PA to MD Bridge

[waky02]

I have recently had a interesting discussion with a medical school Dean on the east coast that is interested in developing a bridge program.

I would go for a program that had these attributes 

• No MCAT required 
• PA's with at least 5 maybe more experience
• A duration of no more than 2 years 
  • Step 1 to taken at end of 1st year
  • Step 2 at end of 2nd year
• Ability to gain entry into all available residencies (I would imagine that the prior PA experience would give us a leg up)
• Isn't excessive in cost

What in your opinion should this program look like.....

[EMEDPA]

1 YR DIDACTIC, 1 YR CLINICAL.  might actually need to be a bit longer. my understanding is that lecom at 3 years is 8 weeks longer than the min acceptable to be approved as a medical school in the U.S.

I would want it structured like Lecom with no requirement that you do a specific field. (50% of lecom folks have to do primary care, the other 50% are open).

[lkth487]

How could they possibly force you to choose a specific field?  You pass the steps and go through the curriculum, do whatever the hell YOU want.  Neurosurg?  Pedi interventional cardiology?  Pathology?  You gotta do you.

[lkth487]

18 minutes ago, EMEDPA said:

1 YR DIDACTIC, 1 YR CLINICAL.  might actually need to be a bit longer. my understanding is that lecom at 3 years is 8 weeks longer than the min acceptable to be approved as a medical school in the U.S.

I would want it structured like Lecom with no requirement that you do a specific field. (50% of lecom folks have to do primary care, the other 50% are open).

https://med.virginia.edu/ume-curriculum/wp-content/uploads/sites/216/2016/07/2017-18_Functions-and-Structure_2016-03-24.pdf

Look at Page 9.  Says you need 130 weeks.  I think you can do it in 2.5 years.   With that said - there are usually loopholes if you work at it.  Maybe LCME would count some or all of PA school (especially if associated with an MD school) towards the 2.5 years.  Or they could change that length.  If I were emperor with unlimited power (a job I would accept), I would count the entire 2 years of PA as med school instruction and just fill in the rest.  Then you'd just need to fill in classes to prepare for Step 1, and maybe with some advanced rotations in different fields thrown in.  Voila.

[waky02]

1 hour ago, EMEDPA said:

1 YR DIDACTIC, 1 YR CLINICAL.  might actually need to be a bit longer. my understanding is that lecom at 3 years is 8 weeks longer than the min acceptable to be approved as a medical school in the U.S.

I would want it structured like Lecom with no requirement that you do a specific field. (50% of lecom folks have to do primary care, the other 50% are open).

1. I am unaware of the minimum requirements

2. this is an established School, I wonder if that counts

3. why the need for a full clinical year (I see little need for clinical rotations other then networking)

4. If the minimum would be 2.5 years, how would you want it structured

[Hckyplyr]

14 hours ago, waky02 said:

I have recently had a interesting discussion with a medical school Dean on the east coast that is interested in developing a bridge program.

I would go for a program that had these attributes 

• No MCAT required 
• PA's with at least 5 maybe more experience
• A duration of no more than 2 years 
  • Step 1 to taken at end of 1st year
  • Step 2 at end of 2nd year
• Ability to gain entry into all available residencies (I would imagine that the prior PA experience would give us a leg up)
• Isn't excessive in cost

What in your opinion should this program look like.....

It is not possible to learn the info required for Step 1 in one year of school. If traditional medical schools can only do it in 2 years (which is equivalent to about 40-50 credits a semester), what makes you think you can cut off a year? Your PA experience will NOT help you for Step 1, period. I think you need to be MUCH more realistic. Thats just my opinion though. 

[EMEDPA]

14 hours ago, lkth487 said:

How could they possibly force you to choose a specific field?  You pass the steps and go through the curriculum, do whatever the hell YOU want.  Neurosurg?  Pedi interventional cardiology?  Pathology?  You gotta do you.

