FORWARD: Looking Ahead to Tomorrow’s PA Education
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How do we create and lead a culture that supports the demands of tomorrow’s Physician Assistant (PA) student? It starts with a strong Program curriculum at its foundation. PA education must be solid from its inception--well before we try to build and add additional layers of education and training on top of the degree--in order to train and graduate PA leaders that will enhance the profession and contribute to healthcare solutions nationwide. Absent this strong foundation, anything we try to layer on top of it will fail.
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FORWARD: Looking Ahead to Tomorrow’s PA Education
- 1. FORWARD Looking Ahead to Tomorrow’s PA Education ELIZABETH BUNTING, MS, PA-C, DFAAPA 2020
- 2. About Me Mom. Wife. PA. I am a Distinguished Fellow of the American Academy of PAs (DFAAPA) with a decade of PA education experience, dedicated to propelling the future of medical education, training the next-generation of advanced practice providers, and forwarding the cause of inter-professional team-based patient care initiatives. As a PA Administrator The University of Tennessee: Program Director and Chair; Associate Clinical Professor of Practice As a PA Educator East Carolina University: Associate Clinical Professor; Director of Admissions; Clinical Coordinator As a Practicing PA Practice clinically across disciplines of family and internal medicine, pediatrics, women’s health, and allergy. W E L C O M E
- 3. Vision for PA Education Creating and leading a culture that supports the demands of tomorrow’s PA student. FORWARD
- 4. Teaching Medical Professionalism Requirement Two Interprofessional Education Requirement Three Basic Health Administration Education Requirement Four Organ-Based Curriculum Fundamental Requirement The Fellowship Experience Phase Three Doctoral Degree Phase Four Dual Degree Offerings Phase Two Combating Clinician Burnout Requirement Five
- 5. Organ-Based Curriculum F U N D A M E N T A L R E Q U I R E M E N T Didactic Coursework Clinical Practicum Basic Sciences Begin Organ Based System Approach Summer 01 Finish Organ Based System Approach Age Related Courses Pathophysiology Spring 01 Continue Organ Based System Approach Pathophysiology Fall 01 Clinical Preparation Procedural Skills Behavioral Health Capstone Pathophysiology Summer 02
- 6. Medical Professionalism R E Q U I R E M E N T T W O Examples / stories instead of lecture based Teaching Style Advisor meetings for building insight Self-Reflection Teaching reaction to criticism via feedback Feedback Reaction Developing student's professional identity Identity Development Ensuring faculty model professional behavior Model Behavior Mapping out the curriculum from Orientation Setting Expectations Assessment Increase feedback from outside evaluators Feedback Topics Evaluation of Professional / interpersonal skills
- 7. Interprofessional Education R E Q U I R E M E N T T H R E E Across disciplines / interaction with students in several specialties Applying Principles Integrating with ethical teaching in Problem- Based Learning (PBL) case settings Integration All disciplines to teach professionalism from professionals in their field Immersion Experiences Critiques from peers as well as professors and supervisors Evaluation / Self-Evaluation DATA COLLECTION & COLLABORATORS
- 8. Health Administration Education R E Q U I R E M E N T F O U R Bring together an interdisciplinary collaboration of students, faculty, and industry leaders to design an innovative solution to a local healthcare challenge through experiential learning using a blend of medical and business knowledge. Hacking Health Labs Guest lectures and panel discussions from healthcare executives, discussing a range of topics from innovation, change management and technology, to strategic planning, systems / design thinking and entrepreneurship. Essential Business Knowledge Discuss real-world case studies of successes and (especially) failures across the healthcare industry. Partner with healthcare executives to develop and co- teach hypothetical cases. Case Studies Offer business ‘lessons’ the classroom cannot by placing students in a healthcare system environment and exposing them to real-world business challenges and difficulties first-hand. Field Projects
- 9. R E Q U I R E M E N T F I V E Combating Clinician Burnout Integrate Mindfulness Based Stress Relief (MBSR) and throughout the curriculum, while encouraging regular journaling and Narrative Medicine to develop self awareness “muscles” to debrief past traumatic experiences in both training and clinical practice Mindfulness & Wellness Create and set a precedent for students to share their experiences, thoughts, and feelings with peers to both learn and help each other through the highs and lows of clinical practice and life. Self-Reflection & Peer Groups Help students brainstorm, prioritize and create an action plan to align their clinical practice experience / structure with their career vision (ideal patient/ procedure mix). Peer Mentorship Help students create and maintain psychological school/work/life boundaries— such as developing a weekly life schedule to invest and prioritize time outside of medicine (i.e. relationships, exercise, hobbies, interests, nutrition, vacation, spiritual, ‘down time’). Coping & Maintenance
- 10. Beyond the PA Degree What the future of our profession will require to remain competitive.
