Differential Diagnosis Skills in Physician Assistant Students

This study explored physician assistant (PA) educators' perceptions of a potential deficit in differential diagnosis proficiency (DDP) among PA students and sought to identify effective strategies for curricular improvement. DDP is a foundational clinical skill that requires robust medical knowledge, critical thinking, and the ability to synthesize patient information into diagnostic possibilities. Deficiencies in these skills can lead to diagnostic delays, unnecessary testing, and suboptimal patient outcomes. Despite its clinical importance, limited research has investigated how well PA programs cultivate DDP or what interventions may enhance it. A cross-sectional, mixed-methods survey was administered to 68 PA educators via a secure listserv. The instrument included Likert-type questions and open-response items that assessed whether respondents perceived a deficit in DDP among their students, how severe they considered the issue to be, and what strategies they recommended for addressing it. Of the respondents, 64.7% (n = 44) affirmed the existence of a DDP deficit. The majority of those respondents (68.2%, n = 30) rated the issue as moderate in severity, while 13.6% (n = 6) considered it minor, and 18.2% (n = 8) deemed it significant. When asked to recommend instructional strategies, respondents most frequently endorsed three equally preferred interventions: incorporating team-based learning events, utilizing instructor-led case studies, and integrating DDP content into existing medicine courses. Each of these received 23.3% of the total votes. Notably, team-based learning also emerged as the most commonly selected second-choice approach, suggesting strong overall support for active, collaborative learning formats. Respondents indicated that overburdened faculty and insufficient formal instruction were the most likely contributors to the DDP gap. This study offers early evidence that PA educators widely perceive a need to enhance DDP training in existing curricula. The preference for interactive instructional strategies underscores a growing belief that passive, lecture-based methods may be insufficient for cultivating diagnostic reasoning skills. These findings support the integration of active learning modalities into PA education and lay the groundwork for further research. Future studies with larger, multi-institutional samples are needed to confirm these findings and evaluate the impact of specific interventions on DDP development and clinical performance.