For the past three years, the Physician Assistant Educational Association (PAEA) has been collecting information on PA students nearing the completion of their training through the End of Program Survey (EOPS).
Along with the Matriculating Student Survey (MSS), which helps to provide insights into the background and experience of students at the start of their PA programs, the EOPS results are published in the annual PAEA Student Report.
By including data from both the MSS and EOPS, the Student Report helps to highlight how career goals, well-being, practice preferences, and financial expectations evolve for PA students over the course of PA school.
In last week’s article, we reviewed the details of PA students who were starting their programs in 2018 through examing the results of the most recent MSS.
This week, we’re getting a glimpse of the most up-to-date experience of PA students nearing the completion of their training in 2018 through the results of the EOPS.
As demonstrated in prior Student Reports, the vast majority of PA students nearing the end of their programs felt prepared to practice.
Six core PA competencies were used to measure their confidence: Medical Knowledge, Professionalism, Interpersonal & Communication Skills, Practice-Based Learning & Improvement, Patient Care, and Systems-Based Practice.
Interestingly, while overall confidence in these areas remains high among near-graduates, there’s been a downtrend since the first Student Report was released two years ago.
In 2016, over 90% of students reported feeling confident or very confident in five of the six core competencies, while only two competencies, Professionalism and Interpersonal & Communication Skills, crested the 90% mark in 2017 and 2018. Also, the latest data showed a slight decrease in confidence in the other four measured competencies compared to prior years.
Of the six competencies, Systems-Based Practice, which is an understanding of the broader health care system, continued to rank lowest for the third year running (79.1%, down from 80.9% in 2017 and 84.3% in 2016).
When asked how challenging they found PA, outgoing students provided feedback on both the didactic and clinical phases. For the didactic period, 50% of students found the challenge to be about what they expected while 41.3% of students felt that the education was either “more challenging” or “much more challenging” than anticipated. (Just 8.7% found the didactic year to be “less” or “much less challenging” than expected.)
For the clinical year, it seemed as if experience helped to set expectations: 69.4% of students found the clinical phase to be as challenging as anticipated, 19.0% found it to be “more” or “much more” of a struggle, and 11.7% were happy to learn that clinical training was easier than they’d thought it would be.
During the didactic phase, the most frequently encountered courses of PA students included Physical examinations/Patient assessment (99.8%), Pharmacology (99.8%), Clinical/Technical skills (99.8%), Patient communication skills/History taking (99.7%), and Clinical medicine (99.3%).
Meanwhile, Genetics (64.7%), Microbiology (62.4%), Neuroscience (61.4%), and Biochemistry (41.3) were more scarce.
Notice that the courses fewer PA students had as part of their PA training are often, but not always, prerequisites for admission to PA school — genetics, microbiology, and biochemistry.
In some cases, programs may not have a course as a prereq because they’ll be covering the subject as part of your PA training. So, what you might be attemping to avoid in your pre-PA work may just be delayed rather than bypassed.
When reporting how well their didactic training prepared them for clinical rotations, near-graduates felt that their Patient communication skills/History taking, Physical examinations/Patient assessment, and Clinical medicine courses were the most helpful (1 = “not at all well” and 4 = “extremely well”; courses scored 3.5, 3.4, and 3.3, respectively) — results identical to the previous year’s survey.
When prospective PA students consider whom they’ll train alongside, they usually imagine their PA school classmates. But, in many PA programs, other types of health sciences students are encountered.
Required interprofessional education (IPE), defined as “curricular activities where PA students had the opportunity to learn with students from different health professions programs,” remained a popular experience; three-quarters of PA students (75.1%) participated in required IPE activities (compared to 75.4% and 76.8% in prior reports).
While physical therapy students remained the most common IPE partners (62.5%) followed by pharmacy (57.8%), registered nursing (BSN or ADN) (56.9%), occupational therapy (44.5%), and advanced practice nursing (NP, CRNA, or midwife).
IPE activities most frequently included patient-center case problems (64.6%), clinical simulations (44.8%), an interprofessional student group (38.9%), active engagement with patients (during rotations or through longitudinal clinics) (34.3%), and team skills training (31.8%%).
Three quarters (75.3%) of those who learned alongside students of other health professions “strongly agreed” or “agreed” that the experience helped them to “gain a better understanding of the roles of other professions in healthcare.”
Of those with IPE experience, 18.2% would have liked more than they received, 8.6% would have preferred less, and the remaining 73.2% hit the Goldilocks mark of “about the right amount.”
Of the PA students who didn’t participate in IPE, 55.6% wished they would have had the opportunity.
As students neared the end of their PA training, they were asked to reflect back on what they felt was the adequacy of instruction in topic areas and rank each as: insufficient, appropriate, excessive, or “received no instruction.”