- 11. Teaching Medical Professionalism Requirement Two Interprofessional Education Requirement Three Health Administration Education Requirement Four 27-Month Academic Curriculum Fundamental Requirement The Fellowship Experience Phase Three Doctoral Degree Phase Four Dual Degree Offerings Phase Two Combating Clinician Burnout Requirement Five
- 12. Phase Two D U A L D E G R E E O F F E R I N G S With offerings across disciplines of MBA, MHA, MPH, EdD, JD, and Health Informatics, students can tailor their learning to their specific professional interests and goals. Personalized Offerings Students gain a broader perspective on caring for patients by learning the skills necessary to assess the impact of the patient’s broader environment on his/her health. Outcome Programs strive to develop healthcare professionals with both the depth of medical knowledge and the range of leadership and innovative thinking skills needed to solve industry challenges. Purpose Combined degree skills can be applied in such areas as population health, clinical research, health administration, education, global healthcare, and community health promotion. Real-World Application
- 13. Considered part of the executive team, expected to impact the organization’s operations. Committees Demonstrate skills learned from their education in real-life, administrative situations. Projects Jointly design rotations that conform to the fellow's interests and expectations. Rotations Phase Three T H E F E L L O W S H I P E X P E R I E N C E
- 14. It is inevitable that all “advanced” healthcare educators will have a doctoral degree. But what about clinically practicing PAs? FORWARD
- 15. Phase Four D O C T O R A L D E G R E E Prepare students with the experience, knowledge, and skills they need to positively impact and participate in the evolving interprofessional setting. Interprofessional Education 02The healthcare field is changing, and PAs are making valuable contributions to the interprofessional healthcare team. But the MPAS degree may no longer be enough. Future of the Field 01 Allows students to make significant contributions to the profession research, grant writing, and community outreach. Research & Scholarship 03 Advance the Profession 04 Further the education and career development that empowers PAs to meet the evolving demands of the healthcare industry nationwide and globally.
- 16. M. D. Arnold and Roslyn Carter "A good leader leads from above them. A great leader leads from within them." (Arnold) "A leader takes people where they want to go. A great leader takes people where they don't necessarily want to go, but ought to be.” (Carter) Better together. FORWARD Leading with Purpose
- 17. Mark Reid "Student, you do not study to pass the test. You study to prepare for the day when you are the only thing between the patient and the grave." Redefining Education FORWARD Focusing on Learning
- 18. Thank You. Questions? I look forward to the opportunity to work with many of you in attendance today to collaboratively design innovative approaches for the changing priorities and challenges facing health and medical education today, while developing mitigation strategies for those existential threats that may present themselves in the future.
Editor's Notes
- Program curriculum is foundational and essential. Physician Assistant education must be solid from its inception before building to add additional education and creating PA Leaders that will enhance the profession and contribute to healthcare solutions nationwide. An organ-based curriculum may seem like a daunting task if you are looking at the grand scheme of your curriculum, but I have made the change and it isn’t impossible. It doesn’t have to be done all at once, and it isn’t as complicated as it seems. It is worth it and the outcomes are incredible. ARC-PA, our accrediting body, institutes new standards effective today. These standards are 1/3 more inclusive than the previous edition. These new standards focus more heavily on a few things that I think go well together—Medical Professionalism (including diversity and inclusion), Interprofessional Education, Basic Health Administration, and Wellness.
- The most significant challenge for PA Programs today is to obtain and retain clinical preceptorships. The single most important element to retaining clinical sites is having students that aid in workflow, give the sites a working interview for future providers, and feed the community with quality healthcare. This is done by preparing students to be strong clinical students that impress clinical preceptors and improve clinical care. Having a strong curriculum is vital to this formula. In looking at the HPU curriculum, the alignment of organ systems within the courses and would work very well with the basic science pathophysiology course carried through the didactic curriculum. The 4th Didactic Semester: PBL capstone course that teaches the students to clinically think. Dedicated semester to Surgery/EM for procedures and simulation. Dedicated semester for behavioral health. Time for clinical prep time, ethical, medical billing teaching, etc.
