Any PA programs left that do not require prior direct patient experience?

[marilynpac]

That's where surgical NPs are going to be filling that need....and even out here in Hooterville, they want EDPAs with at least 2-5yrs experience.

[LESH]

That's where surgical NPs are going to be filling that need....and even out here in Hooterville, they want EDPAs with at least 2-5yrs experience.

 

LOL Hooterville...I haven't heard that in years.

[VictoriaO]

Wow, cervantes, as a fellow PA student I'm going to have to respectfully disagree with you.

 

PA school is designed to build upon previous knowledge of medicine, not teach you everything from the ground up. Sure, "a lot of docs you know didn't have any hce." That's why they went to medical, not PA school. That's why medical school is 4 years plus residency, they take the time to teach you patient communication, go into-depth on pathophysiology and clinical med, spend weeks on topics we have a 3-hour lecture on (that should mostly be review). If your GPA is that good, you have no HCE (not "shadowing" or "scribing"), you're young and don't have a family to support, then why not just go to medical school? Heck, I can't begin to fathom how some applicants can afford to view their HCE as a "minimum prison sentencing" to meet hours, for many of us it was just an interesting job we did to pay bills that we happened to be good at.

 

I'm sorry but IMHO there's no way you can be a decent practitioner from your average PA education without this HCE footing to stand upon. I don't care what your IQ is, no one can learn enough medicine from the very beginning in 26-28 months and hit the ground as a competent practitioner. I strongly disagree that 2-5 years prior experience is "too long", if anything it's not enough. Every single day I draw on medicine I've learned for years as a stand-in "tech" for RNs; shadowing or sitting in a lecture doesn't teach you who's about to crump, the med lists and faces that match chronic diseases like Hep C, HIV, CHF, COPD, renal failure and what acute on chronic failure looks like, who's faking it, and what v/s make you say "oh sh**!" Undergrad GPA and high GRE and PANCE scores while important, don't mean diddly squat if you don't how to communicate with worried families or calm angry psych patients, what "sick" looks like, what it means to be responsible for a patient.

 

I'm with the old-school PAs that it's HCE or the highway (ie med school expressway)

[GREATMDPA]

Wow, cervantes, as a fellow PA student I'm going to have to respectfully disagree with you.

 

PA school is designed to build upon previous knowledge of medicine, not teach you everything from the ground up. Sure, "a lot of docs you know didn't have any hce." That's why they went to medical, not PA school. That's why medical school is 4 years plus residency, they take the time to teach you patient communication, go into-depth on pathophysiology and clinical med, spend weeks on topics we have a 3-hour lecture on (that should mostly be review). If your GPA is that good, you have no HCE (not "shadowing" or "scribing"), you're young and don't have a family to support, then why not just go to medical school? Heck, I can't begin to fathom how some applicants can afford to view their HCE as a "minimum prison sentencing" to meet hours, for many of us it was just an interesting job we did to pay bills that we happened to be good at.

 

I'm sorry but IMHO there's no way you can be a decent practitioner from your average PA education without this HCE footing to stand upon. I don't care what your IQ is, no one can learn enough medicine from the very beginning in 26-28 months and hit the ground as a competent practitioner. I strongly disagree that 2-5 years prior experience is "too long", if anything it's not enough. Every single day I draw on medicine I've learned for years as a stand-in "tech" for RNs; shadowing or sitting in a lecture doesn't teach you who's about to crump, the med lists and faces that match chronic diseases like Hep C, HIV, CHF, COPD, renal failure and what acute on chronic failure looks like, who's faking it, and what v/s make you say "oh sh**!" Undergrad GPA and high GRE and PANCE scores don't mean diddly squat if you don't how to communicate with worried families or calm angry psych patients, what "sick" looks like, what it means to be responsible for a patient.

