Practicing medicine with online degree

[Becca8]

Upregulated, not everyone has professors that just read the PowerPoints, there are also discussions and being called upon to think on your feet. When I say "easier" I am referring to the fact that with some online NP program, you can take exams at your home while being watched on webcam by a remote proctor. This opens up the possibility to cheat and not learn the material. I personally would not want to be diagnosed by someone that took all their didactic exams at their house with Google and other resources at their fingertips. The school I am interested in does not accept online prerequisites in certain subjects.

[Marinejiujitsu]

I think going to lectures and being engaged with someone lecturing is by far more effective in absorption of knowledge if you have interesting lecturers. Far too many distractions at home.

 

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[EMSGuy1982]

I echo the distractions at home as well. I know being in an actual classroom with others that are also trying to learn a massive amount of information is benificial. You support each other, keep each other sane and help each other out. I wasn't the best with renal topics but I sure knew that my buddy in class who worked in lithotripsy knew his stuff so I would get together with him. It's a collective effort to get through PA school. Definitely not the hunger games.. online programs are just another way for programs and organizations to generate revenue in my opinion. No limit on class sizes. There would be a disconnect between student and faculty as well I think. The healthcare field is based on human interaction. I would hate to see these online programs pumping out PA's that were socially inept and have a horrible bedside manner.

[overthehorizen]

online programs are just another way for programs and organizations to generate revenue in my opinion. No limit on class sizes. There would be a disconnect between student and faculty as well I think. .

The expansion of PA programs every year both by increasing class size and establishment of new programs is just an effort to generate revenue. Despite the "certification" by the schools, they rarely have established relationships with didactic faculty and often have no established sites for clinical rotations. It is simply a money grab by unscrupulous college presidents who want to generate more tuition revenue. The quality of PA education is sinking to that of NP education. 

[Boatswain2PA]

The quality of PA education is sinking to that of NP education.

Sinking? Perhaps.

 

To that of NP? That is laughable.

[Rhizopus]

Lecture slides are the old way of doing things. Flipped classrooms are becoming the new normal. This highly enhances the in-person experience. Many MD programs are beginning to ditch lectures entirely. This is a much better learning model and simply cannot be achieved online.

 

I've never been a fan of online classes. You just can't replace face-to-face discussions. If Yale does proceed with their program, I would like to see detailed statistical outcomes of their online vs in-person grads.

[UpRegulated]

My original points stand (post #23 in this thread).  There is little (if any)  advantage to sitting in a lecture hall listening to a lecture vs. sitting at home listening to a lecture online via streaming video.  The research available on this topic bears this out (though there isn't much).  But interaction with the professor and students can be enhanced online vs. on-ground.  I ask again.  What is the INHERENT advantage of on-ground vs. on-line?  Interaction with students post-lecture in the hallways of the lecture hall doesn't count - that can be as deleterious as it is advantageous (kinda' like study groups).

 

As for on-line testing.  The comments on this thread demonstrate the lack of knowledge on how that works.  In a classroom, there is rarely (if ever) someone to monitor what you are doing on an individual basis.  On-line, there is a camera on you at all times which records video footage.  How, exactly, is testing in a classroom (especially a large one) INHERENTLY more fool-proof than testing on-line? How about PA-C license exams?  You did that test on a computer, right?  How is one person (that is "in-person") behind a glass window, who is responsible for checking-in every exam candidate while also answering phones and trying to monitor 20+ test takers, INHERENTLY better than someone using an Internet camera to monitor you?

 

Produce cogent arguments and/or evidenced-based data for your assertions that "on-line" is INHERENTLY inferior.  I think that most of these arguments against "on-line" learning come from those that do poorly at self-study and need "in-person" interaction to grasp the material, but that's just my opinion.  These arguments, I think, also come from those that did things the "old-school" way and will never think there could be a better (or even equivalent) way of doing things.  With some, perhaps it's a combination of the two. But again, that is purely an opinion.

[Reality Check 2]

I am not sure the point of the argument for some.

 

My take on online education for our field - PA students need to be in a classroom with PAs teaching them.

 

One can be a social nightmare with poor communication skills, poor personal hygiene but a 4.0 average and look "good" in online classes.

 

I can look at the PA student - do scenarios - have conversations - look at body language, mannerisms and character and KNOW if this person will make a good clinician.

 

Leaving someone at home in their jammies to their own devices does not a clinician make.

 

If you are studying English Literature or even accounting to a certain extent - go for it.

