Online PA Programs

[Guest Paula]

I had proctored exams and they had to be taken by a certain date and time or fail the exam.  I did not bring notes, books, charts, graphs, write on my wrist or put cheat sheets up my sleeve.

 

I attended every single on campus lab for two years, spent one summer in cadaver lab for 8 weeks on campus. 

 

I sat in the same classroom with my on-campus cohorts, except my seat was in front of the computer and nearly every lecture I looked at the back of Jon's head.  Curious how we sit in the same seats day after day!

 

My DE program accepts a limited number of students yearly.  Initially was 2, the second and third years was 4.  Now I think the limit is 6-10. 

 

My program truly is focused on keeping local students in their home communities with the idea we would return to primary care in rural/undeserved areas.

 

They have the support of WisTrec, (rural health association), the 3 major health systems in N. Wisconsin, and other stakeholders. 

 

The requirement to get in is the exact same as on-campus and is just as competitive.  Tuition is the same. 

 

I believe I was the ONLY supporter for the program on the AAPA FB site. (where's my smile emoticon)? I was sorry to see it deleted from AAPA FB site.

 

I think smaller class size is key to success.  After thinking about it, the goal of 300-350 students yearly may dilute quality and rotation sites.

 

Let's allow ARC-PA do their job.

 

We all get frustrated when we have no say and I am saddened to hear the Yale PA grads had no say in the matter and it appears it was not a transparent process.  (I absolutely hate that term "transparent".  It is a meaningless term since 2008).

 

Onward to the doctorate and CAQs for PAs.......  And autonomy, full professional responsibility, collaboration and the ability for PAs to direct and manage our own profession.  We are all doing our part to be involved and I salute all of you....pros and cons....because you are involved and care about our profession. 

[SHU-CH]

I am inclined to agree with Paula. I view this as an experiment and it will take some time for everyone (including the ARC-PA) to decide if it works. There are many posts in many threads here that describe PA school as "the most expensive self-study program ever."

 

Technology can do remarkable things. My lectures in PA school were all delivered either via chalkboard or acetate on an overhead projector. I know that the technology our program is currently using is delivering much better curricular content than I received. We are working to deliver as much content on line as we can to save our precious face to face time for things that really need it, like the physical examination. It might be possible that through return trips to campus DE students get as much hand-on time as traditional students. I have not seen enough info about the program structure to judge this.

 

As others have mentioned, my biggest issue would be the loss of camaraderie. I enjoyed the shared suffering of hanging out with classmates at the library or a diner hashing through the material. They will have to select extremely disciplined, motivated students for this. I am sure this has been thought through.  

 

I have come across a lot of things in my day that worked, even though they intuitively might not make sense.

[browndog]

I am an NP who disagrees with online NP programs so I understand the PA community concerns. Online education provides an excellent pathway where appropriate. I just feel that medical education is best obtained In a conventional face to face setting.

[Guest Paula]

oops, forgot one thing:  The UW-Mad program now has a satellite campus, UW-Marathon College where the DE students meet as a group for some of their education.  The site is 70 miles south of where I live.  I'm not sure exactly what they do there, I think some labs? guest lecturers in person? some on-line education as a group and being beamed in to the Madison campus for "live" discussions with other students?  (Beam me up, Scotty). 

 

I need to check it out and they have expanded in their creativity of delivering the education for the  rural PA students.

[marktheshark89]

http://www.buzzfeed.com/mollyhensleyclancy/yales-first-online-degree-gets-cheers-from-investors

[PACdan]

http://www.buzzfeed.com/mollyhensleyclancy/yales-first-online-degree-gets-cheers-from-investors

 

What a great, organized, strong opposition response from Yale alumni, students, faculty, and other PAs. Too bad the university won't listen. The fact that 2U's stock rose 25% after the announcement will ensure that.

[whoRyou]

Things that make you go hmm ...

[MedicinePower]

Really bad idea. Nothing can compare to forming a relationship with your professors and fellow students while mastering the material.

[marktheshark89]

We have started a letter writing campaign:

 

We encourage alumni, PAs, and the general public to write an email or letter stating your opinion about the online program announcement. Please send letters to the Dean of the Yale School of Medicine at Robert.alpern@yale.edu or

 

Office of the Dean

PO Box 208055

333 Cedar Street

New Haven, CT 06520-8055

[JamBra0]

^^ Sent. 

Everyone should join in.

[Nostraadms]

I haven't really heard of any intelligent argument against the online program, other than the comment about it not being transparent. The argument that it "degrades the profession" isnt an argument - just your opinion. After all, people who practice PA profession must pass the PANCE and employers don't really care where you graduated (yet).

