title: Dermatology diagnoses among rural and urban physician assistants.
abstract: OBJECTIVE
  Dermatology is not heavily covered in the curricula of physician assistant (PA) programs or on the certification examination, even though patient visits to PAs for skin complaints are very common. If significant on-the-job training is thus required for dermatology care, then practice setting differences likely impact the quality of that informal training. This study sought to identify differences in the ability of rural and urban PAs to diagnose skin disorders.
  
  
  METHODS
  An Internet-based survey of rural and urban primary care PAs (n = 295) was conducted. The survey collected demographic information and provided case scenarios with questions related to diagnosis of a skin disease or complication.
  
  
  RESULTS
  Average quiz score was higher for rural PAs than for urban PAs (61.6% versus 55.4%, P = .024). Rural PAs more commonly treated the majority of their patients seen for skin complaints. Rural PAs reported a greater comfort level in diagnosing and treating skin disease than did urban PAs (91% versus 80%, P < .05). Both groups referred a comparable percentage of patients to skin specialists. Regression analysis identified several factors that accounted for the ability to predict success scores for both the rural (P < .05) and urban (P < .05) groups.
  
  
  CONCLUSIONS
  The stronger overall ability of rural PAs to diagnose a variety of skin diseases is likely impacted by the higher number of dermatologic cases they see. PA educators should re-evaluate the curricula devoted to skin conditions and consider elective opportunities for students with an interest in a dermatology career.
authors.affiliation: Bryon Brown was a student in the PA program at the Medical University of South Carolina (MUSC), Charleston, when this article was written and is the principal investigator and primary author. Co-investigator Reamer Bushardt is Associate Professor and Director, and co-investigator Kevin Harmon is Assistant Professor, both in the Division of Physician Assistant Studies, MUSC. Research mentor Shaun Nguyen is a physician, biostatistician, and Assistant Professor, Department of Otolaryngology, Head and Neck Surgery, MUSC. The authors have indicated no relationships to disclose relating to the content of this article.
authors.forename: Bryon
authors.initials: B
authors.lastname: Brown
authors.forename: Reamer
authors.initials: R
authors.lastname: Bushardt
authors.forename: Kevin
authors.initials: K
authors.lastname: Harmon
authors.forename: Shaun A
authors.initials: SA
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D002983:Clinical Competence; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010823:Physician Assistants / Q000523:psychology; D012017:Referral and Consultation; D019035:Rural Health Services / Q000706:statistics & numerical data*; D020377:Self Efficacy; D012871:Skin Diseases / Q000175:diagnosis* / Q000628:therapy; D019037:Urban Health Services / Q000706:statistics & numerical data*; D055815:Young Adult