1/2 the slots are held for individuals who will sign an agreement that they will do primary care. I believe some of the 3 yr traditional md programs do this as well. I don't know what the penalty is if you try to match to something else. Maybe the program just won't write you a letter of recommendation if you try to match a specialty. don't know how it works. here is stuff from the 3 yr TX program:

F-MAT Family Medicine Accelerated Track

The Family Medicine Accelerated Track, or F-MAT, is an innovative 3-year accelerated medical school curriculum that culminates in the M.D. degree and will prepare participants for a standard 3-year family medicine curriculum at one of three Texas Tech programs, in Lubbock, Amarillo, or the Permian Basin.

The purpose of F-MAT is two-fold:

1. To increase the number of medical students choosing a career in family medicine, especially in under served areas, who will provide patient-centered care.

2. To prepare primary care physicians more efficiently and with less cost.

For complete information on the program, visit TTUHSC SOM website.

[EMEDPA]

6 minutes ago, Hckyplyr said:

It is not possible to learn the info required for Step 1 in one year of school. If traditional medical schools can only do it in 2 years (which is equivalent to about 40-50 credits a semester), what makes you think you can cut off a year? Your PA experience will NOT help you for Step 1, period. I think you need to be MUCH more realistic. Thats just my opinion though. 

agree with this. most of step 1 is ms1 and we do very little of that. PAs are more prepared for step 2/3, but not step 1.

I think 18 months of didactic and 6 months of clinical would do the trick. most PAs complete the equivalent of MS3 during their PA2 year. MS4 is known to be full of fluff like vacations, interview time, self-designed electives, etc

[PAtoMD]

22 minutes ago, EMEDPA said:

1/2 the slots are held for individuals who will sign an agreement that they will do primary care. I believe some of the 3 yr traditional md programs do this as well. I don't know what the penalty is if you try to match to something else. Maybe the program just won't write you a letter of recommendation if you try to match a specialty. don't know how it works. here is stuff from the 3 yr TX program:

F-MAT Family Medicine Accelerated Track

The Family Medicine Accelerated Track, or F-MAT, is an innovative 3-year accelerated medical school curriculum that culminates in the M.D. degree and will prepare participants for a standard 3-year family medicine curriculum at one of three Texas Tech programs, in Lubbock, Amarillo, or the Permian Basin.

The purpose of F-MAT is two-fold:

1. To increase the number of medical students choosing a career in family medicine, especially in under served areas, who will provide patient-centered care.

2. To prepare primary care physicians more efficiently and with less cost.

For complete information on the program, visit TTUHSC SOM website.

Two of the medical schools in my state have this. I also believe Penn State has an ER one

[lkth487]

Interesting. I would never do that even if I was pretty sure about a specialty.  The vast majority of people change their minds in med school. 

[dfw6er]

17 hours ago, lkth487 said:

How could they possibly force you to choose a specific field?  You pass the steps and go through the curriculum, do whatever the hell YOU want.  Neurosurg?  Pedi interventional cardiology?  Pathology?  You gotta do you.

So basically, if you snag a primary care slot (6 are primary care, 6 undeclared)....you sign a contract stipulating you'll enter a primary care residency and work for 5 years (IIRC) in that specialty after you finish residency.  If you do not honor the terms of that contract, you agree to repay LECOM the cost of a 4th year of tuition...again IIRC...at the cost of a year's tuition at the time you default on the contract.   

LECOM is one of the cheapest private medical schools in the country, so it's not crippling debt if you had to repay a year...depending on what field you enter eventually.   

That being said, if your goal is to practice primary care, 3 years tuition is pretty darn cheap....and you can always get a NHSC scholarship or apply for loan repayment or work for the Indian Health Service to hasten the time to become debt-free.

[lkth487]

Ahh I see.  Well that makes sense.  

[waky02]

So assuming that 18 months would be needed for step 1, that would mean an additional 12 months for step 2. This is predicated on minimal length of 2.5 years.

Is that the consensus?