- Why Teach Medical Professionalism? We are finding that students are not taught formal professionalism in their formative or undergraduate education. When given scenarios and real-life situations in their Professional education, they do not understand their errors or consequences. One brief example to set the stage: A student goes into a clinical rotation on a dare from a medical student he met in the library. He spoke in a British accent for the first day of his Peds rotation. He completes the dare, but then goes in on day 2 and doesn’t know how to address the fact that he isn’t British and can’t fess up that he lied day 1. So, he speaks in a British accent for the next 4 weeks. The next student goes in on day 1 of her Peds rotation and hears about the pleasant British student that was there the month before. When she hears the name and laughs, it comes out that he isn’t British…... Incomes the compromise of the preceptor, site, and trust of all of the patients, providers, and community. Not to mention the clinical site relationship for our program. How does this reflect on our program? How does this reflect on PAs? Tactics for Teaching Professionalism: Setting expectations and map out the curriculum from Orientation- discuss diversity and inclusion as they pertain to the program and to medicine, the responsibility of taking care of patients, and their communities Assisting in the professional identity development of the student Important to interact with members of the medical profession to develop their sense of identity including multidisciplinary exposure Ensuring faculty and staff model professional behavior Taught and evaluated in multidimensional format Examples and stories instead of lecture based Teaching reaction to criticism via giving and receiving feedback throughout courses Establishing meetings with advisors regularly for self-reflection and building insight Increase feedback frequency and topics from outside evaluators during Intro to Clinical practice and clinical preceptors Evaluation of Professionalism through OSCE SOURCE: The formation of professional identity in medical students: Considerations for educators, John Goldie, Pages e641-e648 | Published online: 21 Aug 2012
- Interprofessional Education is a chameleon with many colors and facets. Many programs and schools begin with parallel teaching offering similar material to students in different programs at the same time. Parallel teaching is important because it allows for efficiency, reduces redundancy, and teaches the students that the information is necessary in disciplines other than their own while allowing for some interaction. Developing and implementing simulation, immersion, and clinical opportunities can be more challenging especially if a formal curriculum is in place. Capitalizing on these opportunities with Pre- and post- surveys to collect much needed data Publications/collaboration Applying principals across disciplines/ interaction with students in several disciplines Immersion experiences in all disciplines to teach professionalism from professionals in their field Integrating with ethical teaching in PBL case settings Evaluation and self-evaluation with critiques from peers as well as professors/supervisors
- Teaching healthcare administration is one of the areas that can be more challenging for PA’s to teach. An area we can be less comfortable with since we don’t always feel as fluent in the verbiage ourselves. Though it is important as healthcare in the US has become plagued with sky-high costs, unequal access, and erratic quality. But the back office of the business has become misaligned with the front lines of patient care delivery. Productivity has continued to drop, and we’re unable to innovate fast enough to keep up with present day needs. Which is why CEOs are increasingly looking towards future needs. They want superb clinicians. But they now also want clinical and business leaders who can investigate problems, find solutions through process and organizational innovation, and drive them forward—people who can work on a diverse team, understand failure and its causes, and manage change toward redesigned care delivery pathways. Which is why this is another area I feel it is imperative to accelerate an improvement in pedagogical techniques to re-align the clinician and the C-suite—an integration of the classroom into the real world. This not only exposes and prepares these students for an innovative mindset needed for tomorrow’s healthcare, but opens the door for dual-degree offerings to train them to become clinical business leaders. To do that, I have started designing the mechanisms for curriculum enhancements that would teach essential business knowledge through lectures, panel discussions, and case studies, but set the stage for interdisciplinary collaboration through hacking health labs and field projects.
