Making Room to Try: What PA Educators Brought to the Conversation in Austin
PA educators have no shortage of ideas for improving clinical education. I was reminded of that in Austin, where more than 200 colleagues joined the first of two sessions we led at the 2026 PAEA Education Forum. What educators sometimes lack is a clear opportunity to test those ideas when they challenge a familiar educational model, without putting quality or public trust at risk.
My colleague Maranda Ward, EdD, MPH, associate professor at the George Washington University School of Medicine and Health Sciences, and I facilitated two working sessions: Accreditation That Enables: Quality, Innovation, and Responsible Flexibility and Accreditation and Continuous Improvement: From Evidence to Action. We wanted participants to do more than discuss curriculum design, quality improvement, and accreditation in the abstract. We asked them to begin with a community need, imagine a different approach to clinical education, and consider what would make it credible.
I have been thinking about what happened in those sessions. Accreditation standards have an essential role in preparing competent graduates and protecting students and the public. Yet the way they are written, interpreted, and experienced can narrow the possibilities educators consider, even when limiting innovation is not the intent of an accreditor or regulator. An idea may have real merit and still be set aside because it does not fit the usual structure. I do not think the answer is to lower expectations. I think we should be asking how to create more intentional, accountable opportunities to try something different.
Beyond the Familiar Rotation Model
We began by asking what participants would like more room to test. Their responses ranged from using artificial intelligence to strengthen clinical reasoning to simulation, service learning, approaches that allow progression based on demonstrated competence, and longitudinal clinical experiences. Others raised familiar problems with clinical placements and wondered whether there were better ways to organize experiential learning. These ideas were rooted in real differences among programs, their resources, and the communities they serve.
We then introduced a fictional PA program proposing a regional clinical hub for 12 students over six months. In response to rural primary care and behavioral health needs, the program hoped to draw on rural hospitals, community health centers, primary care practices, and behavioral health services rather than rely entirely on short rotations organized by discipline. Students could follow patients and families over time, learn with different members of the clinical team, and complete a project shaped by local population health priorities. The possibilities were appealing, but the questions about clinical exposure, supervision, reliable assessment, student support, and resources were substantial.
What interested me most was where the table discussions went. Some groups started by considering how to invest in the people and relationships that would make the clinical education possible. They proposed stronger affiliations with rural and underserved communities, more professional development for preceptors and clinical instructors, and better practical support for the clinicians who would teach students. Others imagined PA faculty organizing and overseeing experiences delivered by a broader group of clinical preceptors, including professionals working in the behavioral health services present in those communities. The question shifted from where to place students to how to build a network that could support their learning.
Other tables focused on the student who might spend six months far from campus. A promising rural experience could also mean loneliness, delayed feedback, or uncertainty about where to turn for help. Colleagues explored additional academic and social support, opportunities to connect with peers, and ways for students to form relationships with people and organizations in the communities where they were learning and might eventually practice. Technology could help connect faculty, learners, and clinical sites, but it could not take the place of belonging, timely feedback, or sound supervision.
There was also interest in moving beyond familiar assessment checklists and encounter counts. Participants were not questioning the importance of competencies. They were questioning whether the measures we commonly use tell us enough about what students have learned, particularly when the design of an experience is new or novel.
Evidence That Helps Us Learn
Early in the first session, we asked participants how they would respond to the proposed clinical hub based on the limited information and details offered. Among 100 responses, 41% favored proceeding with conditions and 37% wanted more information. Another 14% would proceed, while 8% would redesign the proposal first. This was a quick workshop poll, not a representative survey. What interested me was not which answer prevailed, but how reasonable educators approached the same opportunity differently. What did each person need to know before deciding that the change was worth pursuing?
We complicated the case with real life challenges as the tables worked. In one scenario, student performance looked reassuring, but some students reported isolation and delayed feedback. In another, overall results remained stable even as preceptors’ assessments became less consistent. Other groups faced institutional pressure to expand before they had completed an adequate evaluation. Each time, the task was to reconsider the plan, not defend the first idea. Whose voices were missing? Which safeguard needed attention? What evidence or finding might prompt a change in direction?
