{"id":9509,"date":"2016-10-04T09:34:12","date_gmt":"2016-10-04T16:34:12","guid":{"rendered":"https:\/\/familymedicine.uw.edu\/medex\/?post_type=post&p=9509"},"modified":"2022-04-04T20:08:45","modified_gmt":"2022-04-04T20:08:45","slug":"medex-and-the-pance-exam-seeing-results","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/medex\/magazine\/2016\/10\/04\/medex-and-the-pance-exam-seeing-results\/","title":{"rendered":"MEDEX And The PANCE Exam: Seeing Results"},"content":{"rendered":"

A<\/span>ll graduates of physician assistant<\/span><\/strong> training programs<\/span> must pass a certification exam before they can practice in their new profession. In the United States, the certifying body is NCCPA\u2014the National Commission on Certification of Physician Assistants. Many take the national test\u2014the PANCE, or Physician Assistant National Certification Exam\u2014right out of PA school, others in the months that follow graduation. Once they register for a PANCE session, graduates report to one of any number of regional testing centers to take the exam. All testing is done using secure computers.<\/p>\n

\"A<\/a>
A typical testing center where MEDEX graduates might go to take the national PANCE licensure exam.<\/figcaption><\/figure>\n

In quick order, the test results are known and reported back to NCCPA, the student, and the educational institution. It’s a simple pass\/fail. Those who pass can add the credential PA-C (for certified) after their name, and begin their careers as physician assistants.<\/p>\n

But for those who fail the PANCE on their first attempt, life gets a bit more complicated. NCCPA requires that they wait at least 90 days before they attempt the certification exam again. That\u2019s 3 months added to the previous 27 months spent fulltime in studies. For most, this has meant foregoing 2+ years without earning an income, focusing all their resources on their education and a future profession.<\/p>\n

For educational institutions, particularly those with high first time pass rates, news of one of its students failing the PANCE test is not taken lightly. In part, this is because it is a matter of public record. In the interest of transparency, NCCPA requires that the cumulative first time pass rates over five years be clearly visible on the institution\u2019s website. For MEDEX Northwest, this information appears through a link in the footer of every page: https:\/\/familymedicine.uw.edu\/medex\/cms\/wp-content\/uploads\/NCCPA-Accreditation-Pass-Rate-2016.pdf<\/a><\/p>\n

The most recent PANCE records from the 2015 graduating classes see MEDEX Northwest at a 93% first-time pass rate. In contrast, the 2009 MEDEX scores were as low as 79%. What could account for this 14-point rise in the MEDEX first-time pass rate over six years? And, perhaps more importantly, what was behind the all time low?<\/p>\n

Facing The Challenge<\/strong><\/span><\/p>\n

First, it\u2019s worth considering the certification exam itself, which \u201chas gotten increasingly more difficult over the past 10 years,\u201d according to Scott Massey, PhD, PA-C, a national expert on PA education. \u201cIt\u2019s become more and more academic. If programs don’t keep up and provide academic preparation for the exam, then the pass rates drop.\u201d<\/p>\n

In the face of this, the falling PANCE pass rates served as a \u201cwake-up call,\u201d says MEDEX Program Director Terry Scott, MPA, PA-C. \u201cMEDEX was facing a challenge. We recognized that the PANCE scores had to improve. But they were also a symptom of a greater issue.\u201d<\/p>\n

In the face of this, the falling PANCE pass rates served as a \u201cwake-up call,\u201d says MEDEX Program Director Terry Scott, MPA, PA-C. \u201cMEDEX was facing a challenge. We recognized that the PANCE scores had to improve. But they were also a symptom of a greater issue.\u201d<\/p><\/blockquote>\n

The profile of the MEDEX cohort reveals an older student, averaging around 33 years in age. In part, this is driven by the MEDEX requirement of 4,000 hours of prior patient contact, something most PA schools do not ask of their applicants. Consequently, MEDEX students are on their second or even third career, and often quite a ways down the road from their previous academic pursuits. As a result, many are unaccustomed to the rigorous classroom and learning demands of PA school.<\/p>\n

\"MEDEX<\/a>
MEDEX Northwest Program Director Terry Scott, MPA, PA-C<\/figcaption><\/figure>\n

