Yale launching an online PA program

[BobbyB]

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how do you guys feel about this? is it time to update our outdated med school curriculum with online preclinicals? is it time to be worried about PA quality?

http://www.nhregister.com/general-news/20150310/yale-to-launch-online-physicians-associate-program

The Yale School of Medicine plans to launch an online physician associate program in the fall of 2016, which will include clinical clerkships across the country.

The program will be the same as Yale’s regular PA program, without the residential requirement, said James Van Rhee, the program director. It must first be approved by the Accreditation Review Commission on Education for the Physician Assistant.

“It will be delivered online,” Van Rhee said. “They’ll come to New Haven, to Yale, to do some immersions … those skills that you typically can’t learn via video.”

Otherwise, he said, “nothing is different other than the delivery method.” The classes for the first 12 months of the 28-month master’s degree program will be available online.

The rest of the program is clinical, in which the student works in the field anywhere in the country.

Van Rhee said he believes it’s the first national program of its kind. Tuition will be $83,000 for the full program. He said Yale will offer four electives, rather than the traditional one or two.

PA programs have undergone tremendous growth since their start in the 1960s. “Nationally, if you look at a lot of the labor statistics, they’re predicting a 38 percent increase by 2022,” with 33,000 PA’s needed.

The degree program fits with the lifestyle for a lot of people, Van Rhee said.

“The reason I did it is I didn’t want to take the time to go to medical school,” he said. “I found this to be exactly what I wanted.”

“The goal is to contribute to the healthcare needs of the country,” said Robert Alpern, dean of the Yale School of Medicine, in a release. “Our hope is to give more qualified applicants the opportunity to earn a Yale School of Medicine Physician Associate degree.”

 

[Jabbed]

You spend 90% of your preclinical time sitting in front of a computer anyway.

 

[calvnandhobbs68]

"The reason I did it is I didn't want to take the time to go to medical school" he said. "I found this to be exactly what I wanted."

What a weird way to justify your career...by saying you didn't want to do something else.

"Hey I didn't want to take the time to be an engineer...so I decided to be a construction worker instead"

 

[deleted480308]

It might depend on your school's curriculum....we do a lot of OMM/dissection/clinical skills practice (standardized patient/H&P) that wouldn't translate to online enough to allow an entire 2 years of online.

I do think it would be possible to do a year of our pre-clinical online and then 1yr in person really hammering all the physical training prior to rotations though

 

[NickNaylor]

 

[Jabbed]

"The reason I did it is I didn't want to take the time to go to medical school" he said. "I found this to be exactly what I wanted."

What a weird way to justify your career...by saying you didn't want to do something else.

"Hey I didn't want to take the time to be an engineer...so I decided to be a construction worker instead"

Oddly enough I think that "I didn't want to (or more often, couldn't) go to med school" is not an uncommon sentiment among PAs, dentists, et al.

 

[vokey588]

Oddly enough I think that "I didn't want to (or more often, couldn't) go to med school" is not an uncommon sentiment among PAs, dentists, et al.

I definitely think that's a reasonable justification. You want to be a clinician but can't/don't want to go through the time and expense of becoming an attending physician.

 

[PL198]

how do you prevent cheating on online exams?

answer: you don't.

 

[W19]

Med school might be next... NP schools have been like that, and now it's PA... I am wondering if LCME has the power to stop a school from offering the first 2-year of preclinical online...

 

[ACSurgeon]

how do you prevent cheating on online exams?

answer: you don't.

Not sure that grades for PA students are meaningful anyways. You need to pass a standardized exam to become certified. You need that to get a job (or keep one). So, one may cheat on your exams to get through the program, but that'll catch up to them later.

 

[Mad Jack]

how do you prevent cheating on online exams?

answer: you don't.

My online tests in undergrad were proctored and require you to do a full, slow 360 degree sweep of the room prior to taking them before a person stared at you for the entire test. Breaks were not allowed. It's about as difficult to cheat in that situation as it is in a classroom.

 

[Mad Jack]

My major problem with this program is the rotation quality- Yale's PAs were great because they got over a year of training in the Yale-New Haven system. "All over the country" sounds like they'll just shove you in wherever they can find, with preceptorship that is likely subpar.

