clinical services in community health centers (CHCs). CHCs also have an increasingly important educational role to train clinicians who will remain to practice in community clinics. CHCs and Area Health Education Centers (AHECs) are logical partners to prepare the health workforce for the future. Both are sponsored by the Health Resources and Services Administration, and they share a mission to improve quality of care in medically underserved communities. AHECs emphasize the educational side of the mission, and CHCs the service side. Building stronger partnerships between them can facilitate a balance between education and service needs.From 2004 to 2011, the California Statewide AHEC program and its 12 community AHECs (centers) reorganized to align training with CHC workforce priorities. Eight centers merged into CHC consortia; others established close partnerships with CHCs in their respective regions. The authors discuss issues considered and approaches taken to make these changes. Collaborative innovative processes with program leadership, staff, and center directors revised the program mission, developed common training objectives with an evaluation plan, and defined organizational, functional, and impact characteristics for successful AHECs in California. During this planning, centers gained confidence as educational arms for the safety net and began collaborations with statewide programs as well as among themselves. The AHEC reorganization and the processes used to develop, strengthen, and identify standards for centers forged the development of new partnerships and established academic-community trust in planning and implementing programs with CHCs.
View details for DOI 10.1097/ACM.0000000000000069
View details for PubMedID 24280858
Exercises in Emergency Preparedness for Health Professionals in Community Clinics
JOURNAL OF COMMUNITY HEALTH
2010; 35 (5): 512-518
Health professionals in community settings are generally unprepared for disasters. From 2006 to 2008 the California Statewide Area Health Education Center (AHEC) program conducted 90 table top exercises in community practice sites in 18 counties. The exercises arranged and facilitated by AHEC trained local coordinators and trainers were designed to assist health professionals in developing and applying their practice site emergency plans using simulated events about pandemic influenza or other emergencies. Of the 1,496 multidisciplinary health professionals and staff participating in the exercises, 1,176 (79%) completed learner evaluation forms with 92-98% of participants rating the training experiences as good to excellent. A few reported helpful effects when applying their training to a real time local disaster. Assessments of the status of clinic emergency plans using 15 criteria were conducted at three intervals: when the exercises were scheduled, immediately before the exercises, and for one-third of sites, three months after the exercise. All sites made improvements in their emergency plans with some or all of the plan criteria. Of the sites having follow up, most (N = 23) were community health centers that made statistically significant changes in two-thirds of the plan criteria (P = .001-.046). Following the exercises, after action reports were completed for 88 sites and noted strengths, weaknesses, and plans for improvements in their emergency plans Most sites (72-90%) showed improvements in how to activate their plans, the roles of their staff, and how to participate in a coordinated response. Challenges in scheduling exercises included time constraints and lack of resources among busy health professionals. Technical assistance and considerations of clinic schedules mitigated these issues. The multidisciplinary table top exercises proved to be an effective means to develop or improve clinic emergency plans and enhance the dialogue and coordination among health professionals before an emergency happens.
View details for DOI 10.1007/s10900-010-9221-1
View details for Web of Science ID 000282703000009
View details for PubMedID 20146093
- EMERGENCY PREPAREDNESS EDUCATION AND TRAINING FOR HEALTH PROFESSIONALS: A BLUEPRINT FOR FUTURE ACTION BIOSECURITY AND BIOTERRORISM-BIODEFENSE STRATEGY PRACTICE AND SCIENCE 2010; 8 (1): 79-83
- Emergency Preparedness for Health Professionals in a Statewide AHEC Program: The First Two Years Academic Medicine 2007; 82 (August): 781-787
- The California PA Workforce: A 10 Year Perspective Perspectives on Physician Assistant Education 2000; 11: 152-156
Evaluating the potential of international medical graduates as physician assistants in primary care
1996; 71 (8): 886-892
The need to increase the nation's primary care workforce, and the presence of large numbers of international medical graduates (IMGs) who encounter barriers to licensure as physicians, have led to consideration of ways that IMGs might practice as physician assistants (PAs). Several states have explored regulatory changes that would allow IMGs to obtain PA certification through equivalency mechanisms or accelerated educational programs. In California, surveys in 1980, 1993, and 1994 collected information about the interest and preparedness among IMGs seeking PA certification. These surveys revealed that few of the IMGs were interested in becoming PAs as a permanent career, and few could show a commitment to primary care of the underserved. Of the 50 IMGs accepted into California's PA programs in recent years, 62% had academic or personal difficulties. Only 34 IMGs became certified, and all accepted jobs in primary care specialties. Two preparatory programs in California have assessed the readiness of unlicensed IMGs to enter PA programs, and they have shown that the participants did not demonstrate knowledge or clinical skills equivalent to those expected of licensed PAs. Therefore, policymakers should not consider that IMGs are or can easily become the equivalent of PAs without additional professional training in accredited PA programs. Preparatory programs appear to lessen the barriers to PA training for a few IMGs. In times of scarce resources for training, however, these programs may not be the best use of public funds to increase the primary care workforce.
