For the past five years, the Physician Assistant Educational Association (PAEA) has been gathering information annually on incoming PA students through the Matriculating Student Survey (MSS), which helps to provide insights into the background, experience, and attitudes of students at the start of their PA programs.
Last year, PAEA started pairing the MSS with the newly developed End of Program Survey (EOPS) and compiling the results in the Student Report, which allowed for comparison of incoming and outgoing PA students and shed new light on the experience of PA school.
By comparing responses from the MSS and EOPS, the Student Report helps to demonstrate if PA students shift career goals, change attitudes towards practice preference, and land in their expected financial situation near the conclusion of their program.
Last week, we explored the responses from the incoming PA students of 2017 on the MSS. This week, we’re taking a detailed look at the PA school experience of near-graduates through the EOPS and how some of these outgoing student expectations and goals compared to the cohort of incoming PA students from the MSS.
As in the prior year’s Student Report, the vast majority of PA students nearing the end of their programs felt prepared to practice as they approached graduation. The survey looked at six core PA competencies: Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Patient Care, and Systems-Based Practice.
Over 98% of students responded that they felt confident or very confident in five of these six core competencies (up from about 90% in the prior year). Of the six competencies, systems-based practice, which is an understanding of the broader health care system, ranked the lowest but was still quite high at 80.9% (down from 84.3% in the prior year’s report).
When asked how challenging they found PA, outgoing students were given the opportunity to rank both the didactic and clinical phases. For the didactic phase, 50.3% of students found the challenge to be about what they expected while 42.8% (!!) of students felt that the education was either “more challenging” or “much more challenging” than they expected.
This one kind of surprised me because I feel like there’s so much information out there about how intense PA school is, and I often encounter pre-PA students who are quite intimidated by what they’ve heard. But apparently, many eventual PA students are still underestimating the challenge.
But, it seems as if most students hit their stride in the clinical year as 70.1% found the clinical phase to be “as challenging” as they expected, and the “more challenging” and “much more challenging” groups dropped to 19.1%.
Required interprofessional education (IPE), defined as “curricular activities where PA students had the opportunity to learn with students from different health professions programs,” remained popular among outgoing PA students. Just over three quarters (75.4%) of PA students participating in required IPE activities with other students, most commonly with students in physical therapy (64.4%), pharmacy (57.5%), nursing (BSN or ADN) (52.3%), and occupational therapy (42.3%) programs.
The most common IPE activities included patient-centered case problems (67.3%), clinical simulations (46.7%), team skills training (39.6%), and active engagement with patients through inpatient or ambulatory-based team rotation, longitudinal clinics, and practice-based rotations (37.9%).
Nearly eighty percent (79.8%) of PA students either strongly agreed or agreed that their IPE learning experiences helped them to “gain a better understanding of the roles of other professions in patient care.” About three quarters (75.6%) felt that their program had the right amount of IPE while 17.2% would have preferred more.
When asked how well didactic courses prepared them, respondents felt that courses in patient communication skills/history taking, physical examinations/patient assessment, and clinical medicine taught during the didactic year were the most helpful (1 = “not at all well” and 4 = “extremely well”; courses scored 3.5, 3.4, and 3.3, respectively) in equipping them for clinical rotations.
Let’s pause here to take some of this in. When outgoing PA students communicate what’s been most helpful (and least helpful) in preparing them for practice, take their cue.
Instead of looking at only program requirements and averages when trying to choose PA programs, it’s important to dive deeper and consider how programs both cover and deliver the content and education that will help you as future, practicing PA.
It can be hard to understand these caveats of programs before you’re in the mix, but outgoing PA students are an excellent source of clues that can help guide your search for programs that are the best fit for you and your learning style.
Okay, back to the stats.
Survey respondents were asked to rank the adequacy of instruction in different areas as either insufficient, appropriate, excessive, or “received no instruction.” The areas where students felt programs most often struck the right balance included diagnosis of disease (92%), disease prevention/health maintenance (90.6%), and management of disease (90.3%).
The areas where students felt instruction was inadequate or non-existent included oral health (32.2%) palliative/end of life care (31.8%), and the role of community health and social services agencies (26%).
Outgoing PA students reported general satisfaction with their program and career choice. These numbers were reported a bit differently than in the prior year’s survey, with students ranking statements about satisfaction on a scale of 1 = “strongly disagree” to 5 = “strongly agree.”
The highest ranking was for those who “would recommend the PA career to others” with an average rating of 4.6, and the lowest ranking was for a statement regarding whether the respondent would attend the same program again with an average rating of 4.0.
When ranking attributes of the program they were most pleased with, students ranked PANCE pass rates (mean (M)=4.6), class size/student-to-faculty ratio (M=4.3), and the program mission being consistent with personal values (M=4.3) at the top.
Program attributes rated the lowest among PA students nearing graduation were scholarships and financial aid (M=3.0), tuition cost (M=3.1), and offering of a dual degree (PA plus MPH) (M=3.3).
The incorporation of the EOPS into the Student Report has allowed for more insights into the health & well-being of PA students over the course of PA school.
PA students near graduation were asked about their psychological sense of school membership.
On a scale of 1 (“not at all true”) to 5 (“completely true”), students commonly felt that they were “treated with as much respect as other students” in their program (M=4.4) and “could really be themselves” in their program (M=4.1). Additionally, students more rarely felt that they wished they were in a different program (M=1.9) or felt as if they didn’t belong in their program (M=1.9).