 

[calvnandhobbs68]

I definitely think that's a reasonable justification. You want to be a clinician but can't/don't want to go through the time and expense of becoming an attending physician.

Yeah but you know the implicit suggestion in this line right?

"I didnt want to spend all that time in medical school so I decided to go be a PA/NP and now I'm basically the same thing"

It's pretty much the whole point of the statement.

 

[PL198]

eh I don't think thats implied. It's just a rationalization coping method( to quote FA). they know they're not a physician, regardless of what they outwardly say.

 

[ACSurgeon]

Yeah but you know the implicit suggestion in this line right?

"I didnt want to spend all that time in medical school so I decided to go be a PA/NP and now I'm basically the same thing"

It's pretty much the whole point of the statement.

As long as realize the value that we provide, and ensure we continue to provide that value. When doctors start providing nurse-type care, that's when we become replaceable. Don't be an auto-pilot type of doctor. Go the extra mile. Stay up to date, etc.

 

[Psai]

The issue with online programs is that they're online. You can learn anything by staring at a computer for long enough but the real advantage of going to a certain institution is from the quality of people there. It's called the hidden curriculum. You learn from your peers, you compete with your peers and you are in constant contact with people who have already walked the path you are on, whether they are an upper level medical student, resident or attending. You adopt their mannerisms, modes of thinking, attitudes, etc. The facts that you need to know to take care of patients can be learned on a computer. But I learned how to push myself when a faculty member in anatomy scared us on day one. I learned how to think critically by having attendings criticize my presentations and challenge my knowledge base with their questions. I learned how to broaden my thinking by reading notes and discussing with my residents. I learned about other people's experiences with the various medical services that I haven't been on at countless dinners and meetings with my peers.

People don't go to Harvard business school because they have some secret educational model that no one else has access to. They go there because the name attracts other high performance individuals and affords the opportunity to make connections. You don't gain a complete education by reading power point slides or glancing through books. The most important lessons are learned at the bedside from patients, from your peers and from your teachers. An online education offers none of that

I do understand that it's only the first year but even then it's a poor idea and an obvious money grab. Just another example of money coming before quality which seems all too prevalent in medicine these days

 

[oldanddone]

how do you prevent cheating on online exams?

answer: you don't.

but don't underestimate the level of difficulty an open-book exam can be written at, especially with a time limit.
and a local proctor to ensure it's the right person writing it.

of course, if the questions are known in advance, then all bets are off...but that's common to offline exams

 

[PL198]

local proctor? how are you going to do that, they take the exams at a 3rd party location?

 

[Mad Jack]

As long as realize the value that we provide, and ensure we continue to provide that value. When doctors start providing nurse-type care, that's when we become replaceable. Don't be an auto-pilot type of doctor. Go the extra mile. Stay up to date, etc.

Nurses generally aren't putting in 60 hours a week, taking call, and managing extremely complex patients. To paraphrase the good Dr. Ronnie Coleman, "Everybody wants to be a doctor, but nobody wants to put in no crazy-ass hours."

 

[Mad Jack]

The issue with online programs is that they're online. You can learn anything by staring at a computer for long enough but the real advantage of going to a certain institution is from the quality of people there. It's called the hidden curriculum. You learn from your peers, you compete with your peers and you are in constant contact with people who have already walked the path you are on, whether they are an upper level medical student, resident or attending. You adopt their mannerisms, modes of thinking, attitudes, etc. The facts that you need to know to take care of patients can be learned on a computer. But I learned how to push myself when a faculty member in anatomy scared us on day one. I learned how to think critically by having attendings criticize my presentations and challenge my knowledge base with their questions. I learned how to broaden my thinking by reading notes and discussing with my residents. I learned about other people's experiences with the various medical services that I haven't been on at countless dinners and meetings with my peers.

People don't go to Harvard business school because they have some secret educational model that no one else has access to. They go there because the name attracts other high performance individuals and affords the opportunity to make connections. You don't gain a complete education by reading power point slides or glancing through books. The most important lessons are learned at the bedside from patients, from your peers and from your teachers. An online education offers none of that

I do understand that it's only the first year but even then it's a poor idea and an obvious money grab. Just another example of money coming before quality which seems all too prevalent in medicine these days

I really don't think you're missing a lot of the hidden curriculum if it's only in the preclinical phase. I am hardly ever on campus, and rarely interact with my professors or fellow students, aside from on required projects. You can basically completely avoid the BS of MS-1 in most schools if you want to. I'm more worried about the effects of having clinical rotations that are overseen by people that aren't exactly the cream of the crop in regard to teaching, which will be what really hurts these students.

