How We Meet Our Goals

The Yale PA Online Program has a primary care focus, with our PA students completing clinical rotations in the following areas: internal medicine (12 weeks), primary care (12 weeks), pediatrics (eight weeks), and four weeks in each of the following: behavioral medicine, general surgery, women’s health, and emergency medicine.

According to the 2022 Statistical profile of certified PAs from the NCCPA, the number of PAs in primary care (family medicine/general practice, general internal medicine, and general pediatrics) has decreased by 2.1% from 2018 to 2022. There are currently 17.7% of PAs working in primary care. One year after graduation the class is surveyed regarding employment opportunities and settings. Quantitative data is collected. No qualitative data is collected. Regarding primary care setting, the program benchmark is 50% of graduates working in a primary care setting. This benchmark is based on doubling the current national average of PAs in primary care (17.7%).

In the post-graduation survey the program asks how many jobs graduates have applied for, with 42 (26%) stating 1-5 jobs, 11 (6.8%) stating 6-10, and 20 (9.2%) stating more than 15. Overall, 36% of those responding are applying for primary care positions. Forty three (43) graduates applied to 1-5 jobs in primary care, 23 applied to 6-10 jobs in primary care, 3 applied to 11-15 jobs in primary care, and 6 applied to more than 15 jobs in primary care. Of note, 53 (33%) of graduates applied to jobs in rural or medically underserved communities. Ninety graduates (56%) reported that they had secured employment as a PA within 6 months of graduation. Currently 38% of graduates responded that they were working in Primary Care which falls below our benchmark.

The Yale PA Online Program enrolls students from diverse locations across the United States and from a variety of careers and backgrounds to become the primary care providers our nation needs.

We have admitted students spanning a wide geographic range, from Maine to Hawaii and Alaska to Florida. Some students live in rural areas such as Booker, Texas and Sedalia, Missouri, while others reside in more populous urban centers such as Los Angeles and New York. 30% of students reside in cities, 41% reside in suburbs, 7% in towns, and 21% in rural areas. These students bring a variety of life experiences and a breadth of perspectives to the program. For example, 24% of our students have advanced degrees including Doctor of Philosophy, Doctor of Pharmacy, Doctor of Health Sciences, Doctor of Education, Master of Public Health, Master of Science, and Master of Education.

The ages of students range from 21 to 62 years (average age 32). The ratio of male to female students is approximately 24%/76%. Academic and career backgrounds also vary greatly among the cohorts.

While academic factors such as GPA can provide evidence of intellectual ability, academic achievement, and potential, the program considers and reviews an applicant’s entire application for other factors pertinent to a successful career as a physician assistant, as well as factors that would enrich our class composition, such as work experience and other life accomplishments.

For example, while patient care hours were not a requirement for admission, the middle 60% of all cohorts reported from 3200 to 12,070 hands-on patient care hours. Some examples of prior work experience are phlebotomist, pharmacist, respiratory therapist, clinical dietician, and paramedic.

This shows that the program continues to strive to meet our goal related to pursuit of excellence by increasing the number of highly educated, qualified physician assistants in primary care across the country. While the program has announced it is graduating its last class in 2026 we will continue to monitor and evaluate this goal along with the goal related to increasing PAs in primary care.

Based upon a review of the program’s current clinical placement sites, the program can offer a clinical experience in a wide variety of settings and numerous locations around the country. By exposing our students to a wide variety of clinical settings, including medically underserved, in the students’ home regions, the program hopes to have an impact on the health care delivery in these regions and settings.

According to the 2022 Statistical profile of certified PAs from the NCCPA, the number of PAs employed in community health centers, rural health clinics, free clinics, and public or community health clinics has decreased by 1.2% from 2018 to 2022. There are currently 5.2% of PAs working in community health centers, rural health clinics, free clinics, and public or community health clinics.

One year after graduation the class is surveyed regarding employment opportunities and practice settings. Quantitative data is collected. No qualitative data is collected. Regarding working in community health centers, rural health clinics, free clinics, and public or community health clinics the program benchmark is 10% of graduates working in these settings. This benchmark is based on doubling the current national average of PAs in community health centers, rural health clinics, free clinics, and public or community health clinics (5.2%).