 

I'm with the old-school PAs that it's HCE or the highway (ie med school expressway)

 

 

I totally agree. I finish medical school outside of the country and even passed my medical boards (USMLE). Due to lack of experience in the US, I'm in PA school to gain that experience. And I feel really bad for the rest of my class who are so lost when faced with a clinical scenario. The PA education is extremely superficial that a PA graduate doesn't have the in-depth understanding to manage patients. That's why PAs need supervising physicians to guide them. Of course, you will learn and gain the experience many years down the road, but not competent enough if you just get out of school

[JasonD]

I see how paramedic, military corpsman, RT or MT experience can be beneficial to a future PA. What I don't understand is how working as a medical aid of some type has much, if any, benefit. Emptying bedpans and feeding patients will make one a better clinician one day? Why do schools accept this type of menial HCE?

[JasonD]

some folks here dont even see MT work as being as good as cna or emt.

 

I agree if the MT worked (as I did) in a large teaching hospital: totally isolated from patients. My only patient contact was when I went to the pathology clinic (a.k.a. morgue) to collect samples.

 

My friends who worked in small hospitals got lots of patient contact.

[marilynpac]

Well let me tell you emptying bedpans and feeding patients...you learn how to communicate with your patient....that's priceless and some healthcare providers never learn it.

[LESH]

I'm with the old-school PAs that it's HCE or the highway (ie med school expressway)

 

Tell Director Ruback and AD Kenney-Moore that Les Howard said you represented the Western Region well! LOL. Its a WR PA Program thing.... lol.

[marilynpac]

As I've stated b/f if you're going the cna route make sure it benefits you as a future PA. The cna can also go private duty, as the RN and LPN. More flexibility in hours, more control, more money...sounds like a win-win situation to me...

[tcd1976]

I guess I think of my years in health care as 'building a file cabinet' or 'assembling a bag of tricks'. I am about to start filling up those file folders and adding countless tricks to my bag, but without the cabinet or the bag, I'd be screwed! Due to those experiences, I know that I can tell a person that they've just lost their spouse of sixty years, or their child, or their sibling in a caring and sincere manner; I've learned how to care for patients as I would have myself or my family treated, without making their emergency my emergency.

 

I can't imagine how one would **know** this is the right arena for them without health care experience. It seems like it would be like trying to act a part in a play without rehearsing the stage movements or racing an Olympic final without practicing your starts. It is unfathomable to me.

[EMEDPA]

I can't imagine how one would **know** this is the right arena for them without health care experience. It seems like it would be like trying... an Olympic final without practicing your starts. It is unfathomable to me.

 

More like competing in swimming in the olympics without learning how to doggie paddle first....

sometimes I feel like that coach would if he knew his team member couldn't swim but in the er it's more like this:

me: "ok, to do a paracentesis you just use seldinger technique like with a central line"

newbie: "what's seldinger technique?"

M: "you know, over the wire...after you see the blood return you snake the wire through your guide needle..."

N: " flash of blood?"

M: "yeah, like with an IV"

N: " I don't know how to start an IV"

M: "well if you can draw blood..."

N: " I can't"

M: " ok, let's back this up a bit...the sharp end of the needle goes in the skin like this...."

[andersenpa]

I'm sorry but IMHO there's no way you can be a decent practitioner from your average PA education without this HCE footing to stand upon. I don't care what your IQ is, no one can learn enough medicine from the very beginning in 26-28 months and hit the ground as a competent practitioner.

 

On what do you base this?

Are there other models of medical education outside the US that are different?

What do you say to the hundreds (perhaps thousands) of practicing PAs who entered with minimal to no HCE?

[NewtonsApple]

I wonder how the HCE requirement will be implemented if the PA degree inflates to a doctorate. Getting several hours of HCE can be the same time as a residency one would do out of med school.

