To achieve our mission, the Yale PA Online Program strives to:

Goal No. 1: Increase the number of graduate physician assistants in primary care setting

The Yale 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.

According to the 2020 Statistical profile of certified PAs from the NCCPA, the number of PAs in primary care (family medicine/general practice, general internal medicine, and general pediatrics) has decreased by 1.39 % from 2016 to 2020.  There are currently 24.4% of PAs working in primary care.

One year after graduation the class is surveyed regarding employment opportunities and settings.  The Class of 2020 is the only class that has completed the survey.  Quantitative data is collected.  No qualitative data is collected.  Regarding primary care setting, the program benchmark is 50% of graduates working in a primary care setting.  This benchmark is based on doubling the current national average of PAs in primary care (24.4%).

In the six-month post-graduation survey the program asks how many jobs graduates have applied for, with 9 stating 1-5 jobs, 4 stating 6-10, and 14 stating more than 15.  With 66% of those applying for primary care positions.  Eight graduates applied to 1-5 jobs in primary care, 5 applied to 6-10 jobs in primary care, 2 applied to 11-15 jobs in primary care, and 4 applied to more than 15 jobs in primary care. The program also asked the graduates what was hindering their employment opportunities.  Reasons given included COVID-19, licensure process in their state, or that they took time off to be with family after graduation. Only 4 graduates had been employed at the 1-year survey. 

Because of the low employment rate, another survey was sent to the graduates from the Class of 2020 in November 2021.  Of the 39 graduates, one has not taken the PANCE so it not eligible for clinical practice.  Of the 38 who have passed the PANCE, 27 responded to the most recent survey (response rate 71%). Eight graduates (21%) are practicing in a primary care area. This is below the program benchmark.  This may be due to the pandemic, but the admissions process was reviewed. 

The program conducts a thorough admissions process to attract and select applicants with the traits necessary to be highly educated, qualified PAs.

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.

We have admitted students spanning a wide geographic range, from Maine to Hawaii and Alaska to Florida. Some students live in rural areas such as Booker, Texas and Sedalia, Missouri, while others reside in more populous urban centers such as Los Angeles and New York. 34% of students reside in cities, 39% reside in suburbs, 4% in towns, and 22% in rural areas. These students bring a variety of life experiences and a breadth of perspectives to the program. For example, 24% of our students have advanced degrees including Doctor of Philosophy, Doctor of Pharmacy, Doctor of Health Sciences, Doctor of Education, Master of Public Health, Master of Science, and Master of Education.

The ages of students range from 21 to 62 years (average age 32). The ratio of male to female students is approximately 25%/75%. Academic and career backgrounds also vary greatly among the cohorts.

While academic factors such as GPA can provide evidence of intellectual ability, academic achievement, and potential, the program considers and reviews an applicant’s entire application for other factors pertinent to a successful career as a physician assistant, as well as factors that would enrich our class composite, such as work experience and other life accomplishments.

For example, while patient care hours were not a requirement for admission, the middle 60% of all cohorts reported from 2250 to 12,200 hands-on patient care hours. Some examples of prior work experience are phlebotomist, pharmacist, respiratory therapist, clinical dietician, and paramedic.

This shows that the program is meeting its goal related to pursuit of excellence by increasing the number of highly educated, qualified physician assistants in primary care across the country.  The program will continue to monitor and evaluate this goal.

While the program has had only one graduating class and the number entering primary care is lower than expected, the program will continue to monitor the goal related to primary care.

Goal No. 2: Develop graduates who amplify Yale School of Medicine’s impact on health care for medically underserved populations

Based upon a review of the program’s current clinical placement sites, the program can 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.

According to the 2020 Statistical profile of certified PAs from the NCCPA, the number of PAs employed in community health centers, rural health clinics, free clinics, and public or community health clinics has decreased by 9.3% from 2016 to 2020.  There are currently 5.6% of PAs working in community health centers, rural health clinics, free clinics, and public or community health clinics.

