Introduction
Over the past decade there has been a movement within the physician assis-tant (PA) profession toward the master’s degree, making it now the most common degree among PA educa-tional programs. In August 2003, 67.6% (n=90) of the 133 institutions offering a PA program had a graduate degree pathway available.1 This progression began with only 14.3% of university-based PA programs offering graduate degrees in 1990,2and grew to
40% of 110 programs by 1999.3 The shift has been fostered by policies and positions taken by the American Academy of Physician Assistants’ House of Delegates4and the Association of PA Programs (APAP)5 in 2000, and changes in the PA program accredita-tion standards made effective in 20016 that recognized and supported PA education at the graduate level. These actions, however, have not specified whether this graduate-level education should be considered academic or professional in nature.
Master’s degree curricula, regardless of the discipline, generally require more than one, but usually not more than two years of full-time study, and often include the following elements:
• Core introductory courses that present the theory and foundations of the discipline
• A concentration or specialization within the discipline
• Cognate courses to support and broaden the curriculum, but that are external to the discipline
• An integrative experience synthe-sizing the discipline’s theory in practice
• A summative experience such as a thesis, research project, or compre-hensive exam to measure student achievement7
By the 1960s, professional schools had developed in a number of fields, including business, engineering, nursing, and social work. As these programs began to require a baccalaureate degree for entrance, the master’s degree devel-oped as the first professional degree in some fields. With strong links to their professions, including accreditation standards for the curriculum, these professional degrees developed as rigorous but career-oriented practice degrees.7
Mark R. Zellmer, MA, PA-C; Robert D. Hadley, PhD, PA-C
A Descriptive Analysis of Capstone Project
Requirements in Academic and Professional
Physician Assistant Master’s Degree Programs
Introduction: Master’s-level physician assistant (PA) programs have increased in number during the past decade. These programs might be described as “academic” or “professional” based on curricula and degree. PA graduate programs may require a thesis or capstone project. The purpose of this study is to characterize the curricula and capstone projects of master’s level PA programs. Methods: An electronic survey of PA programs was conducted regarding degree status and capstone requirements. Results: Responses project that over 80% of PA programs will grant master’s degrees by 2005. There are currently equal numbers of academic and professional curricular and degree types. The professional degree is more common among programs anticipating a transition to the master’s degree. The typical capstone project requires a formal proposal, allows 12 months to complete the project, involves about 5 academic credits, and generally does not require institutional review board review. Conclusion: As more master’s-level PA programs have developed there appears to be a shift toward a professional degree. There exists substantial diversity of requirements, project products, and types of research included in PA program capstone requirements.
(Perspective on Physician Assistant Education 2004;15(2):82-87)
Mark Zellmer is an associate professor and director of UW-L–Gundersen–Mayo Physician Assistant Program, La Crosse, Wisconsin. Robert Hadley is director of Graduate Studies, University of Kentucky Physician Assistant Program, Lexington, Kentucky.
Correspondence should be addressed to:
Mark R. Zellmer, MA, PA-C UW-L–Gundersen–Mayo PA Program 1725 State Street, 4046 Health Science Center La Crosse, WI 54601
Voice: 608-785-6629 Fax: 608-785-6647
Table 1 identifies some distinguishing characteristics for professional and acade-mic master’s degree programs generally.7 There is, however, limited published research describing the nature of PA master’s curricula or the features that distinguish graduate from undergraduate PA education. There is even less research on the difference between academic and professional PA master’s degrees.
A 1995 survey characterizing the nature of PA graduate programs at that time indicated that most PA graduate programs required some type of research experience.8In 1998, 22 of the 25 grad-uate PA programs had some type of thesis, senior project, capstone project, or comprehensive exam.9 In 2001, Teasdale et al studied the nature and impact of one PA program’s 9-year history of requiring a research project and reporting the results of the project in a master’s paper. This collection of 164 master’s papers included primarily descriptive and observational studies; about 18% were experimental studies. A survey of graduates of the program indi-cated that the research project and master’s paper was effective in providing skills to critically evaluate the medical literature, learn the research process, and identify possible research questions in practice. For 42% of these graduates, the project fostered their interest in continu-ing research activities; however, it did not influence their first job preference.10
The literature describes distinctions between professional and academic degrees at the doctoral level in a number
of health-related disciplines including nursing,11 physical therapy,12 and occu-pational therapy,13 among others. However, there is little literature distin-guishing the academic from the profes-sional master’s degree in the health professions. Being able to identify distinctions between academic and professional PA master’s degrees will contribute to a better understanding of these differences and may assist the profession in coming to a consensus on a common degree. With the rapidly growing number of graduate-level PA programs, a descriptive analysis of the nature of capstone projects will be helpful in identifying trends and appreci-ating the diversity of this element of PA graduate curricula.