Also, there is no data that shows online programs "fail" or produce PAs of quality. If there is, I'd like to see it. On top of that, these aren't 100% online. There are aspects where you need to show up in person

Another failed argument is that we need a smaller classroom size. Why? If there is a professor who can teach ochem, or calculus, or patho very well (and believe me teaching is a skill that even some very intelligent people lack) then why should we limit the number of students he or she can teach?

We already see this in South Korea where great teachers make millions because they're great at what they do.

As an undergrad, I absolutely loved it when my professors posted their lectures online. I had an amazing organic chemistry professor, I'd attend class maybe 50% of the time and watched the lectures at home.

Also, online is great for people like me who can't sit in the same spot for hours straight. I don't know about the rest of you, but I feel the need to get up every 40-50 minutes and walk around, grab some water, take a break or just do something else!

And one more thing to add...what about the PA's who have already graduated from online programs? Are they any less qualified or capable than traditional PA's because of their education?

[LESH]

One thing you can say about this brave new PA world is that "This its not your father's (or mother's) PA program."

[Nostraadms]

One thing you can say about this brave new PA world is that "This its not your father's (or mother's) PA program."

Is that a bad thing Lesh? We need to change with the times. The worst thing I can see is producing too many PA's and over saturating the market as has been the case for RN's here in SoCal.

[LoRezSkyline]

 The worst thing I can see is producing too many PA's and over saturating the market

 

...that's a pretty bad outcome in my book.  

 

I already have major reservations about programs doing away with or softpedaling the hands-on pt care experience requirements to allow for potentially under-qualified applicants - this only opens the door to even more, as there will be an even greater number of seats for those folks looking to take the quickest, most convenient route to "THE BEST MASTERS DEGREE IN AMERICA" (TM Forbes Magazine) and a rosy future in which they can easily make six figures, be out of work & headed home with no charting to do at 5:01P every day, take all the time off they want to have children and spend as much time as they need with their patients! (...cue inspirational music backing Yale/2U online pitch video)

 

I don't look forward to a job market saturated with newly-minted online degree PAs that employers can't wait to give a lowball offer to and all of us throwing elbows in the scrum.  With any luck, by that point I'll be 10 years deep in my career, already have a CAQ under my belt, and won't be stuck settling for that.  We need to maintain the high standards the profession has always been based upon - our patients deserve it, and those of us already in the profession have worked too hard to watch that erosion happen.  

 

I'll end my rant by saying I am not opposed to distance/online ed across the board, and in some cases as what Paula has described above it seems to work when intended for a small number and with the specific focus of generating providers for areas in need.  But the mass-production-style, driven by a for-profit company at the same cost and with the same name the traditional Yale PA degree is what doesn't sit well with me in this case - and I'm not even a Yale alum, just another PA-C working in the trenches. 

[LESH]

Is that a bad thing Lesh? We need to change with the times. The worst thing I can see is producing too many PA's and over saturating the market as has been the case for RN's here in SoCal.

Only time will tell Nostraadms. The good the bad and the ugly. I am all for ways to increase the PA workforce in rural and urban areas of need. I remember when both the Dakota and Madison programs went online. The PA world didn't end. Those students passed and continue to pass the only thing in place that certifies they meet the minimum requirement to be a PA. Like others, I am aware of Yale's PD's extensive background in online PA education and have no doubt that James will do a good job. Others far smarter than I have asked how this could eventually impact clinical training sites for local programs? As far as oversaturing the market in SoCal like the RNs, that is another story. I remember that also. A lot of it was caused by state and federal funding to increase nursing training because of a perceived shortage. Unfortunately (in my opinion) the large concentration of RN programs in SoCal increasing enrollment got blindsided by the number of hospital closures, mergers and hiring freezes. So only time will tell how this will all play out. I am sure there will be “unintended consequences” there always are…

[rpackelly]

Yale's online program featured in piece in "The Atlantic".  This piece conveniently does not mention the clinical year, which doesn't make me feel good about the message to the consumer. 

 

see:

 

http://www.theatlantic.com/education/archive/2015/03/learning-how-to-practice-medicinevirtually/388276/

[PACdan]

I haven't really heard of any intelligent argument against the online program, other than the comment about it not being transparent.

 

Here is one: Perceptions.

 

Is it possible to structure a great program online? Sure. Could their training and subsequent performance equal traditional classroom programs? Sure. Do many people in the public still hold negative connotations about "online" degrees? Absolutely.

 

There is a reason PAs don't wear shorts and a t-shirt to work each day. Would it lower your skill level? No. Is there any evidence that it would harm pts.? No, in fact there is evidence it would be beneficial (bare below the elbows, no ties, etc.). Would it make some providers more comfortable and save time? Yes. So why let tradition stand in the way? Oh right...NEGATIVE PATIENT PERCEPTIONS.