Facing a downward slide in the PANCE scores, there was a tendency to offer excuses based on this typical MEDEX student profile. \u201cOur students are special,\u201d was often heard, or \u201cOur students are older.\u201d<\/p>\n

\u201cThere were excuses made,\u201d says Terry Scott, \u201cand that just didn\u2019t serve them. We are proud of the type of people we go after. They are mission-driven, but there is no reason that they can’t perform at the highest level on any exam. MEDEX can have a social justice mission, and we can still have high quality academics with the students we choose.\u201d<\/p>\n

Scott directed the combined efforts of the MEDEX faculty and staff to both \u201cown\u201d the situation and to remedy it. \u201cWe needed to look at this in a very open and transparent way,\u201d he says.<\/p>\n

In response, the MEDEX faculty came together in the spring of 2012 for a retreat to discuss the challenge before them. The retreat included a psychometrician from the NCCPA to talk about test item writing. Participants heard firsthand how the NCCPA had moved to more closely align the PANCE exam with the demands of the workforce. MEDEX also brought in the nationally recognized PA education and remediation expert, Scott Massey, PhD, PA-C for advice.<\/p>\n

Program Director Terry Scott remembers the 2012 retreat as a \u201cvigorous and boisterous\u201d one. \u201cIt was like the uncorking a lot of energy. This was an opportunity to address some of the long-standing issues that we weren’t able to address up until now. We were not going to blame our students. We had to own this. We had to own it as an organization and address the issues.\u201d<\/p>\n

In 2014 the faculty came together for another retreat where MEDEX set forth a new vision and value statement for the program: \u201cWe work on behalf of our students, the community and organization to make it better.\u201d<\/p>\n

Step by Step, A New Approach<\/strong><\/span><\/p>\n

Of course, this kind of major change doesn\u2019t come simply, or easily. \u201cThis is work that takes multiple approaches, and they all need to be done simultaneously,\u201d says Dr. Linda Vorvick, the former Director of Academic Affairs at MEDEX from 2008 to 2015. \u201cWe looked at the problem from both a macroscopic view and a microscopic view,\u201d adds Amee Naidu, MEDEX Director of Student Affairs. \u201cThere were so many areas in our program that needed to be changed.\u201d<\/p>\n

\"Dr.<\/a>
Dr. Linda Vorvick, former Director of Academic Affairs at MEDEX from 2008 to 2015.<\/figcaption><\/figure>\n

First, it was agreed that MEDEX had to make it crystal clear to its students that they are expected to study and prepare for the PANCE. This included deciding to purchase and provide the students with online tools to use in practicing and better preparing for the examination.<\/p>\n

Next, MEDEX added curriculum in the second year to keep the students practicing their testing skills throughout their entire clinical year. \u201cWe gave them practice exams,\u201d explains Dr. Vorvick, \u201cand used our faculty resources, like MEDEX researcher Doug Brock, PhD, to develop metrics that let our students know their likelihood to pass or not pass the PANCE. That way they know how much effort is needed to put in to prepare for the test.\u201d<\/p>\n

It was also decided to up some of the prerequisites, so that candidates entered the program with stronger science backgrounds. \u201cWe increased the specificity of what kind of science we want to see before people come to MEDEX,\u201d adds Dr. Vorvick.<\/p>\n

Additionally, steps were taken to map the MEDEX didactic curriculum to the PANCE blueprint. \u201cWe made sure that we were teaching the things that were on the exam, so that the students were made familiar with these concepts at least once in the classroom before they got to their clinical year,\u201d says Dr. Vorvick.<\/p>\n

Additionally, steps were taken to map the MEDEX didactic curriculum to the PANCE blueprint. \u201cWe made sure that we were teaching the things that were on the exam, so that the students were made familiar with these concepts at least once in the classroom before they got to their clinical year,\u201d says Dr. Vorvick.<\/p><\/blockquote>\n

\"Doug<\/a>
Doug Brock, PhD, a faculty researcher for MEDEX Northwest.<\/figcaption><\/figure>\n

T<\/span>his effort would require<\/span><\/strong> the assistance of the entire didactic faculty over the course of several years. \u201cIt was very complicated,\u201d says Doug Brock, PhD and a researcher for MEDEX. \u201cThere was an enormous rescheduling and rejiggering of the didactic curriculum. Linda Vorvick gets a lot of credit for the restructuring of the curriculum to better meet what the modern needs are. We had a curriculum that was truly out of date in terms of how it fit with the profession, what the profession saw as important to measure.\u201d<\/p>\n