One year after graduation the class is surveyed regarding employment opportunities and settings.  The Class of 2020 is the only class that has completed the survey.  Quantitative data is collected.  No qualitative data is collected.  Regarding working in community health centers, rural health clinics, free clinics, and public or community health clinics the program benchmark is 10% of graduates working in these settings.  This benchmark is based on doubling the current national average of PAs in community health centers, rural health clinics, free clinics, and public or community health clinics (5.6%).

Unfortunately, at the time of the survey, only four graduates were employed.  Three graduates had a PA job but had not started employment.  Three more of the graduates were employed in a health care capacity other than as a PA. In the survey the program asks about how many jobs graduates have applied for in rural or underserved committees.  53% said yes, they had applied to these settings. When asked how many rural or underserved community positions they had applied for, 11 graduates applied to 1-5 jobs and five applied to 6-10 jobs. The program also asked the graduates what was hindering their employment opportunities.  Reasons given included COVID-19, licensure process in their state, or they took time off to be with family after graduation.

Because of the low employment rate, another survey was sent to the graduates from the Class of 2020 in November 2021.  Of the 39 graduates, one has not taken the PANCE so is not eligible for clinical practice.  Of the 38 who have passed the PANCE, 27 responded to the most recent survey (response rate 71%). Three graduates (8%) are practicing in a community or rural health clinic. This is just below the program benchmark.  This may be due to the pandemic, but the admissions process was reviewed. 

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.

We have admitted students spanning a wide geographic range, from Maine to Hawaii and Alaska to Florida. Some students live in rural areas such as Booker, Texas and Sedalia, Missouri, while others reside in more populous urban centers such as Los Angeles and New York. 34% of students reside in cities, 39% reside in suburbs, 4% in town, and 22% in rural areas.

The program also promotes leadership among the students, faculty, and staff.  Examples of student leadership includes Northeast Regional Director of the AAPA Student Academy, Chair of AAPA Student Academy Advocacy & Policy Committee, member of AAPA Student Academy Leadership Committee, member of AAPA Student Academy Communication and Outreach Committee, PAEA Future Educators Fellows, PAEA Health Policy Fellow, Connecticut Academy of Physician Assistants Student Board Member, Fire and Rescue Leaders, PAEA Future Educator Development Steering Committee, and members of the AAPA Student House of Delegates. 

Faculty members have and continue to hold several leadership roles.  Faculty serve as models for the students in leadership and service. Examples of faculty leadership and service include the following:

This shows that the program is meeting its goal in having an impact on the health care field with an emphasis on patient care in medically underserved areas.  The program will continue to monitor and evaluate this goal.

Goal No. 3: Enhance pedagogy throughout the Physician Assistant Online Program through innovation

The goal is to 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:

The program evaluates curriculum in the following areas: overall, asynchronous curriculum, and by content area at the end of each semester using a system called the net promotor score (NPS).  This score is the percentage of promoters minus the percentage of detractors.  A scale of 1 to 10 is used with the promoters being those who score an area 9 or 10, passives being those who score 7 or 8, and detractors being those who score 0 to 6.  Scores can range from negative 100 to positive 100, with a score of 0 being average/benchmark.  Comments are also reviewed and grouped together by themes. Overall, the curriculum has NPS that ranges from 15 to 57.  The asynchronous curriculum has NPS that ranges from 16 to 54. These are above the benchmark score of 0. 

This shows that the program is meeting its goal related to innovation in education.  The program will continue to innovate, possible use of virtual reality in the future, and will continue to monitor.

Goal No. 4: Educate students to integrate the clinical data that they obtain from their patient’s medical history, physical examination, and laboratory analysis to form a differential diagnosis, as well as assess and plan for the patient’s condition

The program uses a blended learning approach that integrates online curriculum with traditional face-to-face class activities in a planned, pedagogically valuable manner; and where a portion of the face-to-face time is replaced by online activity.

Problem-based learning (PBL) is the centerpiece of the curriculum. PBL is driven by problems, from which students identify and pursue their own learning needs and then reapply what they have learned to the problem. The objectives of PBL include guiding the students in how to direct and manage their own learning, develop their problem solving and clinical reasoning and learn important principles and key concepts.

