Introduction
Physician assistant (PA) education is an exciting potential career for practicing PAs to consider. For PAs who enjoy teaching and mentoring students, becoming a PA educator offers many opportunities for career advancement, an enormous variety of tasks and experiences, a flexible lifestyle, and excellent benefits. This chapter provides an overview of PA education as a career and the specific roles held by PA educators within the program. Although educators perform different duties within the PA program based on their roles, all PA educators must have certain skills in common. Those who are considering PA education as a career should seek certain experiences to position themselves well for moving into education after time in clinical practice.
All PA educators need experience in both clinical practice and teaching. Because most PA programs require at least 2 or 3 years of clinical practice experience for potential faculty, a PA who is interested in teaching should choose a generalist specialty as opposed to a narrow subspecialty. PAs who have only focused on total hip replacement surgeries, for example, may have difficulty explaining the intricacies of diabetes management to students. Laying a foundation for teaching with broad clinical experience, including general patient assessment, psychiatric assessment, and exposure to clinical procedures, sets up a PA well to move into education.
A PA education position is not for people at the end of their PA clinical careers who are looking for semiretirement. Many years of clinical experience can prepare a PA for teaching; however, most new educators are surprised by the time-consuming nature of education and the steep learning curve, particularly during the first year. Whether creating lesson plans, developing curriculum, understanding PA program accreditation, maintaining clinical partnerships, or responding to students and administrators, the PA professoriate offers a wide variety of job tasks as well as a very flexible schedule in meeting those tasks. Clinical PAs should realize that they are likely to work more hours as PA educators than they did in clinical practice but that the tasks in education are less routine and offer a lot of variety.
Before considering a full-time academic appointment, PAs who are interested in education should teach in both clinics and classrooms. Becoming a preceptor gives PAs experience in one-on-one mentorship of students and helps PAs develop clinical teaching skills. Being a preceptor also gives PAs a window into the administrative aspects of the clinical year. PAs who are moving toward education should also seek opportunities to guest lecture or work as part-time PA faculty members. Part-time teaching gives exposure to academia without having to carry the additional administration, service, or scholarship requirements that full-time faculty members do. Taking the time to lecture or lead a small group allows PAs to improve their teaching techniques and to assess whether moving into full-time education is the best fit.
PAs who are considering moving into full-time PA education should also seek out opportunities to gain experience with PA professional organizations and in research. Professional organization involvement helps the clinical PA become more aware of current practice issues (e.g., reimbursement, legislative) that impact PA practice. PAs who participate in professional service also gain organizational skills and professional contacts, which will serve them well if they choose to enter PA education. Although PA programs have traditionally focused on the clinical education of PAs, more universities are requiring PA faculty to participate in the development of original research. Few PAs have research experience or expertise. PAs considering joining the faculty of a PA program should seek opportunities to be involved in research and bolster their expertise before moving into PA education. Potential opportunities include conducting clinical research at your workplace, assisting the research conducted by PA professional organizations to which you belong, or serving as readers for student research projects at local PA programs.
As clinical PAs move into academia, they are often surprised at how different the culture of higher education is compared with the culture of health care institutions. A certain mystique exists among doctorally prepared professors. They often assume that everyone has taken the same path to the professoriate that they did: bachelor‘s degree, master’s degree, and then doctorate. Particularly when the PA program is relatively new to the institution, other faculty often need some education to help them understand the differences in the structure of PA education and the qualifications of the PA faculty. PA programs are atypical within higher education. Especially if the institution does not have other graduate health programs, many other graduate professional programs are offered part-time or online. Administrators and other faculty may be shocked to learn that PA students are expected to be in class 32 to 40 hours per week. Few other graduate professional programs run year round. Unlike traditional academic master’s degree programs, many PA programs do not have an intensive research or master’s thesis component, and PA education is not designed for a student to progress on to the doctorate. PA faculty need to understand the academic culture and assumptions to be able to effectively advocate for the PA program and its students. Every institution has policies and processes, but in higher education, these processes can be very entrenched. New faculty may feel frustrated by the higher education bureaucracy, but maintaining a flexible attitude and taking the time to develop relationships on campus can mitigate the frustration and allow PA faculty to become happy members of the academic community.
Didactic director
The primary role of the didactic director of a PA program is to oversee, develop, and coordinate the didactic curriculum. Most students are familiar with a didactic curriculum as the traditional way of learning experienced in undergraduate education. The curriculum is organized into distinct courses and the content of each course comprises the essential pieces of the didactic curriculum. The courses are organized to form a progression of learning to enable each student to achieve the knowledge, skills, and critical decision making necessary to enter supervised clinical practice experiences. The didactic director works with each member of the didactic faculty to ensure compliance with the program’s published mission, goals, and educational objectives. These objectives must comply with the published standards of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), and the role of the didactic director is to ensure compliance for the didactic phase. The didactic director supervises and mentors faculty during the creation and implementation of course content. This process occurs at both an individual and team level, and hence it is important for the didactic director to establish a robust process that incorporates the free flow of ideas and respectful debate during curriculum development.