View details for Web of Science ID A1996VC54200018
View details for PubMedID 9125965
- Effectiveness of Education Strategies Preparing Physician Assistants, Nurse Practitioners and Certified Nurse-Midwives for Underserved Areas Public Health Reports 1994; 109: 673-682
- Meeting the Needs of the Underserved. The Roles of Physician Assistants and Nurse Practitioners in Primary Care Associaton of Academic Health Centers 1993
THE EVOLUTION AND IMPACT OF THE NATIONAL AHEC PROGRAM OVER 2 DECADES
1991; 66 (4): 211-220
The national Area Health Education Center (AHEC) program began in 1972 with the purpose of addressing problems of the shortage of physicians and the maldistribution of health professionals. The 40 projects of the program have involved 37 states, 55 medical schools, numerous other health professions schools, and 117 local community AHECs. This 19-month study (1988-1990) was undertaken to systematically assess and clarify the organization, functions, activities, and effects of the national AHEC program over two decades. Data sources were mainly 263 interviews of persons representing the full spectrum of those associated with and participating in AHECs. The findings describe a national network of school and community partnerships that were engaged in planning and implementing educational activities and were responsive to changing needs of health care. The individual AHECs differ in structure and activities as a function of the era in which each began, legislative requirements, and the specific community's needs for health professionals. As organizations, AHECs have unique functions that appear to have benefited the target communities or regions, participating schools, students, and medical school residents. Viability of AHECs in the future will depend on their ability to maintain a focus on health professions education in spite of state or community pressure to provide direct services--both clinical services and public education. At the same time, success will depend on the AHECs' capacity to respond effectively to changing needs of the community and the health care delivery system.
View details for Web of Science ID A1991FG78300011
View details for PubMedID 2012653
FACTORS INFLUENCING THE DEVELOPMENT OF AREA HEALTH-EDUCATION CENTERS WITH TEXAS-MEXICO BORDER POPULATIONS
1990; 65 (12): 762-768
Area Health Education Centers (AHECs) have been viewed as an appropriate vehicle for implementing new initiatives for training health professionals who will work along the U.S.-Mexico border. Perceptions about this program in Texas were evaluated from July 1988 to June 1989 to identify problems and formulate suggestions that might be of use to academic health science centers (HSCs)--and in particular medical schools--working with Hispanic populations. Interviews were conducted with 116 people: the presidents and/or deans of all eight Texas HSCs and/or medical schools, other deans and faculty, community leaders in five border counties, and state officials. The school and community perspectives about past and present AHEC activities were compared. Some of the barriers were: insufficient components of the health care delivery system to support medical education in severely underserved areas; differing school and community priorities; cultural differences between the school faculty and the community; and feeling among community physicians and dentists that AHECs were a source of competition. The school and community respondents agreed that the AHEC program needs more cooperative planning and training that emphasizes public health education for future AHEC-like activities with border populations.
View details for Web of Science ID A1990EN32800013
View details for PubMedID 2252495
- A Profile of California's PAs The Western Journal of Medicine 1990; 153: 328-329
- Effects of a Program for Faculty Development in Geriatrics for Physician Assistant Teachers Gerontology and Geriatrics Edducation 1989; 9: 83-94
The effects of a program for faculty development in geriatrics for physician assistant teachers.
Gerontology & geriatrics education
1989; 9 (4): 83-94
A Geriatric Education for Physician Assistant (PA) Faculty program enrolled teachers from 21 of the 55 PA training programs in the country to participate in three-week training sessions at Stanford University. The faculty trainees took part in lecture/discussion, audio-visual review, clinical training, and individual conferences. They prepared a lecture and a complete geriatric teaching plan for their home program, and were assigned a text and numerous articles to read. Measures of effect of the training found the following: a significant increase in knowledge scores, although the trainees came into the program with relatively high scores; a heightened awareness and increased positive attitudes toward aging; high ratings of performance on a functionally oriented comprehensive health assessment; and augmented geriatric curriculum and clinical training in their home PA programs.
View details for PubMedID 2573563
RECRUITMENT AND RETENTION OF MINORITY-STUDENTS IN A PHYSICIAN ASSISTANT PROGRAM
JOURNAL OF MEDICAL EDUCATION
1987; 62 (6): 477-484
The authors report two years of experience in the recruitment and retention of minority physician assistant students and the employment patterns of graduates from one physician assistant program. Recruitment strategies increased the proportion of minority students to 54 percent in the first year of the program and to 44 percent in the second year. The number of years of postsecondary education and clinical experience acquired by the minority students before admission to the program tended to have less impact on their performance in training than did their prior completion of formal academic degree programs and prior level of clinical responsibility. Attrition was higher for the minority students than nonminority students, and the minority students took longer than nonminority students to complete the program. The rates at which the students passed the certifying examination of the National Commission on Certification of Physician's Assistants were comparable for the two groups. Minority graduates tended to practice in areas of health manpower shortage.