- Patients are almost never prepared when we, as clinicians, deliver bad news to them and while we prepare PAs educationally and they are ready for practice, they are ill-prepared for the burden and toll patient care takes on their lives. We don’t prepare them for the exhaustion, the burnout, the mental health degradations, and—tragically—increasing amounts of suicide that are occurring as a result of the way today’s healthcare system is designed. Burnout is real. It is the single biggest threat to an individual clinicians career, and the largest negative influence on quality of care. Redesigning the healthcare system will take decades. It will plague clinicians for years to come. But we can start combating the challenges they will face before they start facing them. Which is why I have started integrating mindfulness and wellness, coping and maintenance into the curriculum—while also setting the foundation for peer reflection groups and peer mentorship to help them better navigate their new life as a clinician and in a work-life balance. This is also a new ARC-PA standards and should be a faculty and student approach within the program.
- Here is the extremely exciting part... Where PAs can and are going professionally every single day. PAs are administrators in hospital and outpatient centers, experts in industry, educators in all facets of medical education, clinical trials and bench researchers, and so much more. Hence the need for multiple options for PAs as dual degrees, fellowships and doctoral degrees.
- Dual degrees broaden the PA’s job opportunities outside of their clinical skills and abilities. Through the COVID-19 pandemic, for example, many clinicians have been furloughed, though opportunities still exist for those with public health, education, and/or administrative knowledge, experience, and education. Beginning with other opportunities offered within the university and streamlining a dual-degree offering without significantly increasing the duration of the program is the overall goal.
- The Fellowship Experience would give the PA exposure, networking, experience, and support through leadership training that would prepare the graduate for clinical and executive level positions. Positions in administration that would give the PA leverage to advocate for patients, health systems, and the profession. The HPU PA Program- Novant partnership is an asset necessary for the development of this program. Utilizing the opportunities within the Novant system, multiple areas of fellowships or residencies would have potential.
- It is inevitable that all “advanced” healthcare educators will have a doctoral degree. Our national organizations are investigating the possibilities as we speak. The questions involve how this affects our clinical environment and our fellow clinicians. It is a pandora’s box of pros and cons.
- Enter the controversy of doctoral training for PAs. And, thus, Phase 4… Clear need to compete in the academic space Need in education, research, leadership, and industry. Controversy in clinical doctorates and many competitors are already pursuing these tracks.
- Turning to the portion of the presentation that is less comfortable for me, because I do not relish talking about myself and my accomplishments. I lead with authenticity, honesty, transparency, respect, and as a member of the team. My most significant and important attribute is recognizing and acknowledging the abilities of others and utilizing these skills to strengthen the individual, the team, the program, and the profession. As a faculty leader: I have led the admissions team transforming the traditional interview into the MMI process while restructuring admissions committee and workflow process. Developed clinical sites and preceptor relationships throughout NC Curriculum revision and restructure Rework of curriculum with data, communication with previous instructors, and student focus groups- with improved outcomes As a Program Director: Navigated relationships/partnerships with upper administration, hospital administrators and community partners, interprofessional program directors and colleagues, university and community stakeholders Oversaw fiduciary responsibilities for programmatic budgeting, facilities, and human resources Managed hiring and evaluations for faculty and staff Recruited clinical sites Developed a strong faculty team for the PA program Team building Faculty development Wrote an “innovative curriculum” Developed SSR and wrote ARC-PA application alone
- Just as we teach our students that they are learning medicine for patient care and not just to pass the boards, our focus is to educate highly competent students focused on patient care and not just to pass accreditation. My experience with self-assessment is several-fold. I have experienced assessment from a continuing program as Director of Admissions, Didactic Course instructor, and clinical coordinator. I was responsible for the reports, data analysis, management, and action items associated with each of these roles. As a program director, I developed a self-assessment plan focused on continual programmatic assessment as a team approach. Clearly defined benchmarks for the program, student performance, faculty success, and data analysis. Retreats scheduled twice a year for full-faculty involvement in the review and discussion process to develop actionable items with not all trends requiring action. Careful evaluation of the data should impact positive change with data driven decisions. Both qualitative and quantitative data should be evaluated. Qualitative data should be evaluated depending on the topic. Student professionalism through student self-reflection, advisor guidance, and feedback throughout the curriculum. Student, faculty, and staff programmatic impressions should be evaluated via 360 evaluations/surveys that are anonymous and given the opportunity for comments. Having written a self-assessment plan in the past after being in a well-established program, I have set benchmarks, made a calendar of assessment throughout the academic year, and developed tools and surveys for assessment while having had the experience of trial and error from a previous program. This experience allows for a unique perspective and the benefit of flexibility.