 

[Psai]

I really don't think you're missing a lot of the hidden curriculum if it's only in the preclinical phase. I am hardly ever on campus, and rarely interact with my professors or fellow students, aside from on required projects. You can basically completely avoid the BS of MS-1 in most schools if you want to. I'm more worried about the effects of having clinical rotations that are overseen by people that aren't exactly the cream of the crop in regard to teaching, which will be what really hurts these students.

If you're not making friends with your classmates, you're doing it wrong. Who do you think you're going to be working with in the future? Learning how to manage the pathologies medical people successfully is an art that takes time to develop. Where do you think patients are going to come from? Just going to fall out of the sky onto your examination table?

 

[NickNaylor]

I really don't think you're missing a lot of the hidden curriculum if it's only in the preclinical phase. I am hardly ever on campus, and rarely interact with my professors or fellow students, aside from on required projects. You can basically completely avoid the BS of MS-1 in most schools if you want to. I'm more worried about the effects of having clinical rotations that are overseen by people that aren't exactly the cream of the crop in regard to teaching, which will be what really hurts these students.

What do you mean by your last sentence? Are you talking about being supervised by non-physicians?

 

[Mad Jack]

What do you mean by your last sentence? Are you talking about being supervised by non-physicians?

Yale's PA program traditionally trained their PAs at YNHH, Bridgeport, Waterbury Hospital, and the other Yale-affiliated hospitals. This PA program claims to train students "around the country." The only way that they can do this is by just throwing the PA into whatever hospital is nearby, as Yale isn't going to set up a nationwide rotation network that they operate and oversee. More likely, they'll try and pay whatever hospital is nearby to let their patient rotate there. This poses a problem, as they won't have direct quality control over the education received at clinical sites. I really have no idea how they're going to manage it, honestly. There aren't just quality training locations for PAs located everywhere in the country, just waiting for them to hop in and rotate.

 

[NickNaylor]

Yale's PA program traditionally trained their PAs at YNHH, Bridgeport, Waterbury Hospital, and the other Yale-affiliated hospitals. This PA program claims to train students "around the country." The only way that they can do this is by just throwing the PA into whatever hospital is nearby, as Yale isn't going to set up a nationwide rotation network that they operate and oversee. More likely, they'll try and pay whatever hospital is nearby to let their patient rotate there. This poses a problem, as they won't have direct quality control over the education received at clinical sites. I really have no idea how they're going to manage it, honestly. There aren't just quality training locations for PAs located everywhere in the country, just waiting for them to hop in and rotate.

Ah, I see. For some reason my brain broke and I thought we were talking about your experience on the wards.

herpderp

 

[Psai]

Yale's PA program traditionally trained their PAs at YNHH, Bridgeport, Waterbury Hospital, and the other Yale-affiliated hospitals. This PA program claims to train students "around the country." The only way that they can do this is by just throwing the PA into whatever hospital is nearby, as Yale isn't going to set up a nationwide rotation network that they operate and oversee. More likely, they'll try and pay whatever hospital is nearby to let their patient rotate there. This poses a problem, as they won't have direct quality control over the education received at clinical sites. I really have no idea how they're going to manage it, honestly. There aren't just quality training locations for PAs located everywhere in the country, just waiting for them to hop in and rotate.

This is pretty much how caribbean schools work

 

[zeppelinpage4]

Didn't read the article...but my classmates and I have been supporting online pre-clinicals for a while now. I heard lecture attendance this week was 1 student (Our class has over 120 students). Even our neuro professor called our class the university of Phoenix online.

99% of my work is on my laptop. I'd rather just have online, well organized classes from one or two good dedicated instructors. The lectures I've been to were taught by too many different lecturers, so I couldn't adjust to any one of them or know what to expect. They also usually involved badly made slides, were very disorganized, and I came out learning very little. The professors are too busy to teach properly any way.
Have two or three instructors who are able to teach well and like to do it, and give them dedicated time away from other responsibilities to focus on making the online material. Let the rest of the doctors and PhDs just go about doing they're research and clinics. Then, everyone gets one consistent and solid teaching source. Also students can study from where they want, and only have to come into school for labs, and simulations and such.

