Most pre-PA students do a pretty good job at looking at what's required to get into PA school. Completing prerequisites, gaining patient contact experience, and logging shadowing hours are part of the routine.
Prospective PA students spend a lot of time and effort in their quest to cross the threshold of PA school acceptance. But, far fewer look into the details of what will happen once they're in school.
You can usually answer what minimum GPA, prerequisite courses, and experience hours are needed for a given program. For your top choice programs, you may even know the stats of the average accepted student. But, do you know what training at that program is like? Do you know how it's different from one program to the next?
If not, you are in good company.
Some PA programs do a better job than others of explaining curriculum details on their websites or emphasizing the program highlights with prospective students.
Even when the information is available, many future PAs don't know what to look for. Looking into how programs teach or how students learn may first come up when considering whether to accept a PA school offer. And, even then, maybe not unless you are weighing multiple offers.
So, let's fix that.
In this post, you'll learn about some key training aspects of PA programs in both the didactic and clinical years and discover how these attributes may influence your decision to apply to or attend a program.
What to consider in the didactic year
The first year of PA school, often referred to as the didactic year, is primarily set in the classroom. However, this classroom-style learning can take a variety of forms.
The most significant factors contributing to how you learn in the first year of PA school involve how information is delivered and the timing of the delivery.
The two typical modes of instruction include the traditional classroom lecture and lab model and a case-based model. Case-based learning (CBL, also called team-based learning (TBL) or problem-based learning (PBL)) is a practice that utilizes small groups of students operating as a team to work through real-world clinical cases.
CBL is popular in many medical training programs including medical schools and nursing schools and can help to foster problem-solving skills while identifying deficits in knowledge.
According to the latest PAEA Curriculum Report, 51.7% of PA programs utilize the lecture/lab model as the primary mode of instruction, 2.9% rely primarily on CBL, and 45% use a combination of both.
Understanding how a PA program delivers content can give you valuable information in your school search. If there is a lot of small group work, perhaps your concern over whether you'd do well with a larger class size matters less. If you learn better in lectures and through lab work than you do in groups, you could focus your search on programs that have a greater emphasis on a traditional classroom style.
The other major factor influencing the curriculum of the didactic year is the timing of how information is delivered.
Some programs follow a modular style format where all of the instruction, including anatomy, physiology, pharmacology, and clinical medicine, is done by body system as a single unit.
So, when you are learning about the anatomy of the circulatory system, you're also learning about the medications used in heart disease and how to perform a proper heart exam. In this model, you're likely to receive an overall grade for the unit rather than for individual courses. The modular style format can be tough to pull off as one system of the human body does not remain isolated from the others.
A more common curriculum style is one where the courses are separate but synchronous and aligned.
With a synchronous curriculum, topics will be closely related, and you'll often be studying how to do the skin exam in clinical medicine while learning about dermatology medications in pharmacology, but there may be a course, like medical ethics, that is outside of the "theme" of the others. Instead of being grouped into one unit, your courses remain distinct, and you receive separate grades for each class.
Alternatively, the curriculum may be asynchronous, and you may learn about neurology drugs in pharmacology long before or after you learn how to perform a neurological assessment on a patient.
You'll find completely asynchronous formats less frequently than the others—there's usually some course alignment in the curricula of most programs. But the degree of alignment can vary program to program. So, it's worth looking into this for your potential target programs.
According to the PAEA Curriculum Report, instruction in anatomy (88.5%), pharmacology (81.6%), and pathophysiology (53.8%) was primarily delivered by stand-alone courses. Education in other basic sciences, including genetics, medical terminology, microbiology, and molecular basis of disease, was more often integrated into several courses.
There was also variability among PA programs in how they delivered content in clinical medicine and behavioral/social science courses. Most programs had stand-alone courses in clinical medicine (74.9%) and physical assessment/examination
However, a minority of programs had stand-alone courses for behavioral and social science topics (including counseling skills, human sexuality, psychological development, and psychological/interpersonal/cultural health factors), professional issues, and public health matters and integrate the teaching of these into other areas of training.
