What kind of clinical experience did you have?

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timerick

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    I had 18 years in third world situations as a linguist/community developer (it included some community health work), 18 months as a full-time hospice caregiver, and 3 months as a mental health worker in a drug rehab program. I feel that clinical experience was the weakest area of my application, but I did meet the minimum and made it in the PA school of my choice!
     

    CVPA

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      I applied with an 8-year background in clinical laboratory medicine as a medical technologist.

      My 2-cents about applicants and clinical experience:

      I have been observing a trend in the applicant pool over the past few years.......a trend that worries me a bit. Correct me if I am wrong EMED, because I know you are directly involved in the admissions process of at least 1 PA program. It seems to me that more and more applicants are being admitted with less and less significant prior healthcare experience. I am concerned about this because I feel that in so doing, we are potentially diluting the quality of the graduates. I am not saying that we definitely are, I am just saying that I see the potential for that and it concerns me.

      One of the reasons that the PA training model has been so successful over the past 4 decades is because PA students have historically and characteristically had strong clinical backgrounds. This has not only allowed them to keep up with the fast pace of PA school, but maximize the educational experience compared to those with little or no significant healthcare experience.

      EXAMPLE: PA student "A" (who has been a Medic for 10-years) is sitting in a lecture next to PA student "B" (who has had minimal volunteer experience as a transporter) and learning about the approach and management of the dehydrated patient. The professor is discussing the importance of reviewing the SMA7, not stopping to explain what an SMA7 is but is instead progressing with his lecture under the expectation that all are familiar with an SMA7. Assuming both students have equally high GPAs, whom would you say will get more out of the lecture, student "A" or student 'B"?

      I believe that this type of scenario can be a re-current theme throughout the entire training process and can potentially diminish the quality of the education for those students without significant healthcare experience.

      Prior healthcare experience should not just be a prerequisite to satisfy anyway possible. Instead, it should be a mandate whose quality is evaluated and critiqued by admissions commitees with the same standards that they would use to critique one's prior academic performance.
       

      12R34Y

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        I agree with the concerns of CVPA.

        Let me preface this by saying that i am not a PA......i'm a medstudent.. However, i think the analogy still applies.

        Having more "real" clinical experience will definately help you to get more out of your education and training.

        I personally wish that they would require med students to have a couple of years of clinical experience before being let in.

        at least just getting familiar with hospital settings and interacting with patients...........many of my classmates have NEVER set foot near a real patient. this disturbs me.

        i was a paramedic and er tech for about 5 years prior to medschool and it definately helps during my training.

        bottom line: the more clinical training the better
         

        roballan14

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          In answer to CVPA's question, the student that gets the A in that class is not the one who knows the SMA7 in class, but the one who is able to synthesize the knowledge at test time.

          As a person coming from the field of academic theology to medicine, I have to recognize my clinical shortcoming and ask about that which I do not know. I must be prepared to do much more reading than my counterparts with clinical background and must be willing to humble myself by asking questions, outside of class (so as not to waste class time).

          I agree that clinical folks "do" better in school; no doubt. But the "A" in the hypothetical example doesn't necessarily go the student with clinical background; it goes to the student who is determined to get it.
           

          CVPA

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            Thank you for your response, Roballan.

            While I agree that determination and desire to learn can often supercede the potential shortcomings of a student, the question at hand is not who will get the better grade, but rather who will get the most out of the lecture, i.e. who will walk away from the lecture with a better conceptualization and understanding of the lecture topic, Student "A" or "B"? The issue of test-taking skills is completely different and obviously beyond the scope of this post.

            I would suggest that student "A" is likely to grasp the material and the "take-home-message" more effectively than student "B". The effect and translation of this, I believe, is that student ?A? will more effectively apply what he/she learned in a clinical setting than student ?B?..........and that is what it is all about, the clinical setting and taking care of patients. Although there are always exceptions to every rule, I am talking about the masses and not the one.
             

            Rob77

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              I have to agree with CVPA. I would have to say that out of the 50 students in my class only about 15 have any real clinical experience and out of that 15 only about 5 of us have an extensive backround. The difference between the students that have experience and those that don't are huge. I have found that the 21 year olds with no experience do well on the tests but dont understand the concepts of the material. For many of them it is simply memorizing facts and regurgitating them on an exam. I also feel that the younger students don't take the program seriously enough and they treat it as high school. People complain that they have to show up to school, they moan about studying and they rather go out on a thurs. nite and party rather than preparing for an exam. Im rambling. All I can say is that on a whole I am disappointed with the caliber of students in PA school.