Students felt programs most often struck the right balance with Diagnosis of disease (91.3%), Management of disease (89.2%), and Disease prevention/Health maintenance (89.0%).
Subject areas that were more often ranked as inadequate or missing from training included Palliative/End of life care (29.4%), Oral health (28.3%), and the Role of community health and social services agencies (23.7%).
There’s been some serious insider scoop contained in the data thus far, so don’t miss it.
While learning what PA students have to do is interesting, tapping into what they find most valuable is revealing — and can be used as fuel in your PA program search and to develop questions to ask during your PA school interview.
Once you understand how PA students can be involved with other health professions students through IPE, you can start seeing what opportunities prospective PA schools offer during your program search.
When you know what courses outgoing PA students have found most helpful, you have the ability to ask more detailed, thoughtful questions about a program’s curriculum on your interview day.
Outgoing PA students reported their overall satisfaction with their program and career choice by ranking statements on a scale of 1 = “strongly disagree” to 5 = “strongly agree.”
The highest-ranking statement, “I would recommend the PA career to others,” had an average rating of 4.6 (Mdn=5.0). The lowest ranking, “If I could revisit my program choice again, I would attend the same program,” had an average rating of 3.8 (Mdn=4.0).
When assessing attributes of the program, near-grad PA students put PANCE pass rates (mean (M)=4.6), Class size/Student-faculty ratio (M=4.3), and Program mission being consistent with personal values (M=4.3) at the top.
Program aspects rated the lowest on the satisfaction scale included Scholarships and financial aid (M=3.0), Tuition (M=3.1), and Offering of a dual degree (PA plus MPH) (M=3.3).
By including data from students at both the start and end of PA school, the Student Report is capable of capturing aspects of stress and well-being and demonstrating shifts that occur over the course of training.
As part of the EOPS, PA students nearing graduation were asked to rate their psychological sense of school membership on a scale of 1 (“not at all true”) to 5 (“completely true”).
As with last year’s report, the positive statements ranked high, while the negative ones ranked low.
Students commonly felt that they were “treated with as much respect as other students” in their program (M=4.3, Mdn=5.0) and “could really be themselves” (M=4.0, Mdn= 4.0). And, students much more rarely wished they “were in a different program” (M=2.1, Mdn=1.0) or “sometimes felt as if” they didn’t belong in their program (M=2.0, Mdn= 1.0).
The Program Report also aimed to measure stress in PA students, and things got really interesting when the incoming PA student scores were compared to those of students near graduation.
In assessing stress, two “positive” measures (“Felt confident about ability to handle their personal problems” and “Felt that things were going their way”) and two “negative” measures (“Felt unable to control the important things in their life” and “Felt difficulties were piling up so high that they could not overcome them”) were looked at.
Both the MSS and EOPS results demonstrated that PA students “often” or “very often” agreed with the positive statements and “never” and “almost never” felt that the negative statements were true.
However, there was an across-the-board trend with both the positive and negative stress measures, which suggested that PA students near the end of their training were more stressed than their new-student counterparts.
Perhaps the relief of getting into PA school can only last so long.
Having the perspectives of both entering and exiting PA students on a topic is one of the most beneficial features of the Program Report. And, in my opinion, there’s no subject that this dual-group input is more captivating than the future practice preferences of PA students.
And, this year’s Program Report doesn’t disappoint as it, again, allows for a glimpse of how career goals and practice preferences shift over the course PA school.
Students who were just starting PA school and those near graduation ranked agreed on the importance of considerations for their career path after PA school by designating the same top-three factors: Work-life balance (MSS: 97% v. EOPS: 95.1%), Availability of jobs (95.6% v. 96.2%), and Stable, secure future (95.3% v. 95.3%).
However, between the two groups, three areas diverged a bit more than the others.
First, experienced PA students (93.8%) more often rated the Supervising physician relationship as “very important” or “essential” compared to newbie PA students (87.7%).
Second, incoming PA students (79.0%) thought High-income potential was more important than outgoing PA students did (72.9%). And, lastly, new PA students (56.3%) were more interested in Social recognition or status than near-graduate students (50.0%).
Now for the part of the Student Report that I love to dissect: a direct comparison between the MSS and EOPS of student’s attitudes towards specialties and future practice.
Both incoming and outgoing PA students were asked to rank specialties as undesirable, neither undesirable nor desirable, desirable, or “do not know enough.”
Over 50% of new PA students ranked eleven specialties as "desirable" at the start of PA school: emergency medicine (66.5%), family/general medicine (62.9%), general surgery (60.5%), cardiology (55.9%), cardiovascular surgery (54.5%), orthopedics (54.4%), general internal medicine (53.7%), critical care (52.2%), general pediatrics (50.5%), and dermatology (50.5%), and urgent care (50.3%).