 

[calvnandhobbs68]

If you're not making friends with your classmates, you're doing it wrong. Who do you think you're going to be working with in the future? Learning how to manage the pathologies medical people successfully is an art that takes time to develop. Where do you think patients are going to come from? Just going to fall out of the sky onto your examination table?

I guess that's the way you feel but there's quite a few other people who feel that you could get away with at least a year online or physically lectureless without an appreciable drop in quality...in fact a common concern heard amongst medical school applicants is "do you have required attendance?"

 

[PL198]

I guess that's the way you feel but there's quite a few other people who feel that you could get away with at least a year online or physically lectureless without an appreciable drop in quality...in fact a common concern heard amongst medical school applicants is "do you have required attendance?"

and you know the schools are lying to the kids, after they find out they have mandatory stuff all the time, what are they going to do, drop out of the school? yeah right

 

[Mad Jack]

Didn't read the article...but my classmates and I have been supporting online pre-clinicals for a while now. I heard lecture attendance this week was 1 student (Our class has over 120 students). Even our neuro professor called our class the university of Phoenix online.

99% of my work is on my laptop. I'd rather just have online, well organized classes from one or two good dedicated instructors. The lectures I've been to were taught by too many different lecturers, so I couldn't adjust to any one of them or know what to expect. They also usually involved badly made slides, were very disorganized, and I came out learning very little. The professors are too busy to teach properly any way.
Have two or three instructors who are able to teach well and like to do it, and give them dedicated time away from other responsibilities to focus on making the online material. Let the rest of the doctors and PhDs just go about doing they're research and clinics. Then, everyone gets one consistent and solid teaching source. Also students can study from where they want, and only have to come into school for labs and such.

It's funny, this kind of seems to vary class-to-class. Last year, there were maybe 20 of 175 per lecture. But our class just ****ing loves their lectures. I'm one of the few people that doesn't go- most have 100-125 students, it's crazy.

 

[deleted480308]

local proctor? how are you going to do that, they take the exams at a 3rd party location?

there are testing centers and community colleges all over the country....it's not hard to find a proctor

Nurses generally aren't putting in 60 hours a week, taking call, and managing extremely complex patients. To paraphrase the good Dr. Ronnie Coleman, "Everybody wants to be a doctor, but nobody wants to put in no crazy-ass hours."

Ronnie is the best

 

[Psai]

I guess that's the way you feel but there's quite a few other people who feel that you could get away with at least a year online or physically lectureless without an appreciable drop in quality...in fact a common concern heard amongst medical school applicants is "do you have required attendance?"

since when do you have to go to lecture to make friends among your classmates

 

[zeppelinpage4]

It's funny, this kind of seems to vary class-to-class. Last year, there were maybe 20 of 175 per lecture. But our class just ****ing loves their lectures. I'm one of the few people that doesn't go- most have 100-125 students, it's crazy.

Haha, I'm honestly surprised...with all the complaining about lectures and class at our school, it's a shock to see med students anywhere appreciate it. I suppose that's why they still keep lectures. As long as they keep it optional, us non-lecture folk can stay at home and watch videos or read, and the ones who like it have the option of going.

 

[ACSurgeon]

Nurses generally aren't putting in 60 hours a week, taking call, and managing extremely complex patients. To paraphrase the good Dr. Ronnie Coleman, "Everybody wants to be a doctor, but nobody wants to put in no crazy-ass hours."

The crazy hours are only a part of the picture; we still owe it to our patients and profession to be thorough and thoughtful providers, and make use of our extensive training. Unfortunately, many doctors become lazy after training and start functioning at the level of an APP (mid level).

 

[gracie369]

OMG, I am so online Yale material.

 

[PL198]

there are testing centers and community colleges all over the country....it's not hard to find a proctor

Ronnie is the best

I mean I don't think they're going to be going into sylvan once a month for their tests. If you're gonna do an online PA program I'm gonna assume the tests are just links online.

 

[Mad Jack]

OMG, I am so online Yale material.

