*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.
PA programs across the nation are figuring out how to move forward while PA students are displaced from clinical sites. Many of the students are scheduled to graduate in a few short weeks following the spring semester. Yet, as clinical sites are being shut down to prevent the spread of Coronavirus, graduation will almost certainly be delayed for many PA students.
PA programs are required to meet specific accreditation standards set forth by the ARC-PA, including clinical experiences in specific clinical settings, as well as opportunities to meet program-specific learning outcomes. In a joint statement released by PAEA and ARC-PA, PA programs are being clearly urged to pursue the best actions to ensure continued education for their students. This includes offering recorded lectures, streaming, and pre-recordings. Also included in the joint statement was a coolly communicated point regarding clinical education: “Please note that waiving SCPE hours is not acceptable and, if necessary, graduation time may need to be extended.”
In an opposing statement, the AAMC is recommending all medical schools allow their medical students alternative learning methods in lieu of clinical experiences. The ARC-PA must consider this policy as a guide to ensure the safety and well-being of all PA students nationally; they must act now.
As mentioned, PA programs are determining how best to respond to students being displaced from clinical sites. How do they handle students who completed some but not all of their clinical rotation in a specific discipline? The biggest question being asked is whether or not simulation can replace clinical experiences. In the past, the commission has consistently answered no, simulation cannot be a fair replacement.
Perhaps this is a time PA education can take a creative look at clinical education, finding alternative ways to improve student learning. In fact, this may actually be an excellent opportunity for new innovations.
Note, the opinions of Massey & Martin, LLC does not reflect the opinions of PAEA or ARC-PA. Rather, we are brainstorming and sharing our perspective, which may prove helpful to PA programs. For clarity, the following list provides the absolute requirements that must be met under all circumstances; we do NOT suggest alternatives to these requirements:
Students must meet the requirements of standard B3.02. This includes meeting program-learning outcomes in the preventative, emergent, acute, and chronic encounters
Students must meet standard B3.03. This includes lifespan, women’s health, operative care, and behavioral and mental health
Each student must meet the requirements of standard B3.04. This involves the different settings
Each student must complete clinical experiences with preceptors in the specific disciplines as outlined in standard B3.07
Each individual PA program has its own method to determine whether PA students have demonstrated they’ve met these learning outcomes. These methods include multiple assessment methods, such as preceptor evaluation of students, cognitive exams, patient presentations, OSCE, etc.
Example of the clinical requirement in a typical clerkship:
First, students would be required to complete all components for a clerkship. A preceptor evaluation would still need to be completed. Students would be required to complete the site evaluation, patient logging, time logging, and weekly SOAP notes, or history and physicals.
Next, look internally at individual PA program policies, looking for any specific clock hour requirements in the presence of patients. For each clerkship, for example, do students need to log 40 hours per week on the actual site? If so, there is less flexibility to consider. If there isn’t a specific number of clock hours required, consider whether the students could meet the program-specific learning outcomes using multiple methods. For instance, can the PA program devise online case studies for students to complete and present virtually in a synchronous manner? This might include focused study in the field in which the student has been displaced.
In addition, preparation for the clerkship exam may be a component of this process for students who have been displaced with a partially completed rotation, so long as the preceptor can complete the required evaluation and the students have logged enough patient encounter necessary to meet program policies. Then the time remaining can be spent with alternative hybrid learning methodologies. The key is to directly connect any alternative learning methodology to the SCPE learning outcomes. If your policies do not allow for any of these elements, perhaps the program can preemptively submit a change of policy to allow for flexibility in the future.
Another possible solution involves looking at the PA program’s elective clerkships. Students displaced from rotations can immediately be placed into an elective rotation, giving the program four to eight weeks. In many cases, there is inherent flexibility where students can rotate in specialty settings. PA programs have devised many alternative elective clerkship models, including research, education, capstone, and special projects.
Creative Elective Rotation Ideas
In this section, we will look at an outline for alternative learning experiences that have been used in the clinical year. Each of these can be potentially adapted into an elective rotation for students. Note, the syllabi for these alternative learning experiences must be approved by the institution and incorporated into the curriculum. Careful documentation about this process will help you avoid potential non-compliance with the standards and elective. Remember, no clerkship can be replaced by an elective rotation.
Capstone Case Study and Presentation
Each student will have the opportunity to present the results of their individual Capstone case study project. This will build upon the initial case presentation given during the first semester of the clinical year.
Upon completion of the course, the student will be able to:
Demonstrate the ability to produce a document that follows the biomedical requirements for scientific journals' style.
Demonstrate the ability to organize, complete, and fulfill project guidelines while meeting proposal deadlines.
Successfully present the project results through the effective use of multimedia equipment, formal oral presentation, and written documentation.
Develop a basic appreciation for and comfort with participation in a self-generated extra-curricular professional activity that will transfer to similar professional behavior following graduation.
Analyze a clinical vignette in case study format and develop a basic hypothesis in the form of a differential diagnosis.
Develop basic critical thinking skills necessary to evaluate a patient with specific signs and symptoms and formulate a differential diagnosis.
Students will work with the course instructor on the topic of research they are developing.
The student will communicate with the instructor through email, live chat, one-on-one meetings, and/or telephone to complete the goals and meet the timelines for project development and completion.
Expectations for the project will be clearly delineated by both parties via a written learning contract/rubric.
Students will complete the project utilizing one of the following graduate project formats: Case-based study
The following chart outlines the material to be covered during the Capstone learning process.
Clinical Research Rotation
This four-week rotation will provide a learning experience about clinical research.
Curriculum Goals Address by the Course
Goal 1: To learn about research design, hypothesis generation, and the development of research questions/problem formulation.
Goal 2: To learn to access, assimilate, and critically evaluate the medical literature pertaining to the research topic.
Goal 3: To learn about research ethics, informed consent, and the regulatory processes that must be followed in the conduct of research - as appropriate to the project.
Goal 4: To learn about statistics and data analysis - as appropriate to the project.
Goal 5: To conduct research and acquire any skills needed to do so (e.g. laboratory techniques, computer skills).
Goal 6: To gather data for the project, interpret the data, and integrate the data with information obtained from the literature review.
Goal 7: To write a report about the research project at the end of the elective. This could be an evidence-based medicine review rather than an actual patient case.
Summary and Conclusion
As PA educators are being presented with unprecedented challenges due to COVID-19, they will need to employ creative and innovative thinking. The above suggestions might be an option that, if executed properly, can reduce the wait time and the delay of students’ completion; all suggestions are the sole opinions of Massey & Martin, LLC. Fundamentally, PA programs still must meet the standards.
If we take an optimistic approach to our current situation, we could innovatively enhance the education of future PA students. Perhaps it’s time to join together to share ideas to shift our perspective about education.