 

[CorpsmanUP]

On 3/9/2018 at 9:22 AM, Hckyplyr said:

It is not possible to learn the info required for Step 1 in one year of school. If traditional medical schools can only do it in 2 years (which is equivalent to about 40-50 credits a semester), what makes you think you can cut off a year? Your PA experience will NOT help you for Step 1, period. I think you need to be MUCH more realistic. Thats just my opinion though. 

Actually Duke has been doing a 1 year didactic program for several years with no adverse impact in Step 1 scores. Harvard moved to a 1 year pre-clinical model in 2015. There are a multitude of programs that do 18 months of didactic education such as Baylor and OHSU to name two.

There is also a trend to move away from Step 1 as the determining factor for residency. Unlike Step 2, Step 1 has shown no correlation to clinical competence. I know at UCSF, at least for the Peds program, they used STEP 2 for their benchmark for match the past two years and will do so going forward.

Medical education and practice is not the same as it was twenty years ago, much less forty years ago. Things like Cochrane reviews, Peds/Neo Reviews, UptoDate and Dynamed, have changed the nature and pace of both clinical education and practice. While Path, Biochem, Histoloigy would be new additions, some of med schools burden would be lighter having clinical med courses be a mix of new and review material. 

If you want to truly be radical, do one year of didactics and then transition to residency at the same teaching institution, with the MD degree offered at the completion of residency. It will meet LCME and WHO minimum education lengths, it sidesteps the match similar to NYU's program, and allows a practicing PA to not take quite as much of a financial hit losing four years of income from being away from clinical practice,

[lkth487]

Yea, absolutely.  Lots of schools are doing the 1 year didactics with more time for clinicals.  Many of those schools have 1 year for research (for example Duke).  However, those students have to study extra for STEP 1, especially for subjects like biochem and pathology.

As for Step 1 vs Step 2, there have been several specialties which look at step 2 scores more highly but the vast majority - especially the competitive ones - only really still look at step 1.  A lot of students havent taken step 2 by the time the applications are completed.

I'll be honest, I did OK - but not great - on step 1, but I did really well on steps 2 and 3.  STEPs 2 and 3 required more 'knowing', but STEP 1 definitely required more 'understanding'.  I think it's an important exam.  I don't know if its a positive or negative that those students miss out on an extra year of didactics.  Having been at institutions that has both, I think it's a negative and those students are not as well prepared.  But I'm just a peon in the grand scheme of things and I don't have any hard data to back it up.  And also, having trained in a traditional 2+2 curriculum, I'm sure there's some of 'back in my day...' type of thinking as well, for me.

As a person about to finish residency and looking back (3 more months!!!), I don't know how important the STEP 1 stuff was for me.  For the majority of things I see, it is completely irrelevant.  However, once a week or so, I definitely see a case where I'm like 'Oh yea, I saw that slide under a microscope...' or 'Maybe I should think about deviating from standard of care because of this biochem thing I remember..' or this 'ddx should be expanded because of this random thing I see'.  I have no idea if that's worth it to spend all that time studying for stuff that may only matter for 5% of cases.  And maybe less than that.  I don't even know if that stuff would be measurable with enough power in any studies that could be done.   That's for smarter people than me to decide.  But I'm glad I went through it.

With all that said, a residency is definitely more important. 

[Joelseff]

https://med.virginia.edu/ume-curriculum/wp-content/uploads/sites/216/2016/07/2017-18_Functions-and-Structure_2016-03-24.pdf
Look at Page 9.  Says you need 130 weeks.  I think you can do it in 2.5 years.   With that said - there are usually loopholes if you work at it.  Maybe LCME would count some or all of PA school (especially if associated with an MD school) towards the 2.5 years.  Or they could change that length.  If I were emperor with unlimited power (a job I would accept), I would count the entire 2 years of PA as med school instruction and just fill in the rest.  Then you'd just need to fill in classes to prepare for Step 1, and maybe with some advanced rotations in different fields thrown in.  Voila.