 

If your job, your career, your passion is to care for patients by TOUCHING them and listening to them - then the classroom cannot be replaced. Proctors and lecturers and faculty NEED the contact to ensure that we are producing cogent, proper clinicians who can handle interactions with other people, show compassion and do the exams properly. 

 

This simply cannot be replaced on line. Nor can anatomy lab with a real cadaver for teaching hands on skills and knowledge of the human body. 

 

So, my very old 2 cents as a long term PA, educator, proctor and lecturer - GO TO CLASS. Show up on time, look decent, smell decent. Show me your interpersonal skills and group skills. Show me how you think with good questions. Let me see your body language and responses first hand.

 

Yoda didn't teach Luke online.......

[EMEDPA]

My original points stand (post #23 in this thread).  There is little (if any)  advantage to sitting in a lecture hall listening to a lecture vs. sitting at home listening to a lecture online via streaming video.  The research available on this topic bears this out (though there isn't much).  But interaction with the professor and students can be enhanced online vs. on-ground.  I ask again.  What is the INHERENT advantage of on-ground vs. on-line?  Interaction with students post-lecture in the hallways of the lecture hall doesn't count - that can be as deleterious as it is advantageous (kinda' like study groups).

 

As for on-line testing.  The comments on this thread demonstrate the lack of knowledge on how that works.  In a classroom, there is rarely (if ever) someone to monitor what you are doing on an individual basis.  On-line, there is a camera on you at all times which records video footage.  How, exactly, is testing in a classroom (especially a large one) INHERENTLY more fool-proof than testing on-line? How about PA-C license exams?  You did that test on a computer, right?  How is one person (that is "in-person") behind a glass window, who is responsible for checking-in every exam candidate while also answering phones and trying to monitor 20+ test takers, INHERENTLY better than someone using an Internet camera to monitor you?

 

Produce cogent arguments and/or evidenced-based data for your assertions that "on-line" is INHERENTLY inferior.  I think that most of these arguments against "on-line" learning come from those that do poorly at self-study and need "in-person" interaction to grasp the material, but that's just my opinion.  These arguments, I think, also come from those that did things the "old-school" way and will never think there could be a better (or even equivalent) way of doing things.  With some, perhaps it's a combination of the two. But again, that is purely an opinion.

see my post #24. I'm not wild about anyone, PA or NP, learning physical dx over 1 weekend/semester when the course easily can take 10+ hrs/week of hands on practice in formal sections and outside of class.

[Marinejiujitsu]

I don't think anyone questions online schooling is likely harder but when you have a crying baby/watching kids at the same time. Distractions distractions. Absorption of knowledge is just not affective.

 

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[Becca8]

I've taken online classes before and all of them were much easier compared to in-class. I'm in the medical field and I've taken a national board exam and GRE, both were taken on the computer but not on a chrome or IE browser. It was a special program that couldn't be closed or manipulated to open up the internet. Furthermore, I was searched and had to show my arms, pull my pockets inside out and nothing was permitted in the room with you. It isnt like opening up your blackboard or canvas page and taking an exam.

When you take exams online at home you can use Google, test banks, your own notes whatever you want. The proctor via webcam just sees you looking at your screen.

Also online programs can take a large number of students. The selectivity suffers because of this and low quality students are accepted. Fully online is not the same quality, especially while taking examinations. Pheonix University?

[camoman1234]

I've taken online classes before and all of them were much easier compared to in-class. I'm in the medical field and I've taken a national board exam and GRE, both were taken on the computer but not on a chrome or IE browser. It was a special program that couldn't be closed or manipulated to open up the internet. Furthermore, I was searched and had to show my arms, pull my pockets inside out and nothing was permitted in the room with you. It isnt like opening up your blackboard or canvas page and taking an exam.

When you take exams online at home you can use Google, test banks, your own notes whatever you want. The proctor via webcam just sees you looking at your screen.

Also online programs can take a large number of students. The selectivity suffers because of this and low quality students are accepted. Fully online is not the same quality, Pheonix University?

No trying to start an argument, just stating facts. My wife is in an online NP program, that requires several onsite visits, but you are incorrect about the online test. She uses a lock down browser that does not allow her to Google, test banks etc while utilizing a webcam to watch her. Also, my wife states if there is a noise made she has to stop and explain what the noise was. Not sure what online college/university you have used, but my wife's NP school is much more strict. It is the same program I used in PA school to take IRATs/GRATs/EORs while in the class room (with a proctor in the room), we did not have a webcam, just a lock down browser. 