View details for Web of Science ID A1987H761700004
View details for PubMedID 2885420
- A Program to Recruit and Retain Minority Students in Physician Assistant Training Programs Journal of Medicial Education 1987; 62: 477-484
THE EFFECT OF DECENTRALIZED EDUCATION VERSUS INCREASED SUPPLY ON PRACTICE LOCATION - EXPERIENCE WITH PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS IN CALIFORNIA, 1972-1982
1984; 22 (8): 760-769
To improve the geographic distribution of physician assistants and nurse practitioners in California, the Primary Care Associate Program established five community-based training sites in outlying areas while continuing to operate its core program within the San Francisco Bay Area. To evaluate this effort, the authors prospectively compared the employment locations of graduates from both groups, achieving a follow-up rate of 95%. Graduates from community sites were twice as likely to locate first practices outside the Bay Area (91% vs. 43%, P less than 0.05) and in towns with less than 10,000 inhabitants (33% vs. 16%, P less than 0.05). Over the decade, the percentage of graduates practicing outside the Bay Area rose from 0 to 9% for trainees both recruited from and entirely trained within the Bay Area versus 76-84 percent for trainees experiencing any element of decentralization. The slopes of these two lines represent the effect of the increasing supply of graduates on practice location away from Stanford (9%); the distance between the lines, the greater effect of decentralization (73%). Given the goal of statewide deployment of a small number of graduates, decentralization appears to have been an effective approach.
View details for Web of Science ID A1984TF17400008
View details for PubMedID 6147445
- The Effect of Decentralized Education Versus Increased Supply on Practice Location: Experience with Physician's Assistants and Nurse Practitioners in California Medical Care 1984; 22: 760-769
- Unlicensed Foreign Medical Graduates in California: Social and Demographic Characteristics and Progress Towards Licnesure Medical Care 1983; 21: 1168-1186
- Educational Decentralization and Deployment of Physician's Assistants Journal of Medical Education 1983; 58: 194-200
UNLICENSED FOREIGN MEDICAL GRADUATES IN CALIFORNIA - SOCIAL AND DEMOGRAPHIC CHARACTERISTICS AND PROGRESS TOWARD LICENSURE
1983; 21 (12): 1168-1186
Foreign-born physicians graduated from foreign medical schools who were unlicensed in California are described by nationality, age, sex, location, visa status, employment, English fluency, and specialty. Over 1,210 unlicensed foreign medical graduates (FMGs) were located in California and 736 were interviewed, approximately 40% of the estimated 3,000 FMGs residing in the state. Most of the FMGs who passed the ECFMG and FLEX were young, had specialty training, had studied for the examination, had participated in review courses, and were unemployed. GMENAC projections for the number of FMGs entering the residency pool to the year 1990 may be far too low, because many unlicensed FMGs are already in the country. Two thirds of the FMGs studied came to the United States after immigration of FMGs was restricted in 1977. Many were refugees or were from countries in political upheaval. Policy issues raised are the role of FMGs in improving care to the underserved, medical standards, humanitarian issues related to the resettlement of refugees and immigrants, and the projected oversupply of physicians.
View details for Web of Science ID A1983RT85200004
View details for PubMedID 6656340
EDUCATIONAL DECENTRALIZATION AND DEPLOYMENT OF PHYSICIANS ASSISTANTS
JOURNAL OF MEDICAL EDUCATION
1983; 58 (3): 194-200
A community-based educational network was established to improve the deployment of physician's assistants away from the original site of training in California's San Francisco Bay Area. The philosophy underlying the program decentralization, lessons learned during its implementation, and outcomes of the decentralization are discussed. The graduates' practice locations for a seven-year period are compared before and after the decentralization of the program. Before decentralization, 58 percent of the graduates established their first practice outside of the Bay Area. Following decentralization, 100 percent of the students trained entirely within community settings took their first jobs away from the Bay Area. Unique aspects of this decentralization experience compared with those reported previously included the lack of a required student-preceptor match at the time of entry into the program, the provision of clinical training in or near the site of student residence, and the opportunity to compare before and after effects of decentralizing educational components other than preceptorships.
View details for Web of Science ID A1983QG92600005
View details for PubMedID 6131139
- The Physican's Assistant Movement: Evolution and Issues Journal of Family and Community Health 1980
COOPERATIVE EDUCATION-PROGRAM FOR NURSE PRACTITIONERS PHYSICIANS ASSISTANTS
JOURNAL OF MEDICAL EDUCATION
1979; 54 (10): 781-787
Traditionally, nurse practitioners and physicians' assistants have been trained separately. Despite similarities in curriculum and graduate practice, there has been little or no articulation between their training programs or professional organizations. In 1977 the Family Nurse Practitioner Program at the School of Medicine, University of California, Davis, and the Primary Care Associate Program at Stanford University Medical Center merged clinical curricula. In this article the authors describe the cooperative educational venture and evaluate its first year.
View details for Web of Science ID A1979HP41000005
View details for PubMedID 40030
- Clinical Assessment for the Nurse Practitioner C.V.Mosby 1973
- A Cooperative Program for Family Nurse Practitioners and Physicins's Assistants Journal of Medical Education 1969