How We Meet Our Goals

The goals of the online program are:

• Goal #1: Continue the pursuit of excellence by increasing the number of highly educated, qualified physician assistants in primary care across the country
• Goal #2: Amplify the impact of Yale on the health care field with an emphasis on patient care in medically underserved areas, as defined by the Health Resources and Services Administration, and leadership
• Goal #3: Improve pedagogy throughout the program with the use of innovative technology
• Goal #4: Educate individuals to integrate the clinical data that they obtain from their patient’s medical history, physical examination, and laboratory analysis in order to form a differential diagnosis, as well as assess and plan for the patient’s condition
• Goal #5: Facilitate the maturation of several important interpersonal characteristics during the student’s education, to practice in an ethical, empathetic, and professional manner, with an emphasis on the team-based approach to the provision of medical care

The goals of the Yale PA Online Program, and how we are meeting them, are set out below:

Goal No. 1: Continue the pursuit of excellence by increasing the number of highly educated, qualified physician assistants (PAs) in primary care across the country.

How we are meeting Goal No. 1:

Student Recruitment

We conduct a thorough admissions process to attract and select applicants with the traits necessary to be highly educated, qualified PAs. Multiple online interviews are used to evaluate applicant qualifications and their fit for an online learning environment, and how they will aid the program in meeting its mission. CASPer also helps the program to identify applicants with the traits necessary to be a highly educated, qualified physician assistant. 

The Yale PA Online Program enrolls students from diverse locations across the United States and from a variety of careers and backgrounds to become the primary care providers our nation needs. Our first cohort, a class of 41 students from 11 states, began classes in January 2018. Our second cohort, a class of 59 students from 24 states, began classes on Jan. 7, 2019. 

We have admitted students spanning a wide geographic range, from New England to Hawaii. Some students live in rural areas such as Smackover, Arkansas, and Richmond, Maine, while others reside in more populous urban centers such as San Francisco, California, and Washington, D.C. These students bring a variety of life experiences and a breadth of perspectives to the program. For example, 22 percent of our students in the second cohort have advanced degrees including Doctor of Philosophy, Doctor of Education, Master of Public Health, Master of Science, and Master of Education. This cohort also includes military veterans, and 10 percent of the cohort reported that they were the first generation in their families to attend college.

The following academic statistics are a representation of the middle 60% of the class of 2021 (20th–80th percentile):

• GRE scores range from the 61st–93rd percentile for Verbal, 38th–69th percentile for Quantitative, and 59th–92nd percentile for Analytical Writing.
• GPA ranges from 3.59–4.00 (prerequisite), 3.34–3.81 (undergraduate science), and 3.36–3.79 (undergraduate cumulative).

While both GRE scores and GPAs can provide evidence of intellectual ability and academic achievement and potential, we consider and review an applicant’s entire application for other factors pertinent to a successful career as a physician assistant, and that would enrich our class composite, such as work experience and other life accomplishments. The fact that many of our applicants graduated from college or a secondary degree program several years ago makes looking at information beyond standardized test scores and grades particularly important.

Attrition Rates

The PA Online Program’s goal is to graduate everyone accepted into the program. Knowing that multiple circumstances can get in the way of a student being successful, the benchmark for student attrition is less than 5%. The Class of 2020 attrition rate was 2.3%, and so far the Class of 2021 rate is 3.4%. 

---

Goal No. 2: Amplify the impact of Yale on the health care field with an emphasis on patient care in medically underserved areas, as defined by HRSA, and leadership.

Summary of Clinical Rotation Requirements

The PA Online Program has a primary care focus, with our PA students completing clinical rotations in the following areas: internal medicine (12 weeks), primary care (12 weeks), pediatrics (eight weeks), and four weeks in each of the following:behavioral medicine, general surgery, women’s health, and emergency medicine. Additionally, each student has three electives of their choice that are each four weeks in duration. These clinical experiences allow all students to have exposure to inpatient, outpatient, operating room, and emergency department settings over the duration of the curriculum.  

Practice Training Settings of Current Students

Based upon a review of the program’s current clinical placement sites, the program is able to offer a clinical experience in a wide variety of settings and numerous locations around the country.

By exposing our students to a wide variety of clinical settings, including medically underserved, in the students’ home regions, the program hopes to have an impact on the health care delivery in these regions and settings. Detailed information related to clinical sites will be available after the first cohort of students completes the clinical rotations in May 2020.

How Students and Faculty Promote Leadership

Students:

Below are roles our PA students have held, all done while attending an online PA program!