Methods
Following approval by the APAP Research and Review Committee and the University of Kentucky Institutional Review Board, a survey was distrib-uted to PA program faculty across the country through a closed electronic mailing list in March of 2003. The survey instrument queried programs regarding their current and anticipated degree, the type of degree offered, the academic or professional nature of the program, and the nature of any capstone, thesis, or project require-ments for the degree. An electronic follow up was sent on two occasions, and a final request for a response was made during the APAP Semiannual Meeting in May 2003. Responses were
received electronically and by hard copy. A single investigator coded the responses for both qualitative analysis and quantitative analysis using SPSS for Windows. The Student t-test was used to determine statistical signifi-cance when comparing means while the Pearson chi square was used to compare proportions with p-values of less than 0.05 identified as statistically significant.
Results
A total of 63 usable responses were received, representing 47% of all PA programs and including 43 of the 90 programs (48%) that currently offer a master’s degree. Nineteen of the remaining 20 respondents represented PA programs that anticipated offering a master’s degree in the future. The antic-ipated date for implementing these graduate program transitions ranged from mid-2003 to 2008, with a median of mid-2004. Respondents were asked to classify the master’s degree as acade-mic or professional based on the following description (quoting from the survey): “Generally, an academic degree is awarded by an institution’s Graduate College, and must meet crite-ria set forth by the Graduate College. Professional degrees are generally awarded by another college, such as Allied Health, and criteria are deter-mined by the program itself.” Table 2 depicts the 60 responses received to this item. Twenty-eight programs identified the degree offered (or anticipated) as being academic and 28 identified the degree as professional, with the remain-ing four classifyremain-ing it as both academic and professional. The academic degree was more common among those programs currently offering a master’s degree, while the professional degree was more common among those that anticipate offering the degree in the future. These differences are statistically significant.
A total of 45 programs, including nine programs not currently offering a master’s degree, indicated that a capstone project was required in their
Table 1
Comparison of Characteristics of Academic and Professional Master’s Degrees
Academic Degree Professional Degree • Used for teaching, research, or predoctoral
study
• Standards determined by the department and graduate college of the institution • Does not demonstrate full competence in
the mode of inquiry for a field
• A consolation prize for those not complet-ing a doctorate
• Oriented to practice, terminal in nature • Standards established by the profession
usually through an accreditation process • Ties to a profession can make it a vigorous
curricula. Of the 43 programs currently offering a master’s degree, 36 programs (84%) currently require a capstone project while two additional programs indicated that they antici-pated adding a capstone requirement to their curricula. Among those programs anticipating implementation of a master’s degree, all 19 have or anticipate requiring a capstone project in their curricula. Thus, among the programs responding to the survey, almost all of them (93%) currently require or anticipate requiring a capstone project in their curricula.
The characteristics of capstone projects collected in the survey included the type of project required, whether or not a formal proposal was required, the source of ideas to gener-ate the project, the number of acade-mic credits associated with the project,
the time allowed from submission of the proposal to completion, institu-tional review board (IRB) require-ments, the number of projects leading to peer-reviewed publications, and the amount of time off from clinical expe-riences that was allowed to complete the project. Tables 3 and 4 depict the results and compare academic and professional program types. The typical capstone project requires a formal proposal, allows 12 months to complete the project once approved, is associated with about 5 academic credits, generally does not require IRB review, and infrequently leads to a peer-reviewed publication. About a month of dedicated research time without clinical responsibilities is allowed by 44% of programs. A comparison of these characteristics between academic and professional
program types shows no statistically significant differences.
Respondents described their capstone projects by selecting as many of the non-mutually exclusive types as applied to their program. Figure 1 presents the frequencies of these capstone project type categories. Analysis of these responses shows that a paper (83%) was the most commonly required capstone product. A formal oral presentation (56%) and poster presentation (31%) also were among the other commonly reported products. Among programs reporting at least one capstone project type, a system-atic review of the literature (70%) was the most commonly reported type of research, with original research the next most common (54%). When comparing these frequencies for programs granting academic or professional master’s degrees (Table 5), original research was signifi-cantly more common among the acade-mic programs.
