PA to MD Bridge

[MedStudent898989]

Because unsolicited advice is the best advice, I thought I might be able to provide some insight into some of the questions being posed here (re: Step 1 and distance learning). I would also really like to see this program happen! Everyone benefits when people are happy in their jobs, and I think building this program would be an incredible advancement for both PA's and physicians.  (background on me: I'm a second year med student currently studying for Step 1).

Regarding Step 1:  One thing to consider when you eliminate the MCAT requirement is that admissions decisions will not be contingent on an individual's ability to perform on standardized tests, which will differentiate this program from current med school programs. Additionally, it seems like this program will have an average age of entry that is somewhat higher than other med schools, thus, the applicants will have spent multiple years outside the classroom. Given these characteristics, I think it would be advantageous to allow for at least 18 months of pre-Step 1 instruction (I'm envisioning roughly 3 semesters). Primarily, I think students will need time to adjust to the intense classroom learning you need to do well on this test. It's an insane amount of boring and esoteric material that simply takes a long time  to memorize. For example, I got a practice question today that asked me which steps in the Kreb's cycle produce a molecule of ATP (shoot me).  I got another one that tested me on the difference between the diameter of a macule vs a nodule. You just have to see this stuff over and over again in multiple different formats in order to be comfortable enough with the material to do well on the exam. Also, I'm sure experience as a PA will help with some of the material the questions are based on. However, the way in which Step 1 tests material is frustrating and exhausting. It takes time to get used to the lengthy clinical vignettes and tricky question stems. I think students in this program benefit from having time to hone their Step 1 test taking skills, because they are different from anything I've ever seen before.  Although, I'm not familiar with PA school tests so maybe that last point isn't as relevant to you all as it is to me : )

Overall, Step 1 is the ticket to residency. I think that it is important for the reputation of this program to have a Step 1 test average that is at least the national average for other medical schools, and I think giving students adequate time to prepare for Step 1 is the way to accomplish this. 

Regarding distance learning: I would ask a residency program director how they would feel about accepting a student from a medical school program that had any of their medical school education completed online. My hunch says that they would not like this (which is completely bogus, because many medical schools do not have attendance policies, so much of M1/M2 are done via distance learning anyway). However, program directors are the gatekeepers of turning MD's into practicing physicians , so we all have to do what they say. I could be wrong about their view of online learning though! However, the perception of distance learning among residency program directors needs to be gauged and weighted before any component of an online curriculum is implemented. It would be a shame for graduates of this program to have limited options for residency based on this component of the curriculum.  

I hope this is helpful!! Take care and best of luck with this project! 

 

 

Edited May 3, 2018 by MedStudent898989
typo city

[brandonhughey]

I had a PA school interview 1 month ago and one of the questions they asked was something on the lines of, "What harm can PA to MD/DO bridge programs do to the PA profession?". I got into this school but am still wondering what they were looking for by asking this question. 

[PAtoMD]

3 minutes ago, brandonhughey said:

I had a PA school interview 1 month ago and one of the questions they asked was something on the lines of, "What harm can PA to MD/DO bridge programs do to the PA profession?". I got into this school but am still wondering what they were looking for by asking this question. 

This is a solid question. Would have thrown me off for sure.  What did you say?

My first reaction is that it would change our medical education model to one similar to the UK.

 

 

[brandonhughey]

Just now, SR0525 said:

This is a solid question. Would have thrown me off for sure.  What did you say?

My first reaction is that it would change our medical education model to one similar to the UK.

 

 

I said that it would make the PA profession appear as a "stepping stone" to become an MD, when becoming a PA should be a career goal and not a stepping stone. It would also reinforce the idea that a PA is less than an MD. But then I added that I didn't see much wrong with someone wanting to continue their education and get the MD/DO degree. I still don't know though if that was right/wrong. I would be interested to see others answer this question. 

[Kaepora]

On 5/2/2018 at 6:03 PM, ProSpectre said:

Edited: Well apparently I was looking at Seton Hall university, not Seton Hill university, and I was wrong on this one (who knew there were two universities with almost the same name that both had dual-degree tracts?). I think you are correct on Seton Hill's BS/MS program, but this is not the norm for the vast majority of PA programs, and students in that program still must complete the normal curriculum for the master's portion of the PA program. 

