PA Program Profile: Case Western Reserve University

In this installment of PA Program Profiles, we’re learning more about the program at Case Western Reserve University (CWRU, or Case). Led by Cynthia (Cindy) Booth Lord, MHS, PA-C, associate professor and founding director, the program matriculated its first class in May 2016.

“Case Western Reserve University views their PA program as an ideal way to expand the health care workforce in Ohio and the United States,” said Lord. “Case’s PA trainees will assist in meeting the expanding population of patients accessing medical services as a result of an aging population and the projected shortage of physicians.”

Read on to find out what else Lord has to say about one of the country’s newest PA programs.

As the founding director, can you tell me a little bit about how this program came about?

Case began its PA program planning process in the fall of 2012. The process began with the School of Medicine’s administration and was led by its dean, Pamela Davis. Davis attended medical school at Duke University in the early 1970s, at a time when Dr. Eugene Stead could still be found rounding on the wards. She was struck by the education and training of this new group of non-physician providers and by how quickly they could enter clinical practice and apprentice with the primary care physicians who hired them.

Why is the CWRU program so pivotal in Ohio specifically?

There are 59 counties in Ohio with Bureau of Health Professions-designated health profession shortage areas (HPSA) in primary medical care (totaling 136 HPSAs). Cuyahoga County, where Cleveland and Case are located, has 16 HPSAs — the largest number of HPSAs of any county in the state of Ohio. All of these designated HPSAs are within 10 miles of CWRU.

CWRU PA Class of 2018 celebrates PA Week. Image courtesy of CWRU.

CWRU PA Class of 2018 celebrates PA Week. All images courtesy of CWRU.

What makes your program unique?

Learning experiences that take place in non-traditional settings are one of the unique features of the Case PA program. Based on the program’s goal to prepare students to address community health issues and health disparities in the context of societal and economic systems, we have built experiential learning and community outreach activities into our curriculum. For example, when students were taught the newborn exam in their physical diagnosis class, they visited a newborn nursery that same week to practice their new skills; to enhance their understanding of the care of the elderly, PA students are working with local home care agencies to make home visits to older adults in the Cleveland area.

How does your program work to encourage and strengthen inclusiveness and diversity, both in its admissions process and in the curriculum?

We are seeking to establish relationships with the local pipeline programs, targeting both high school and regional college students. Similar to Project Access, the School of Medicine has a number of programs, including “Horizons,” where medical students, PA students, and nursing students meet with Cleveland high school students to talk about possible health professions careers. In addition, Case has been a participant of the Robert Wood Johnson Summer Medical and Dental Education Program (SMDEP) for the past 20+ years. For the past two summers, the PA program (faculty and students) has been included in the SMDEP program to meet with the students and to talk about the PA profession and how to become a good PA program applicant.

CWRU PA students. Image courtesy of CWRU.

CWRU PA students

We focus on diversity of all kinds in our Culture and Health course, and it is also woven throughout the didactic part of the curriculum. Diversity will be a focus and strength in our clinical curriculum, given the wide range of clinical sites to which we have the good fortune of sending our students.

All of our students and faculty are also required to participate in Diversity 360 and Safe Zone training. Diversity 360 trains participants to increase their capacity to recognize and engage in dialogue across differences as well as to deepen their understanding of how affiliations in privileged and marginalized groups impact treatment on campus. Safe Zone trains participants to be more inclusive and sensitive towards the LGBTQI community.

Do you do any team-building or philanthropic activities with your cohorts (for example, volunteering in the community)?

To allow for the integration of prevention and wellness education from classroom to practice, students are working in the Cleveland public schools to help deliver “Wellness Wednesdays” and “Fitness Fridays.” These sessions include healthy eating, oral health, fitness, and exercise. To reinforce the importance of childhood developmental milestones learned in the classroom, students work with Cuyahoga Country early intervention services. These services are delivered through an evidence-based early intervention approach that includes a team with an occupational therapist, a physical therapist, a speech-language pathologist, and a developmental specialist from the Cuyahoga County Board of Developmental Disabilities. PA students help sign up families for these services at local library programs, and they attend team meetings where cases are reviewed and services determined.

All students in our inaugural class (and in our second class) entered the program with significant community service experience, and their service continues once in the program. Case’s PA community service programs provide students the opportunity for developing deeper relationships within and demonstrating commitment to our local population, which include:

CWRU students participate in a foot exam workshop. Image courtesy of CWRU.

CWRU students participate in a foot exam workshop.

Student Run Free Clinic: Working with an interprofessional team of medical students, nursing students, and social work students, the PA students help connect under-insured patients to ongoing care. They function as part of the assessment team, which carries out a focused history and physical, and — with the help of a seasoned clinician — develop a plan for treatment and further care.

MedWorks: Homeless Stand Down: PA students help provide access to resources for individuals and families facing poverty and homelessness. In addition to providing immediate care, students work with nurses, social workers, and patient navigators to help connect patients with resources and referrals.

Faith-Based Blood Pressure Initiative: PA students provide blood pressure screening programs to local African American churches, directing clients who need additional services to available local free clinics and other health care programs.

In a similar vein, we hear a lot about networking and collaboration in the PA world. How have you been able to collaborate with other programs or community members?

The program has been highly effective in collaborating with both the internal (Case) and external (greater Cleveland) community. One such example is our work with the Greater Cleveland Hunger Network. One in five Clevelanders faces hunger on a daily basis. The PA program works with the Hunger Network’s Stay Well Project — a community outreach program that focuses on health education and promotion in an effort to bridge the gap between hunger and health by improving opportunities for food-insecure clients to access health care and prevention strategies.

Similarly, our collaboration efforts within the Case community are quite strong. One project that will launch this summer pairs PA students with dental students in Case’s dental clinic. PA students will work with dental students to review the exam of the mouth and fluoride varnish as well as enhance their skills in identifying diseases of the oral cavity. In return, the PA students will teach the dental students other components of the physical exam to enhance the dental student’s physical assessment skills. In addition to clinical skills, students will learn about the medical-dental collaboration and how to make referrals to each other.

CWRU PA students. Image courtesy of CWRU.

CWRU PA students

We have been working closely with the schools of nursing and medicine to create two interprofessional simulation opportunities. One involves navigating a patient and family member in an emergency room setting with a focus on enhancing communication skills. The other simulation involves a “team” (including a PA student, a medical student, and a nursing student) performing a physical examination on a patient with a focus on enhancing teamwork skills.

The Cleveland Clinic and the Ohio Association of PAs have both been important forces in facilitating collaboration between the Ohio PA programs. Not only does Cleveland Clinic serve as a major clinical training site for many Ohio programs, but they also host an annual PA Student Workshop. The workshop brings students from all over Ohio together for professional development and to participate in a medical challenge bowl.

And finally, if you could give developing programs any advice, what would it be?

I would offer two simple pieces of advice to developing programs.

  1. Think beyond the possible! There is a lot of work to be done to get a new program up and running and established in the community. Challenges like finding quality clinical placements are shared by all PA programs, both new and established. PA educators and their students are innovators and collaborators, and we need to use our individual strengths to help strengthen the profession as a whole.
  1. As Maya Angelou once said, “You shouldn’t go through life with a catcher’s mitt on both hands; you need to be able to throw something back.” As PA programs and educators, we depend on the community to help educate our students. It is important that we establish strong relationships in our communities and that we take time to give back to those communities to help improve the residents’ lives and their health.