Yale PA Online Students Gain Clinical Experience Early in Program

Dane Davis and Joshua Wageman

Danae Davis, a first-year student in the Yale Physician Assistant (PA) Online Program, describes the experience of studying about the head and neck in class, and then having to think through, analyze, and apply what she just learned when a patient presented with an ear problem. “It is challenging at times, but helping patients is why I want to be a PA,” she said.

Davis has this opportunity because three months into their didactic year, Yale PA Online students begin their Clinical Experience in Early Didactic (CEED), spending four to six hours a week in a health care clinic in their community, under the supervision and mentorship of a preceptor selected and approved by the Yale team.

Strong Preceptor Mentorship

Through CEED, over the course of the didactic year, students obtain at least 120 hours of direct patient care experience, applying what they learn in the classroom and gaining exposure to the different health professionals with whom they will work throughout their careers. The clinical settings in which students are placed include primary care, family medicine, internal medicine, and urgent care, aligning with Yale PA Online’s focus on primary care in light of the shortage of primary care doctors in the United States.

Davis drives about 30 minutes from her home in Southern California to a clinic in Rancho Cucamonga to participate in CEED every Wednesday. She describes her preceptor, who is a doctor, as “an excellent mentor,” adding that whenever an issue arises that is particularly interesting, or something that Davis and other students on clinical rotations will see frequently, he calls everyone together to discuss it. One lesson she has learned from him is “to close the deal, meaning if you refer a patient to a specialist, get on the phone and make the appointment for him or her, to ensure no one slips through the cracks.”

Significant Patient Engagement

Josh Wageman, also in his first year of the Yale PA Online Program, spends four to five hours at his CEED site every Thursday afternoon, which is located in Meridian, a suburb of Boise, where Wageman lives. The site is part of the Primary Health network, which functions as a dual urgent care and family practice unit. Wageman’s preceptor is a family practice provider at the clinic, but Wageman notes that he interacts with all the providers. Like Davis, Wageman has found his preceptor to be an outstanding mentor. “My preceptor emulates the ideal blend of clinical acumen and compassionate care,” he said. “He really is a perfect example of what a PA should be, and he strongly desires to equip me with the best opportunities to fortify my skills.”

CEED provides the students with significant opportunities to engage with patients in a variety of capacities, addressing a range of issues. As Wageman describes, “I typically see around 15 patients each afternoon. I’ve seen many different conditions and pathologies, but the most common malady is type 2 diabetes. However, there have been cases of COPD, atrial fibrillation, pulmonary fibrosis, antiphospholipid antibody syndrome, Addison’s disease, and plenty of others.” He continues, “I mostly observed at first, but since the beginning I have actively taken patient histories and performed parts of the physical examination, including auscultation. Recently I have been doing otoscopic exams when indicated and doing a more thorough assessment. I have also assisted with some seborrheic keratosis removals and removed stitches.”

Lessons Learned

Davis similarly reports on her meaningful engagement with patients. She is the first person patients interact with in the office from a medical perspective—she greets patients in the waiting room, escorts them into the exam room, and takes their history. Now that she has over six months experience in CEED, she often can provide the patient with a preview of what to expect from the doctor. Her patients span from teenagers to people in their 90s, and the types of issues range from routine physicals, to patients presenting with multiple complex conditions.

After each clinical session, Davis excitedly calls her father, a doctor in California, to update him on what she is learning through CEED. She also shares experiences with another classmate located at the same clinic on a different day, via face-to-face conversations, Facetime, or through the PA Online Learning Management System. Additionally, her PA Online cohort discusses their CEED experiences in their problem-based learning sessions, which a PA Online faculty member facilitates.

Wageman adds that his cohort is “required to do assignments related to CEED throughout the semesters, and we have the opportunity to participate in Grand Rounds in which we share interesting cases and clinical practice applications with one another.”

Integrative Didactic Into Clinical

Both Wageman and Davis believe gaining clinical experience during their didactic training heightens their learning experience. Wageman explains how PA Online Program Director Jim Van Rhee’s mantra has always been ‘Trust the Process.’ As the curriculum has progressively unfolded, I have been able to integrate the copious information learned in our courses into my time spent in CEED. Now when a patient comes in the door with a vague complaint, my mind immediately starts racing through differential diagnoses, appropriate physical examination techniques, potential pharmacological interactions, and drug-drug interactions, and a big reason for that is the quality of our lectures.”

Wageman adds “as someone who has gone through multiple graduate programs in health care professions, I believe seeing real patients in a clinical context is far more valuable than even the most realistic of simulations.”

Davis says that her preceptor “thinks it is so valuable that students are getting clinical experience during the didactic year, believing that students need to be learning and applying what they learn at the same time, otherwise there is a deficiency.” Davis shares this view.

Gaining Confidence

In January 2019, Davis and Wageman will transition from their didactic/CEED experience to their clinical rotations. CEED has been a tremendous confidence builder for both of them, in preparation for these rotations. Davis’ first clinical rotation will be at her CEED site, and her CEED experience “absolutely will make it so much less stressful.” Davis added that she was thrilled when one day a patient told her, “I’m used to seeing students when I go to the doctor, but you are the best student I’ve ever seen and I appreciate the time you took with me.” Wageman will return to his CEED site for his February through April rotations. Describing CEED, he said it “absolutely makes me more excited for my clinical rotations; I don’t think I’d feel the same level of confidence without CEED.”

Davis has advice for her Yale PA Online successors, encouraging them to “take advantage of every opportunity you can to practice assessments and exams, and tell your preceptor that you are studying a particular issue that week so that if an opportunity comes up to have an experience addressing that issue, you can have that experience.”

Citation for this content: Yale School of Medicine Physician Assistant Online Program