An Inside Perspective on the Future of PA Education

 

Founded in 1972 (as the Association of Physician Assistant Programs, or APAP), the Physician Assistant Education Association (PAEA) is the national organization representing PA programs in the United States. All accredited U.S. programs are members of PAEA, which provides services and resources for PA programs, faculty members, applicants, and students. 

 

 Dr. Bill Kohlhepp, President of PAEA, Dean of Health Sciences at Quinnipiac Univerisity

Dr. Bill Kohlhepp, President of PAEA, Dean of Health Sciences at Quinnipiac Univerisity

The current PAEA president, Dr. Bill Kohlhepp, has been deeply involved in the PA profession since attending Rutgers University PA Program and graduating in 1979. He has extensive experience serving in a variety of roles for the major PA organizations, including AAPA, NCCPA, and, most recently, PAEA. He also serves as the Dean of Quinnipiac University’s School of Health Sciences, where he is a PA program faculty member, and has been involved in PA education for most of his career.

 

Dr. Kohlhepp recently shared his experience and insights as a PA educator with me in an interview, which is packed with valuable information for those preparing for PA school.

 

 

First, can you share why you do what you do?

I went to PA school in New Jersey at a time when it was illegal to be a PA in New Jersey. I graduated in 1979, and it was illegal to be a PA in New Jersey until 1992. So, I knew I needed to get involved to make change. During my time in school, there was only one PA in New Jersey who worked at the VA, so a lot of the responsibility to make change fell on the students. That experience instilled in me a commitment to serving my profession that I have not been able to get out of my system and, frankly, don’t want to get out of my system.

 

I have been continuously involved in serving the profession since PA school. I do what I do because I think I can contribute something to the organizations I’m involved with but also, selfishly, I want to be able to have my voice at the table and be able to say that my ideas were considered when important topics were discussed. It’s still a very young profession even though we’re now 50 years old.

 

 

Can you describe your role as president of PAEA?

The president of an organization like PAEA isn’t the person who’s in charge because the strategic plan of the organization drives our thinking, our efforts, and the way we spend our money.

 

The role of the president involves three major responsibilities. One is to facilitate the work of the board by chairing meetings, creating the agenda, making sure the important topics are being considered, and that the board is well prepared for those topics.

 

Another important aspect is representing the organization to outside bodies. I testified before Congress this past year in regards to the Title VII funding for PA programs and met with leaders at HRSA, the organization that supports the training of health professionals. So, there is a lot of external representation.

 

Then there’s the job of waving the flag and letting our members know what we are doing. At our annual meeting recently, I gave an address to help our members better understand what we are doing and what we are thinking about the important issues facing our profession.

 

It’s not like you are king or queen when you’re leading the organization, you’re really just at the helm of a ship that is sailing in the right direction, and your goal is to help keep it moving forward.

 

 

How did you get your start in education?

I’m a good example of being a PA. I’ve been in four different specialties. For me, the ability to change specialties is magical. As a PA, you don’t have to go back and do a residency to change specialties. So for me, the flexibility is one of the biggest reasons to go into the profession. I worked for four years in a hospital-based surgical emergency room, another two years in a large group practice in internal medicine and then the same group practice in family medicine, and then I worked for an additional six years in a hospital-based occupational medicine practice where I continued to work part time after starting in education. I practiced full time for about 16 years before I went into full-time PA education.

 

When I started working, I was at Yale New Haven Hospital and happened to have really good mentors there. There were some really good examples of PAs who were very involved in the PA profession who I really, in many ways, idolized. Even though they were clinicians, they were very involved the Yale PA Program as adjunct faculty, and they were also taking students as clinical preceptors.

 

I just followed their lead, so I taught part time as a faculty member at Yale for all the years prior to joining Quinnipiac. One day when I was working in my occupational medicine practice where I was in charge of occupational therapy, and one of the occupational therapists left to teach full time at Quinnipiac and I thought, “Wow, that’s a really interesting idea. I never thought about teaching full time.” I literally said to her, “You know, they’re thinking about starting a PA program or in the process of that. If you ever see a job opening there, let me know.” Then she called me up and said there was a position. So, I applied to Quinnipiac and the rest is history. I’ve been here for 22 years now.

 

When I look back and think, “Why did I do that?” it’s because I feel so strongly about the PA profession. For the person that wants to be a health professional, it’s a fabulous way of having a meaningful career where you can positively relate to patients and truly make a difference in their health, wellbeing, and recovery. It’s a wonderful profession, but nobody knew about it back in the early days.

 

Over my career, I have tried to make sure the ideals of those early days of the profession—being patient-centered, having flexibility, possessing strong medical knowledge, practicing as a team, and being altruistic—carried on. There were some key things that I felt I really wanted future generations of PAs to know. I could continue to do that one patient at a time, but I realized that being an educator allowed me to multiply my thinking by instilling students with those ideas. Being an educator made sense, and I enjoyed teaching.

 

 

What do you feel has changed the most about PA education over the past decade?

If you look at the structure of PA programs, with 12 months of classroom work and 12 months of clinical work, plus or minus, that hasn’t really changed much at all. So, you could think PA education is the same since the original Duke model.