The new understanding emerged that MEDEX would have to look at what the PANCE is testing for, accept that this is how the profession is defining competency, and determine that they would have to teach to that.<\/p>\n

All of these changes forced nothing less than an upheaval in the school\u2019s educational objectives, and had to be made while staying true to the new MEDEX vision and value statement that emerged from the retreat.<\/p>\n

Dr. Linda Vorvick believes these efforts all combined to bring the PANCE rate up over the course of six years. \u201cThere is no one particular thing that made the difference\u201d, she says.<\/p>\n

Testing To Determine Who Needs Assistance<\/strong><\/span><\/p>\n

Since 2012, these efforts have focused on the PANCE examination itself. \u201cWe\u2019re preparing our students\u2014our at-risk students\u2014for the PANCE exam,\u201d says Naidu. \u201cWe prepare all students, of course, but we’ve identified data that helps us narrow down the students who need a little bit of extra help to pass the exam.\u201d<\/p>\n

\"MEDEX<\/a>
MEDEX students taking the PACKRAT II test on the University of Washington campus.<\/figcaption><\/figure>\n

The process of determining which students might need assistance begins in December of their didactic year with a national test called the PACKRAT I<\/em>, short for Physician Assistant Clinical Knowledge Rating Assessment Tool<\/em>. \u201cAnd it’s online, they get the results right away,\u201d explains Naidu. The students\u2019 scores are compared to all others from across the nation, yielding solid stats on these peer-reviewed questions. \u201cIt’s basically a practice test for the PANCE,\u201d says Naidu. \u201cIt’s an indicator: if they score above a certain amount or below, we know how they’re going to perform.\u201d<\/p>\n

In January\/February of their clinical year, MEDEX students return to their home site classroom for Campus Week. At that time they take their second national practice exam, the PACKRAT II.<\/em><\/p>\n

The PACKRAT II exam is used to generate a predicted PANCE Score. Those students who have a predicted PANCE score below 400 are contacted by Amee Naidu, and they begin remediation. Typically, she begins by asking the students to write ten test questions per week especially on their weaker topics. \u201cTest question writing is a great way for students to enhance their critical thinking process,\u201d says Naidu. After repetitively utilizing this method over weeks, students notice a difference in the amount of medical information that they understand and retain. \u201cThese sorts of remedies can make a big difference\u201d, reports Naidu, as evidenced by seeing struggling students, who were predicted not to pass, go on to achieve their certification.<\/p>\n

Custom Testing<\/strong><\/span><\/p>\n

Then again in December, the clinical students return to their campus to take what\u2019s called a Formative Exam<\/em>. Essentially, it\u2019s a custom PANCE practice exam developed by Scott Massey, PhD, PA-C, to help identify those students who could be at risk for failing the certification exam. In 2012, MEDEX engaged the services of Massey and his supplementary testing methods, which he built from his research with 1,500 PA students over eight programs across 10 years.<\/p>\n

\"Scott<\/a>
Scott Massey, PhD, PA-C, a national expert on PA education and remediation.<\/figcaption><\/figure>\n

These practice exams\u2014called the Summative One<\/em> and the Summative Two<\/em>\u2014are large 700-question tests administered to all MEDEX students during their clinical year while they are assigned clerkships out in the field. Doug Brock crunches the data from the Summative<\/em> exams. \u201cI define at-risk status as a greater than 20% chance of failure on the PANCE,\u201d he says. \u201cIn our worst years we were hitting estimates that 30 to 35% of our class were at risk.\u201d<\/p>\n

Scott Massey has some thoughts on this. \u201cA lot of PA programs struggle with this because, in the clinical year, the students have to study independently,\u201d he says. \u201cThey don’t have the structure that they had during the didactic year, and some students just aren’t able to keep it together along with all of the responsibilities they have going on at their clerkships for that second year.\u201d<\/p>\n