How do we get you to be emperor?!? [emoji6][emoji16]

Sent from my SAMSUNG-SM-G891A using Tapatalk

[waky02]

The following is the text of the Email sent to the dean...

As you very well may know there are over 100K active PA's with more then half holding Masters degree in nearly every conceivable field of medicine barring a select few, there is 1 bridging program that have been somewhat poorly received, (see link below) I think secondary to several failures.

 

An ideal program would not require prior aptitude testing such as the MCAT, rather a recognition of the knowledge and clinical skills of the certified PA.

 

In addition the length of didactic aspect should reflect the baseline knowledge already possessed with focus on testing requirements (Step 1).

 

Furthermore the primary didactic aspect of PA school and clinical training should reflect well on the content for Step 2. 

 

There are several schools that have accelerated MD/DO programs of 3 years in duration.

The minimum length of Medical school is set by the state at 130 weeks which is 2.5 years.

 

A program that is reflective of the above, that also takes in to account that a practicing PA would face an income loss of $250,000 at minimum before the incurrence of new tution obligations.

The prospective cohort would be older and more settled then the standard student population, I imagine that multiple years of experience in medicine/surgery would be attractive to most residency directors notwithstanding a accelerated medical schooling.

 

I believe that an appropriate  set of requirements and a lack of limitations of graduates would see a increased uptake in enrollment.

[waky02]

Anything missed?

[CorpsmanUP]

If you looked at this option coupled with several of the current three year program curriculums you could actually do a 2+3 or even 1+3 program; where didactics are followed by going directly into residency. Residencies are where clinicians are grown, not student rotations.

 

An excerpt from an article on the texas 3+3 program: https://www.texmed.org/Template.aspx?id=7284

While each program had unique features, the general approach was to choose mature students in the top half of their class to complete the fourth year of medical school and first year of residency concurrently. All requirements of the fourth year of medical school had to be met either during residency rotations or in a four-month education block. All were paid as residents and some received scholarships or tuition deferment, as well...

...Not only was training time shortened by a year, but also the  medical school debt of those in the accelerated residency program was reduced. 

Reports from the medical schools involved with accelerated residency programs in the 1990s concluded that the program's residents actually scored better on certification and training exams than did traditional residents.

A  2002 report  [ PDF ] from Marshall University found that over nine years, accelerated residents scored on average 30 points higher on training exams. "The program demonstrates that for carefully selected candidates, the program can provide an overall shortened path to board certification and attract students who excel academically and have high leadership potential," that report concluded.

Despite that success, the early pilot programs were discontinued by 2002, after ACGME chose not to endorse accelerated residency permanently because allowing trainees to begin residency before graduating medical school violated its rules...

[EMEDPA]

I remember those 3+3 programs. they allowed ms4 to count as pgy-1 in family medicine. it was a brilliant idea and it worked...but it decreased med school tuition by 25% so had to be done away with....:(

[MediMike]

14 hours ago, waky02 said:

The following is the text of the Email sent to the dean...

As you very well may know there are over 100K active PA's with more then half holding Masters degree in nearly every conceivable field of medicine barring a select few, there is 1 bridging program that have been somewhat poorly received, (see link below) I think secondary to several failures.

What was the poor reception that you bring up here? I was under the impression that LECOM has had a rather outstanding success rate?

[EMEDPA]

2 hours ago, MediMike said:

What was the poor reception that you bring up here? I was under the impression that LECOM has had a rather outstanding success rate?

agree- it is a highly successful program...

[DizzyJ]

17 hours ago, waky02 said:

The following is the text of the Email sent to the dean...

As you very well may know there are over 100K active PA's with more then half holding Masters degree in nearly every conceivable field of medicine barring a select few, there is 1 bridging program that have been somewhat poorly received, (see link below) I think secondary to several failures.

 

An ideal program would not require prior aptitude testing such as the MCAT, rather a recognition of the knowledge and clinical skills of the certified PA.

 

In addition the length of didactic aspect should reflect the baseline knowledge already possessed with focus on testing requirements (Step 1).