 

One may argue "oh, but we can be the ones to change that perception", however I think it's more prudent not to be. Let medical schools adopt this practice before we do. PAs don't have all their ducks in a row for legislation, autonomy, or even proper recognition in some areas. PA programs should not be the ones breaking the mould on this concept. There are enough battles to fight.

 

I can envision many examples where "huh, PA is an online degree" will be thrown in our faces, and a few others where it does nothing more than benefit schools financially.

 

What Yale is doing wrong is two-fold: They are opening the door to this trend by flashing brand recognition (unlike the other online PA program, which I never saw this kind of attention for) and they're outsourcing the clinical phase management to a for-profit company. It doesn't help that someone in their institution waxed gleefully about adding 300+ PA students in 5 years either.

 

For right or for wrong, perceptions matter! (So you're a medical assistant? Is PA kinda like an NP? When will you be a real doctor?) We need to shut all those drafty windows before opening this huge door.

[Nostraadms]

Thanks for yor answer PACdan. I'm still glad that Yale is offering this option, and those who think it's a good idea should apply. I haven't heard anything from yale that the online program will be easier to get into than the traditional programs. Again, some people like me like the online idea and it'll definitely be one school I'll apply to this cycle.

[db_pavnp]

Here is one: Perceptions.

 

It is commonly said on this forum that from where you graduated matters next to nothing once you have the license.  If there is any perception involved with this issue, it is the positive one of graduating from Yale.

[PACdan]

It is commonly said on this forum that from where you graduated matters next to nothing once you have the license.  If there is any perception involved with this issue, it is the positive one of graduating from Yale.

 

I'm thinking more broadly than that, as in online vs. traditional education perceptions, not which institution grants the degree. Moreover, it's about the precedent set by this step: Yale's same high cost of program + outsourced, for-profit management of clinical year. I posit you this; since our model for schooling is based on medical school, let the medical schools be first to adopt this model en masse. At least then we can be shielded from detraction by their precedent & customs.

[Whitcc1]

Still can't imagine someone would actually pay $80K plus on an online program... Seems like a risky gamble if after it you can't pass the PANCE!

 

 

Sent from my iPhone using Tapatalk

[db_pavnp]

I'm thinking more broadly than that, as in online vs. traditional education perceptions, not which institution grants the degree. Moreover, it's about the precedent set by this step: Yale's same high cost of program + outsourced, for-profit management of clinical year. I posit you this; since our model for schooling is based on medical school, let the medical schools be first to adopt this model en masse. At least then we can be shielded from detraction by their precedent & customs.

 

If you want to call that thinking more broadly, fine.  I would not.

 

Obviously, I am really missing what is pulling so tightly at heartstrings here.  It seems to me that any education is based on a handful of components.  We can dissect out those components and make simple conclusions about whether the quality is roughly equivalent or not.

 

Online lectures are currently utilized by med schools.  The days of raising your hand in class might be over, but you still have access to the professor.  Doesn't anyone remember what it's like to have students ask endless questions that divert and distract a class?  Questions are for after class.  When you have access to video, you have options.  Playspeed options, taking poop options, breakfast at home options, pause and google options.  These options are better.  Online lectures are better.  Disagree with some of this if you want, but this is why med schools use them and why people like them.

 

The clinical education is face to face, the lectures are online, the rotation are whatever, organized at home.  I see an immediate advantage here as in my city I have access to a top 5 US hospital, the state's largest pysch hopsital, two level 1s, two OB's, plus a local PA and multiple NP programs so those hospitals are familiar with it.  I strongly doubt that the majority of PA programs have a quarter of the access that I do from my home city.

 

Anyway, there is definitely no changing minds on this.

[gbrothers98]

Perception can be an issue.

But there is a standard to be met, the PANCE, along with passing an exit practical exam that indicates having the clinical skills to practice. While there is plenty of anecdotal insight into what is thought to be needed to get to that point, this is a multifactorial process that has not been studied in depth. The Yale PA online program will be part of a continuation to determine exactly what is needed to produce a quality PA.

 

There are a certain percentage of newly graduated PAs out of traditional programs that fail the PANCE. Dont see a backlash against that method though the fact that there are failures is indicative that the method is not perfect. Or is there just an overwhelming need to hold onto the established rite of passage, even though that act is bereft with fault and inconsistencies?