In the survey the program asks about how many jobs graduates have applied for in rural or underserved committees. 53 (33%) graduates applied to jobs in rural or medically underserved communities. When asked how many jobs graduates have applied for, with 42 (26%) stating 1-5 jobs, 11 (6.8%) stating 6-10, and 20 (9.2%) stating more than 15. Overall, 36% of those applying for primary care positions. Forty three (43) graduates applied to 1-5 jobs in primary care, 23 applied to 6-10 jobs in primary care, 3 applied to 11-15 jobs in primary care, and 6 applied to more than 15 jobs in primary care. Eighteen graduates (8%) are practicing in a community or rural health clinic. This is just below the program benchmark.

The Yale PA Online Program enrolls students from diverse locations across the United States and from a variety of careers and backgrounds to become the primary care providers our nation needs.

We have admitted students spanning a wide geographic range, from Maine to Hawaii and Alaska to Florida. Some students live in rural areas such as Booker, Texas and Sedalia, Missouri, while others reside in more populous urban centers such as Los Angeles and New York. 30% of students reside in cities, 41% reside in suburbs, 7% in towns, and 21% in rural areas.

The program also promotes leadership among the students, faculty, and staff. Examples of student leadership includes PAEA Board of Directors, Student Member at Large,

Northeast Regional Director of the AAPA Student Academy, Chair of AAPA Student Academy Advocacy & Policy Committee, member of AAPA Student Academy Leadership Committee, member of AAPA Student Academy Communication and Outreach Committee, PAEA Future Educators Fellows, PAEA Health Policy Fellow, Connecticut Academy of Physician Assistants Student Board Member, Fire and Rescue Leaders, PAEA Future Educator Development Steering Committee, and members of the AAPA Student House of Delegates.

Faculty members have and continue to hold several leadership roles. Faculty serve as models for the students in leadership and service. Examples of faculty leadership and service include the following:

• Medical Director and volunteer attending at HAVEN, the YSM Student run clinic
• Consulting editor, Physician Assistant Clinics
• Physician Assistant Education Association Research Fellow
• Don Pederson Research Grant award winner
• Faculty Skills 101 Workshop Facilitators
• Future Educator Fellowship Committee
• Student Advisory Task Force
• Global Ambassador, AAPA
• Graduate advisor to the AAPA student academy, and secretary and treasurer.
• Diversity & Inclusion Multicultural Affairs, committee member, Physician Assistant Education Association
• Director of Physician Assistants for Global Health
• Dean’s Advisory Council on LGBTQI+ Issues, YSM
• Director, Policy and Education, LGBT PA Caucus
• Board of directors of the US Professional Association for Transgender Health (USPATH)
• CASPA Advisory Committee member
• Service to state physician assistant academies

This shows that the program is meeting its goal in having an impact on the healthcare field with an emphasis on patient care in medically underserved areas. The program will continue to monitor and evaluate this goal.

The goal is to develop new pathways of teaching and develop the skills of lifelong learning and critical thinking in students. The program is constantly developing innovative ways to teach, but not just for the sake of being innovative. The curriculum blends a lecture-based curriculum with problem-based learning and other small-group sessions. This enhances the student learning process, assisting the students with application and retention of the material.

The students view video-recorded lectures prior to meeting in small groups. In these small groups, the students complete a variety of exercises. Examples of these small-group sessions include EKG problem sets, lab interpretation problem sets, problem-based learning cases, Yale School of Medicine internal medicine and pediatric office-based clinical cases, and bioethics discussions—to name just a few. During the didactic year, students take part in the Clinical Experience in Early Didactic (CEED). During this clinical experience, the students spend time directly involved in patient care, enhancing their clinical skills and knowledge.

Other examples of innovation developed and used by the program include:

• FLICKs (Focused Lectures in Clinical Knowledge): To provide clinical lectures to all students regardless of their clinical site rotation, the program created a lecture series that can be viewed by the students on their phones or iPads during downtime at the clinical site or after clinic hours.
• Online Grand Rounds: This is a platform for students to think critically about the patients they are seeing during rotations and practice presenting their findings in a formal academic setting. Through peer discussion, they can view the cases from multiple perspectives and learn from the experiences of others.
• Online Standardized Patient Program: Using online standardized patients, students can develop their skills in communicating serious news and shared decision-making.
• Anatomy Surgical Videos: A series of videos was developed to provide students on their surgery rotations with a quick review of human anatomy related to the more common surgical procedures. These videos are 10 to 20 minutes long and use a Socratic method in presenting the material.
• Anatomy Dissection Videos: Yale Department of Surgery Section of Anatomy has created “Anatomy Clinic,” an online resource that assists students in their learning of anatomy through an online dissector with video instruction and learning exercises.
• EKG Virtual Lab: Students use custom, interactive 3D cardiac imaging to integrate content from anatomy, physiology, and clinical medicine and apply it to EKGs. Students can trace electrophysiologic pathways and identify anatomical structures while witnessing how EKG patterns change in real time.