              Prereq's should be a minimum of 4000 hours of full time direct patient contact or if on a vol. EMS level 8000 hrs of ALS experience.
              rob
               

              CVPA

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                Rob:

                Your input is valuable and appreciated as you are experiencing it first-hand. I wish your report was contrary to my concerns.

                I don't really get why this is happening. I realize that the applicant pool is higher, however, one would think that the result would be a more selective process resulting in admissions committee only selecting people with both high academic achievements and significant prior healthcare experience. Does anyone have any insight into this?

                The younger kids getting in concerns me also because I can't help but wonder how many of them are just going to use the PA profession as a stepping stone to another profession. For every 22 year-old who uses it as a stepping stone, there is a 30+ year old who desperately wants to be a PA, but is denied. Furthermore, being a PA does require a certain level of maturity because as such, we are not always making the final medical decision. One has to have a certain level of confidence, maturity, and lack of arrogance to function in this capacity for any significant period of time. In my opinion, that triad of personality traits are more often seen in the older applicant than the younger applicant. I am not saying that only the older applicants will make good and lasting PAs, but I would venture to say that the older ones with years of clinical background and life-experiences will probably be among the best.

                Just one man's gut feeling with nothing to back it up.
                 
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                PA-C Texas

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                  I think your comments do have some truth to them. I was 25 when I entered PA school, but I also had five years experience as a Paramedic (seven in EMS total) running about 15 to 20 calls per shift on average.

                  Despite the fact that I was young and not as experienced as some PA applicants, I feel that my experience was adequate and that it helped me succeed in school. Most of my class consisted of people in their mid-to-late twenties and early thirties, and I believe that I was the third youngest that year.

                  PA is not for someone who just walks in with a Bachelors in communications and has been pushing paper for the last ten years. I think PA's need to become active in their professional organizations and let these universities know we are intent on maintaining the integrity of PA education. The programs have gotten to be so competitive lately that you would assume the qualifications of those accepted would likewise be going up. I am afraid that schools are sacrificing stellar experience for stellar academics.

                  NP programs (besides being so much easier to get into) are having similar problems. You see programs now that are RN/MSN.

                  Ironically, I have decided to go to medical school after agonizing over the choice for about two years, so I am guilty of leaving the profession in a sense and I suppose I don't have any room to talk.
                   

                  Rob77

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                    CVPA,

                    I think a big part of it is the area of the country I live in. I live on Long Island and there are 5 PA programs within 20 miles of my house and this is not including programs that are in NYC. I think many programs (not all) are in it for the money and are concerned with the number not the quality of the applicants. So although the applicant pool is high the amount of available seats may be higher resulting in programs just trying to fill slots. Hopefully once all programs change to Masters it will help solve some of these problems. That will atleast lessen the applicant pool.

                    rob
                     

                    niko327

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                      This thread is really interesting. I definitely agree that experience is a huge plus in PA school, as is the maturity that older students bring to class. I think that alot of the problems with PA training is not with younger students but rather the mixing of experienced and non-experienced students. I do agree though, that lazy or party-time high school type students really have no place in a PA class.
                      Aside from the obvious difficulty that less experienced students encounter, experienced students also tend to suffer. An example of this I see in my class every day. I frequently find myself and maybe 2 others the only people asking questions in class. Initially I thought that I wasn't grasping concepts that other students found obvious as evidenced by their silence. I later realized that the silent less experienced students were still struggling with the basic concepts of the discussion. The results.... less experienced students get annoyed or mad because they have no idea what you and the instructor are talking about, and consequently others now feel inhibited to ask questions and actually learn something new.
                      So whose fault is all of this? Perhaps PA school should have been attracting younger applicants from the very beginning like med school has historically done. I don't think that anyone should be denied a medical education based on age or lack of experience, but the work ethic needs to be there. I think the learning process may benefit by virtue of a homogenous experience level. Conversley a class made up of only experienced individuals (as in the traditional PA school applicant) would greatly facilitate learning as well. I don't really know what the answer is but I have a feeling that the reception of paying, younger and less experienced applicants will not decrease any time soon, and as such the quality, intensity, and accessability of instruction will need to increase in order to accomodate them, which may not be such a bad thing after all. Ok i'm done rambling, thanks for letting me walk the slippery slope.
                       

                      PACtoDOC

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                        Hey Texas PA, when and where did you go to school, practice? We may know each other. If you want to go to med school in Texas PM me because I am 3 years ahead of where you are, and I can help you understand the Texas issues at hand. Thats if you're interested.