Each year, graduates complete a survey that evaluates the entire program. They are asked to respond to a variety of issues related to instruction, activities, and resources of the program. The 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 benchmark is 3.85, this is based on data from the program director’s previous positions. All scores were above the benchmark.

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

Clinical rotation preceptors also evaluate the students on several 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.” This scale also ranges from 1.0 = “strongly disagree” to 5.0 = “strongly agree.” The benchmark is 3.85, this is based on data from the Yale Physician Associate program and from the program director’s previous positions.

History taking average score was 4.66, range from 4.56 in general surgery to 4.70 in emergency medicine.  Physical examination skills averaged 4.60, range from 4.53 in internal medicine to 4.73 in behavioral medicine.  Oral presentation skills average score was 4.61, range 4.52 in general surgery to 4.73 in women’s health. Fundamental knowledge averaged 4.54 with emergency medicine 4.44, general surgery 4.49, internal medicine 4.61, primary care medicine 4.60, pediatrics 4.51, behavioral medicine 4.57, and women’s health 4.55.  All above the benchmark. Each individual score which scored a 1 or 2 was then evaluated.  There were few negative scores and limited comments on the low scores.  Negative comments focused on oral presentation skills and developing a differential diagnosis. The negative comments were isolated to a few select students who had also done poorly on the rotation.  Overall comments were reviewed and there were no negative themes noted.  Many positive comments were noted on how prepared the students were related to evaluated skills.

At the end of the didactic year and the clinical year, the Yale PA Online students complete the Physician Assistant Clinical Knowledge Rating Assessment Tool (PACKRAT). 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 7 of the 13 specialty organ systems and 4 of 7 of the task areas. The classes average score was 137.9, with the national average of 134.5. The Class of 2020 completed a new version of the exam in April 2020 and exceeded the national average in 12 of the 13 specialty organ systems and 5 of 7 of the task areas. The class average score was 154.0, with the national average of 150.8. The Class of 2021, who took the exam in December 2019, exceeded the national average in 6 of 13 specialty organ systems and all seven of the task areas. The class average score was 131.2, with the national average of 129.1. The Class of 2021 completed a new version of the exam in April 2021 and exceeded the national average in 8 of the 13 specialty organ systems and 4 of 7 of the task areas. The class average score was 163.0, with the national average of 162.3. The Class of 2022, who took the exam in December 2020, exceeded the national average in 8 of 13 specialty organ systems and 5 of 7 task areas. The class average score was 136.8, with the national average of 134.9.

This shows that the program is meeting its goal to educate individuals to integrate clinical data into patient care.  The program will continue to monitor and evaluate this goal.

Goal No. 5: Facilitate the development of interpersonal characteristics during the student’s education, to lead, serve, and practice in an ethical, empathetic, and professional manner

The program exposes the students to several educational and clinical experiences to develop these interpersonal skills.

During the program, interpersonal skills in cultural sensitivity are noted in the behavioral medicine course series in activities related to cultural sensitivity, health literacy workshop, 30-day behavioral change challenge, standardized patient encounters in communicating serious news and shared decision-making, and training in emotional intelligence during both Immersion I and II.

Exposure to a wide variety of patients is important in the development of interpersonal characteristics to assist the student in putting skills into practice. For the classes of 2020 and 2021 the following is a breakdown of patient populations cared for during the clinical year.

The patient populations seen by our students while on clinical rotations are reflective of and consistent with national demographics. Our students learn from and evaluate patients of all gender identifications, all ages, and all ethnicities.

The Yale 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 Yale PA Online Program.

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. The scale ranges from 1.0 = “strongly disagree” to 5.0 = “strongly agree.” The benchmark is 3.85, this is based on data from the program director’s previous positions.

The preceptor evaluations of students include the following areas with scores.

The program has been successful in meeting this goal as evidenced by the opportunities provided the students and preceptor evaluations of these skills during the clinical year. The program will continue to monitor and evaluate this goal.