Our second session went deeper into that decision process. Participants developed practical evaluation plans built around a question worth answering, credible sources of evidence, a point at which to reassess, and a clear reason to continue, adapt, expand, pause, or stop. We were not asking programs to collect more data simply because a template or regulator calls for it. We were asking them to identify and use evidence to make better decisions.
I particularly appreciated the participants’ questions and discussion about qualitative approaches. When we introduce a previously untested educational experience, we may not yet know the most useful questions or measures. Observation, interviews, student narratives, and conversations with preceptors and community partners can help us discover what is happening and what deserves closer examination. Those methods complement quantitative outcomes. They can help explain why a model works, for whom it works, and what a reassuring average might conceal. We need to be able to learn while we innovate.
Could Accreditation Help Make Room to Try?
The conversations also returned us to a larger question. Could educators and accreditors work together more deliberately to explore promising approaches that may not fit the conventional accreditation model? I am not talking about setting aside core competencies or protections. I am imagining a transparent way to agree in advance on the learning outcomes, safeguards, resources, evaluation, and oversight that would make a limited pilot worth trying.
There are examples outside PA education that are worth considering. The New England Commission of Higher Education (NECHE) has a Policy on Innovation that allows institutions to propose initiatives that may be, or may appear to be, inconsistent with aspects of its standards. Institutions must address their mission and a demonstrated need, available resources, student protections, evaluation measures, and ongoing Commission review. Medical education’s Education in Pediatrics Across the Continuum project tested progression based on demonstrated competence rather than time alone. Physical therapy has also explored an integrated pathway linking entry level professional education and residency training. These initiatives were developed within different educational and accreditation systems, each with their own expectations and oversight processes. While none provides PA programs with a pathway to depart from current accreditation requirements, they offer useful examples of how educators and oversight bodies can work together to explore promising approaches, establish appropriate safeguards, and evaluate whether new models can achieve the same educational goals in different ways.
What might a comparable opportunity look like in PA education? Could a program bring forward a proposal grounded in a particular learner, workforce, or community need, and work with institutional leaders, clinical partners, and the appropriate accreditation and regulatory bodies to design a responsible test? Could we share what we learn, including ideas that fail to produce the hoped-for results, so the next program does not have to start from scratch? None of this would be simple. It seems to me, however, a conversation worth having.
When we asked what PAEA should carry forward, participants called for stronger partnerships among programs and health systems, support and incentives for preceptors in rural and underserved areas, examples of innovative models that have and have not succeeded, and usable frameworks that others could adapt. Two comments from the closing poll have stayed with me:
“Keep boundaries while innovating.”
“Give us frameworks to build off of, so programs don’t have to design from scratch.”
These comments reflect some of the practical instincts we heard from colleagues trying to improve education while meeting their responsibilities to students and the public.
What I Took Away from Austin
PAEA’s Guiding Principles on PA Programmatic Accreditation helped frame our work around quality, accountable governance, clear expectations, fair process, and continuous improvement. The principles are not standards. However, they invite us to consider what a trustworthy accreditation system must protect and what it should make possible.
We did not leave Austin with one preferred model, and I am glad we did not. I saw educators with different experiences and perspectives willing to question assumptions, respond to the realities of underserved communities, and make one another’s ideas stronger. The conversation was more useful because people did not always agree. The ingenuity was there, alongside a serious commitment to getting the safeguards right.
Our profession has a long history of responding to unmet health needs by finding different ways to work. I hope we bring some of that same willingness to experiment to how we educate the next generation, without losing the rigor and accountability that our students and the public deserve. We should not mistake the familiar for the essential. If we can create better opportunities for educators, institutions, communities, and accreditors to explore new approaches together, we may discover better ways to prepare PAs for the people and places that need them most.
References and Resources
Physician Assistant Education Association (PAEA). PAEA’s Guiding Principles on PA Programmatic Accreditation (2026).
New England Commission of Higher Education (NECHE). Policy on Innovation (editorial changes July 2026).
Association of American Medical Colleges (AAMC). Competency-Based Medical Education, including Education in Pediatrics Across the Continuum (EPAC).
American Board of Physical Therapy Residency and Fellowship Education (ABPTRFE). Piloting a New Innovative Program Model in Physical Therapist Education.
Forum observations, participant comments, and poll results are from the October 10, 2026, workshop materials and live poll responses (unpublished).