Maybe I can do the online Yale program while concurrently going through DO school, just so I can talk about that one time I went to Yale and it was a silly place. I could do all of the coursework online and crush it because I already know way more than they need to, then just stack the rotations with my med school rotations... If not for that 83k price tag I'd totally do it for the lulz.

 

[Mad Jack]

I'd totally get a white coat with "MJ RRT PA-C DO LMFAO BBQ" just to mock all of the NPs that have ridiculous strings of letters after their names.

 

[Yadster101]

I learned how to think critically by having attendings criticize my presentations and challenge my knowledge base with their questions. I learned how to broaden my thinking by reading notes and discussing with my residents.

You did this stuff in the first 2 years?

But I learned how to push myself when a faculty member in anatomy scared us on day one.

...I imagined a faculty member popping out of a dark room wearing a costume scaring people

 

[oldanddone]

local proctor? how are you going to do that, they take the exams at a 3rd party location?

Yeah, I've heard of that being the case. The clinical supervision is being farmed out, so can the proctoring.

I agree with prior posts that imagine doing clinical supervision elsewhere, and losing the opportunity to network, really waters down the advantages of this being 'yale' education. but perhaps yale has good connections to the mayos etc and will find top tier placements.

in a previous post, maybe even a different thread, a poster made the comment 'welcome to the corporate market taking precedence over any historical understandings of what makes a good education in healthcare'. that may also apply here.

edited to add: i definitely was one of the ones who did lectures from home. stopped listening, even, and just reviewed slides with a fellow classmate along with reading textbooks. that seemed to be the most efficient use of time. the slides were comprehensive, though, and covered what would be covered clearly, usually. when going in, was in the 'satellite' room, that held overflow, where feet could be put up, etc. typically there were about 8-10 of us that liked the satellite room with video conferencing atmosphere much better than big lecture hall.

edited to also add: watching the recording also meant being able to speed it up, so that hearing the lecture and filtering for important verbal stuff took 1/2 or 1/3 the time

 

[67552931811]

I'd totally get a white coat with "MJ RRT PA-C DO LMFAO BBQ" just to mock all of the NPs that have ridiculous strings of letters after their names.

Man, I love BBQ.

Don't forget your BA/BS, sir.

 

[charmiedermie]

You spend 90% of your preclinical time sitting in front of a computer anyway.

Not at all medical schools.

"The reason I did it is I didn't want to take the time to go to medical school" he said. "I found this to be exactly what I wanted."

What a weird way to justify your career...by saying you didn't want to do something else.

"Hey I didn't want to take the time to be an engineer...so I decided to be a construction worker instead"

The reasoning makes perfect sense all PAs I know have said this. An engineer and a construction worker aren't the same scope. Don't blame PAs, blame the Yale Medical School dean who has given this program his blessing.

 

[cbrons]

I don't see a big deal at all. My entire first 2 years of med school except some very poorly taught clinical exam skills were basically independent study.

 

[charmiedermie]

I don't see a big deal at all. My entire first 2 years of med school except some very poorly taught clinical exam skills were basically independent study.

If u were given just the textbooks, u think you would be just as knowledgeable after 2 years, left on your own?

 

[cbrons]

If u were given just the textbooks, u think you would be just as knowledgeable after 2 years, left on your own?

If I was given a free subscription to Dr Najeeb, Pathoma, and some Kaplan lectures for micro/pharm and had first aid, AND didn't have to do the worthless busy work our school assigned, I'd probably know 2x what I do now. But I am the type of person who can't pay attention in a lecture hall, would probably play hearthstone or solitaire during lectures, and would have to teach myself anyway.

 

[SilentSoldier]

One of our classes is taught completely via online modules and its the most poorly structured, haphazardly put together class in the entire block. I'm totally against pure online preclinicals

 

[zgp209]

.