Some programs are flexible in accepting capstone projects produced by individual students or groups or pairs of students. Of the 51 programs reporting these requirements, 32 (63%) only accept individual capstone projects while seven (14%) programs accept only group or paired projects. Academic programs more commonly accept
indi-Table 2
Frequency of the Type of Master’s Degree Offered by Current and Anticipated Master’s Program Respondents
Academic Professional Both Total Chi square
(n) (n) p value
Current master’s 22 (51%) 18 (42%) 3 (7%) 43 <0.001 Anticipated master’s 6 (35%) 10 (59%) 1 (6%) 17 <0.001
Total 28 (47%) 28 (47%) 4 (6%) 60
Table 3
Capstone Project Characteristics
Percent of Standard N Respondents*
Capstone Project Characteristic Programs Mean Median Deviation Range (anticipated)†
Formal proposal required 96% 53 (14)
Time from proposal to completion (months) 12.5 12 9.5 1-60 44 (11)
Number of academic credits for project (semester hours) 5 4 4.9 1-32 43 (13)
Source of ideas for the project 52 (14)
Faculty 6%
Students 38%
Both 56%
Proportion of projects requiring IRB review (%) 32 5 9.5 1-60 31 (2) Proportion of projects in peer-reviewed publications (%) 6.6 3 8.3 0-30 26 (2)
Dedicated research time provided 44% 44 (10)
Amount of time off from clinical experiences (weeks) 4.9 4 3.4 2-14 15 (3)
*Total respondents to the item
vidual projects (75%) compared with professional programs (48%). This difference, however, did not reach statis-tical significance (p=0.14).
Most responding programs (65%) require a project or thesis committee for capstone projects, with the mean number of committee members being 2.5 (with a range of 1 to 6). Again a thesis/project committee was more common among academic programs (58%) than in professional programs (48%), but the difference was not statis-tically significant (p=0.85). There was a wide variety of membership structures
reported for the thesis/project commit-tees, including those that allowed only faculty with graduate faculty status to serve on the committee, while other programs included all faculty including preceptors and other faculty with adjunct appointments. In 89% of the responding programs, at least one PA program core faculty member was required to serve on each committee.
There was a wide variety of ways in which programs reported recognizing the workload associated with serving on thesis/project committees. Six of the responding 22 programs described a
formal means of accounting for this committee work in faculty workload. Others described reporting the activity as service or including it in promotion portfolios. However, some respondents suggested that this workload was not well recognized by the program or insti-tution, with responses such as “acknowl-edged with moans and groans,” “it is not (recognized),” or “ha ha.”
Respondents were asked to describe the impetus for having a capstone project requirement in their curriculum. Of the respondents (n=36) to this question, a minority (28%) indicated that it was an institutional requirement or a require-ment of institutional accreditation. A majority of responding programs (78%), however, reported that the capstone requirement was optional in their institu-tion or that it is a requirement estab-lished by the program. Among professional programs, 18% reported that their capstone requirement was driven by institutional or accreditation requirements. Among the academic programs, 35% reported that their capstone requirements were driven by these institutional or accreditation requirements. This difference, however, was not statistically significant (p=0.28).
Discussion
The movement within the PA profes-sion toward the master’s degree certainly accelerated through the decade of the
Table 4
Comparison of Capstone Project Characteristics for Academic and Professional Physician Assistant Master’s Degrees
Number of Standard t-test
Capstone Project Characteristic Type respondents Mean Deviation p-value Number of academic credits for Academic 21 (51%) 6.2 6.4
0.20
project (semester hours) Professional 20 (49%) 4.2 3.0
Time from proposal to Academic 19 (48%) 15.0 13.1
0.18
completion (months) Professional 21 (52%) 10.5 5.1
Proportion of projects requiring Academic 15 (54%) 37.1 45.0
0.83
IRB review (%) Professional 13 (46%) 33.3 44.4
Proportion of projects in peer-reviewed Academic 14 (58%) 6.5 9.0
0.98
publications (%) Professional 10 (42%) 6.6 8.4
Amount of time off from clinical Academic 8 (57%) 5.6 4.6
0.39
experiences (weeks) Professional 6 (43%) 4.1 1.0
Figure 1
Frequency of Capstone Project Types
0 10 20 30 40 50
Other Narrative review Systematic review Poster Formal oral presentation Original research Community service Paper
Frequency, type of project
1990s and into the 21st century. If programs do in fact transition to the master’s degree as anticipated by respon-dents to this survey, at least 81% of current PA programs will offer a master’s degree by 2005. At that point, the level of the degree awarded with PA program completion may be approaching stan-dardization, following the debate on this point during the 1990s.
There is little apparent overall consensus about the nature of the PA master’s curriculum, whether academic or professional; survey respondents were about equally divided. Despite the criteria provided in the survey instru-ment to assist the respondents in deter-mining whether their program represented an academic or professional master’s degree, respondents still had some apparent difficulty in making the distinction between “academic” and “professional” for their programs. The definitions of the terms in the survey were based on the personal experiences of the authors with various academic institutions, and through discussions with other PA educators, and thus may not have been accepted by all respon-dents. With 6% of respondents identi-fying their degree type as “both,” these two degree types may represent two ends of a spectrum rather than mutually exclusive groups, further complicating
the interpretation of this characteriza-tion of the degree type.
