Three Steps to Create More Equitable Professional Standards 

PA educators bear the important responsibility of preparing students for professional practice. As educators know, refining professional skills is a key part of student development. However, what happens when a program’s established standards of professionalism conflict with a student’s cultural norms or religious beliefs?  

Some PA faculty or staff may be surprised to learn that PA students across the nation find themselves grappling with this conflict. Many programs’ professional standards provide substantial leeway for faculty, staff, and preceptors to exercise subjective judgment on students’ actions and presentation. This latitude can inadvertently allow implicit or explicit biases to affect students’ performance.  

PAEA Chief Equity, Diversity, and Inclusion Officer, Emma Sellers, MS, and Yolonda Freeman-Hildreth, PhD, PA-C, assistant professor and diversity and inclusion chair, University of Detroit Mercy, recently shared advice to help programs evaluate their formal standards for professionalism and identify opportunities to make these criteria more equitable and inclusive.  

  1. Look at the rubric and make it as objective as possible. Ask yourself, “Is this standard measuring objective professionalism or some subjective conformity to an irrelevant social standard?” Remember this standard will have a real impact on students, not only in their future in the profession but also on their mental health and well-being. Minimize bias! 
  2. Consider religious and cultural differences – not everyone abides by the same set of beliefs. Include a diversity of perspectives in the team that is defining your standards. Your college or university may also have an EDI officer who can help. 
  3. Be open to making adjustments. Having an open mind will help you create your standards but note that this should be a dynamic process. Society and culture change over time so be sure to have a mechanism in place to revisit these standards regularly. 

Freeman-Hildreth noted that the last few years have been a point of inflection. 

“It’s hard, at times, to really evaluate, depending on the rubric you use, our underrepresented minority students. The students are subjected to the person evaluating them and the evaluator could have a lot of subjectivity and not a lot of objectivity,” she said. 

Freeman-Hildreth noted that some of the rubrics consider subjective factors like a subject’s clothing, demeanor, and tone. The program rubric may miss that a student’s dress or hairstyle, for instance, are acceptable and respected by the standards developed by the student’s point of view. 

If a program has only a few students who are underrepresented in medicine (URiM,) that small group of students may feel pressure to conform rather than honor their authentic selves. As a result, students may find themselves trying to reconcile their “school self” and their “authentic self.” 

A student who successfully completes a program may earn their degree, but program directors and staff may want to consider whether that program is truly preparing a student to practice in what may be a very diverse community. Freeman-Hildreth raised concerns about whether enough time is spent on developing a student’s professionalism in areas like integrity, ethics, empathy, compassion, and self-awareness. 

“These are things we want to see in our PAs when they graduate. How they take care of our mothers, our aunts, our grandparents. That’s what we want to see and not the misinterpretation of tone or whether the student is seen as aggressive or how they wear their hair, which is something some of our students go through in their programs,” she said. 

She cautioned that programs should be considering how to not only attract but also retain URiM students. Failing to meet students where they are can have a detrimental effect on their mental wellness, leaving them feeling isolated, depressed, and ultimately less engaged and invested. 

Sellers added that Freeman-Hildreth’s thoughts made her ask herself whether programs were looking at the internal characteristics that a PA program values instead of external factors like a student’s hairstyle and whether it conforms with the educator’s expectations.  

Addressing such important issues can be challenging. Despite the difficulty, studies show that communities served by health care providers with diverse backgrounds show better health outcomes. Doing this work will advance equity, diversity, and inclusion in the PA profession and your program and result in healthier patients. 

For more ideas to help address equity, diversity, and inclusion in your program, download PAEA’s DEI Toolkit and accompanying Best Practices Guide.