For Christy Cline, a second-year student in the Yale School of Medicine (YSM) Physician Assistant Online (Yale PA Online) Program, connecting coursework to the clinical experience makes all the difference. She describes how after learning about carotid endarterectomy surgery in her first-year coursework, she saw a patient who had undergone that surgery and had the opportunity to listen to that patient’s carotid arteries. Similarly, after learning how to do physical exams for a certain organ system in class, such as cardiology or neurology, she got to practice performing these skills on patients.
These opportunities took place through the Yale PA Online Program’s Clinical Experience in Early Didactic (CEED) program. During the didactic year, through CEED, each student typically obtains at least 120 hours of direct patient care experience in a clinical setting in their community, under the supervision and mentorship of a preceptor. This enables the students to apply what they are learning in the classroom in an interprofessional setting. While CEED typically runs from late March through December of the didactic year, last year most students’ experiences ran from June through December, for approximately four hours a week, because of COVID-19 hindering the ability to place students in the spring.
Students’ CEED experiences can be in primary care, family medicine, internal medicine and urgent care settings. For example, one student in the Class of 2022 was placed at a dual urgent care and primary care clinic with a team of PAs in Chula Vista, California, about eight miles north of the US-Mexico border, while another was at a family-owned practice in Newport News, Virginia with a physician as preceptor. A third student traveled with his preceptor, who was a PA, to three different urgent care clinics in Maine that were affiliated with a local hospital.
While the locations and types of practices differed, students all found it valuable to engage with patients in conjunction with their didactic learning. Second-year Yale PA Online student Cammie Nguyen says her preceptors taught her how to adapt to the differences between textbook medicine and real-world medicine, such as a patient lacking insurance coverage for diagnostic tests or treatments that are taught as being the gold standard. She says, “it’s imperative to know how to navigate these barriers, to advocate for your patients, and to continue to provide high quality patient-centered care.”
Jay Mudge, another second-year Yale PA Online student, echoes these points stating, “it was enlightening to have things ‘click’ every now and then when I was able to correlate patients' presentations, symptoms, stories, lab results, etc. with different things I was learning about” in course work. And while he also encountered issues he had not yet covered in his didactic year training, this encouraged self-learning. “I would usually have a bullet list of things to look up and go over by the end of the day.” Nguyen similarly found coming across not-yet-taught issues as a valuable opportunity for self-directed learning and exercising one’s critical thinking abilities, giving the example of seeing patients with diabetes and thyroid abnormalities before studying endocrinology.
Students also appreciated how CEED enabled them to practice in an interdisciplinary setting. Second-year Yale PA Online student Aaron Sents, whose preceptor was a doctor, said the office where he had his CEED experience also had an LPN and a medical assistant. He adds that a couple of medical students had rotations during his CEED time, “which was a great opportunity to interact and learn from other students.” Mudge, whose preceptor was a PA, similarly learned from interacting not only with PAs, but also nurses, medical techs, radiology techs, and an emergency medicine physician.
Another shared response to CEED is a tremendous appreciation for the guidance of preceptors. Nguyen describes how although she only was at the clinic for one-half day a week, the PAs at the practice, which included a Yale PA Online alumnus, would walk her through other interesting cases they had seen that week. For example, during her neurology unit, her PA preceptor discussed a recent patient who had presented with unilateral facial paralysis. “We covered differentials including Bell’s Palsy and stroke and I was able to apply what I had just learned to identify the major physical exam differences between the two conditions. It turned out this patient had been able to wrinkle his forehead which indicated that the patient was having a stroke, so he was immediately transported to the emergency department next door. I will never forget that clinical pearl because of that case.”
Cline shares two valuable lessons she learned from her preceptor—to go the extra mile for patients and to stay up to date on journal articles so that she could provide the best treatment plan for her patients.
Sents explains his CEED day was Thursday when the clinic was only open until noon. “This was nice because neither my physician mentor or I was rushed to get out and could discuss patients or general concepts as interesting topics came up.”
The students’ positive preceptor experience also is reflected in many students expressing interest in one day serving as a preceptor. Mudge, who has been a preceptor for paramedic students, says he would find it “valuable and enjoyable to act as a preceptor to a PA student in the future.” Sents shares that the time investment his preceptor made in him gives him “a sense of gratitude and desire to reciprocate that investment in someone else. I would love to be a preceptor someday.” Nguyen says, “I owe everything I’ve accomplished to mentorship and have always had an interest in becoming a preceptor. Having been mentored by such enthusiastic and compassionate PAs at my CEED site has reinforced this sentiment even more.”