Clinical Education: Implementing a Hybrid Clinical Year Plan

*The following views and opinions belong to Scott Massey PhD PA-C, an educator with 29 years of experience. We do not claim these are the views of the ARC-PA orPAEA.

The COVID-19 pandemic is continuing to progress. The announcements on the news are changing by the minute. PA education is still figuring out how to overcome unprecedented challenges as we strive to meet the needs of our students while ensuring their individual safety. At this point, almost every single PA program has withdrawn their students from clinical sites. As I discussed in Part 1, PA programs are, to the best of their ability, responding by transitioning to online education.

ARC-PA revised statement

The ARC-PA would like to provide clarification on the Joint ARC-PA/PAEA statement made on March 10, 2020, where they stated, “Waiving SCPE hours is not acceptable and, if necessary, graduation time may need to be extended.” Now, they have revised that statement:

“Waiving program requirements for students to meet SCPE learning outcomes is unfortunately not an option. Programs that are unable to ensure that all students meet their learning outcomes due to the temporary suspension of SCPEs may need to delay the date of program completion until they are able to do so.”

The latest challenge is to consider how clinical year students will meet the learning outcomes set forth by each individual program. In a statement released from the ARC-PA, guidance was provided regarding how to help faculty make informed decisions regarding clinical requirements.

“Please be reminded that the ARC-PA does not dictate the length of supervised clinical practice experiences (SCPEs). (See also B3 Standards.) Each program determines the amount of experience need for students to achieve the program’s expected learning outcomes. Some programs are adjusting the length of their SCPEs while still ensuring students meet expected learning outcomes in an expedited manner.”

This provides PA programs with an opportunity to rethink the concept of competency-based education.

In the time-based model of competence, many PA educators believed the experience of training an adequate amount of time was sufficient for the learner to emerge as competent. This has influenced the length of clinical rotations in numerous cases. The outcomes-based model of competence, on the other hand, emphasizes the primary focus of education and training should be based upon the desired outcomes. This could be informative as PA programs develop their action plan for the next several months.

Implementing a hybrid clinical year plan

PA Programs now have the choice to operate a hybrid clinical year plan over the next several months, the assumption being students will not return to clinical rotations for at least several more weeks. This time can be spent in concerted focus study time.

Here are a few ideas to consider when implementing a hybrid clinical year plan:

  1. Preemptive EORE Study plans: Anticipating clinical rotations may be truncated, a focus study plan for the EORE can be implemented immediately. PA students would not take these exams until they have completed the clinical experience. This process would, however, jumpstart their completion of the study process. Time spent studying for each discipline can be logged as learning activities prospectively assigned to each clinical clerkship.

  2. Completion of program-assigned case studies: PA programs can utilize resources involving clinical case studies online. Students will be assigned to complete case studies in all the core disciplines (internal medicine, emergency medicine, women’s health, pediatrics, emergency medicine, surgery, psychiatry). The time spent can be logged as learning experiences assigned to each respective SCPE that is not yet completed.

  3. Guided Independent Study: PA programs can assign students to a reputable and quality online review system that will allow them to study medical topics appropriate to the clinical year. This can be for EORE or to allow students to focus on weaknesses and deficits revealed on the PACKRAT and previously completed EORE.

  4. Nonclinical elective clerkship: Programs can preemptively initiate nonclinical elective clerkships that allow for several weeks of continued progress for graduation.

SCPE Action Plan

PA programs can immediately begin planning for an alternative clinical year. Hypothetically, if students return to clinical rotations in June, they can shorten the clerkship time by 50%. For instance, a four-week rotation will be completed in two weeks; a five-week rotation completed in 2.5 weeks, etc. As mentioned in the ARC-PA’s statement, this process will not preclude students meeting program-specific learning outcomes. Students are still required to log clinical time, complete paperwork, and receive an evaluation from a preceptor. The focused study described above can certainly facilitate the learning process and, indeed, better prepare the student for these shortened SCPEs.

Summary and Conclusion

PA programs can be proactive by planning appropriate learning experiences for their students and streamlining the clinical year experiences. The concept of competency-based education could better inform PA faculty about thinking outside the box as it pertains to students’ clinical skills.

This is a time for us to be creative and proactive. I believe this will ultimately improve PA education because of the thoughtful innovation that will undoubtedly come about during this process.

As a community, PA educators are strong; we will get through this. Our students will graduate. They will be quality PAs. Now, we must let go of the status quo and tradition. Our students need to grow strong for this process and take more responsibility for self-directed learning. Perhaps the hybrid clinical year model will result in even better outcomes—time will tell.

© 2021 by Massey & Martin, LLC

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