Beyond the Capstone: Turning Doctoral Preparation Into Lasting Contribution
Alan Heckman, DMSc, PA-C, NRP, PHPE, NCEE
President-Elect, ADPA
Graduate Program Director, DeSales University
For those of us who have completed—or are pursuing—doctoral education, the capstone often feels like the culminating achievement. It represents months of inquiry, writing, revision, and persistence. It demonstrates that we can identify a meaningful problem, critically evaluate the literature, select an appropriate methodology, and develop or assess a potential solution.
But after the final paper is submitted and the degree is conferred, an important question remains:
What will we do with that preparation?
The capstone should not be the endpoint of doctoral education. It should be the beginning of a sustained professional practice in which we repeatedly use evidence to improve patient care, education, organizations, and the PA profession.
Recent research demonstrates substantial growth in PA-specific doctoral education. These programs vary in length, structure, concentration, and the type and amount of research or scholarly preparation they provide.1 This diversity reflects the many reasons PAs pursue doctoral education and the different settings in which we hope to make an impact.
It also makes defining the outcomes of doctoral education increasingly important. The value of our education cannot rest solely on completing a final project or adding another credential. Ultimately, it must be demonstrated through what we contribute afterward.
Expanding Our Understanding of Scholarship
When we discuss scholarship, we sometimes default to a traditional academic model: conducting original research, obtaining grants, and publishing in peer-reviewed journals. The PA profession needs more scholars engaged in all of these activities. However, they are not the only ways doctorally prepared PAs can contribute.
Most PAs with doctoral degrees continue to work primarily in clinical practice.2 For many of us, scholarship will therefore occur within the clinical, educational, and organizational environments where we already work.
It may involve examining unwarranted variation in care and leading the implementation of an evidence-based pathway. It may mean evaluating a new teaching strategy rather than relying solely on tradition or learner satisfaction. It may involve using data to redesign a process, improve access, strengthen patient safety, or inform professional advocacy.
These activities can represent meaningful scholarship when they are systematic, evidence-informed, evaluated, and shared.
This broader understanding does not lower the expectations associated with doctoral preparation. It raises them. We should be able to do more than recognize that a problem exists or introduce a promising idea. We should be prepared to ask answerable questions, critically appraise evidence, select appropriate methods, engage stakeholders, measure outcomes, and communicate what we learn.
The goal is not for every doctoral PA to become a traditional researcher. The goal is for more of us to approach the problems within our reach with scholarly discipline.
Moving From Knowing to Doing
As PAs, we regularly use evidence to inform clinical decisions. Doctoral preparation should extend that evidence-based mindset beyond the care of an individual patient and into the systems in which care is delivered.
Healthcare does not suffer from a lack of published evidence alone. It also struggles to move available evidence into routine practice.
The Knowledge-to-Action model provides a useful framework for this work. It describes a process that includes identifying a problem, reviewing and adapting knowledge to the local context, assessing barriers, implementing interventions, monitoring knowledge use, evaluating outcomes, and sustaining change.3
This work is rarely linear. A strong evidence base does not guarantee that an intervention will be adopted, implemented correctly, or sustained. Successful change also depends on organizational culture, available resources, workflow, leadership engagement, communication, and the priorities of those affected by the change.4
Doctoral education can help us develop the skills needed to navigate this complexity. It can prepare us to connect clinical experience with critical inquiry, data analysis, organizational leadership, and change management. It can move us from being consumers of evidence to becoming translators and implementers of evidence.
That distinction is important. Knowing what the literature recommends is not the same as knowing how to make it work in a particular clinical practice, PA program, healthcare organization, or community.
Measuring More Than Completion
A completed initiative is not necessarily a successful one.
Implementation scholarship distinguishes outcomes such as acceptability, adoption, appropriateness, feasibility, fidelity, cost, penetration, and sustainability from clinical or service outcomes.5 These distinctions should influence how we approach our work.
An intervention may appear successful initially but be too burdensome to continue. A new protocol may be introduced but used inconsistently. An educational innovation may improve short-term learner satisfaction without improving knowledge, performance, or patient care. A quality initiative may produce encouraging results while it has a dedicated champion, only to disappear when that person leaves.
Our doctoral preparation should teach us to ask more difficult questions:
· What problem are we actually trying to solve?