 

After my program moved from a BS to an MS the change was rough to the order that our program director championed the idea to create an MS program that could also be turned into a doctorate on the drop of a dime. Our credits, requirments, etc are already in place except the doctorate project, as I suspect it will be more intense that what our current one one is. None of our PA professors want the doctorate and only one thinks it is inevitable. Any one else in a program such as this, student or professor?

[andersenpa]

It's funny to see so many PA students and pre PAs speak so emphatically about which type/quantity of experience is more valuable than another. The only person who can really make an assessment on that is someone who has had those experiences and THEN has experience as a PA to see how they draw on that.

 

With all deference to EMEDPA et Al, clinical experience is only one aspect of the game. Any experience which gives the individual exposure to patient care areas, medical systems, facilities, terminology, etc has value. In my own experience I have seen former medics who had a buff bag in the trunk and a laundry list of technical skills but who sucked at the bedside. Furthermore there are those with much more minimal skills who become stellar PAs.

 

There is no one way. Just as we treat every pt as a unique circumstance, the same goes for the pre-PA.

[Guest cabkrun]

I totally agree. I finish medical school outside of the country and even passed my medical boards (USMLE). Due to lack of experience in the US, I'm in PA school to gain that experience. And I feel really bad for the rest of my class who are so lost when faced with a clinical scenario. The PA education is extremely superficial that a PA graduate doesn't have the in-depth understanding to manage patients. That's why PAs need supervising physicians to guide them. Of course, you will learn and gain the experience many years down the road, but not competent enough if you just get out of school

 

Extremely superficial? Wow. That isn't the impression I have gotten, but I am not in PA School yet. I only base it on what I have been told by others and by my work experiences. The docs for whom I have worked and currently know have all been very enthusiastic PA supporters. Last doc I worked for in San Francisco told me "you belong in PA school, because PAs are better (he was answering a question posed about PA vs NP). They are better trained and are able to come in and hit the ground running far more quickly."

 

I guess you base your thoughts from having gone through Med School, which is a different experience. Where did you attend Medical School? You are in PA school to gain experience to practice as an MD? That's very interesting.

[cervantes21]

Wow, cervantes, as a fellow PA student I'm going to have to respectfully disagree with you.

 

PA school is designed to build upon previous knowledge of medicine, not teach you everything from the ground up. Sure, "a lot of docs you know didn't have any hce." That's why they went to medical, not PA school. That's why medical school is 4 years plus residency, they take the time to teach you patient communication, go into-depth on pathophysiology and clinical med, spend weeks on topics we have a 3-hour lecture on (that should mostly be review). If your GPA is that good, you have no HCE (not "shadowing" or "scribing"), you're young and don't have a family to support, then why not just go to medical school? Heck, I can't begin to fathom how some applicants can afford to view their HCE as a "minimum prison sentencing" to meet hours, for many of us it was just an interesting job we did to pay bills that we happened to be good at.

 

I'm sorry but IMHO there's no way you can be a decent practitioner from your average PA education without this HCE footing to stand upon. I don't care what your IQ is, no one can learn enough medicine from the very beginning in 26-28 months and hit the ground as a competent practitioner. I strongly disagree that 2-5 years prior experience is "too long", if anything it's not enough. Every single day I draw on medicine I've learned for years as a stand-in "tech" for RNs; shadowing or sitting in a lecture doesn't teach you who's about to crump, the med lists and faces that match chronic diseases like Hep C, HIV, CHF, COPD, renal failure and what acute on chronic failure looks like, who's faking it, and what v/s make you say "oh sh**!" UndergPA and high GRE and PANCE scores while important, don't mean diddly squat if you don't how to communicate with worried families or calm angry psych patients, what "sick" looks like, what it means to be responsible for a patient.

 

I'm with the old-school PAs that it's HCE or the highway (ie med school expressway)

 

Ha ha! It sure seemed like they were trying to give everyone a condensed version of everything from the ground up, no matter what your background (and yes the emt's and others struggled just as much).

