While receiving my PA education during the mid-1980s, I believed that PA school was similar to a hazing experience. The first day my PA Program began, I was told that some of us would not make it to graduation. This proved prophetic when only nine of us graduated, despite starting the PA Program with seventeen students in the class. The faculty cared for us as students, but the model of education focused on weeding out the weak to ensure those who survived would be fit to be PAs.
This sort of pressure and stress intensified when I entered the practice as a newly certified PA in 1987. Jobs were not plentiful, and a 60-70-hour work week was an expectation. Although I have always enjoyed and loved the practice of medicine, this lifestyle did not promote a healthy work/life balance. PA school didn’t prepare me to address the issue of impairment and burnout; I was a functioning alcoholic during the first fifteen years of my PA career. Juggling a career with graduate school and my social life had proved too daunting. Fortunately, I ultimately entered treatment and achieved sobriety. Of course, I don’t blame PA school for my alcoholism, but I can attest to the level of stress I was experiencing. I was lucky to emerge on the other side in one piece. Yet this experience has left an indelible mark on my life.
The Impact of Stress on PA Students
Thus, I thought it was almost poetic for ARC-PA 5th Edition to now include a curriculum requirement regarding impairment and burnout:
“Standard B2.20—The curriculum must include instruction about provider personal wellness including prevention of a) impairment, and b) burnout.”
Those of us who have entered PA education often have preconceived notions regarding how students are simply going to struggle; they will expectedly experience PA school the same way we did before them. Nothing will be different, because this is the way things have always been. Yet tradition and our own perspectives are having an adverse impact on our students.
For most of us who have been in PA education for a period of time, we have seen the negative impact of stress on the lives of our students. In my own research, I have witnessed the stress indicators rise precipitously during the first year, eventually returning back to a regular baseline. Indeed, there is a dearth of research regarding the frequent occurrence of stress and depression in our PA students; research provides grim evidence of the high incidence rates of divorce, substance abuse, and depression among healthcare practitioners that are far beyond the norm. Is it possible these ill realities are being fostered within the PA education programs? If so, how can we address it as PA educators?
How PA Educators Can Create a Positive Learning Atmosphere
Exemplify a Healthy Work/Life Balance
PA educators must become positive role models for our students as they work through their PA education. We can begin by providing academic instruction about the necessity of a healthy work/life balance. We can provide viable examples of how our students might achieve a healthy balance by sharing our own stories. I have shared my own story with my students in the sincere hope that it might stop some from going down the same path, while also showing them my own humanity. We cannot create an image that students must be superhuman to succeed in PA school and life.
We can also warn them about burnout and depression and provide insights regarding the incidence rates of substance abuse among PA students. When they are better informed before experiencing these struggles on their own, they are more likely to see the warning signs and make positive changes.
Lead Discussions on Survival Skills
I annually provide discussions and instructions about survival skills during the PA Program. I emphasize the importance of finding a maintainable balance. Time management is a premium and must include normal life events. If a student’s religious faith is significant to them, they ought to take time to worship or pray. Spending time with family is just as important as studying for upcoming exams. Having a balanced social life is key to a healthy work/life balance. I remind them that PA school is not a sprint but a marathon. They might not get perfect scores every time, and that’s okay.
In addition to time management skills, I review the nuances of skills related to studying and test-taking, using individual learning styles, and employing foundational skills, such as reading and note-taking. We cannot assume that every student enters a PA Program with each of these skills already highly-developed, so we must consider how to help them.
Employ a Mentoring/Coaching Process
Over the past few years, I have adopted a mentoring and coaching process that involves frequent discussions with students about their current status. Reinforcing the PA study skill modules needs to continue throughout the program. I also employ a mental health professional who provides basic lifestyle counseling, intended to provide a conduit by which students can be referred appropriately. Overall, this mentoring and coaching process has positively impacted students as it emphasizes foundational skills and stress management.
Meeting the 5th Edition’s Standard B2.20
We can work towards meeting the 5th Edition’s Standard B2.20 by providing a robust study skills curriculum that emphasizes a healthy work/life balance, which meets the basis for the curricular requirements. I suggest allocating time during the first semester to provide a series of seminar-like discussions. Include the foundational skills, such as time management, test-taking, and learning styles, as well as a discussion regarding the impact of stress in PA school. Emphasize that students are allowed to be human; succeeding on every test and assignment is not an expectation. This will provide a logical connection to the research involving substance abuse and burnout in healthcare providers. Be sure to weave in critical skills, as well, such as motivational interviews for patients.
In summary, providing a holistic approach to teach our students about burnout and impairment in the PA profession may be the most effective. As PA educators, we will always be clinicians first. We walk a dual path as a healthcare provider and a mentor of students. Promoting health and wellness to our patients in a believable manner requires us to walk our own path of self-care. The same is true for our students, but if we are poor managers of our own health and wellness, how can we promote this belief system within our students? We must remember where we came from, what we endured, yet embrace the students of today. We must adapt to a new generation of learners. We cannot fall back on the “good old days” as the quintessential example of how medical education should be delivered. Remember, helping to inculcate an environment of humanity and compassion provides a critical example for our students. It is our hope that they graduate and become the compassionate and empathetic providers of the future.