PA Programs’ Evolving Response to the Pandemic

One day it was business as usual, and then the next day it wasn’t. That’s how quickly the novel coronavirus seemed to come upon us. Almost overnight, PA education — and in fact all education — was uprooted, leaving schools and faculty scrambling to protect their students and move classrooms online.

“Initially, we went to more of a hybrid model — some in-person, some remote, enhanced cleaning of classrooms, and social distancing. Then when the state put in strict guidelines, we had to switch on a dime to go to complete remote learning,” said Augsburg University PA Program Director Alicia Quella, PhD, PA-C.

Transitioning the didactic curriculum to an online format required some programs to purchase additional equipment and software, and faculty to learn or enhance their technological skills, but dealing with clinical rotations presented an even more complicated situation.

“The biggest challenge was knowing what the right thing to do was, as opposed to what everyone thought was the right thing to do,” said Jeff Midgley, MS, PA-C, clinical assistant professor for Marist College’s PA program. “We’re training health care professionals, and half of our students would say, ‘This is what we signed up for,’ and then the other half would say, ‘This isn’t what I signed up for.’ So balancing everyone’s safety with trying to keep the same level of excellence and helping everyone graduate as close to on time as possible was a challenge.”

“We trained everyone on PPE, and each student had to undergo modules of what it is, how to put it on, how to take it off, so they would understand the gear,” said Quella.

At the York College/CUNY PA program, only six out of 30 students were allowed to continue at their clinical site. Program Director Robert Brugna, PhD, MBA, said “The remainder of the students are doing EKG and pharmacology review, so they’ll be ready when they are allowed to return. And there’ll be an overlap with students starting in January.”

Staying Connected

To make up for the loss of face-to-face interaction in the classroom and at clinical sites, programs have come up with creative ways to stay connected. Pacific University Program Director Mary Von, DHEd, MS, PA-C, said they continually asked students for their feedback. “I was doing what I call weekly ‘fireside chats’ with each class to make sure they knew what was going on, to give them the latest data. We started a wellness newsletter. We bought pizza for every clinical site we could think of as a way to keep in touch with them.” 

The Duke University PA program created an elective course in which PA students help the Durham County Department of Public Health with COVID-19 case interviews and contact tracing.  

At Marist, they’ve used a lot of Zoom meetings to make it feel as normal as possible, and Midgley has incorporated ethical decision-making regarding moral injury and burnout into his classes. “We’ve discussed social determinants in the emergency department,” said Midgley. “Who should be required to show up for work? What if they feel unsafe? What if they’re worried about bringing COVID home to their families?”

There’s clearly been more than enough stress to go around. At Augsburg, Quella said that the increased workload on faculty has taken a toll. “They have had to completely readjust their curriculum. And if technology goes down, we’re dead in the water.” For some faculty, the whole technology piece has presented a significant learning curve. It’s been easier for students — who have been raised with technology — but the uncertainty of not knowing how and when they will graduate has caused major anxiety.

“Every layer of graduate education is stressed right now,” said Von, “which is why it’s so important to reach out to each other and ask, ‘How are you doing?’ Connecting with faculty, staff, and students. All of these layered relationships are what make us stronger. This whole situation has just really brought it to the forefront.”

Having a Head Start

The Yale Online PA program had a distinct advantage — at least as far as delivering their didactic curriculum. “Being an online program already, it didn’t really affect us too much,” said Director of Didactic Education Stephanie Neary, MPA, MMS, PA-C. “The biggest hurdle was our clinical-year students who are dispersed around the country. Outbreak rates were different from state to state. We were dealing with individual hospital systems in different states, so it was different for every student.” Yale’s online program already had one distance rotation created before the pandemic, which helped, but Neary emphasized the need to introduce technology into the clinical year.

Perhaps the pandemic has simply accelerated the move to technology in more areas of both education and health care. As Midgley pointed out, “Until now, we’ve seen telemedicine as almost a luxury, but now we realize that it’s going to become a necessity for practicing medicine in the 21st century.”

And the allure of working from home can’t be ignored. “I think I’ll get requests from faculty to continue teaching online,” said Brugna, “now that they’ve discovered the advantages. People have busy schedules. They don’t miss the commute, and they say they can focus on a task without being distracted.”

“The Only Constant in Life Is Change

As we all wonder when and if life will go back to “normal,” everyone we spoke with said that being flexible and innovative in times of crisis is key.

“You need to have back-up plans for your back-up plans!” said Neary. “I don’t think we ever thought that a nationwide shutdown could impact us like this. But we’ve now worked out some of the kinks. We now know we can run summative exams remotely. This has proven that our online didactic curriculum works.”

Some programs, like Augsburg, are now focused more on competency-based outcomes. “Instead of just putting in time and a certain number of patients, we follow learning outcomes,” explained Quella. “We’ve used the PAEA competency guidelines. Now we’re asking, ‘What are the learning outcomes, and how are students meeting these and documenting them?’”

“Something challenging like this pandemic is an opportunity to bring everyone together,” said Midgley, “to look at where they are, to listen to others, and triage accordingly.” He highlighted the institutional support at Marist that has allowed PA faculty and undergraduate faculty to collaborate. “We were in a meeting and one of them said that in her online organic chemistry class, she puts a whiteboard behind her to draw chemical structures during class. I wondered, ‘Why didn’t I think of that? That’s brilliant!’”

On the subject of adapting, Neary noted a study that she and co-authors Jim VanRhee, MS, PA-C, director of Yale’s Online PA program, and Chris Roman, MS, MMS, did for an article about COVID-19’s impact on PA educators for the September 2020 issue of JPAE. “We thought most programs going forward would make changes, but most said they would only make minor changes to their curriculum. That was shocking to us. Because I don’t think this is the last time something like this is going to happen.”

“Never let a serious crisis go to waste. And what I mean by that is it’s an opportunity to do things you thought you could not do before.” 
 — Rahm Emanuel

For more information about how programs initially adapted to changes brought about by the pandemic, see PAEA’s Rapid Response Reports.