So...what is the point of pa school? Why don't they just give those with so much hce a pance review book and test them in a month or two? (yeah I know, money). I'll respectfully disagree with you that you can be a decent practitioner without a boatload of hce. You may not believe it or care, but, I guess this is a topic that is so subjective, it's a little funny.

Plus, a three week topic for med students that should be "review" for a pa student? No way. Doc are lectured to know the "minutiae". Will they use it day to day? Plus they have histology, embryology, dedicated pathophysiology, not to mention way more anatomy etc...

Overall, good points, but you know that I didn't mean 2-5 years prior hce is "bad" or a waste of time or won't be useful. I just think that sure, go ahead and pay your bills with the emt or whatever, but realize that the field you end up in might not utilize those exact medical skills that you bring to the table, and will certainly demand more....that pa school won't teach you. Also, just because your not an rt tech(or nurse or whatever) before school doesn't mean that you're a callous jerk that can't deal with a difficult patient or situation. There are smart, caring people that work outside of health care, if you can believe it (and there are plenty of jerks and big egos it in). I agree that pa school is a complete whirlwind and there is no way to teach ddx, clinical medicine...blah blah blah......in that amount of time and be completely ready to hit the ground running. I think the whole point of my post is that I feel grateful to be in a field with so many brilliant, quality people; doc's, pa's and np's (and of course everyone else). If fact, my little sis was a direct entry np (no hce), trained three months in dermatology after graduation and two years later is doing wonderful....just sayin'.

[cinntsp]

Extremely superficial? Wow. That isn't the impression I have gotten, but I am not in PA School yet. I only base it on what I have been told by others and by my work experiences. The docs for whom I have worked and currently know have all been very enthusiastic PA supporters. Last doc I worked for in San Francisco told me "you belong in PA school, because PAs are better (he was answering a question posed about PA vs NP). They are better trained and are able to come in and hit the ground running far more quickly."

 

I guess you base your thoughts from having gone through Med School, which is a different experience. Where did you attend Medical School? You are in PA school to gain experience to practice as an MD? That's very interesting.

 

She's a disgruntled Caribbean grad that couldn't get a residency slot so now she is having to "settle" for the "superficial" PA career.

[VictoriaO]

On what do you base this?

Are there other models of medical education outside the US that are different?

What do you say to the hundreds (perhaps thousands) of practicing PAs who entered with minimal to no HCE?

 

Hi AndersonPA,

You're absolutely right, this is not based in fact whatsover (just early morning insomniac musings). Just from talking with practicing providers I've heard a variety of opinions about the length of PA school, how "good" we are as greenies, and how much difference the prior HCE makes. Interestingly I've heard a lot of ruckus about the direct-entry NP programs with not many accolades to their graduates.

While it is amazing what one can learn in 26-28 months, I'm really curious about immediate success after the PANCE, ie starting a job after only a year of clinical experience during rotations and quit/firing rate at new jobs, and what specialties are pursued by folks without HCE. I'm sure some folks must do just fine, it takes all types to be good healthcare providers and there's many, many fields to choose from. I suppose my mindset is biased to my specialty of interest in hospital based/EM, it could be a whole 'nother ballgame for someone wanting to care for less critical patients. Mostly I'm basing my opinion on my personal utilization of prior HCE, comments from preceptors and practicing PAs, observations of study habits, and just stubborn opinion that medical school is the "right" way to do things, if there's nothing barring you from going, then why not do so?

 

Overall I'm very interested in the direction of PA education. If you have some data/studies/information, I'd love to read it!

