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PA Online course weathers the pandemic

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In March 2020, COVID-19 led Yale University to close the campus and forced the Yale School of Medicine MD and Physician Associate (PA) programs to shift to online didactic classes and pause clinical rotations. With COVID-19 continuing to prevent many in-person learning experiences, the PA and MD programs have switched temporarily to a blended model, with most didactic learning occurring online while skill-building sessions and clinical rotations take place in person.

When the 2020 spring semester ended, PA program director Alexandria Garino, PhD, PA-C, and her colleagues evaluated what had worked well online and what had not. They found Zoom to be effective for delivering didactic content when teaching is structured in a highly interactive way, such as using breakout rooms and polling. Most fall semester classes will be held online, though faculty members may choose to hold small group sessions in person.

Garino explains that while there is a lot of content that can be delivered effectively online, there are still situations in medicine when there is no substitute for touch and close contact. Content like clinical skills and anatomy lab work is better delivered in person. The blended model, she believes, allows students to learn by using the best of each platform.

When COVID-19 interrupted the PA program’s clinical skills curriculum in March, the students were about three-quarters through it. To complete the course, the students were asked to make videos of themselves performing clinical skills on a housemate—or a homemade mannequin if they lived alone. Each student received one-on-one feedback from a faculty member. This approach was labor-intensive and logistically difficult, especially for students living alone or with poor Internet connectivity.

Garino explains that it therefore became a priority to have the students practice clinical skills in person going forward, which occurred in July 2020 with extensive safety measures. Students wore personal protective equipment (PPE) from head to toe; had to test negative for COVID-19 before participating; and used the clinical practice rooms in Edward S. Harkness Hall, which have better airflow than the PA classrooms.

Similarly, in moving to a blended educational model, faculty and staff for the MD program carefully evaluated the curriculum to determine what can be taught effectively online and what requires in-person learning. Further, they investigated how in-person subjects like clinical skills, anatomy, and the medical coaching experience (MCE) can be done safely. This extraordinarily complex and time-intensive curricular evaluation guided the decisions for ways to best deliver a multifaceted curriculum.

For example, the clerkships for both the second- and third-year classes had to be restructured so that the loss of clinical time during the spring clerkship suspension for third-year students did not result in two classes being crowded into the same clinical learning environment. This problem was solved by having the didactic and clinical aspects of each clerkship occurring separately, allowing the second-years to be in didactic classes while the third-years finished their clinic-based experiences.

Although many faculty members were trained in the spring on using Zoom, Associate Dean for Curriculum Michael Schwartz, PhD, explains that the Office of Education staff had to train over 300 additional faculty members for the fall semester. This training was necessary because different courses are taught in the fall and spring. In addition, the pre-clerkship curriculum spans 18 months, so first- and second-year students are both taking online classes in the fall.

While many students are eager for in-person learning, COVID-19 restrictions have reduced in-person capacities, so that a lecture room that could hold 100 MD students pre-COVID can now accommodate only 35. Moreover, not all faculty members are comfortable with in-person teaching. Therefore, a lottery system is used to determine who attends lectures or workshops in person, while others watch on Zoom or listen to a podcast.

Meanwhile, YSM’s Physician Assistant (PA) Online program, which has offered a blended curriculum to students who engage in the program from their home communities since its launch in 2018, did not have to alter its 12-month highly interactive online didactic curriculum when COVID-19 began to affect the United States.

In addition to taped lectures by Yale faculty that students watch asynchronously, the didactic curriculum includes small cohorts of students and faculty engaging online for six hours of problem-based learning each week. Faculty members also use an asynchronous Socratic method, asking questions and discussing issues—just not in real time. The program has successfully piloted a virtual interprofessional education event and using standardized patients for online training in shared decision making and delivering difficult news.

PA Online students participate in 120 hours of direct patient experience near where they live during their didactic year, followed by 15 months of clinical rotations in or near their hometowns. Some PA Online clinical rotations have had to be delayed because of COVID-19 concerns. The program’s three one-week immersions on the Yale campus have also been affected. The program is creating an online immersion that program director James Van Rhee, MS, PA-C, believes will be successful: “Because of the highly interactive nature of the program, students feel very connected to their classmates, faculty, and the program.”