The professional portion of the program is the same.  That's not an issue.  My question was why does this bachelor's to master's PA program, held on the same campus as the PA to DO bridge program, not prepare their students so they can apply to said bridge program?  Or does the LECOM bridge program waive the undergraduate requirements for matriculation into their program for all PAs?  In other words, do they say, if you are a PA you can apply even if you don't have a full sequence of inorganic and organic chem, physics, etc?

[EmoryandHenryPA2020]

As a person who is about to enter PA school starting later this month (just 11 days away woo) I know that I do not have any experience yet. However that doesn't make me any less interested in this idea. LECOM is the first and well still the only program to try and allow PA's who are interested in furthering their education a somewhat cost effective route for medical school. LMU recently tried to do something with their DMS program that....well was just too good to be true. 2 years all online leading to a Doctor of Medical Science degree? Their program I do not believe would have ever been able to actually achieve higher practice rights to PA's. However I do believe that other schools (probably DO schools) could benefit tremendously by creating programs similar to LECOM. I myself currently am trying though to focus on whats in front of me which is attending and graduating PA school and subsequently Direct Commissioning into a branch of the armed forces. I would love to have options later in my career if I wanted to further my medical knowledge and increase my ability to care for my (hopefully future) family. However its been 8 years since LECOM announced their program and no other college has successfully came forward to follow in their example. I truly hope that more do because I just don't see the negatives of it outweighing the positives

[ProSpectre]

2 hours ago, Kaepora said:

The professional portion of the program is the same.  That's not an issue.  My question was why does this bachelor's to master's PA program, held on the same campus as the PA to DO bridge program, not prepare their students so they can apply to said bridge program?  Or does the LECOM bridge program waive the undergraduate requirements for matriculation into their program for all PAs?  In other words, do they say, if you are a PA you can apply even if you don't have a full sequence of inorganic and organic chem, physics, etc?

Honestly, my guess is that they tailor the entrance requirements for the bridge program to the vast majority of PAs who do have a strong background in the sciences (and have usually completed most if not all of the med school prerequisites). I'm sure they still allow PAs from their dual-tract program to apply as long as they meet the other prereqs (one course of physics and O-chem with labs), but they may do so because they trust the rigor of the master's portion of their program to prepare them (this is just speculation). Not sure if I agree with that, but that's my guess. 

Also, the idea of prereqs for PA school is to prepare students for PA school, not medical school (or for a bridge program to medical school); not sure how old their PA program is, but it may pre-date the bridge program. I will say though, that this is the first program I have ever seen that allows non-science major classes to work for prerequisites. I looked into a large number of schools when I applied a couple years ago, and every other one I have seen specifies prerequisite course must be for science majors. 

Edited May 4, 2018 by ProSpectre

[Kaepora]

19 hours ago, ProSpectre said:

I will say though, that this is the first program I have ever seen that allows non-science major classes to work for prerequisites. I looked into a large number of schools when I applied a couple years ago, and every other one I have seen specifies prerequisite course must be for science majors. 

St. Francis University is the same.  Their BS/MS portion only has "human chemistry 1 & 2", although, starting fall of 2018 they're calling it "general chemistry 1 & 2".  No organic or biochem.  No physics.  Their 1 math class is a "gen ed/PA math".

[DannyPADO]

4 minutes ago, Kaepora said:

St. Francis University is the same.  Their BS/MS portion only has "human chemistry 1 & 2", although, starting fall of 2018 they're calling it "general chemistry 1 & 2".  No organic or biochem.  No physics.  Their 1 math class is a "gen ed/PA math".

You’ve been led astray. The Seton Hill PA program is not affiliated with LECOM. The medical school just has a campus within Seton Hill’s university campus. View them as separate entities. 

Edited May 4, 2018 by DannyPADO

[lkth487]

1 hour ago, Kaepora said:

St. Francis University is the same.  Their BS/MS portion only has "human chemistry 1 & 2", although, starting fall of 2018 they're calling it "general chemistry 1 & 2".  No organic or biochem.  No physics.  Their 1 math class is a "gen ed/PA math".