The program evaluates curriculum in the following areas: overall, asynchronous curriculum, and by content area at the end of each semester using a system called the net promoter score (NPS). This score is the percentage of promoters minus the percentage of detractors. A scale of 1 to 10 is used with the promoters being those who score an area 9 or 10, passives being those who score 7 or 8, and detractors being those who score 0 to 6. For easier use and program continuous evaluation, the scale has been converted to align with the traditional Likert scale. Comments are also reviewed and grouped together by themes. The asynchronous curriculum has NPS that ranges from 3.87 to 4.5. These are above the benchmark score of 3.85.

This shows that the program is meeting its goal related to innovation in education. The program will continue to innovate, possible use of virtual reality in the future, and will continue to monitor.

Educate students to integrate the clinical data that they obtain from their patient’s medical history, physical examination, and laboratory analysis to form a differential diagnosis, as well as assess and plan for the patient’s condition.

The program uses a blended learning approach that integrates online curriculum with traditional face-to-face class activities in a planned, pedagogically valuable manner; and where a portion of the face-to-face time is replaced by online activity.

Problem-based learning (PBL) is the centerpiece of the curriculum. PBL is driven by problems, from which students identify and pursue their own learning needs and then reapply what they have learned to the problem. The objectives of PBL include guiding the students in how to direct and manage their own learning, develop their problem solving and clinical reasoning and learn important principles and key concepts.

Each year, graduates complete a survey that evaluates the entire program. They are asked to respond to a variety of issues related to instruction, activities, and resources of the program. The didactic year survey included the following average student ratings, with a rating scale ranging from 1.0 = “strongly disagree” to 5.0 = “strongly agree”. Results from the first 4 cohorts are:

• The Yale PA Online program prepared me for my role as a PA (averaged): 4.24
• The PBL curriculum enhanced my clinical reasoning ability (averaged): 4.49.
• The clinical experiences (CEED) prepared me for clinical practice (averaged) 4.56.

The benchmark is 3.85, this is based on data from the program director’s previous position. All scores were above the benchmark.

Each year, the students complete a survey that evaluates the didactic year. They are asked to respond to a variety of issues related to instruction, activities, and resources of the program. The didactic year survey included the following average student ratings, with a rating scale ranging from 1.0 = “strongly disagree” to 5.0 = “strongly agree”:

• The clinical medicine course/PBL adequately prepared me in developing a differential diagnosis (averaged) 4.74.

The benchmark is 3.85, this is based on data from the program director’s previous position. All scores were above the benchmark.

Clinical rotation preceptors also evaluate the students on several areas related to the didactic year curriculum and how it prepares the student for the clinical year. The preceptors are asked: “Thinking back to the beginning of the rotation, was the student prepared for the rotation in the following areas: history taking skills, physical examination skills, and foundation of knowledge for this rotation.” This scale also ranges from 1.0 = “strongly disagree” to 5.0 = “strongly agree.”

History taking average score was 4.69, ranging from 4.61 in general surgery to 4.70 in internal medicine. Physical examination skills averaged 4.61, ranging from 4.55 in emergency medicine to 4.70 in behavioral medicine. Oral presentation skills average score was 4.62, ranging from 4.50 in general surgery to 4.72 in women’s health. Fundamental knowledge averaged 4.59 ranging from 4.47 in emergency medicine, to a 4.70 in behavioral medicine 4.57. All scored above the benchmark of 3.85. Each individual score which scored a 1 or 2 on the Likert scale was evaluated. There were few negative scores and limited comments on the low scores. Negative comments focused on oral presentation skills and developing a differential diagnosis and were isolated to a few select students who had also done poorly on the rotation. Overall comments were reviewed and there were no negative themes noted. Many positive comments were noted on how prepared the students were related to evaluated skills.