 

But, what’s going on in the classroom is much different now. Medical knowledge is changing and doubling so rapidly today compared to 15-20 years ago, that if I learn a fact about taking care of a patient, that fact may or may not be obsolete a few years from now. There’s still a level of content that you need to get across to the students, but how we deliver that content has changed from the “sage on the stage” model we used to follow. Meaning, I used to stand in front of the class trying to be entertaining and informative, get the students engaged, and if I imparted knowledge to them, I was a success.

 

Teaching still involves imparting knowledge, but I also have to assist the students in putting that knowledge in context and teach them how to apply that knowledge through critical thinking. That involves many more exercises in class. It might involve a “flipped classroom,” where students do some work in advance and then come to class where they only do case studies. There is much more of a focus, at least in the didactic phase, of getting students to be able to contextualize knowledge — I might say something like, “It appears the literature is telling me there’s been a change in the way we classify someone as hypertensive. That means I might change my thinking and what I am doing, and consider how that might impact the patient in front of me.” So I think the classroom experience has changed a lot.

 

The driving force of change in the clinical phase has been that in the past, clinicians had time between patients, so it wasn’t slowing them down to take a student. But in this productivity-driven world, many clinicians are saying they are too busy to take on a student as a preceptor. It’s a different world, so there needs to be some level of creativity in the clinical side.

 

PA education is a competency-based education, and it’s not enough just to earn a 3.2 GPA in a class. You need to be able to take that knowledge, critically think about it, and apply it. It’s not enough just to be able to do a history and physical or go in a room and ask the right questions. You need to be able to do that efficiently and demonstrate it consistently.

 

So the outcomes, rather than the process of what we need to do, are becoming more and more important. Clinical sites are asking that before students are sent, they are evaluated for competency to be sure they have the knowledge, skills, and ability to be successful on that clinical rotation. There’s a lot more focus on assessing competency and milestones to evaluate student performance now compared to previously.

 

 

What do you feel has changed the most about the students who are going to PA school?

Though statistically it’s not dramatic, students are younger and younger coming into PA school. It used to be that everyone who was in PA school was in PA school because it was a second career. They understood the health care system. They were effective in the health care system. They were comfortable in the health care system, but in a different role. All we had to teach them about the system was what a PA does versus what they were doing.

 

Now there are people, depending on what PA program you go to and what is expected for direct patient contact requirements, who have a different level of comfort and success in the field before PA school. And while age is not always a measure of maturity, maturity is really important to be able to take care of patients. It’s really important to be able to develop altruism where it’s not “all about me” and the focus is on the patient.

 

It makes it more important for us to develop those perspectives as part of the education processes, or we need a different admissions process that is much more focused on things that relate to attitudes, behaviors, professionalism, and the ability to critically think versus what was someone’s GPA or number of patient contact hours. I don’t think we’re there yet. But when you look down the road, that may be something that’s a possibility.

 

The biggest thing I would advise for applicants is to get away from the check-box mentality, which focuses on the minimum requirements of schools. Instead, I would look at the messages a PA program is sending through their requirements, which tells you things you can do that will make you more successful in PA school and, more importantly, more likely to be successful as a clinician who has responsibility at the highest level for patients.

 

Direct patient contact is not just a hoop. It’s a way for us to make sure you know what you’re getting into, that you’ve considered the other options, that you’re comfortable in the health care system, and that you enjoy taking care of patients. If you do not like community service or get a minimum of 10 hours only because it’s required without taking it to heart or being able to describe what you got out of the experience, then it is just a checkbox.

 

I would try to get away from that way of thinking and consider what will actually prepare you for this career. Did courses you took in college make you think differently than ones you took in high school? Did they give you the foundation you need to be successful in PA school? I think it’s thrilling that the PA profession has attracted as much attention as it has and that so many people are applying, but I think it’s important that students are preparing in the right way rather than simply going through a checklist.

 

 

What would you recommend that prospective PA students understand about PA school curricula?

There are two major models of PA education today: the Duke model and the MEDEX model. The Duke model is hospital-based clinical rotations where you’re in a specialty for a period of time, whereas the MEDEX model is typically outpatient rotations that are a bit longer, where you are looking at patients on a continuum. So I’d look at which model is closest to that of the program to start. Typically, the east coast schools have more of the Duke model, but not always, and the west coast schools have more of the MEDEX model, but again, not always.

 

These days, I can’t imagine that the classroom work would be much different program to program. The length of the didactic phase is pretty standard. So it comes down to whether the program is more of a lecture-learner or self-directed learning style program. I’d look at whether the curriculum is case-based and also how I would be evaluated at the end of the program — is there a thesis or a comprehensive exam?

 

One thing I would look at is how long it takes for you to get out to see patients. Early immersion, even just being out in the health care setting or shadowing for a few hours a week, is helpful. Once you learn how to do histories, do you have an opportunity to get out and do histories on patients? I think whether early immersion during the didactic year is available is something to consider.

 

 

What educational aspects of PA school do you feel prospective PA students may not know to look for?