Another element of timing to consider is the sequence of the program courses. A program may use the first semester of PA school as a primer for the rest of your training. You might start off with anatomy, anatomy lab, pathology, and ethics courses in the first semester, and move on to applying this knowledge in patient care in the following semester. Or, there may be a more significant element of patient care training in the first semester.
Understanding how topics will be delivered can help you find schools that will be compatible with your learning style. Most programs post their curricula by semester on their websites, so don't miss out on taking a look at how a program is structured.
INTERPROFESSIONAL EDUCATION (IPE) OPPORTUNITIES
A majority of PA programs (80.9%) provide students with opportunities for interprofessional learning (IPL) with other health-related students (medical, nursing, PT, OT), but the degree of interaction and under what setting it occurs can vary.
The most common PA student IPE experience was through an IPE seminar or series of seminars (26.6%), anatomy lecture (18.3%), and objective structured clinical examination (OSCE) simulations (16%) (where students work together in a simulation lab to work through patient scenarios).
At programs with IPE opportunities, a median of 5% of didactic time was dedicated to interaction with other health professional students. PA programs that offer IPE are most commonly housed within a "School of Allied Health/Health Professions/Health
Sciences," which makes sense as that's where you can find other health professional students.
If IPE is important to you, be sure to look into the types, amount, and frequency of interaction offered as these factors vary program to program.
Though opportunities for IPE probably won't make or break what a program offers overall, it may be something to consider in the overall picture of school selection.
EARLY CLINICAL EXPOSURE
Though much of the first year of PA school is centered around classroom instruction, some programs also provide first-year students opportunities for clinical exposure.
When offered, this type of experience usually looks something like you spending a half-day a week observing a provider in practice after the first semester (or the first few units). This early exposure can offer a lot of insight into how the concepts you are learning in the classroom are used in clinical practice.
It also can provide a welcome break to the otherwise academic-heavy first year during which you can start to get a little stir crazy. As most first-year PA students will tell you, you'll be itching to get out there and start seeing patients.
With the current nationwide clinical training site shortage, not all programs can offer this opportunity. So, it's worth digging into your potential target programs to see if early clinical exposure is offered.
One final aspect to consider regarding the didactic year is how you'll be evaluated. Most written exams are delivered through computer-based programs, but some are given by scannable device (like Scantron) or on paper.
To move on from the didactic to the clinical phase, PA students are required to meet some academic minimums. Most programs require a minimum GPA for the entire didactic curriculum (83.9%) while others require a minimum average percentage or letter grade (33.7%). Some have a minimum GPA for some but not all courses (9.8%).
Programs may also require that students pass OSCEs (49.7%) and/or pass a pre-clinical summative examination (45.6%) to demonstrate their clinical readiness before starting the clinical year.
The number of students who fail out of PA school or who are decelerated (to a slower track or the next class) is, overall, very few. But, finding out how a program addresses and helps students who are struggling can give you insight into the level of program support to expect as a student as well as a sense of the program culture.
What to consider in the clinical year
The didactic year of PA school can feel like information overload, but once you hit the clinical year, you'll feel like you're learning at warp speed.
Most of us who have been through PA school will tell you that the clinical year is when concepts really start to stick. It's much easier to remember an unusual presentation or a rare diagnosis when you can link it in your brain with a real-life patient.
So, understanding the clinical training opportunities that a PA program offers can be an important consideration when choosing where to apply.
All PA programs are required by ARC-PA (the body that accredits PA programs) to provide training in seven disciplines: emergency medicine, family medicine, general surgery, internal medicine, pediatrics, behavioral and mental health, and women's health. The vast majority of PA programs accomplish this by having required rotations in each of these areas of medicine. So, the availability of rotations in each of these areas is fairly uniform among programs.