Oof.  I feel like physics/math classes are vital, they teach you to problem solve and think in a logical manner.  I don't think it's a good idea to water down the pre-reqs to fill the shortages of providers.  I think you can find enough people.

Edited May 4, 2018 by lkth487

[eze8923]

On 3/13/2018 at 1:21 PM, DannyPADO said:

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.

Just graduating from the LECOM APAP program at the end of this month - I would echo pretty much everything DannyPADO took the time to write, especially the bit about being at a relative disadvantage when it comes to networking and audition rotations leading up to residency applications. If the goal is to get into an extremely competitive residency, it is a steep uphill battle. It isn't as much of an issue for those who are planning to go into some of the less competitive specialties.

In terms of Step 1 preparation, also keep in mind that PAs in clinical practice, especially those who have many years under their belt may be somewhat rusty with some of the basic science topics that are taken for granted by traditional students who have just graduated from college with a science-related bachelors degree. Using myself as an example, I had not seen biology, chemistry, etc. topics for more than 10 years prior to matriculating at LECOM. Furthermore, I did not need to prepare for MCAT, and again, made it so that I hadn't seen that type of material in ages.

I can see traditional medical students taking Step 1 at the end of the MS1 year, since that knowledge is still relatively fresh in their minds, but coming in as a PA who is typically far removed from that kind of material that is the focus for Step 1... it would make it difficult to replicate the "Step 1 at the end of the MS1 year" model IMHO.

[EMEDPA]

 

eze8923- did you match in the specialty you wanted? 

[ventana]

12 hours ago, eze8923 said:

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.

 

 

sorry I don't buy that one second.... I think the same as physician.....   course if you are only referencing the ability to get in line and learn in the formal residency setting - well that is something that is teachable.....

[DannyPADO]

1 hour ago, ventana said:

 

 

sorry I don't buy that one second.... I think the same as physician.....   

This is the exact mindset residency directors may have a concern with. 

[EMEDPA]

Danny- what specialty did you match to? did you get your first pick? 

[eze8923]

5 hours ago, EMEDPA said:

 

eze8923- did you match in the specialty you wanted? 

I did - after much thought, I made the switch from EM to anesthesia.

Will be headed to Johns Hopkins for anesthesia with a short stop at Highland Hospital in Alameda, CA for my preliminary medicine year.

[lkth487]

6 hours ago, ventana said:

 

 

sorry I don't buy that one second.... I think the same as physician.....   

A lot of residency directors don't like physicians who have been working for a while (and are changing careers) for the same reason.  

[EMEDPA]

1 hour ago, eze8923 said:

I did - after much thought, I made the switch from EM to anesthesia.

Will be headed to Johns Hopkins for anesthesia with a short stop at Highland Hospital in Alameda, CA for my preliminary medicine year.

congrats!!!

[lkth487]

Congrat$ on Ane$the$ia.  The intern year is gonna suck but it gets a lot better for the next three years!

My advice - plan from the beginning to subspecialize!

Edited May 8, 2018 by lkth487

[Joelseff]

Congrats E! Man that went by fast!

 

Just graduating from the LECOM APAP program at the end of this month - I would echo pretty much everything DannyPADO took the time to write, especially the bit about being at a relative disadvantage when it comes to networking and audition rotations leading up to residency applications. If the goal is to get into an extremely competitive residency, it is a steep uphill battle. It isn't as much of an issue for those who are planning to go into some of the less competitive specialties.

In terms of Step 1 preparation, also keep in mind that PAs in clinical practice, especially those who have many years under their belt may be somewhat rusty with some of the basic science topics that are taken for granted by traditional students who have just graduated from college with a science-related bachelors degree. Using myself as an example, I had not seen biology, chemistry, etc. topics for more than 10 years prior to matriculating at LECOM. Furthermore, I did not need to prepare for MCAT, and again, made it so that I hadn't seen that type of material in ages.

I can see traditional medical students taking Step 1 at the end of the MS1 year, since that knowledge is still relatively fresh in their minds, but coming in as a PA who is typically far removed from that kind of material that is the focus for Step 1... it would make it difficult to replicate the "Step 1 at the end of the MS1 year" model IMHO.

 

Sent from my SAMSUNG-SM-G891A using Tapatalk

 

 

 

[ventana]

On 5/7/2018 at 2:13 PM, DannyPADO said:

This is the exact mindset residency directors may have a concern with. 