Massey is the first to admit that his tests are not the perfect instrument. \u201cBut based upon the blueprint that is used for the certification exam, I believe that if you create some testing instruments that simulate that exam closely enough that you could track scores. And using some statistics like regression, for example, we can actually generate predicted scores or at least look at ranges of potential scores that a student would potentially achieve if they did not have intervention.\u201d<\/p>\n

It’s about obtaining feedback on the students and their academic progress. For the students identified by the Summative One<\/em> and Summative Two<\/em> as potentially at risk, the prescription is to provide more robust mentoring such as test-taking skills, study skills, individual counseling and remediation during the clinical year.<\/p>\n

Remediation Efforts<\/strong><\/span><\/p>\n

Over the years, MEDEX has deployed remediation in different forms, most often in the form of retesting. Yet according to Doug Brock, MEDEX was remediating students \u201cwho maybe needed just a bit of time and a bump, while we were missing students who were consistently scoring low but passing.\u201d Brock\u2019s application of Scott Massey\u2019s testing methods and the subsequent research revealed a better understanding of the particular challenges at MEDEX.<\/p>\n

As a result, there was a new effort surrounding remediation, which was led by Amee Naidu. In this instance, remediation means something specific. \u201cIt means training our students who are struggling to learn medical information by giving them the tools necessary to build their critical thinking skills so that they can take examinations better and pass their PANCE exam,\u201d she explains.<\/p>\n

Naidu isn\u2019t a fan of the terms remediation<\/em> or at-risk<\/em>. \u201cThese are struggling students,\u201d she says. \u201cThe course that I promote to them is the PANCE Skills Course<\/em>. It\u2019s designed to enhance critical thinking skills.\u201d<\/p>\n

\"amee-naidu-horizontal\"<\/a>
MEDEX Director of Student Services Amee Naidu, MMS, PA-C<\/figcaption><\/figure>\n

Individuals with passive learning habits are often challenged by PA school and the requisite testing. Naidu believes critical thinking skills are essential for any practicing clinician. \u201cWhen patients visit the clinic, they\u2019re not going to say, \u2018My situation is described on page 37, look me up.\u2019 They come in with extra variables\u2014they have several symptoms\u2014in addition to complex personal lives. On the spot, you have to pull together 5 to 10 pieces of information, and come up with a solution. If you’re a passive learner versus an active learner, when you go into the clinic, you will not be able to pull medical information together and come up with a solution. It\u2019s the same thing for the PANCE exam.\u201d<\/p>\n

Naidu is the first to say that being good at testing is not necessarily the measure of a good clinician.<\/p>\n

\u201cCountless times with our struggling students, I see their bedside manner and their approach to patients as just phenomenal,\u201d she says. \u201cI would send family members to them once they are practicing. Students are often surprised to hear this but are also encouraged. In my mind, being a good PA is not just about being good in academics.\u201d<\/p>\n

\u201cCountless times with our struggling students, I see their bedside manner and their approach to patients as just phenomenal,\u201d she says. \u201cI would send family members to them once they are practicing. Students are often surprised to hear this but are also encouraged. In my mind, being a good PA is not just about being good in academics.\u201d<\/p><\/blockquote>\n

D<\/span>oug Brock stresses<\/strong><\/span> that the PANCE is strictly an academic measure. \u201cIt doesn’t measure skills,\u201d he says. \u201cThere was also always this disagreement about whether or not it was even important to focus so much on the PANCE, which is both a very good question and one that is a little frustrating. Because passing the licensure exam is a necessary hurdle to being able to practice as a PA. But I don’t know anybody, myself included, who thinks that the PANCE is necessarily a strong indicator of clinical proficiency or later skill or value in the workplace.\u201d<\/p>\n

Naidu continues: \u201cTo me, sometimes the struggling student has a little more humanity, so long as they’re safe. As a PA, you have to know when to ask questions and know your limitations. But for sure, with guidance, struggling learners can fulfill this mission and go on to become successful PA\u2019s.\u201d<\/p>\n

Often, these deficiencies come as a surprise to the student. After all, they have to be very high functioning to be selected as one of the 130 students from among the 1,200+ applicants to MEDEX each year. Students find that even though they studied hours for course exams, it may not be reflected in their scores. \u201cBut now it’s at a new level,\u201d says Naidu. \u201cThey’re learning a lot of information all at once. They\u2019re taking several classes. There’s a lot of peer pressure, and they don’t have enough time to digest the material because they’re in class all day. On top of it, they have additional responsibilities at home.\u201d<\/p>\n