• Annually, One Connecticut Student Resident Serves as a Connecticut Academy of Physician Assistants Board Member
• Team Leader and Founders of International Medical Missions
• Fire and Rescue Leaders
• Future Educator Development Steering Committee, Committee Member (2018–Present)

Faculty:

James Van Rhee

• Accreditation Review Commission on Education for the Physician Assistant, Commissioner, Chair, and Vice Chair (2008–2017)
• Distinguished Fellow of the American Academy of PAs (2009–Present)
• Outstanding Achievement Award, PAEA (2013)

Stephanie Neary

• Yale PA Online Student Society, Faculty Advisor (2018–Present)
• Grand Canyon University Faculty Advisory Board, Board Member (2017)
• Physician Assistant Education Association, Future Educator Development Steering Committee (2017–2018)
• Physician Assistant Education Association, Future Educator Development Council (2016–2017)
• Physician Assistant Education Association, Student Advisory Task Force (2014–2016)

Mary Showstark

• Chief, Physician Assistant Trauma Surgery (2004–2006)
• Director/Creator Taste of Gramercy (2012–2013)
• East Coast Director, Surfer’s Medical Association (2010–Present)
• Director of New Development Physician Assistants for Global Health (2018–Present)
• Welch Allyn Advisory Board Member (2018–Present)

Jane McDaniel

• Secretary, Physician Assistant Education Association Board of Directors (2018–Present)
• Director at Large, Physician Assistant Education Association Board of Directors (2015–2018)
• Board Representative and Chair, PAEA Planning and Governance Division, Physician Assistant Education Association (2017)
• Physician Assistant Education Association Board Representative to the PAEA Student Advisory Task Force (2016)
• Physician Assistant Education Association Board Representative to the PAEA Governance Council (2015)
• Basic Skills Faculty Development Pando Workshop, Physician Assistant Education Association (2011–2014)
• Chair, Central Application Service for Physician Assistants (CASPA) Committee, Physician Assistant Education Association (2008–2013)

Diane Bruessow

• Dean’s Advisory Council on LGBTQI+ Issues, YSM (2019)
• Lifetime Achievement Award: PA of the Year, NY State Society of PAs (NYSSPA) (2019)
• Secretary-Treasurer, American Academy of PAs (AAPA) (2017–Present)
• Chair, Finance and Audit Committee, Board of Directors, AAPA, (2017–Present)
• Distinguished Fellow, AAPA (2009–Present)
• Humanitarian of the Year, NJ State Society of PAs (2017)
• Member, Lesbian, Gay, Bisexual, and Transgender (LGBT) Policy Task Force. Office of the Bronx Borough President, Ruben M Diaz, Jr., Bronx, NY (2017–Present)
• Director, Policy and Education, LGBT PA Caucus (2011–Present)
• Editorial Board, Transgender Health journal, Maryanne Liebert publishing (2015–Present)
• Director at Large, AAPA (2013–2017)
• Vice President, NJ State Society of PAs (2012–2013)
• Chair, Policy, and Government Affairs Committee, GLMA (2012–2013)
• Director at Large, GLMA (formerly Gay and Lesbian Medical Association) (2011–2013)
• Chair, Membership Commission, AAPA (2011–2013)
• Editorial Board, Journal of the AAPA, Lippincott Williams & Wilkins Publisher (2009–2013)
• Board Officer (Secretary), GLMA (2011–2012)
• Member, Sexual and Gender Minority Work Group, Centers for Disease Control and Prevention, Department of Health and Human Services (2009–2013)
• NY Delegate to the House of Delegates (2006–2013)
• Chair, Annual CME Conference, GLMA (2010–2011)
• President, Immediate Past President, and Chair of the Board, LGBT PA Caucus (2008–2011)

Staff:

Jacqui Comshaw

• Yale Latino Networking Group Steering Committee (2016–Present)
• Member, Yale Latino Networking Group (2006–2015)
• CASPA Code of Conduct Work Group (2019)
• CASPA Enhancement Committee (2012–2017)
• CASPA Advisory/Recruitment and Admissions Council (2012–2016)
• PAEA Recruitment and Admissions Advisory Council (2011–2015)

Renée Kamauf

• Member, Medical Education Social Planning Committee (2018)
• Member, Graduate and Professional Registrars Group (2018–Present)
• Co-Chair, Transfer Student Enrollment Committee, The George Washington University (2015–2016)

---

Goal No. 3: Improve pedagogy throughout the program with the use of innovative technology. Develop new pathways of teaching, and develop the skills of lifelong learning and critical thinking in the students.