 

Furthermore the primary didactic aspect of PA school and clinical training should reflect well on the content for Step 2. 

 

There are several schools that have accelerated MD/DO programs of 3 years in duration.

The minimum length of Medical school is set by the state at 130 weeks which is 2.5 years.

 

A program that is reflective of the above, that also takes in to account that a practicing PA would face an income loss of $250,000 at minimum before the incurrence of new tution obligations.

The prospective cohort would be older and more settled then the standard student population, I imagine that multiple years of experience in medicine/surgery would be attractive to most residency directors notwithstanding a accelerated medical schooling.

 

I believe that an appropriate  set of requirements and a lack of limitations of graduates would see a increased uptake in enrollment.

Several grammatical errors first off.  The first paragraph is confusing.  Nearly half of PAs have a master's degree in nearly every conceivable field of medicine?  Huh?  We do?  

I think the LECOM program has been recieved pretty well by the PA community.  I have a friend graduating from the program.  

Overall, I don't read this letter and get a clear understanding of what exactly you are asking the dean to do.  I get the impression you are asking this dean to create a bridge program for PAs, but it does not seem clearly stated that is exactly what you are suggesting.  

[DannyPADO]

I was in the LECOM APAP program and very much support more bridge programs for PAs willing to take on this change of career.

Your proposal should include adaptations to the traditional medicine pathway that the APAP program has adopted. An accelerated program is sensible for specialties such as FM and IM, as these specialties require you to be an "average" applicant. Competitive specialties require an incredible amount of high performance, including high board scores, high class rank, letters from program directors, audition electives. The accelerated program takes away the opportunities for auditions, networking potential, opportunities for clinical learning, and I think most importantly, time for examination preparation. In an accelerated program, you take Step 1, Step 2, 6 shelf examinations all within a 6-month span, while at the same time, applying to residency. The curriculum is no joke. The difficulty in all of these examinations versus the PANCE/PANRE is enormous. Having said that the APAP program has placed previous PAs into amazing residencies within anesthesiology, radiology, dermatology, EM, and other surgical subspecialties, in addition to FM and IM. I have heard the current match will be incredible again. I am not aware of this program being "poorly received."

While I do not think the MCAT should be a requirement for admission to a bridge program, there should be an objective way to measure aptitude beyond clinical experience gained as a PA, such as a minimum score on the PANCE/PANRE and GPA. Performance in standardized examinations is important for board and examination purposes, pre-clinical examinations, and eventually board certification examinations. Our clinical experience is not an appropriate substitute for this. Prove that you can handle the rigor of medical school.

The difficulty that residency directors may have with PAs with many years of clinical experience is their ability to "unlearn and relearn" in order to think like a physician. There are some directors who value this experience and equally as many who do not. Their concern is, are they malleable to thinking differently and analyzing / solving problems with a different approach than what they have been previously trained. My experience helped immensely with clinical rotations, but contributed minimally to the core sciences in the first 2-years of medical school. While on residency interviews, my clinical experience was minimized versus tangible measurements seen in board scores.

I do not think there should be a minimum level of experience for any bridge program. I think anyone with the right academic fortitude and motivation should be worthy of admission.

The first year of medical school is unlike anything in PA school and Step 1 is the most important examination in medical training. The amount of content cannot be covered and mastered in 1-year alone. You cannot skimp on this. Step 1 will need to be taken after 2-years. Step 2 just needs 2-3 months of preparation. PA clinical experience will help immensely with this and Step 3, especially those working in FM/IM.

As far as tuition, I have no problem with it being the standard cost of your typical medical school. No one is forcing you to go to medical school and it is the sacrifice you take on for making this choice. They have no obligation to give PAs a discount. An accelerated program would alleviate you of an entire year of tuition.

[waky02]

Thank you for the replies, I will amend the text accordingly.

my intent regarding poorly received was not meant to malign the the success or the product of LECOM, rather the poor uptake of PA's actually joining this program