                        Age is not the major factor in PA student selection but experience often parallels age. I was 24 when I applied after having been an active duty Navy Corpsman for 4 years. A corpsman is the most highly trained medic in all branches of service and can function in the military hospitals as basically an RN or in the field with Marines doing things as high speed as chest tubes and minor surgery. It is basically an LVN type of training mixed with EMT and some paramedic training. There is also a lot of preventive medicine in the training, along with unparalleled weapons training. At night I went to community college for my last 2 years to get my NREMT-P and then I worked for a year as a medic before getting into PA school in civi land. That experience put me ahead of even the RN's in my class and it was a huge asset.

                        But there were plenty of people my same age or older with virtually no experience other than "volunteering" at some hospice for instance. My thinking is that health science centers across the country saw in the early to mid 90's that there was a lot of money to be made in having a PA school, especially since there were more applicants that ever. Salaries had just recently gone skyrocketing and the number of PA schools went up about 150% in the years after I got in in 1995. So the bottom line answer in my opinion is that educators have had to settle for fewer applications, less qualified students, due to their being so many schools now having to pay the bills. The bills are still definitely getting paid but my prediction is that 25% of these schools will close within 10 years and the damage may already be done then to the credibility of our profession.
                         

                        fab4fan

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                          One of the worst PA's I worked with had his BS in accounting...no previous medical exp. whatsoever.

                          I am sure that there are excellent PA's out there; some of them post here. But it's pretty bad when a nurse has to explain to someone with prescriptive priv. fundamental medical concepts.

                          Clinical exp. should be mandatory. I think too many of the newer students are looking only for $$. Maybe I am still a bit naive, but shouldn't it be about more than that?
                           

                          wickliffe2

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                            I don't know if this is standard in other programs or not, but the program I am in (joint BS/MS @ Philadelphia University) requires 100 hours of shadowing/clinical hours for the sophomore year and 200 for the junior year. I know it's not the same as being an EMT or other health professional, but I think it's definitely a good step toward getting some clinical exposure.

                            On a side note, I just joined this forum today (I'm already a member of Physicianassociate.com) and I have never seen so much pointless bickering and name calling from adults in my life...this is mainly regarding posts by Papilloma...it made my blood boil! :mad:
                             

                            JustaPA

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                              Hmmm, shadowing experience, lets see 300 hrs of looking vs 30 years as a respiratory therapist doing codes, ventilators responding to lots of ER things, looking at lots of chest x-rays, learning how to read EKG's, listening to thousands of sets of lungs, sure, 300 hrs has to be as good as 30 yrs........... right :D
                               
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                              PACtoDOC

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                                Its too late, the market has already been flooded with inexperienced young PA's who have discredited the basis of the profession. I see no way to fix it until adcoms stop looking at the bottom line. But since that will never happen, the PA profession will eventually drive its own salaries down for starting PA's probably into the high 40's, and experience will start to reflect in longevity pay. Nothing like a 22 year old PA with no previous experience trying to play doctor!!
                                 

                                PACtoDOC

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                                  Rural,

                                  Don't take this wrong, but all those things are great and knoble, but none of them really make you an ideal candidate for PA school. But now days that will get you in for sure. If I were the person deciding what professions would grant one admission to PA schools, the list would be as follows:

                                  military medic >4 years
                                  paramedic>4 years
                                  LVN >5 years
                                  Rad tech > 4 years
                                  RN> 2 years
                                  RT>2 years
                                  PT/Pharm/OT/
                                  FMG
                                  medical assistant > 5 years
                                  CNA > 5 years

                                  plus, I believe the above titles should waive pre-reqs of BS (no punn intended) courses like organic, nutrition, and other liberal arts requirements.
                                  All of the above professions are likely to have involved significant direct patient carfe experience.
                                   

                                  RuralPA2B

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                                    PACtoDOC said:
                                    Rural,

                                    Don't take this wrong, but all those things are great and knoble, but none of them really make you an ideal candidate for PA school. But now days that will get you in for sure. If I were the person deciding what professions would grant one admission to PA schools, the list would be as follows:

                                    military medic >4 years
                                    paramedic>4 years
                                    LVN >5 years
                                    Rad tech > 4 years
                                    RN> 2 years
                                    RT>2 years
                                    PT/Pharm/OT/
                                    FMG
                                    medical assistant > 5 years
                                    CNA > 5 years

                                    plus, I believe the above titles should waive pre-reqs of BS (no punn intended) courses like organic, nutrition, and other liberal arts requirements.
                                    All of the above professions are likely to have involved significant direct patient carfe experience.