The program is constantly developing innovative ways to teach, but not just for the sake of being innovative. The curriculum blends a lecture-based curriculum with problem-based learning and other small-group sessions. This enhances the student learning process, assisting the students with application and retention of the material. 

The students view video-recorded lectures prior to meeting in small groups. In these small groups, the students complete a variety of exercises. Examples of these small-group sessions include EKG problem sets, lab interpretation problem sets, problem-based learning cases, Yale School of Medicine internal medicine and pediatric office-based clinical cases, and bioethics discussions—to name just a few. During the didactic year, students take part in the Clinical Experience in Early Didactic (CEED). During this clinical experience, the students spend time directly involved in patient care, enhancing their clinical skills and knowledge. Other examples of innovation developed and used by the program include:

• FLICKs (Focused Lectures in Clinical Knowledge): To provide clinical lectures to all student regardless of their clinical site rotation, the program created a lecture series that can be viewed by the students on their phones or iPads during downtime at the clinical site or after clinic hours.
• Online Grand Rounds: This is a platform for students to think critically about the patients they are seeing during rotations and practice presenting their findings in a formal academic setting. Through peer discussion, they are able to view the cases from multiple perspectives and learn from the experiences of others. 
• Online Standardized Patient Program: Using online standardized patients, students are able to develop their skills in breaking “bad news” and shared decision-making.
• Anatomy Surgical Videos: A series of videos was developed to provide students on their surgery rotations with a quick review of human anatomy related to the more common surgical procedures. These videos are 10 to 20 minutes long and use a Socratic method in presenting the material.
• Anatomy Dissection Videos: Yale Department of Surgery Section of Anatomy has created “Anatomy Clinic,” an online resource that assists students in their learning of anatomy through an online dissector with video instruction and learning exercises.
• Virtual Reality Heart: Normal function of the heart and an understanding of congenital heart disease are taught using virtual reality. Through virtual reality, the students are able to climb inside the heart and examine its structures and how the various congenital heart diseases disrupt cardiac function.
• EKG Virtual Lab: Students use custom, interactive 3D cardiac imaging to integrate content from anatomy, physiology, and clinical medicine and apply it to EKGs. Students are able to trace electrophysiologic pathways and identify anatomical structures while witnessing how EKG patterns change in real time. 

---

Goal No. 4: Educate individuals on how to integrate the clinical data that they obtain from their patient’s medical history, physical examination, and laboratory analysis in order to form a differential diagnosis, assessment and plan for the patient condition.

Rating of Curriculum Instruction

Each year, students complete/will complete a survey at the end of the didactic year and the clinical year. They are asked to respond to a variety of issues related to instruction, activities, and resources of the program. The Class of 2020’s didactic year survey included the following average student ratings, with a rating scale ranging from 1.0 = “strongly disagree” to 5.0 = “strongly agree”:

“The first year curriculum adequately prepared you in the process of assessing patients and suggesting treatment plans”: 4.2

“The curriculum provided you with a sufficient foundation of knowledge”: 4.7

“The clinical experiences (CEED) in the first year enabled you to apply your clinical knowledge”: 4.7 

Clinical rotation preceptors also evaluate the students on a number of areas related to the didactic year curriculum and how it prepares the student for the clinical year. The preceptors are asked: “Thinking back to the beginning of the rotation, was the student prepared for the rotation in the following areas: history taking skills, physical examination skills, and foundation of knowledge for this rotation.” The average score in history taking skills was 4.6, physical examination skills was 4.4, and foundation of knowledge was 4.6. (This scale also ranges from 1.0 = “strongly disagree” to 5.0 = “strongly agree.”)

The evaluation of the clinical year has not been completed at this time because the clinical year is ongoing.

Summary of PACKRAT Performance

At the end of the didactic year and also the clinical year, the PA Online students complete/will complete the Physician Assistant Clinical Knowledge Rating Assessment Tool (PACKRAT). As of March 8, 2019, the Yale PA Online students exceeded the national average on the end-of-didactic-year PACKRAT examination. More specifically, based on the data from the PACKRAT examination, the Class of 2020—which took the end-of-year-one PACKRAT examination in December 2018—exceeded the national average in 10 of the 13 specialty organ systems and all seven of the task areas.

The year-two PACKRAT data will be published here when available. 