At the end of both the didactic and the clinical years, the Yale PA Online students complete the Physician Assistant Clinical Knowledge Rating Assessment Tool (PACKRAT). Data from the PACKRAT examination for the Class of 2020 through Class of 2022 exceeded the national average in 6 of the 13 specialty organ systems and 4 of 7 of the task areas. Additionally, the average score for these classes also exceeded the national average on the exams. More recently, the Class of 2023 completed a new version of the exam in April 2023 and met the national average in nearly every content and task areas with the class average mean score aligning with the national mean score.

This shows that the program is meeting its goal to educate individuals to integrate clinical data into patient care. The program will continue to monitor and evaluate this goal.

Facilitate the development of interpersonal characteristics during the student’s education, to lead, serve, and practice in an ethical, empathetic, and professional manner.

The program exposes the students to several educational and clinical experiences to develop these interpersonal skills.

During the program, interpersonal skills in cultural sensitivity are noted in the behavioral medicine course series in activities related to cultural sensitivity, health literacy workshop, 30-day behavioral change challenge, standardized patient encounters in communicating serious news and shared decision-making, and training in ethics and emotional intelligence during both Immersion I and II.

Exposure to a wide variety of patients is important in the development of interpersonal characteristics to assist the student in putting skills into practice. Across all graduating classes (YR 2020-2023) the following is a breakdown of patient populations cared for during the clinical year.

Gender Male: 42.9%, Female: 56.2%, Transgender: 0.9%

Race and ethnicity breakdown White: 59.3%, Black: 12.2%, Asian: 5.0%, Hispanic: 13.3%, Other: 12.5%

Age breakdown is <2 years: 5.7%, 2-4 years: 3.6%, 5-11 years: 5.5%, 12-17 years: 5.5%, 18-49 years 33.9%, 50-64 years 20.5%, >65 years 23.9%.

The patient populations seen by our students while on clinical rotations are reflective of and consistent with national demographics. Our students learn from and evaluate patients of all gender identifications, all ages, and all ethnicities.

The Yale PA Online Program recognizes the importance of developing graduates who have the knowledge and skills to function as a highly qualified physician assistant, and this includes professionalism.

In all interactions, face-to-face and online, both during the didactic and clinical years, students are required to exhibit professional behavior to fellow classmates, faculty and staff, preceptors, and, most importantly, patients. During orientation, students are advised of program expectations related to professionalism. Furthermore, every student is evaluated for professional behavior throughout the Yale PA Online Program.

The preceptors evaluate students after each rotation in the following areas of professionalism: effort, relationship with patients, relationship with other professionals, and overall professionalism. Overall professional expectations of the Yale PA Online student are ethical, trustworthy, reliable, and compassionate behavior that includes the maintenance of appropriate personal boundaries and the ability to adapt well to change. The scale ranges from 1.0 = “strongly disagree” to 5.0 = “strongly agree.” The benchmark is 3.85, this is based on data from the program director’s previous positions.

The preceptor evaluations of students from the Class of 2020 through Class of 2023 include the following areas with scores.

• Student respectfully interact with patients, families, and their significant others. Student is sensitive and responsive to patient needs, appropriate for the setting (i.e., acute, chronic, or emergent)- scored 4.76 across all rotations. All specific rotations and classes scored above the benchmark.
• Student positively and respectfully interact with peers, physicians, other health care professionals and staff. Student functions effectively as a member of the interprofessional patient care team- scored 4.77 across all rotations. All specific rotations and classes scored above the benchmark.
• Students overall professional behavior is acceptable and appropriate to the clinical setting. Professional expectations of the Yale PA Online Student include ethical, trustworthy, reliable, and compassionate behavior that includes the maintenance of appropriate personal boundaries and the ability to adapt well to change- scored 4.78 across all rotations. All specific rotations and classes scored above the benchmark.
• Responds to to the patient’s concerns and needs while establishing a trusting relationship- scored 4.72 across all rotations. All specific rotations and classes scored above the benchmark.
• Student utilizes effective techniques to inform, educate, and enlist the patient (and/or caregivers) to participate in the care plan, appropriate for the setting (i.e., acute, chronic, preventive, or emergent care) and patient’s age scored 4.65 across all rotations. All specific rotations and classes scored above the benchmark.

The program has been successful in meeting this goal as evidenced by the opportunities provided the students and preceptor evaluations of these skills during the clinical year. The program will continue to monitor and evaluate this goal.