Unseen Influences in Physician Assistant Education: Exploring Latent Factors in Supervised Clinical Practice Experiences

INTRODUCTION: Physician assistant/associate (PA) programs assess student clinical competence using both standardized exams and preceptor evaluations from supervised clinical practice experiences. However, it remains unclear to what extent the clinical environment influences preceptor evaluations and what specific constructs these evaluations capture. This study explores the relationship between the latent factors underlying standardized exams and preceptor evaluations. METHODS: A retrospective, cross-sectional analysis of student-level data from 3 PA programs across diverse regions of the country (2020-2024; n = 782) was performed. Measures included PA National Certification Exam (PANCE) task scores; end of rotation (EOR) exam task scores for internal medicine (IM), family medicine (FM), and emergency medicine (EM); and preceptor evaluations for the corresponding clinical rotations. Exploratory factor analysis (EFA) (least-squares estimation, Promax rotation; eigenvalue >1 criterion) identified latent factors. RESULTS: A 4-factor solution explained 54.3% of variance. Standardized assessments (PANCE and EOR task scores) loaded together on a single factor, whereas preceptor evaluations formed 3 distinct factors corresponding to FM, EM, and IM. Each factor contributed comparably equal to the variance, with minimal cross-loading between standardized exams and preceptor ratings. DISCUSSION: Findings indicate that standardized exams assess a common knowledge or clinical reasoning construct, while preceptor evaluations capture rotation-specific dimensions. This may be due to context-dependent performance and interpersonal/professional behaviors, distinct from test-based knowledge. These findings have implications for programs and stakeholders. Future work should examine environmental and evaluator influences and incorporate additional noncognitive domains.