 

Over the last decade there has been much research in what occurs in learning and how to be successful. The traditional model of learning, at a physical institution, classroom lectures, knowledge expert delivering content, just does not work without additional adjuncts. The fact that there are plenty of students on this forum whom would like to thank Up to date, Google and YouTube at their graduation ceremony is indicative that programs are only providing a portion of what the student requires. It also is indicative that the main source to be successful at becoming a PA lies with the individual and that programs have the responsibility to foster and encourage this process. 

 

Which leads to the proliferation of programs across the country and the concern of quality and oversaturation of the market. Quality of the programs is overseen by the ARC-PA. I have had several discussions with faculty that interact with the ARC that believe there will be future changes that will be directed at sponsoring institutions of PA programs that will address faculty staffing levels, rotation quality and other directives that will have direct positive effect where it needs to be, on the PA student, to ensure as much as possible that the product developed meets the standards and quality the public needs and desires. Institutions that leverage a small amount of faculty and work them to burnout will face a hostile accreditation with much remediation and possibly probation status. They will have no choice but to put in the resources needed or face loss of accreditation. Given that the structure to produce a PA is built like a house of cards, if this base is not attended to, the whole will come crashing down for some programs. The hard choice will have to be made concerning continuation vs teach out the remaining cohort and shut it down.

 

Saturation of the employment market is a different issue, a workforce conundrum that affects all of healthcare in general. The example of Southern California nursing saturation (I personally dont know if this is an issue) is similar to other areas of the country. The job market locally has it's needs or perceived needs met. Or has it? Are there inroads that could be met in a region that is perceived as saturated but there are other factors that actually are the basis for stymied employment? Anecdotally the critical access hospital I work at has always been an obvious setting for PAs to make a legitimate impact. But it has taken nearly a decade and a half to see PAs (and NPs) have a presence here. There is still a bastion of physician dominance in the hospitalist service and a preference to expand much effort to recruit physicians to IM and Peds even though it is painfully obvious that there is a distinct lack of bonafide candidates while PAs and NPs whom have strong local ties and are more than competent but not seriously considered. 

 

For the PA world to shy away from this change is not the right action. The profession needs to be at the decision making table and be part of the change. This should occur with a clear pathway to a doctorate, a means to achieve autonomy and independence for the seasoned PA, removal of financial obstacles and a hard insightful reevaluation of what is actually needed to produce a competent PA. Physicians are already able to determine their profession's future. NPs are working hard to get there. We should also. If we can develop a process that will be efficient and beneficial for the public, we should be in the vanguard. It has already been proven it can work at other institutions. The perception this is a money grab comes from interpretation of media articles that can't understand nor convey the underpinnings of decisions leading to this announcement. I find it perplexing that graduates of the Yale PA program will outline the frustration felt while attending the program and at the same time defend it as a sacred bastion of PA academics. While I wouldn't characterize this as hubris, there seems to be a disconnect between what was actually experienced and again, after the fact perception. Anecdotally, I worked with a colleague whom had graduated from the other Ivy League PA program. He summed up his experience with one word, meh! I wonder what prior graduates of the medical schools transitioning to a 3 yr program vs a 4 yr say about their potential future alumni? Or the medical school that is allowing students to proceed at their own established pace, challenging exams when felt prepared and shortening their program of study to what is needed for the individual vs the cohort. In the meantime there are PAs on this forum whom feel that their years of experience should count towards a transition from PA to physician or a certificate PA with the same credit hours should grandfather to a master's degree automatically at their alma mater.

 

Finally, rotations or clerkships. There are hundreds of thousands of PAs, NPs and physicians in this country. Only a small percentage provide a PA student clinical instruction. Why? Do they have insight that they are bad teachers and shouldnt be involved? Can't know till you try. But most wont even consider. There is no incentive and there is no training. If this is replaced by an organization that provides both, then bring it. The current status of the clinical year for many programs can be described as haphazard at the worst, luck of the draw for many. To provide incentive and reward to a successful clinical teacher is what's needed. To assume that this will occur because it is the right thing is naive and has been proven to not work. For those whom state they do this on a regular basis, I personally say you need to be recognized. If that means someone is going to pay you for your expertise, that is no different than any other facet of this country's economy. Southwest doesnt move us across this country every day, Honda doesnt build quality vehicles and Apple doesnt make devices that cant be lived without through the goodness of their collective hearts. Neither should any of us.

 

G Brothers PA-C

[marktheshark89]

Just in response to your last point, Yale will not and does not pay any clinical preceptors for their time. We have been assured that will not change. Whether that is good or bad is debatable, but that is a school of medicine policy and is unlikely to change anytime soon.

[CByersPAC]

how about a pa to doc bridge with no mcats, 1 yr online, and 1 yr clinicals in one's home community then automatic acceptance to affiliated primary care residency....that program I would do....:)

 

In a heartbeat.