[Becca8]

The university I attended for undergrad used a lockdown browser as well for in-class testing, I am a big fan of that. The NP I know stated that all she had to do was turn the webcam around before the exam to show the proctor that there were no books or anything on her desk then proceed with the exam and they did not use a lock down browser. Your wife has a quality program if that is the way they conduct their exams. NP programs must vary greatly in quality. I have only worked with local NPs that all seem to get their degree from the same program. There is definitely a deficit somewhere as I and others have noticed, and they just keep pumping more out. Thanks for clearing that up.

[Reality Check 2]

Lock down browsers and all are fine for a test.

 

I am talking about day to day interpersonal contact - teaching hands on skills that simply cannot be replaced by a computer or virtual experience.

 

Anyone who is going to practice medicine needs to have both interpersonal skills and good hands on skills to be a good clinician.

 

NONE of that can be taught virtually.

[camoman1234]

Lock down browsers and all are fine for a test.

 

I am talking about day to day interpersonal contact - teaching hands on skills that simply cannot be replaced by a computer or virtual experience.

 

Anyone who is going to practice medicine needs to have both interpersonal skills and good hands on skills to be a good clinician.

 

NONE of that can be taught virtually.

I agree with you as my wife and I compare our programs. She agrees that my learning in PA school was/is much more superior to hers. I do think her school is much than most of the NP schools out there as they are very strict with their testing and on-site practicums. My wife wants to finish her FNP and then go back to get her mid-wife degree so she can better enhance her women's health knowledge as this is what she wants to do. She does not want to do WHNP as this is very limited for various reasons, 1 of her preceptors was a WHNP and had to get her FNP so she could be more marketable to employers. Anyways, I 100% agree that you need a lot of on campus time and time with professors to grow into a great provider. Which online education cannot give you. I do agree with some parts of online instruction, but disagree with other parts.   

[EMEDPA]

I took my first stats course online about 15 years ago. I had to go to a formal testing center for exams, empty my pockets, sit under a camera, sign in/out for BR breaks, etc

[Reality Check 2]

I took my first stats course online about 15 years ago. I had to go to a formal testing center for exams, empty my pockets, sit under a camera, sign in/out for BR breaks, etc

 

 

Just like NCCPA at Pearson Testing - multiple cameras, empty pockets, no watches. I even had to pull up my pant legs to show my ankles.....

 

How I long for the day of the bubble sheet............

 

Dang, I am old.

[EMEDPA]

Just like NCCPA at Pearson Testing - multiple cameras, empty pockets, no watches. I even had to pull up my pant legs to show my ankles.....

 

How I long for the day of the bubble sheet............

 

Dang, I am old.

yup, if I remember correctly we are the same age. My new attendings were born the first year I started working as an ER tech...

[Joelseff]

As I remember PA school (tongue in cheek since it was only 6 years ago lol) didactic was not only lectures. We had Clinical Problem solving class, science labs, clinical exam workshops/courses that could not have been done online. We had actor/models who simulated patients etc. And our lectures were given by the same faculty of our Medical school which weren't illiterate hack jobs. They were pioneers in medicine. Our basic radiology courses were taught by this ancient guy who invented Ultrasound for INSTANCE (He was a sonar operator in The Navy during WWII and developed ultrasound for medical uses, pretty awesome guy). Yeah he was like 100yo but was still an effective professor/lector IIRC.

 

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[cbrsmurf]

I know you guys don't like it, but education will continue to shift to an online format, especially the didatic portions.  If there are too many distractions at home, well, that's honestly your own damn fault.  Many medical school programs don't even require medical students to be physically present at lectures.  They can stream it or download it to view and/or playback.

 

You won't get any argument from me that clinical examination, anatomy lab/dissection, etc should be taught in person for now.  In a few years, though, VR and tactile feedback systems will be widespread and probably replace actor/models for training.  It could be even more effective as you could construct a patient with a rare diagnosis or presentation, or a catastrophic presentation (ie traumatic limb amputation).

[Reality Check 2]

I know you guys don't like it, but education will continue to shift to an online format, especially the didatic portions.  If there are too many distractions at home, well, that's honestly your own damn fault.  Many medical school programs don't even require medical students to be physically present at lectures.  They can stream it or download it to view and/or playback.