There are a few questions I would ask of a program. The first would be if there is an opportunity for simulation or high-fidelity simulation in the program. I’m a big believer that long-term high fidelity simulation and standardized patient experiences will play an important role in evaluating competency as PA students move through milestones in their education. Hospitals and health care systems are using high-fidelity simulation. If you’ve never done that in PA school, how will you fare when you go out into the job field?

 

I’d also ask about opportunities for interprofessional education. You can’t be a health provider today without working with other health professionals. If a student is looking at a liberal arts college where the only health professions program is the PA program, then I would ask how they would provide an opportunity to work with medical students, pharmacy students, nursing students, therapy students, and others to truly have an interprofessional education.

 

Also, although the accreditation standards do not allow for programs to demand that students find their own clinical preceptorship sites, I still wonder if that goes on to some extent. I’d want a student to go in with eyes wide open about how assignments are made for their clinical rotations, the kinds of settings they will be in, and how they are evaluated in the experience. That’s something that is outside of what they would see during a school visit, and I think it’s important to be more thoughtful about what the clinical experience may look like.

 

 

How do you envision the future of PA education?

I think PA education is going to be less and less about someone standing in front of you and imparting knowledge. I think it’s going to be more about case-based learning. I don’t think the PA profession will become entirely case-based, but I think there are elements of that model that will be key in growing critical thinking skills.

 

I think the move to simulation and standardized patients to improve clinical readiness will be important. I think there will be a move to push PA programs to not only show they have the pieces in place to provide the needed education but also to establish outcomes, beyond PANCE pass rates.

 

We had a stakeholder summit last year where PA employers and others sat down and talked about what’s most important for PAs in the workplace today. Critical thinking, maturity, professionalism, developing patient relationships, and functioning as part of a team, things that are not just book learning, rose to the top of the discussion. I think more than just medical knowledge will be looked at as we move to focusing on outcomes in PA education.

 

 

What advice do you have for future PAs who might be interested in making PA education part of their career?

When I look at people who go into PA school, to our credit as a profession, they say “I want to take care of patients for the rest of my life.” I’m sure it’s close to 90% of PAs who stay as clinicians. But for us as a group to have influence within the health care system, we need to think beyond only taking care of patients.

 

We need to think about becoming hospital administrators, becoming involved in regulatory bodies, and being involved in research. When you think about health professions that have elevated themselves, many times that elevation occurs due to things that are happening in educational institutions.

 

For me, thinking about a career in education is something I would like all future PAs to do. The thing that I’m so frustrated about is people who had practicing PAs, physicians, and others give of their time to serve as their clinical preceptors, and then, once they are working in the clinical world, do not want to give their time to be a preceptor to PA students.

 

For the long-term survival of the profession, PAs who graduate at least need to be focused on education by serving as a preceptor. It doesn’t need to be a full-time job. Maybe you can help a local PA program with the admissions process and interviews. You can serve as a content expert for PA students by giving a lecture; students love practicing PAs as guest lecturers.

 

I would love all PAs to think about educating future generations of PAs as clinical preceptors or adjunct faculty. Being a preceptor also keeps you fresh. Having a student ask you “why” and you can’t remember why really keeps you on your toes.

 

If it’s something they really enjoy, I think they will genuinely catch the bug once they start seeing the impact they make. Seeing that you are making a difference, watching students blossom, seeing the light bulb go on, or when they get a fabulous job and come back to thank you, that’s really infectious.

 

 

What’s next for you?

For me, professional involvement was a calling that started in my time as student at Rutgers. It really is a part of me to be involved in one of the professional organizations. I’ve gotten much more out of my experiences than I’ve put in. It’s given me skills, allowed me to develop in a number of ways, and given me the opportunity to give back. I also know I don’t want to stand in the way of other people taking on roles. I have a habit of getting involved then moving on, first with AAPA then NCCPA and now PAEA. I was the student member of the board of PAEA (then APAP) right after I graduated PA school in 1980, so it’s funny that after all of these years I’m back on the board.

 

The one organization whose work I’m really excited about is the PA History Society. Their work meshes with my philosophy of people understanding where the profession came from, and I’m thinking about the kind of role I could play in that organization, particularly since they have a lot of artifacts that they’re trying to make available to PA programs to teach some of the profession’s history. I’m interested in thinking about how to present those for use in teaching.

 

I have respect for a lot of people on their board. So, that might be my next step. I can’t imagine not being involved in something.

 

I also now have four grandchildren, including a set of 18-month-old triplets from my youngest son. So I’ll have to balance being Grandpa and my regular job with any additional role in the PA world.


I'm incredibly grateful to Dr. Kohlhepp for taking the time to share his insights and to Steven Lane, Senior Director of Communications at PAEA, for seamlessly pulling everything together for the interview all for the benefit of future PAs. 

 

Resources

Full bio on Dr. Kohlhepp: https://pahx.org/assistants/kohlhepp-william-c/

More on Title VII Funding: Nelson M. (2015, August). 5 Things You Should Know About Title VII. Retrieved: http://paeaonline.org/title-vii/

More on PAEA: http://paeaonline.org/