[VictoriaO]

Hi cervantes,

 

PA education and the future of our education is a fascinating topic, I didn't mean to ruffle your feathers with my insomniac rambling, I just happen to disagree. :)

 

Perhaps our school's program were designed differently to accommodate the differing HCE of the students, I know at my school while we quickly reviewed every topic, we spent only a little time on the basics before diving into the more complex stuff. I've found it much easier to study for tests when the disease names and medicines are familiar, and you can match a face with it. Sure, many types of people can bring wonderful skills to the table. You're absolutely right that it doesn't take an RT/RN/Paramedic to have good bedside manner, it's the other skills that people (namely preceptors and other PAs in my experience) worry about. I am just of the opinion that medical school is the "right' way to learn things. If you can do so, then why not? PA school (the way it is traditionally designed) is the way for those of us with a scaffolding in place of basic medicine and skills to build up to competency in caring for another human life at the level of a clinician. A "second chance" at medicine for those of us who can't go to med school for some reason or another (as I see it). I'm interested to see other people's take on this.

 

I can also understand the appeal for some PA educators to want to start with a blank slate. Sometimes your prior HCE can work against you in seeing years of sloppy prescribing practices, or being trained in poor technique.

My spin on it is thus, if PAs, NPs, and Doctors are essentially seeing the same patients in many circumstances, how can 26-36 months of education compare to 8 years? Should PAs always be relegated to less-complicated patients? How can we advance further in our fields of interest to be doing the procedures and seeing the acuity we would like to be? Should there be a separate PA program for those without HCE that's 3 years? Interesting things to think about.

Maybe my mindset is biased to my specialties of interest in critical patients, maybe it's hard to understand without HCE, but every dang day I thank my lucky stars during my clinicals I can do things like mentally process a 4-page nursing home med list in a minute or so, etc. To be the type of PA I want to be, I know I'll be using my prior HCE every step of the way. But everyone's path is different.

 

I do agree 100% that I'm grateful to be in a field with so many brilliant quality people.

Best wishes, and we can agree to disagree.

[marilynpac]

It's too bad that PA spot was wasted on that FMG, instead it could have been given to someone who was more appreciative and deserving.

[Just Steve]

Earlier posting made note of the ability to tell "sick" from "not sick". In my current line of work as a paramedic, I tell each and every new paramedic who cares to listen that the ability to identify "sick from not sick" in a time frame that is measured in breaths is probably THE MOST critical skill set that they can learn (right after personal/crew safety). While the setting of a family practice clinic may give the provider a bit more time (after all, the patient is stable enough to walk into the clinic), the concept is the same...when to refer, when to transport, when to treat on your own..so on and so forth. It's a skill that needs to be groomed just like anything else. I am aware that my penchant for it may get me into trouble by "hanging onto" a patient that may be over my head somewhere along the road. Being aware of that will ensure that I be vigilant of my SP's expectations and guidelines to help guide me along the proper branch of the decision tree.

 

My official stance on HCE before PA school is that I fully support the notion that 3-5 years of direct patient care prior to school will provide a better PA IMMEDIATELY out of school than someone of no HCE. Of course, that leads down the road of "define what I mean by better" Is it better bedside manner? More accurate diagnosis? Better long term outcomes?" That list goes on forever. We have seen the studies that report that there is no difference between PA's with or without HCE after 2 or 3 years of being a PA-C. That goes with any profession...MD, pilot, professional athlete, accountant, carpenter...it just makes sense. You get better with experience.

 

Sometimes I read these threads and I just giggle to myself. I joined the Navy when I was 17. I attended a 14 week "A" school as a hospital corpsman, then a 5 week course called Field Medical Service School which was designed to get Navy Squids acclimated with Marine life. Upon graduation, they cut orders for us to head to Iraq during the first Gulf War. We were destined to be put into platoons and be their company "doc". I was still trying to figure out my tukus from my elbow. I was no more prepared to serve in a combat role as a medical provider than I was ready to fly to the moon. And yet...somehow it works out. I'm not saying its with the best of results all the time but I am saying it's a system that has been around since the Loblolly Boys (http://en.wikipedia.org/wiki/Loblolly_boy) and still continues today.