 

[didymus]

*I'm not a medical student, but I saw the topic in my feed and it was of particular interest to me, so I wanted to offer my perspective--I apologize if, as a premed, I'm an interloper here.*

I am in a distance masters program through a top private university, and it is rigorous. There are live lectures given via webcam, so I am "in class" with my cohort, also on their webcams, as well as the professor as s/he instructs via webcam. We break up into small groups in private chat rooms, work through case studies, do research projects and give presentations via powerpoint, we have discussion topics each student must present on during our live sessions, we write research papers, and take proctored exams (that are significantly more challenging than many exams I took during my traditional, in-person, undergraduate years). The educational experience I'm receiving online through this institution is of higher quality than that of my state school undergrad education (plus, the institution attracts students with impressive backgrounds. I have classmates who are alumni of Berkeley, Harvard, Yale, Northwestern, Emory, and so on). The professors were educated at equally reputable institutions. The online format also allows for professionals to participate in the program, and I have many attending physicians, healthcare administrators, and executives from various fields in my cohort. I believe it adds a richness to the experience, and wouldn't really be possible through a traditional, on-campus requirement.

Just a couple weeks ago during the winter storm(s) that pummeled much of the East Coast, and resulted in the main campus of this university being closed, one of my professors remarked during our live session, "This is the future of education: no more snow days."

The fact is, by and large, much of university-level education is delivered electronically and online. Universities use Blackboard, the in-person lectures are given by TA's with terrible English reading from powerpoint slides (which can usually be accessed online later), the bulk of university libraries have online access to their resources for paper writing and research, quizzes are online, lectures are recorded and uploaded to be accessed at the students' convenience, and so on and so forth. Shoot, I did 98% of my studying online for the lab when I took A&P in undergrad. I only had to be on campus for the practicals, but nearly all of the actual learning took place via Youtube videos and online flashcard sets, sitting at home with my laptop.

There are enough threads on SDN with med students talking about how they rarely attend lectures because they are all recorded and offered online. I've read about students who sleep in until 10, hop online, access their lectures and play them at 1.5x speed, only to go to campus for the exams. There still exists a stigma with online education (possibly because of how places like U of Phoenix have influenced the public perception), but the format just makes a lot of sense for how plugged in the world is these days. Moreover, online programs are not for the unmotivated or lazy. There can be a high bar for participation on discussion boards, daily "checking in," regular assignments, video lectures, etc. that requires a remarkable amount of motivation and a strong work ethic to keep up with the pace and do well.

I think offering the didactic portion of physician assistant training online is a logical step that makes good sense.

 

[zeppelinpage4]

If I was given a free subscription to Dr Najeeb, Pathoma, and some Kaplan lectures for micro/pharm and had first aid, AND didn't have to do the worthless busy work our school assigned, I'd probably know 2x what I do now. But I am the type of person who can't pay attention in a lecture hall, would probably play hearthstone or solitaire during lectures, and would have to teach myself anyway.

+1 .

 

[Mad Jack]

I think @Psai 's post nailed it. A huge part of medical education, even the preclinical years if they are done right, is the hidden curriculum, assimilation, induction, whatever else you want to call aspect.

I have heard from students at the school I'm at now (i.e. where I am doing residency) that they feel M1-M2 years they are basically at "commuter school". There are even a couple of students who apparently only live in town part time - crashing in a friend's apartment when they have to be here for required activities. I think it's sad, but the more I hear I don't think it is particular to this school but rather a temporal shift. Scary to me.



A lot of PA schools they basically just have to go find a PA preceptor somewhere and that's it. The PA agrees to take them on for a 6 week rotation or whatever.

In addressing the 1st point- I'm only in-state for just over 4 days a week. I spend the rest of my time three states away with my gf and friends back home. I'm actually fine with the medical school curriculum not changing who I am, and it's part of why I keep my distance from school- I don't want to have all of my strong opinions and distaste for authority beaten out of me, nor do I want to hop on the "professionalism" (and I use those quotations for pure sarcastic effect) train. For a lot of younger students, the hidden curriculum is probably a good thing. But I also feel like it is what has made us a weak profession politically, as it beats all dissent out of you in the name of conformity, and it's that lack of conformity and constant ceding to authority that has let us crumble while the nurses gain in power.

In regard to the second point, that's what kind of concerns me- Yale used to be known for better than that. They would have their PAs rotate in the same capacity as residents, at a massive and decently well respected teaching hospital. If Yale says online distance education with whatever schmuck is happy to take you is adequate to train a PA, I fear the whole profession will take note and then general quality within the profession will get flushed right down the tubes.

 

[Mad Jack]

You highlight negatives of the profession, but I think there are also a lot of necessary and even positive aspects of the hidden curriculum.

Such as?