When potential students consider online educational programs, they rarely visualize a traditional classroom setting. “People think we are sitting in a room on a computer all day in our pajamas,” says Yale Physician Assistant (PA) Online student Melissa Smith ’20. Nothing, for Smith and her classmates, could be further from the truth.
Yale’s PA Online students spend the majority of their 28-month program in their home communities, which span from Maine to Hawaii. At the end of their didactic year, however, in December 2018, they gathered in New Haven for what is known as an “Immersion Week”: five days steeped in hands-on training on the Yale campus, and a chance to interact in person with their classmates and instructors. PA Online students complete three Immersion Weeks during their training.
Like many traditional PA programs, the PA Online program consists of a 12-month didactic year, focused on lectures, small group discussions, and simulations, followed by a 16-month clinical experience, spent in rotations in a variety of community practices. The difference is that, except for two Immersion Weeks, students convene strictly online for their didactic year coursework. The Yale PA Online program is unique: it is the first and currently only program in the country offering a nearly complete digital didactic year. No long-term residency in New Haven is required. It is also Yale’s first online degree-granting program.
“The Yale Physician Assistant Online program enables students to stay in their local communities,” says Program Director James Van Rhee, MS, PA-C, associate professor in the Physician Assistant Online program. “This allows them to be close to their support systems and hopefully decrease the stress of graduate studies.” The program has received provisional accreditation from the Accreditation Review Commission on Education for the Physician Assistant. The next site visit is set for spring of 2020, shortly before the first class of students graduate.
Though geographically separated, PA Online students all know each other’s faces through their Immersion Week experiences and frequent training sessions that require students to be present in front of their computers, interacting with their instructors and classmates. In Problem-Based Learning, also known as PBL, students gather in a web-based setting with a faculty facilitator, and work through simulations of patient care situations, moving from patient introductions, through treatment and follow-up. While they must be camera-ready for PBL, lectures in the PA Online program are asynchronous, and students can view them whenever and wherever they wish. Utilizing a variety of instruction methods “allows the student to increase their medical knowledge, apply this knowledge, reflect on the application of knowledge, and continue to refine their skills,” says Van Rhee.
“There is tremendous value to making a high-quality Yale PA education accessible to a greater number of qualified students, thereby increasing the number of PAs available to meet the nation's growing health care needs, especially in primary care,” says Richard Belitsky, MD, Harold W. Jockers Associate Professor of Medical Education and associate professor of psychiatry and deputy dean for education. “Our goal is to provide an innovative educational experience that blends sophisticated, highly interactive didactic learning with exceptional clinical training at carefully chosen sites throughout the country.”
Immersion Week I occurs early in the didactic year and is dedicated to the Anatomy Lab, in which William Stewart, PhD, associate professor of surgery (gross anatomy), leads the students through the same anatomy preparation given to all YSM students. They also have an opportunity to practice physical exam skills on each other. In Immersion Week III, held in the final month of the program, students will undergo required summative assessments, which includes written assessments, practical assessments, and Observed Structured Clinical Examinations (OSCEs). This week also will culminate in celebrating the class graduation.
In December’s Immersion Week II, students participated in patient exams known as “Sensitives,” in which they worked with patient-instructors on vaginal and prostate exams, experiences that could not fully be replaced by online instruction. Students also gathered for lively discussions of key topics in bioethics, and for candid test prep sessions, as well as for meals and social events where they had the opportunity to socialize in person, catching up on news and conversations that began online, and transferred easily to shared meals on campus.
In addition to the campus immersions, students receive in-person training through the Clinical Experience in Early Didactic (CEED) program, which provides students with significant clinical time during the didactic year. Students are connected with a preceptor in a community practice near their home, which could be a primary care, urgent care, or specialist practice, and shadow a PA or physician for four to six hours a week from March to December. In CEED, students gain new hands-on patient interaction skills, such as taking histories, reviewing diagnostic tests, and performing routine procedures like suturing, providing a chance to gain confidence before the clinical year rotations, in which they will have more patient care responsibility.
Clinical time near their homes means that students get a head start on practicing as PAs in the communities in which they will ultimately serve. “A lot of our assignments are in our own community,” notes student Mary Garrison ’20. She adds that she has been tasked as part of her coursework with locating local resources such as free dental clinics, food pantries, and rehabilitation programs. “I have a list of resources now in my own community that I didn’t know existed,” she says. This will allow Garrison to connect her future patients with these community resources.
The type of long-distance learning that the PA Online program provides allows students a great deal of flexibility in how they conduct their education. They can balance their full-time education with health, family, or religious obligations, several say, as well as manage their time so they can maximize hands-on time at their CEED clinics. “Because of the asynchronous nature of much of the didactic curriculum, we could do that,” says Garrison. After spending time in the clinic, “I could come home, and then do my lectures and my work into the afternoon and evening. You have that flexibility with your schedule, so you can maximize all of the opportunities that they give us.”
Students say they often confront an assumption from people outside of the program that an online program cannot foster the same sense of community that on-campus programs enjoy. This is not the case, they say. “We are closer to each other in this program than any other educational program I have been in, brick and mortar or otherwise,” says Smith.
Because their home computer is most often their classroom, school is open for PA Online students around the clock. Students make extensive use of group text lists, as well as a very active Facebook group, where students share information, both personal and professional.
“Our professors email us back in the middle of the night, and answer students immediately,” says Garrison. “The answers can be shared with the rest of the community in nearly real time.” For this community of students, the classroom is always open.