· What does the best available evidence suggest?
· How must that evidence be adapted to our local context?
· Who needs to be involved?
· How will success be defined and measured?
· What unintended consequences should we monitor?
· Can the change be sustained?
· What have we learned that may help others?
The purpose is not to transform every workplace initiative into a formal research study. It is to bring scholarly discipline to decisions that might otherwise be guided by habit, anecdote, or urgency alone.
Sharing What We Learn
Our work cannot contribute to the broader profession if no one outside our immediate setting knows about it.
A capstone stored in an institutional repository may satisfy a graduation requirement, but its potential impact remains limited. Dissemination is what allows a local project to become part of a larger professional conversation.
Not every project will warrant a peer-reviewed manuscript. Dissemination may also take the form of a conference presentation, professional newsletter article, clinical protocol, educational resource, policy brief, webinar, or implementation toolkit. The appropriate format depends on the project, the strength of its findings, and the audience that can benefit from them.
The Standards for Quality Improvement Reporting Excellence, or SQUIRE 2.0, demonstrate that healthcare improvement work can be reported systematically. These guidelines emphasize theory, context, intervention design, evaluation, and interpretation when sharing improvement initiatives.6 Frameworks such as SQUIRE can help us transform local improvement efforts into knowledge that other PAs and organizations can evaluate and use.
We should also acknowledge that scholarship is difficult to sustain. PA educators and scholars report barriers that include insufficient time, limited training and experience, competing responsibilities, and inadequate resources.7,8 Research involving successful PA scholars suggests that scholarly identity develops over time and is supported by mentorship, collaboration, persistence, and strong professional relationships.9
A doctoral program can begin that development, but it cannot complete it. We need continued mentorship, collaboration, access to data and methodological expertise, and organizations that recognize scholarly work as a meaningful professional contribution.
The Academy of Doctoral PAs (ADPA) can have an important role in building that culture by connecting doctoral PAs, creating opportunities to share work, encouraging collaboration across institutions, and helping members move worthy projects beyond the capstone.
Our Responsibility After Graduation
We should not evaluate doctoral education solely by counting credentials, capstones, presentations, or publications. Nor should we assume that earning a doctorate automatically produces scholarly productivity, organizational change, or improved outcomes.
Doctoral education creates capacity. It is our responsibility to convert that capacity into contribution.
The strongest evidence of the value of our preparation may not be the project we completed at the end of a program. It may be the clinical pathway we redesign several years later, the curriculum we improve through thoughtful evaluation, the quality initiative that becomes sustainable practice, the policy we inform with better data, or the mentorship we provide to another PA beginning a scholarly journey.
The capstone proves that we can complete a scholarly project.
What we do afterward demonstrates who we have become.
References
1. Martin AER, Kayingo G. Doctoral education for physician assistants/associates: trends and characteristics in the U.S. BMC Med Educ. 2025;25:2. doi:10.1186/s12909-024-06606-5
2. Klein A, Kayingo G, Schrode KM, Soria K. Physician assistants/associates with doctoral degrees: where are they now? J Physician Assist Educ. 2024;35(1):14-20. doi:10.1097/JPA.0000000000000549
3. Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13-24. doi:10.1002/chp.47
4. Damschroder LJ, Reardon CM, Widerquist MAO, Lowery J. The updated Consolidated Framework for Implementation Research based on user feedback. Implement Sci. 2022;17(1):75. doi:10.1186/s13012-022-01245-0
5. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65-76. doi:10.1007/s10488-010-0319-7
6. Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf. 2016;25(12):986-992. doi:10.1136/bmjqs-2015-004411
7. Roberts AL, Rizzolo D, Bruza-Augatis M, Frias-Sarmiento D. An update on scholarly productivity for physician assistant/associate faculty. J Physician Assist Educ. 2025;36(1):e74-e79. doi:10.1097/JPA.0000000000000641
8. Reed H, Artino AR Jr. Finding success in scholarship: how physician assistant educators can overcome barriers to publication. J Physician Assist Educ. 2021;32(4):237-241. doi:10.1097/JPA.0000000000000386
9. Garino A, Cawley JF, Kayingo G, Min EA. PA scholars: what drives and inhibits success? J Physician Assist Educ. 2024;35(2):121-128. doi:10.1097/JPA.0000000000000562
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