However, some programs with a primary care focus may allot a greater number of weeks for rotations in primary care and internal medicine. Some offer longer rotations in emergency medicine.
Others may have required rotations, like orthopedic surgery, which are not required for other programs. Programs may also differ on whether or how many elective rotations are offered.
Programs with rotation sites at large teaching hospitals may give you the opportunity to see cutting-edge medicine, but you may also be competing with medical, NP, and other PA students to get more hands-on experience with patients.
Community medicine-based programs may offer less exposure to complicated medical cases but may also provide opportunities for students to be more involved in patient visits or to first-assist in the OR.
All of these factors may play into your school choice. If you're particularly interested in surgery, you may look for programs that have a greater number of required surgical rotations or ones that provide more elective rotations so you could opt for additional surgical rotations.
[Keep in mind that PAs are trained as generalists, so you won't be disqualified to work in a particular discipline of medicine just because you didn't have a clinical rotation in it. Understanding what programs offer is really about deciding what may be a good fit for you and your training goals.]
Another consideration when looking at clinical rotation opportunities is the amount of discretion you have in choosing your clinical training sites. If you are in a large class or if clinical training sites are limited, you may be assigned clinical rotations rather than having the opportunity to choose them.
Due to the clinical training site shortage, your clinical year may also require traveling for some rotations that are out of town or out of state. In addition to the issues that may come from being away from your "home base," one away rotation typically adds about $3,496 to the cost of PA school. This cost is usually the responsibility of the student. If you're using total program expense as part of your school selection process, it's wise to take into account any added cost of away rotations.
CLINICAL YEAR EVALUATIONS
As part of your clinical rotation, your preceptor will complete an assessment of your performance for your PA program. Additionally, programs may administer periodic clinical assessments to ensure competency for specific skills before students set out on particular rotations.
Clinical rotations last, on average, 4-8 weeks each. At the end of each rotation, you'll undergo an assessment using an "end of rotation" (EOR) exam.
You most often return to campus to take your EOR exam. If you're on an away rotation or going from one away rotation to another, this may not be the case, but exceptions and how these are addressed will be up to the individual program.
Most PA schools, and very soon all PA schools, grant a master's degree, which requires some work in addition to the standard elements of the didactic and clinical years.
Research for your degree may involve conducting original research, writing a scholarly paper, or working on a project.
If you've made it as far as PA school, you're fully capable of completing any of these requirements. But, it's good to know the amount of time you'll have to work on the project, if it will be a solo or group project, and what resources (statisticians, mentors, advisors) may be available to help you along the way.
Have you noticed that I've not yet mentioned PANCE pass rates? It's not by accident.
The most recent national first-time board pass rate was 96%. You need to study and prepare for the exam, but I'd encourage you to view any exam that has a 96% pass rate for first-time takers as manageable, regardless of the school you attend.
However, I would be interested in knowing how a program prepares students for the PANCE. Usually, this takes place after clinical rotations have been completed in the few months before graduation. Often, preparation is done with a combination of guest lecturers and practice exams.
The key to evaluating this as a prospective student is to understand your learning style and if the prep offered aligns with this. It's also important to know how much time is devoted to prep.
I would not choose a school based on high PANCE pass rates or what resources are devoted to board prep. But, it's good to know what will be provided by the program. If you feel like you'll need more time to prepare than what is offered, it may mean you'll delay your job search a bit as you focus on prepping for the boards.
Whew, that's a lot! There are a lot of similarities in the didactic year curricula and clinical year training among PA programs. They're all required to meet the same criteria to earn accreditation, but they can accomplish this is a variety of ways.
Knowing what to expect and, perhaps more importantly, what you want in your PA school training will help you home in on programs that are the best fit for you, your learning style, and your future goals as a PA.
Physician Assistant Education Association, By the Numbers: Curriculum Report 2: Data from the 2016 Didactic Curriculum Survey. Washington, DC: PAEA; 2018. doi: 10.17538/CR2.2018
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