The professional degree was more common among programs anticipating the master’s degree than those currently offering the degree. Several factors might contribute to these differences, including: a belief among transitioning programs that a profes-sional degree is more appropriate for clinicians, a relative lack of core faculty with credentials and skills to imple-ment a more traditional academic graduate degree, and the fact that the programs anticipating transition to the master’s degree may be located in insti-tutions that may not require academic master’s degrees to be of the academic type, or may be more supportive of the professional degree.
The analysis of capstone project characteristics in Tables 3 and 4 demon-strates considerable diversity among PA programs. The only characteristic on which there was substantial consensus is the requirement for a formal project proposal. The remainder of these char-acteristics have standard deviations that approach or exceed the value of the mean; have large differences between mean and median, suggesting that the data may be skewed by a small number of outliers; or generally have very large ranges. This all suggests wide variation
and limited central tendency for these characteristics. Such diversity of peda-gogy has been traditional among PA programs, and appears to continue with program’s capstone projects. Subgroup analysis based on academic or professional type fails to demon-strate any greater consensus on these characteristics within these subgroups.
The analysis of the capstone project type categories also shows considerable diversity and creativity among PA programs. The types of research include many non-traditional types, including systematic and narrative reviews and community service. The high ranking of the systematic review appears to recognize the importance of evidence-based practice. The inclusion of some alternative forms of research may also be the result of the diverse backgrounds of PA core faculty and is consistent with a profession that has relied on compe-tency-based credentials rather than a degree throughout much of its history. The fact that academic programs more commonly require original research for their capstone projects may not be unexpected.
Programs also appear to be using a variety of individual, paired, and group projects as capstones. Reasons for this might include the belief that the team concept is important in the completion of the capstone project much like it is in PA clinical practice, and that paired and group projects represent a useful means of efficiently utilizing limited time resources among faculty and students.
There is also considerable diversity in the structure and composition of the thesis/project committees among the programs. While some programs require the committee to be composed entirely of core faculty, some use no core faculty in this role. Institutional recog-nition of the workload involved with thesis/capstone committees and projects appears to have been accomplished in only a minority of programs. With the relatively recent arrival of many PA programs at the graduate level, programs may now just be developing
Table 5
Academic and Professional Program Capstone Project Type Comparison
Percent of Percent of Chi square Capstone Project Type Academic Programs Professional Programs p-value
Paper 84 80 0.11
Community service 20 20 0.83
Original research 64 48 0.04
Formal oral presentation 68 40 0.10
Poster 28 32 0.86
Systematic review 72 68 0.15
Narrative review 24 32 0.23
Other 32 12 0.24
Only one project type 8 20 0.08
Mean number of project types 3.5 2.8 Programs reporting at least
these mechanisms. Given the sometimes non-traditional types of capstone projects used, some institutions may need to find new means to recognize the associated workload.
A capstone project requirement is even more common among PA programs than the master’s degree itself, since 93% of programs respond-ing indicate they have or will have this requirement while only 81% have or anticipate granting a master’s degree. Future research that more completely describes capstone projects, identifies the skill set(s) to be developed by these projects, and reports the best pedagog-ical methods to accomplish these projects would benefit the PA profes-sion and PA educators. The develop-ment of faculty skills in teaching and mentoring these activities will benefit the profession.
Conclusions
The past decade has seen a rapid increase in the number of PA programs granting the master’s degree. This survey suggests that this trend will continue and will include by 2005 over 80% of PA programs (if the expectations of respon-dents are realized). This transition has been fostered by national physician assis-tant policy-making bodies that have deliberately not established a mandate for either an “academic” or a “professional” master’s degree. Thus, there continues to
be development of both types of master’s degrees, though the “professional” type is more common among those anticipating transition to the graduate level. Overall, survey respondents are equally divided between these two types of curricula and degrees.
A capstone project has been and continues to be a very common require-ment in master’s degree PA programs. The typical capstone project requires a formal proposal, is allowed 12 months to complete once approved, is associ-ated with about 5 academic credits, generally does not require IRB review, and infrequently leads to a peer-reviewed publication. About a month of dedicated research time without clin-ical responsibilities is allowed by 44% of programs. Consistent with the historic diversity in PA education there is a wide variety of requirements, prod-ucts types of research meeting PA programs capstone requirements around the country.
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