All the students that are not doing well will end up working with Amee Naidu. When Naidu makes her assessment, she\u2019ll often discover some studying or concentration deficiency. \u201cThey\u2019d been getting by, but they\u2019ve not been studying correctly this whole time,\u201d she says. \u201cNow they have all these major, hard core medical courses, and everything comes out. The students may be assessed with poor organizational skills, poor executive functioning skills, test anxiety, or they\u2019re just having difficulty coping with the pressures of PA school.\u201d<\/p>\n

During her individual assessment session, Naidu talks with the students to see what they need in order to succeed. \u201cSometimes we refer them to Accommodations DRS (Disability Resource Services) or to Intermediate Studies Strategies. It\u2019s this latter effort that Amee Naidu leads. It starts with individual counseling, and there\u2019s the PANCE Skills Course<\/em> that Naidu developed over a year\u2019s time.<\/p>\n

It\u2019s a self-directed course built in three different plans\u201413-week, 18-week and 32-weeks. Depending on the individuals and their needs, she\u2019ll recommend a study plan of specific duration. The course then becomes available to them through Canvas, a proprietary web learning management system or LMS.<\/p>\n

An Option For Uncertified Alumni<\/strong><\/span><\/p>\n

This is all well and good for students currently enrolled in MEDEX. But what of those who have long since graduated from MEDEX, failed the PANCE once, maybe more, and are not yet certified to work in the profession in which they trained? After all, there is a limit on the number of times they can take the national certification exam and fail. After six failed attempts or six years, NCCPA rules require that they reenroll in PA school.<\/p>\n

Naidu was given the additional job of reaching out to these former students and offering them the PANCE Skills Course<\/em>. \u201cSome hadn\u2019t been able to pass the exam for a couple of years. They were all struggling.\u201d<\/p>\n

\u201cI knew they weren’t going to be happy with MEDEX contacting them after all this time,\u201d says Naidu. \u201cThey were going to be upset and suspicious of our efforts.\u201d Many had returned to their old line of work in the absence of a PA certification.<\/p>\n

\u201cI knew they weren’t going to be happy with MEDEX contacting them after all this time,\u201d says Naidu. \u201cThey were going to be upset and suspicious of our efforts.\u201d Many had returned to their old line of work in the absence of a PA certification.<\/p><\/blockquote>\n

F<\/span>or these former MEDEX students<\/span><\/strong>, Naidu has developed an additional study tool kit. She refers to it as a feel-good gift containing various items useful for effective study habits: a planner, notebooks, post-its, a dry-erase sheet and more. Together, these items were meant to engage the individual in the process of studying.<\/p>\n

\"Amee<\/a>
Amee Naidu, MMS, PA-C has developed a PANCE Skills Course for struggling students.<\/figcaption><\/figure>\n

For those who accept help, these former students from across the 5-state WWAMI region can logon to follow the self-directed courses, week by week. The onus is on the individual to check-in with Naidu on a weekly basis to receive direction and counseling. Naidu suggests personal rewards for every study milestone achieved.<\/p>\n

The rigors of the course can prove overwhelming for some. \u201cBecause it requires 8 to 10 hours training a day, some just can\u2019t struggle through it,\u201d says Naidu. Anyone who has applied themselves to Naidu\u2019s course has realized success, but it demands commitment and regular communication. \u201cSome people start on the course, and they’re supposed to check in with me regularly. Later on, I’ll find out they failed. But I didn’t know they took the exam or I would have told them, \u2018No way, don’t take it.\u2019\u201d<\/p>\n

In working with Amee Naidu, Doug Brock finds a lot of hopefulness for these graduates who remain uncertified. \u201cShe is doing some things which are unique in the profession,\u201d he says. \u201cShe’s is doing things that nobody has even thought of. She has a willingness to work with people who have failed the PANCE. And most programs, whether it’s for good reasons or poor reasons, once you’ve graduated, they don’t want to see anything but the back of you. Her actions send a message that MEDEX actually really cares.\u201d<\/p>\n

In the past there were concerns from students that remediation was somehow punitive, and that the program was picking on them. \u201cThat’s sort of disappearing or becoming less pronounced than it was, which is good news,\u201d say Brock.<\/p>\n