For those nearing graduation, only four specialties remained above this 50% “desirable” mark: emergency medicine (69%), urgent care (62%), family/general medicine (58.0%), and general internal medicine (50.2%).
Let’s adjust the bar down a bit for the specialties considered “undesirable” and use 30% as our measure (as new PA students tend to be fairly open-minded when imagining their future options).
Among new PA students, eight specialties were considered "undesirable" by at least 30% of respondents: pain management (49.2%), retail clinic (47.9%), geriatrics (40.3%), palliative care (38.8%), psychiatry/behavioral medicine (38.2%), correctional medicine (35.4%), urology (34.2%), and occupational medicine (31.6%).
However, with a bit of experience, 29 specialties became “undesirable” to at least 30% of PA students who were near the completion of their training.
So, through the PA school experience, 11 “desirable” specialties, as rated by at least 50% of students, are reduced to just four. And the list of disciplines classified as “undesirable” by at least 30% of graduating PA students expanded from eight to 29.
That’s pretty extreme. But I don’t think it’s indicative of poor clinical experiences or picking up a negative attitude while in PA school.
With experience, it gets easier to see what you don’t want to do, even if you’re not yet quite sure of what you want to do.
Think back to your decision to become a PA. You probably didn’t immediately land on being a PA, but explored some other options along the way — like becoming a physician, nurse, pharmacist, or teacher — before figuring out your career path.
The same process often takes place during PA training — we discover what we want to do through a process of elimination. In determining what you’d prefer to avoid, you can find the sweet spot in how and where you want to practice.
Along those lines...
When PA students near graduation were asked to distinguish the influences on their specialty choice when applying for jobs, “fit with personality, interest, and skills,” “experience in clinical rotations,” and “advising/mentoring from a preceptor” had the biggest impact (94.2%, 88.7%, 77.1%, respectively).
Survey respondents were asked about the likelihood of working in a medically underserved area after graduation. And, as with specific specialties, enthusiasm went down with experience: 65.7% of students in the MSS thought they were “likely” or “very likely” to practice in an underserved area, but the figure dropped to 45.2% by the EOPS.
Of students nearing graduation, 46.3% had accepted or received at least one job offer.
Among those students who had accepted position at the time of the survey, 32.8% were set to work in primary care specialties (e.g., general medicine, internal medicine, pediatrics, ob/gyn), 31.8% in surgical specialties, 28.1% in emergency medicine or urgent care, and 7.9% in internal medicine subspecialties (e.g., cardiology, endocrinology, ID, oncology).
And of those who had locked down positions, 84.1% accepted jobs in their first-choice specialty.
For the 15.9% who accepted positions that weren’t within their top-choice specialty, their decision was most commonly attributable to the desirability of the location of their accepted job/specialty (42.7%), because they did not get an offer in their first-choice specialty (34.7%), because the role they took allowed for great scheduling flexibility (28.0%), or because there was a lack of jobs in their specialty of choice to apply to (28.0%).
Of those that were hired, 54.6% were offered a salary that was “about what was expected,” while 26.0% would be earning more than they anticipated and 19.4% would be earning less.
While the MSS explores what incoming PA students expect for their PA school expenses, the EOPS reveals how those expectations measure up to reality for graduating students.
While most incoming PA students (73.5%) had taken out education loans (Mdn=$56,000) at the start of PA school to pay for their graduate education, this percentage increased to 85.2% for those nearing graduation, with the median amount accumulating to $100,000.
Students who received grants, scholarships, or stipends increased during PA school, with 29.4% of graduating students receiving an award (Mdn=$4000) compared to 16.9% of incoming students. (Which makes sense as many smaller PA school scholarships are only available after the didactic year.)
About 77% of incoming PA students expected their total debt from attending PA school to be less than $100,000, while in reality, only 46% of graduating students were able to stay under that target, with nearly 48% incurring between 100K-175K in debt.
The lesson here? Have a financial plan based in reality, explore alternative options, and don’t let the stress of training derail your intentions.
The PAEA Student Report includes an incredible amount of detail and reveals more about PA students with each new release. Seeing the trends over time and also the similarities and differences between early and experienced PA students provides a ton of insight into the experience of PA school.
And you can also access the full PAEA Student Report 3 if you want to be sure not to miss a thing. I expect next year’s report to hold even more treasures than before.
But until then, you can pore over the latest results of incoming PA students as contained in the Matriculating Student Survey by checking out last week’s article.
Physician Assistant Education Association, By the Numbers: Student Report 3: Data from the 2018 Matriculating Student and End of Program Surveys, Washington, D.C.: PAEA, 2019. doi: 10.17538/SR2019.0003
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
Physician Assistant Education Association, By the Numbers: Program Report 32: Data from the 2016 Program Survey,
Washington, DC: PAEA; 2017. doi: 10.17538/PR32.2017