 

Medicine is an art that which we practice. Things are ever changing. As the system pendulums towards matriculating non HCE students into the roles of PA it could very well realize that it's not the best course of action and the pendulum will swing back the other way. Or...things may turn out pretty darn well and the ball could keep rolling in that direction. Only a healthy dose of "Tincture of Time" will flush out the end results. I am grateful to be accepted into school and will do my best to ensure I finish strong so I can join in this next adventure.

[just_me]

Menial experience has its perks. Yes its always great to have higher responsibility. I have done several menial jobs that have awarded me great experiences--some that people with higher level experience may not even have. How many MTs know how to perform and read an EKG? How many know how to perform an X-Ray and understand the basics of it? How many EMTs take a course in EKG interpretation? How many OTs and PTs draw blood? Everyone has some sort of knowledge to bring to the table...even the one with no HCE may be a biochem, micro or anatomy major----wonder how many PA students would like to be in that persons study group during the 1st year?

 

Do I think you need many years of experience? Its debatable...afterall you can teach anyone (that is teachable anyway) anything. I do think without a doubt they should have some experience (at least a year) working directly with patients mainly for the experience of dealing with different patient types, seeing different situations and to learn the nuances of patient communication. Reading a patient can be difficult if youre not use to working with them...

[andersenpa]

I totally agree. I finish medical school outside of the country and even passed my medical boards (USMLE). Due to lack of experience in the US, I'm in PA school to gain that experience. And I feel really bad for the rest of my class who are so lost when faced with a clinical scenario. The PA education is extremely superficial that a PA graduate doesn't have the in-depth understanding to manage patients. That's why PAs need supervising physicians to guide them. Of course, you will learn and gain the experience many years down the road, but not competent enough if you just get out of school

 

Exam Review

USMLE (Usual Superficial Medicine Learnin'-n-Education) Step I

The above poster is

A) A troll

B) Blazingly ignorant

C) Woefully uncultured in medicine

D) Unskilled in veiling dismissiveness as empathy

E) all of the above

[Sparkles9708]

[quote name=just_me;282624

Do I think you need many years of experience? Its debatable...afterall you can teach anyone (that is teachable anyway) anything. I do think without a doubt they should have some experience (at least a year) working directly with patients mainly for the experience of dealing with different patient types' date=' seeing different situations and to learn the nuances of patient communication. Reading a patient can be difficult if youre not use to working with them...[/quote]

 

I don't think you can teach someone how to deal with a difficult patient for example or even one thats terminal. Recently I had to go in to a terminal patients room and had to maually feel a pulse because the sreen was showing a heart rate of 0. The RN then also felt for the pulse after and told the family he was gone. A couple of the family members came out grabbed me by the hand and thanked me for giving him such great care. This is what makes the bad days worth it. I think this is why atleast a year should be required, plus like just me mentioned earlier, some of these menial jobs can give you some great experience on basic skills. I think working in healthcare teaches you how to face some difficult/ethical situations. I echo the sentiment above that some techniques can be easily taught, but not the communication aspect that is vital to this field. Everyone has mentioned the patient themselves, but also being able to talk to family members as well, is important.

[Hemegroup]

I don't think you can teach someone how to deal with a difficult patient for example or even one thats terminal. Recently I had to go in to a terminal patients room and had to maually feel a pulse because the sreen was showing a heart rate of 0. The RN then also felt for the pulse after and told the family he was gone. A couple of the family members came out grabbed me by the hand and thanked me for giving him such great care. This is what makes the bad days worth it. I think this is why atleast a year should be required, plus like just me mentioned earlier, some of these menial jobs can give you some great experience on basic skills. I think working in healthcare teaches you how to face some difficult/ethical situations. I echo the sentiment above that some techniques can be easily taught, but not the communication aspect that is vital to this field. Everyone has mentioned the patient themselves, but also being able to talk to family members as well, is important.

 

Very true, which is why I always recommend volunteering in Hospice. Great experience in working with the terminally ill, as well as dealing with their families.