                                    Do not take this wrong, but I don't recall asking for your opinion. :laugh:
                                     

                                    PACtoDOC

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                                      I am not sure why you want to be a PA. You sound like you are on your way to the Vatican for your Sainthood ceremony. The PA profession is unique in that you are caring for people and intervening in their lives just as a doctor does within 2 short years of the first day of class. Scrubbing lepromatous lesions off of death bed lepers in Uganda might make you a special person, but I would not wanting you writing a script to my kid without a tad more substantive medical training prior to PA school. Sorry you took my post wrong, but its not your fault the PA profession has waivered from its original goal and been hijacked by greedy schools trying to make a buck. You'll understand on day one of your career when you realize how unprepared you are. Your credentials would make you a better candidate for medical school than PA school.
                                       

                                      CanuckPAGirl

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                                        I have next to no clinical experience. Maybe 40 hours training as an aide with local EMS, and I got in. I'm in a BS program and I think I need 50 hours before the clinical rotations but nevertheless. I did not shadow. I'm at a disadvantage but nothing I don't feel I can overcome. I mean my first few years as a PA will be tough as will the rotations but I think after a certain number of years pass it will be a more level playing field. Oh, I'm 21.

                                        I am the very ESSENCE of what most of you are complaining about :p *shrugs* Hey, I understand why, but honestly, would you turn it down to work as a few years as a paramedic or a tech if you got accepted already? Obviously if they admitted me it is entirely possible for me to still succeed, just tougher.
                                         

                                        Febrifuge

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                                          CanuckPAGirl said:
                                          I have next to no clinical experience. ... I'm 21... I am the very ESSENCE of what most of you are complaining about :p *shrugs* Hey, I understand why, but honestly, would you turn it down to work as a few years as a paramedic or a tech if you got accepted already?
                                          Honestly? Yeah.

                                          I'm 34. If I were 21, and didn't have a BA already, odds are good I'd be right there with ya; I would value the "get me on the floor taking care of patients ASAP" factor more highly. But I've spent the last 18 months shadowing, volunteering, making up my mind, earning EMT-Basic (last August), and working as a tech in my local Level One. I had a choice between the med school and PA routes, and I'm going to try it "the hard way" first.

                                          Because of my experience, I know that -- for me -- the "get me on the floor" factor takes a back seat to the "teach me everything I feel I need to know" factor. I'll be a 41-year-old intern, and that will most definitely suck. Being a 44-year old resident, however, will be far better for me than being a 44-year-old PA who feels like he coulda, woulda, shoulda done more.

                                          Much respect to the competent, professional, brilliant folks who choose PA over MD or DO for their own well-considered reasons (which may be none of my business). But the stereotypical kid who "just wants to help people" and needs to be shown which end of the stethoscope to use freaks me right the heck out. I think everybody's workday improves, and the PA profession benefits, from making sure that stereotype has as little encouragement from reality as possible.
                                           

                                          sbrudd

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                                            Do you honestly think this inexperience applies solely to PAs? I mean how many med students have any prior medical experience like many of you have exhibited? Very few. And yet they are thrown into the mix with the same amount of supervision.
                                             

                                            sbrudd

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                                              PACtoDOC said:
                                              Physicians have a 7-11 year process to learn how to practice medicine unsupervised. PA's have to make it through this process in 2 years. There is a huge difference.

                                              From what I have read here, PAs are supervised . . . at least until the supervising physician feels comfortable to let them handle 90% on their own.
                                              Is this not the same process med students go through in rotations and then residency? i.e. As their skills improve the physician lets out the rains a bit? And again after residency a physician is expected to be liable to themselves. Where as the supervising physician is liable for the PA.

                                              I guess my question is why is it ok for a med student to have no prior medical experience and begin rotations or residency (I am not saying practicing solo), but it's not for a PA? Is more expected of a PA at graduation than a med student beginning residency? I am honestly asking this question, not trying to prove a point because I am not in the field as either.
                                               

                                              DeLaughterDO

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                                                "I guess my question is why is it ok for a med student to have no prior medical experience and begin rotations or residency (I am not saying practicing solo), but it's not for a PA?"

                                                This is a very good point, and something I've tried to get across to the adcomm here at TCOM. Pre-meds should be required to have a good amount of experience before they are admitted to medical school - across the board. A whiny 20 year old that has never seen a patient is at a great disadvantage when it comes to medicine than someone that has had a previous healthcare career. MD/DO/PA/NP, it doesn't matter.

                                                Hell, we had 2 people in my first year class that weren't even 21 yet. It's disgusting. Medicine requires maturity, stability, wisdom and insight. You don't get that reading books. Sorry. This is why entrance into medical school shouldn't be all about numbers.

                                                Jonethan De.
                                                 
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