Summary of Student Rotation Evaluations by Preceptors

Each year, the program’s clinical preceptors evaluate students on how prepared they were coming into the clinical rotation and how well they performed at the clinical site. Areas evaluated include: basic and clinical science, obtaining a medical history, performing a physical examination, ordering and interpreting diagnostic studies, patient management and patient education, and professionalism. To-date, the preceptors have rated the students at 4.61. (This scale also ranges from 1.0 = “strongly disagree” to 5.0 = “strongly agree.”)

Summary of PANCE Performance

No students in the Yale Physician Assistant Online program have taken the PANCE at this time. In the future, once the scores are available, first-time PANCE pass rates for Yale PA Online students will be provided here, and a breakdown of the data will be available on our Accreditation and Board Certification page.

---

Goal No. 5: Facilitate the maturation of several important interpersonal characteristics during the student’s education, to practice in an ethical, empathetic, and professional manner, with an emphasis on the team-based approach to the provision of medical care.

Ways in Which Cultural Sensitivity Is Encouraged During the Didactic Phase of Training

In addition to students completing the Behavioral and Preventive Medicine course series, which focuses on, in part, cultural sensitivity, students also participate in activities such as:

• Standardized patient encounters in breaking “bad news” and shared decision-making
• On-site training in emotional intelligence during both Immersion I and II
• Service outreach to assist underserved areas of their community

Demographics of Patients Seen by Students on Clinical Rotations

Pie chart shows the percentage breakdown by gender. 61.42% female, 38.52% male, 0.06% transgender, 0.01% unmarked

 

Chart 2: Pie chart shows the percentage breakdown by race and ethnicity. 33.93% white, 32.28% non Hispanic, 11.37% Hispanic, 7.62 American Indian, 6.59% other, 4.29% black, 2.71% Asian, 0.40% unknown, 0.28% native Hawaiian or other Pacific Islander

Chart 3: Pie chart shows the percentage breakdown by age. 4.14% < 2 years old, 2.90% 2-4 years old, 4.73% 5-11 years old, 4.20% 12-17 years old, 36.05% 18-49 years old, 21.53% 50-64 years old, 26.40% >=65 years old, 0.05% unmarked

The patient populations seen by our students while on clinical rotations are reflective of, and consistent with, national demographic numbers. Our students learn from and evaluate patients of all gender identifications, all ages, and many ethnicities. All data from (date) to May 26, 2019.

Ratings on Exit Surveys Regarding Sensitivity to Diversity

At the end of the program, the students will complete a program evaluation that looks at a number of areas. One area includes rating the following statement about cultural competency: “The behavioral and preventive medicine course prepared me to be a caring and compassionate provider and helped me develop a sensitivity to effectively work with patients who are different than myself.” This evaluation has not been competed at this time, but results will be posted here when available. 

How Student Professionalism Is Evaluated

The PA Online Program recognizes the importance of developing graduates who have the knowledge and skills to function as a highly qualified physician assistant, and this includes professionalism. 

In all interactions, face-to-face and online, both during the didactic and clinical years, students are required to exhibit professional behavior to fellow classmates, faculty and staff, preceptors, and, most importantly, patients. During orientation, students are advised of program expectations related to professionalism. Furthermore, every student is evaluated for professional behavior throughout the PA Online Program.

During the didactic year, students are evaluated by their small-group facilitators on professionalism. Specifically, students are evaluated on initiative, accountability, self-improvement and adaptability, professional behavior, and relationship with the group. The student average in these areas for the class of 2020 was 8.7 on a scale of 1 to 9, with 1 being the lowest score and 9 being the highest.

The preceptors evaluate students after each rotation in the following areas of professionalism: effort, relationship with patients, relationship with other professionals, and overall professionalism. Overall professional expectations of the Yale PA Online student are: ethical, trustworthy, reliable, and compassionate behavior that includes the maintenance of appropriate personal boundaries and the ability to adapt well to change. To date, the preceptors have rated the students at 4.89. (The scale ranges from 1.0 = “strongly disagree” to 5.0 = “strongly agree.”)

The following is the score breakdown by area:

How Student Professionalism Is Evaluated

Areas of Professionalism	Class of 2020
Effort	4.83
Relationship With Patients	4.89
Relationship With Professionals	4.93
Overall Professionalism	4.90

Ways in Which Professionalism Is Encouraged During PA Training

Participation in White Coat Ceremony

This annual celebration recognizes students’ entry into the clinical phase of the PA Online Program. Students and their families attend this ceremony during which students receive their first white coat, provided by the program.

---