 

You won't get any argument from me that clinical examination, anatomy lab/dissection, etc should be taught in person for now.  In a few years, though, VR and tactile feedback systems will be widespread and probably replace actor/models for training.  It could be even more effective as you could construct a patient with a rare diagnosis or presentation, or a catastrophic presentation (ie traumatic limb amputation).

I trained in a level one trauma center - missing limbs were a normal day in the ER. There was no shortage of things to see and do.

A VR setting does not encompass the emotion, tactile tension nor replicate the team approach.

Sorry - I am not going to condone online any  more than absolutely necessary.

Our society is all too distant and interpersonally disconnected now - we don't need any help.

[Marinejiujitsu]

I know you guys don't like it, but education will continue to shift to an online format, especially the didatic portions. If there are too many distractions at home, well, that's honestly your own damn fault. Many medical school programs don't even require medical students to be physically present at lectures. They can stream it or download it to view and/or playback.

 

You won't get any argument from me that clinical examination, anatomy lab/dissection, etc should be taught in person for now. In a few years, though, VR and tactile feedback systems will be widespread and probably replace actor/models for training. It could be even more effective as you could construct a patient with a rare diagnosis or presentation, or a catastrophic presentation (ie traumatic limb amputation).

Yep. Don't like it. Things changing but hey that's why are school system and medical care is dropping lower than any other developed country.

 

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[cop to pa]

Online for the didactic may be the way of the future.  But, as others have pointed out, this is a hands on business. You need physical, hands on time to learn techniques and develop the needed skills.  Didactic year is more than classroom time, and there in lies the rub in this conversation.

[Kaepora]

Bear in mind as you read this I am a huge critic of NP education.  But I'll give you a brief run down of how my program is structured.  I am in an acute care program so I was required to have a minimum of 2 years of ICU experience.  So first of all, I don't know how my professor seeing me showered and paying attention is better than my patients, their families and my health care team members seeing me do those things while taking care of critically ill patients for the last 5 years.  My classmates and I have experienced some of the most high stress situations possible.  I think my school's requirement does a pretty good job of making sure those accepted are ready to practice medicine.  BUT, not all schools require this - a big complaint of mine.  However, you are required to have gone through a BSN program.  So every NP matriculant has around 1000 hours of working with patients by simply having a BSN.  Even direct entry programs.  I also want to quickly point out that ACNP programs and CRNA programs have much stricter requirements than FNP.  Not to the level of PA, but still an improvement.

 

My first Bachelor's degree and my BSN were in person and, so far, I love the online setup.  My tests are conducted through a website called ProctorU.  I am watched through the webcam, my browser is locked down so I can only access the exam, and the person is no kidding watching.  If I look down too long they make me explain/show them what I'm doing.  And if you are distracted at home that's your own fault.  I was a distracted when attending class in person.  Who's fault was that?  My own.  

 

Once my didactic portion is complete, we'll start the more clinically oriented classes for the last half of the program.  During which, I have to go to campus each semester in order to learn/practice these skills, do simulations, standardized patients, practical exams, etc.  Most "online" NP programs are actually modified distance programs that require visits to campus for experiences such as these.  There are some programs that, with the exception of clinicals, are completely online.  They're considered poor programs.  But, there will always be students with bad stats who are desperate enough to pay the tuition.  It's unfortunate for sure.

 

And, as an ICU nurse I've been doing complete systems assessments for years.  I've heard normal and abnormal heart, lung, and abdominal sounds.  When I've asked patients to close their eyes tight, puff out their cheeks, shrug their shoulders, etc I may not have known which cranial nerves I was assessing, but I've learned it now in NP school.  NP school was meant to build on RN experience.  Many schools are gotten away from this but there are still quite a few that do it right-ish.  My main complaint is I had to take an extra class through the medical school for anatomy.  It was inconvenient and is a huge downfall of 99% of NP programs.

[cbrsmurf]

I trained in a level one trauma center - missing limbs were a normal day in the ER. There was no shortage of things to see and do.

A VR setting does not encompass the emotion, tactile tension nor replicate the team approach.

Sorry - I am not going to condone online any  more than absolutely necessary.

Our society is all too distant and interpersonally disconnected now - we don't need any help.

 

That's great that you had that kind of experience, but many PA students don't get that (I bet 95% of PA's, including me, never dealt with a traumatic limb amputation in an acute, emergent situation as a student or as a PA).  

 

AI and VR will reach a point, I am guessing in the next 10 to 20 years, where the computer can provide a good clinical simulation including team members.