Impact of physician assistants on resident training: rapid mixed methods review

<ns3:p> Study question What is the impact of physician assistants on resident training? Methods A rapid mixed methods systematic review was conducted of quantitative, qualitative, or mixed methods studies published between January 2005 and January 2025 in economically developed countries. The main outcomes were impact on the education and training experience and opportunities of resident doctors. Two reviewers independently extracted data on study design, methods, and findings from eligible studies. Studies were assessed for quality using a critical appraisal tool. A descriptive summary of the included studies and a narrative synthesis of main findings was used to report the data, categorised by geographical region, based on a convergent integrated approach. Results Of 1903 studies screened, 32 were eligible, and 12 met the inclusion criteria. 4/12 were from North America and 8/12 were from the UK. Studies were judged to be of moderate to high quality. Three themes were identified: the impact of physician assistants on resident training is mixed and depends on how they are deployed; residents are uncertain about the place of qualified physician assistants in the medical team, whether they are an assistant, in training themselves, or can practice at a higher level than a junior resident; and there is a mismatch between the tier doctors think physician assistants can practice in, and what physician assistants themselves think. A consistent positive impact of physician assistants on resident training was found in inpatient areas, with physician assistants working under supervision and deployed specifically to support resident workload and access to training opportunities. Conclusions The identified themes are sources of tension between different groups of clinicians. The results of this study can inform practice and policy to optimise the impact of physician assistants on resident training. Study registration <ns3:ext-link xmlns:ns4="http://www.w3.org/1999/xlink" ext-link-type="uri" ns4:href="https://www.crd.york.ac.uk/PROSPERO/view/CRD42025643185">https://www.crd.york.ac.uk/PROSPERO/view/CRD42025643185</ns3:ext-link> Registered 29 January 2025 Registration no: CRD42025643185 </ns3:p>