Working with the program director and other members of the leadership team, the didactic director establishes benchmarks for individual course and student performance. A scholastic benchmark is a measured criterion set by the faculty and program administrators for a course, an individual, or a program. An example of a course benchmark may be that 70% of students rate each course “above average” or better for organization. An individual student benchmark may be that each student maintains a 3.0 grade point average for each semester. These benchmarks help establish the goals for the program and, in this way, contribute to the overall quality of the program. Working with the assessment committee, the didactic director participates in program self-analysis to identify areas where benchmarks have not been met in the didactic curriculum. An important role of the didactic director is to identify performance improvement initiatives and to direct and manage the implementation of these initiatives. The goal is to meet or exceed all established benchmarks. As the program changes and develops, benchmarks will need to be revised. New benchmarks may need to be set and old ones updated. Thus the didactic director needs to have a solid understanding of course, curriculum, student, and faculty evaluation. Student progress must also be tracked. The didactic director identifies students at risk and develops remediation plans with the faculty. Watching a student progress in knowledge and skills to successfully complete a remediation plan is a very gratifying experience ( Fig. 59.1 ).
After the goals, objectives, and benchmarks are set for the program, the task turns to management of the didactic phase. Semester schedules must be created so that topics and modules are sequenced in the most effective manner to promote learning. For example, instruction in electrocardiography (ECG) should ideally occur close to the same time as instruction in cardiovascular disease and dysrhythmia management. Nevertheless, the students’ schedules may not accommodate instruction in all topics simultaneously, so the didactic director and faculty team must decide if ECG instruction can occur at another time. Course mapping is a technique used to visualize the timeline of all courses in a curriculum simultaneously. This tool helps to ensure that topics are distributed appropriately across the curriculum. In the previous example, while students are learning cardiovascular disease, they also need to learn about cardiac laboratory testing and interpretation, as well as the procedures used for cardiac disease. Because these topics may be taught in separate courses, a curriculum map helps to determine the proper timeline.
Faculty development is another very important role for the didactic director. Typically, individual didactic faculty are responsible for assigned courses within the curriculum. Some courses require expert adjunct faculty or guest lecturers to deliver specialized content. The didactic director assists faculty with recruitment of additional resources and assists in the evaluation process of all instructors. He or she reviews the evaluations of each instructor with the assigned faculty course director to provide guidance and quality control. Each faculty member needs to be familiar with different educational theories, learning domains, and styles of education. Test item writing is also a critical skill. Proficiency with spreadsheets, databases, and learning management systems is essential. The didactic director should educate and mentor faculty in all these skills.
The role of the didactic director requires competent leadership skills. He or she must be an effective communicator with personnel management and administrative proficiency. It is important for the didactic director to create a productive environment and to model professional behavior. Directing the didactic curriculum is similar to conducting a band or chamber orchestra. There are many moving parts, and when organized appropriately, the outcome can be very rewarding for both students and instructors. One of the most gratifying experiences in education can occur when you request a consult on a patient and you see one of your former students arrive on the scene and provide competent, effective medical care; afterwards, you may realize the role you had in developing that PA.
Clinical director
The clinical year of a PA program is a pivotal time for budding PAs. The hands-on knowledge gained during clinical training enables students to combine foundational medical knowledge with practical skills to competently care for patients. Faculty who work in this phase of the program, called clinical directors or clinical educators, have the unique opportunity to closely mentor, guide, and direct students through this advanced phase of PA education.
PA faculty who are involved in clinical education must be organized, energetic, adept at change, positive, and determined. No 2 days are alike for clinical educators, and those who enjoy flexible schedules and multifaceted work environments are well suited for this area of education. One day may involve driving to a rural clinic to observe and evaluate a student, the next day may be spent writing and revising an examination, and a third day may include meeting one on one with students or facilitating a small group.
A crucial aspect of clinical education is establishing and maintaining training sites. Clinical educators are involved in recruiting new preceptors, facilities, and hospitals. Recruitment may involve visiting clinics, meeting with hospital administrators, networking at regional and state meetings, or calling area providers to discuss new opportunities. Communication and collaboration with nearby PA programs and other health care training programs is imperative when coordinating rotation schedules. After preceptors begin working with students, the faculty will continue to contact or visit the sites to maintain appropriate connections to the program as outlined by the institution policies and the ARC-PA’s standards.
Clinical directors supervise the scheduling of student rotations. Unlike the academic phase of the program, during each class block, every student has an individual schedule that consists of an assigned course, location, and preceptor. For example, in the first block of the clinical schedule, the 50 students of the PA program will not be enrolled in a single common course but will be assigned various individual courses (e.g., pediatrics, women’s health, surgery) that take place in up to 50 unique sites. Scheduling 50 students for 12 or more clinical placements is challenging and requires a large amount of institutional, legal, and informational paperwork. Clinical directors may need to meet regularly with legal counsel and other administrators to develop clinical agreements called affiliations. These affiliation agreements are required to allow students to practice at clinical sites ( Fig. 59.2 ).