A Moral Imperative<\/strong><\/span><\/p>\n

Scott Massey holds a unique perspective on all of this. As a researcher, an educator, and a four-time PA studies Program Director, \u201cI was the one that often worked with students that didn’t pass the certification exam,\u201d he says. \u201cI saw the pain, the agony that students go through when they didn’t pass. And I started to think, \u2018How could I intervene?\u2019 Which really was the beginning of all this. It’s really about preventing failures.\u201d<\/p>\n

Massey talks about the education of physician assistants as two parallel processes.<\/p>\n

\u201cYou’ve got their holistic education, which involves all aspects of their competency,\u201d he says. \u201cWe’re talking about forming them into clinicians through their experiences\u2014academic, didactic and clinical. As their clinical and interpersonal skills evolve, you get a student that emerges as this polished clinician. That’s one arm of it.\u201c<\/p>\n

\u201cThe other arm of it is, like it or not, we\u2019re teaching to the test. I understand the controversy. I’ve heard that argument a number of times, and some people don’t like it. But I’ve been the one that’s sat with many students that fail. And so I kind of have a sense that, yeah, I know the whole argument about teaching to the test.\u201d<\/p>\n

For Massey, programmatic changes assure that schools will not see their students fail the PANCE. \u201cYou don’t want to have that happen because once they fail, the stats on that are not very positive,\u201d he says. \u201cWhen people fail the first time, the second time pass rate goes down to 50%. And if somebody fails a second time, it goes down to about 20%. So you have to capture them during the program.\u201d<\/p>\n

\u201cTo me, it\u2019s a moral imperative to ensure that they pass,\u201d he adds.<\/p>\n

\u201cTo me, it\u2019s a moral imperative to ensure that they pass,\u201d he adds.<\/p><\/blockquote>\n

\"Doug<\/a>
Doug Brock, PhD, faculty researcher at MEDEX Northwest.<\/figcaption><\/figure>\n

Doug Brock agrees. \u201cAmee and I both hold this philosophical belief that if you accept somebody into PA training, you’ve already conferred upon them an expectation that they can succeed. The program holds a lot of responsibility for failure at that point, not just the individual. Of course the individual is responsible to an extent, but the program is also responsible to help where help is needed.\u201d<\/p>\n

With the most recently available first-time PANCE pass rate from the 2015 graduating cohort at 93%, Doug Brock is encouraged that all the concerted efforts by MEDEX are showing real results. \u201cThis past year we had our first uptick, which is actually indicative of a change versus some sort of random fluctuation,\u201d he says.<\/p>\n

Today, Scott Massey is the Director of a new PA program at the State University in Pennsylvania. His education research work continues, and his contributions to MEDEX are pro bono. \u201cI know many of the faculty at MEDEX, and I consider them to be colleagues,\u201d he tells us. \u201cI’ve enjoyed working with them, immensely. It made my day or made my week when Linda Vorvick would come to me and say, \u2018We’re seeing results.\u2019 That, to me, is what it’s all about. It\u2019s that people, maybe three years ago who might have not passed the PANCE, today, some of them are passing. That makes it all worth it.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

In six years, MEDEX saw its students\u2019 first-time pass rate for the national licensure exam go up from 79% to 93%. This took nothing less than a complete overhaul of the didactic and clinical curriculum to better fit how the profession defines competency. Over this period, MEDEX faculty and a prominent PA education researcher worked in concert to better understand and support the needs of struggling MEDEX PA students. <\/p>\n","protected":false},"author":1,"featured_media":9520,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[20],"tags":[],"class_list":["post-9509","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medex-stories"],"cp_meta_data":{"_edit_last":["1"],"student_name":["MEDEX & the PANCE"],"_webdados_fb_open_graph_specific_image":[""],"_thumbnail_id":["9520"]},"_links":{"self":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/9509","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/comments?post=9509"}],"version-history":[{"count":9,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/9509\/revisions"}],"predecessor-version":[{"id":17264,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/posts\/9509\/revisions\/17264"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media\/9520"}],"wp:attachment":[{"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/media?parent=9509"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/categories?post=9509"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/familymedicine.uw.edu\/medex\/wp-json\/wp\/v2\/tags?post=9509"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}