So for outgoing PA students, the positive statements ranked high while the negative statements ranked low, which is encouraging.
Now for an interesting comparison of stress between incoming and outgoing student cohorts. From the questions posed, the stress levels reported by students were quite comparable between the two groups. So it seems that the fear of entering PA school and actually completing PA school produce equal amounts of anxiety — in most aspects.
But there was one area that showed a more significant difference between the groups. About 18% of experienced PA students reported “often/very often” feeling “unable to control the important things in their life,” compared to 12.3% of incoming PA students.
I kind of love that the other numbers related to questions on stress stayed pretty stable between the two cohorts but this one changed. It’s as if experienced PA students surrendered and were just hanging on for the ride, but the loss of control somehow had no impact on the other areas of stress. It feels like a rather zen approach, and I respect it.
I think that one of the most fascinating aspects of the combined MSS and EOPS reports has been the ability to look at how the future practice preferences of PA students change over the course of PA school.
Students who were near graduation ranked the considerations for their career path after PA school with work-life balance (96.5%), availability of jobs (95.5%), secure future (95.3%), and supervising physician relationship (92.9%) as the most important. These factors were ranked in the same order of importance by new PA students.
Now for my very favorite part of the Student Report: a direct comparison between the MSS and EOPS of student’s attitudes towards specialties and future practice. (My side plea to PAEA: I know the Student Survey is altered yearly to make improvements and adjustments, but please please never get rid of this part.)
Both incoming and outgoing PA students were asked to rank specialties as undesirable, neither undesirable or desirable, desirable, or “do not know enough.”
Over 50% of new PA students ranked nine specialties as "desirable" at the start of PA school: emergency medicine (67.3%), family/general medicine (63.6%), general surgery (61.8%), cardiology (57.2%), internal medicine (54.9%), orthopedics (54.8%), critical care (53.2%), general pediatrics (51.9%), and urgent care (50.3%). There were no specialties considered “undesirable” by more than 50% of incoming PA students. Remember that.
Once completing clinical rotations and gaining hands-on experience in a variety of disciplines, these attitudes shift. PA students near the end of their program ranked only four specialties, emergency medicine (69.7%), urgent care (60.7%), family/general medicine (59%), and general internal medicine (50.5%), as desirable for over 50% of respondents.
Additionally, the number of specialties considered undesirable climbed from zero to eight: pain management (73.2%), retail clinic (68.7%), correctional medicine (63.4%), palliative care (58.3%), psychiatry (52.7%), urology (52%), and nephrology (50.4%).
In a related survey item, new and experienced PA students were asked about the desirability of practice environments. For every category (e.g., suburban, urban, rural, VA), experienced PA students ranked a practice environment as undesirable more often than new PA students.
So, are PA students getting judgy with experience? I don’t take it that way.
A huge part of the PA school experience is discovering what, when, and where of how we want to practice medicine. Much of that decision making comes from learning what we don’t want in a role.
When PA students near graduation were asked to identify the factors that had the greatest influence on their specialty choice when applying for jobs, “fit with personality, interest, and skills,” “experience in clinical rotations,” and “advising/mentoring from a preceptor” were the top three influencers (94.9%, 89.9%, 76.1%, respectively).
I think this is a strong argument for PA students learning more about who they are and what they want in their career through their clinical experience.
Of students who accepted a position at the time of the survey, 87.3% of respondents had accepted a position in their first choice specialty. Over half (53.6%) agreed to a salary that was about what they expected.
While the MSS covers the expected cost of PA school for incoming PA students, the EOPS tells us how those expectations shake out for graduating students.
While nearly three quarters (74.1%) of incoming PA students had already taken out loans (Mdn=$54,000) to pay for their graduate PA education in the MSS, the number of students taking out loans by the end of their program increased to 83.7% with the median amount rising to $100,000.
Students who received grants, scholarships, or stipends increased during PA school, with 31.1% of graduating students receiving an award (Mdn=$4000) compared to 17.8% of incoming students.
Many smaller PA school scholarships, often sponsored by state or specialty PA organizations, are available to PA students who have completed their didactic year, so this trend makes sense and is an encouraging one.
About 46.4% of incoming PA students anticipated a total debt from attending PA school to be more than $100,000, while in reality, 55.6% of graduating students incurred a debt load that was above $100,000 by the end of their program. Another 22.2% were graduating with between $50,000 and $99,999, and 11.2% (that’s awesome!) of students were graduating debt-free.
If you want to be among the 11.2% earning a PA-level income without having to make student loan payments, you should starting planning now.
The PAEA Student Report is interesting in so very many ways. I love seeing how incoming student demographics change over time, and the addition of the EOPS last year allows for a robust picture of the PA student experience.
I can’t wait to see what next year holds! But until then, be sure you checked out the breakdown of the Matriculating Student Survey that we covered in last week’s post. There are plenty of gems to find there that complement the information revealed in the EOPS.
Physician Assistant Education Association, By the Numbers: Student Report 2: Data from the 2017 Matriculating Student and End of Program Surveys, Washington, DC: PAEA; 2018. doi: 10.17538/SR2018.0002
Physician Assistant Education Association. 2017. By the Numbers: Student Report 1. Washington, DC: PAEA. doi: 10.17538/SR2017.0001