I think the question is not the mind set but are you ready to learn....

 

I would have no problems stepping back in to a limited responsibility role as part of a formal residency program (but then again I have worked under many different doc's whom had had a wide breadth of expectations)

I think PA's (in my world of primary care) function and think IDENTICAL to the Doc's.

As for mindset of a PGY-1-3  Well I can fake that, and learn when I need to learn, and just "move the meat" when needed as well.  

This is really no different than rank in the military - you need to know where you fit...  Officially a O-1 outranks a E-8, but see who the CO sides with when the chips are down.....

I can see an overconfident PA struggling to accept the PGY 1-2 roles, but there is so much to learn and the object is learning not politics, so learn, learn.....  But I can see your point and since I have ZERO experience in this role I can't comment any further.

 

 

Honestly I am to old at this point to do it (unless I won 10m in a lottery - shucks didn't happen today...) and my desire to learn is appeased with staying abreast of the advances in medicine, and starting to do a little teaching in a PA program.

 

 

I would again state that I am talking two separate things here

 

1) is the point of the "Way in which a PA thinks" in practice - it is the same as a doc (as far as I know in primary care)

2) I can see how some PA's might struggle with the PGY1 role, but life is about learning, and capturing your audience.  A good program should welcome the diversity and the opportunity to have a wide variety of people in their programs....

[LT_Oneal_PAC]

On 5/7/2018 at 1:13 PM, DannyPADO said:

This is the exact mindset residency directors may have a concern with. 

If you’re saying that a PA has a different process for arriving at differential diagnosis and treatment because of perceived supervised status, then you’re wrong. If it were true, I could extrapolate this that no resident can become an attending because they were supverised for 3 years. There is no difference in Physician thought process vs PA. I’m in residency now and my experience has been very appreciated and considered an asset. I could elaborate, but it would sound like boasting.

If you’re saying someone who was autonomous would have trouble receiving instruction, that could be the case but easily determined in an interview. I’ve seen many go back and perform a second residency without trouble.

[DannyPADO]

This was the concern and opinion of residency directors brought up at several of my interviews for a non-IM/FM specialty at institutions like Einstein, Brown, and Case Western. I apologize if I was not clear enough previously. 

[lkth487]

6 hours ago, LT_Oneal_PAC said:

 

If you’re saying someone who was autonomous would have trouble receiving instruction, that could be the case but easily determined in an interview. I’ve seen many go back and perform a second residency without trouble.

 

People drop out of residency and do another.  Or do another residency after completing one.  Or do one within a couple of years of completing one.  But it's not very common to be practicing independently for any period and then go back and do another residency.  Part of that is just the time commitment.  The other is the significant reduction in pay.  But I've definitely heard from my PD as well, that he would be worried about taking someone who has been an attending for a long time back into residency. 

I don't honestly know what I think about it.  I can see both sides of it.  I'm not even graduated yet, and I already feel that I would probably make a terrible intern.  Having gotten used to independence, it's hard to go back to a place where you have to do what someone else says or run your plans by other people and be subject to their whims and preferences. 

Edited May 11, 2018 by lkth487

[LT_Oneal_PAC]

12 hours ago, lkth487 said:

People drop out of residency and do another.  Or do another residency after completing one.  Or do one within a couple of years of completing one.  But it's not very common to be practicing independently for any period and then go back and do another residency.  Part of that is just the time commitment.  The other is the significant reduction in pay.  But I've definitely heard from my PD as well, that he would be worried about taking someone who has been an attending for a long time back into residency. 

I don't honestly know what I think about it.  I can see both sides of it.  I'm not even graduated yet, and I already feel that I would probably make a terrible intern.  Having gotten used to independence, it's hard to go back to a place where you have to do what someone else says or run your plans by other people and be subject to their whims and preferences. 

Coming from the military, it’s very common for Physicians to go back. 

I agree it’s very hard to go back. After being independent in familymilitary medicine for 3 years I have to make a conscious effort to not operate outside intern parameters in my residency. But initial evaluations are looking great, so I think I’ve been doing a fine with it and many have commented well on clinical maturity due to previous experience.