It’s Time for ARC-PA to Support PA Students

UPDATE: This article was posted on 3/19/20. On 3/20/20, the ARC-PA issued a revised statement which can be found here. This speaks to the many students and programs who spoke out in support of PA students across the country during the uncertain times.

COVID-19, the quarantine, and all subsequent fallout has everyone struggling to figure out what to do next. Medical education is no exception.

As the CDC strengthened their recommendations on social distancing over the last two weeks, and while health systems combat PPE shortages and attempt to limit non-essential staff, nearly every PA program across the country is left scrambling to transition to virtual education. Didactic education is moving online and programs are trying to figure out what to do with clinical students pulled from sites.

While all PA students are anxious and worried about their education, one group in particular is left quite vulnerable. That is, those students expected to graduate this spring and early summer.

Let me start by saying, these steps have been necessary to slow down a global pandemic and prevent catastrophic consequences of this novel virus. I am not here to question whether or not PA students should be on rotations right now. I am in full support of social distancing and only using essential medical staff to limit exposure and preserve PPE equipment.

What I am here to talk about is the deplorable way both ARC-PA and some programs have handled this situation.

What Students are Saying

I asked my nearly 20,000 following of PA students and members of the PA community on Instagram, how their programs were handling this situation. Some said their programs are working diligently to figure things out and help them graduate on time. The majority, however, said they were essentially told “tough luck.” Reading through the responses broke my heart. I know many programs could be handling this better despite the ambiguous recommendations they’re receiving from ARC-PA, but I’m also not surprised because of how ARC-PA has responded.

ARC-PA’s Response

On March 10th, PAEA and ARC-PA released a joint statement attempting to guide programs as they respond and adapt during this pandemic. The statement was written when the primary discussion at that time was whether or not students should be potentially exposed to patients with COVID-19 symptoms while on rotations. They followed what AAMC was recommending for medical students at that time.

They also made the statement, “Please note that Waiving SCPE hours is not acceptable and if necessary, graduation time may need to be extended.” They then went on to say they were not planning on canceling their upcoming conferences.

And that was it. Today, March 19th, this is still the only statement they’ve released. My local gym has released more updates than ARC-PA. The problem is, our country has changed A LOT since March 10th.

Two weeks ago, we were telling students to limit their contact to suspected COVID-19 cases. Now, there are hardly any clinical sites even allowing students on site. We have new problems that need to be addressed by ARC-PA immediately in order for these highly intelligent and hardworking students to graduate in a time where we need healthcare workers in the field.

The Statement

Let’s talk about their statement. After bluntly telling us waiving any hours is not acceptable, they go on to say “Therefore, ARC-PA and PAEA encourage programs to contact the ARC-PA if their institutions anticipate significant changes in the program that may impact the structure, timing, duration, or location of the program. We encourage programs to work closely with their medical and community leaders to find effective ways to manage the education of students while maintaining compliance with the ARC-PA Standards.”

So, is there flexibility to make changes, or not? I reached out to ARC-PA on March 17th asking them to clarify what they mean by waving SCPE hours is not acceptable, but that programs can make significant changes to their structure and should reach out to ARC-PA if they do.

They responded the following day with “The ARC-PA has no further guidance beyond the joint ARC-PA/PAEA statement posted on our website.” By the way, as I type this, ARC-PA is still promoting upcoming conferences on the landing page of their website.

What Do the ARC-PA Standards Really Say?

So, if ARC-PA isn’t going to provide guidance, I will attempt to provide some. I am of course giving you my own interpretation of the ARC-PA standards based of my knowledge and some guidance I’ve received from mentors in PA education. Ultimately, what they say goes, and not my or anyone’s interpretation.

ARC-PA has standards for PA education that must be followed. Currently, they are using the 4th edition (a 5th edition will be utilized starting September 2020). PA programs are responsible for creating a program with competencies that meet these standards, and must be approved by ARC-PA.

In regards to SCPE (supervised clinical practice experience, or “clinical rotations”), the standards say this:

“Supervised clinical practice experiences must enable all students to meet the program’s learning outcomes expected of students, to include preventive, emergent, acute, and chronic patient encounters. Supervised clinical practice experiences must enable all students to meet the program’s learning outcomes expected of students, for patients seeking:
a) medical care across the life span to include, infants, children, adolescents, adults, and the elderly, b) women’s health (to include prenatal and gynecologic care), c) care for conditions requiring surgical management, including pre- operative, intra-operative,
post-operative care and d) care for behavioral and mental health conditions.”

It also says:

Supervised clinical practice experiences must occur in the following settings: outpatient, inpatient, emergency department, and operating room.

What is DOES NOT say, is how many hours are required in each clinical specialty.

A SCPE is essentially a course, just like any other course in the PA curriculum. Programs have the ability to set up courses however they feel is best. ARC-PA has to approve these when a program is accredited, but programs create their own SCPEs. Remember, ARC-PA only says SCPEs “must enable all students to meet the program’s learning outcomes expected of students“.

This means SCPES can include a variety of activities outside of direct, face-to-face clinical practice that help meet learning objective.

The problem we have now is that many programs set up their SCPEs, which were approved by ARC-PA, to only include clinical hours or number of patients. Those programs are feeling really stuck right now, because if their students didn’t meet that threshold, then there’s not much to do.

Side note to students: log every single patient you see on rotations. This is going to end up being a big deal. Yes, it’s annoying, but for some this is going to mean the difference between graduating on time or not.

Programs who structured SCPEs as more competency based, with flexibility for learning and assessment outside of face-to-face clinical hours, have more wiggle room here to figure out how students can still meet their ARC-PA approved SCPE rotation.

As it stands, it seems like many programs are in the former group.

Where Do We Go From Here?

No one is suggesting we lower the standards of PA education. But we all know there’s are other ways to learn and assess clinical competency outside of clerkships.

The feedback I’m getting is programs either don’t know whether or not they have flexibility, or they’re afraid to make changes for fear ARC-PA will say they are not meeting standards.

THIS IS WHERE ARC-PA NEEDS TO STEP IT UP AND SHOW THEY CARE!

ARC-PA should take notes from AAMC, who responded on March 17th stating they support medical students being pulled from clinical sites and will “organize efforts by our medical education community to compile and disseminate information and resources for alternative clinical learning approaches.”

They went on to do what ARC-PA certainly did not, and that was to reassure medical students by saying “We appreciate that this interruption and reorganization in student education raises concerns for students about timely graduation.”

ARC-PA, you need to support PA programs through this. You should be providing guidance on how programs can create alternative clinical learning experience in a time when we honestly don’t know when students will make it back to clinical rotations.

Everyone understands things are changing on the daily. You need to be proactive and malleable, like AAMC is. The domino effect of holding back students so close to graduation is a concern. What happens if we can’t get students back in rotations for three, four or five months? Where will we place current didactic students who by that time will also need clinical sites?

We’re simply asking you to do what everyone else has done, and that is pivot. Make creative and innovative adjustments. If you truly believe it’s not possible to do that while still maintaining high standards in PA education, then that says a lot about you and your limited beliefs in this profession.

Students, I Hear You

Students, I do hear you. And I am sorry. I’m so sorry your schools are not giving you information, or telling you they can’t do anything to help you. Ask your program what your SCPE competencies are and if there are ways to meet them outside of traditional clinical medicine. Push them for answers.

Programs. Do your part. Do your research. Look at your competencies and see if you have flexibility. ARC-PA said to contact them, so do that! Your students are scared and counting on you. Instead of telling them “I don’t know, you’ll have to contact financial aid,” why don’t YOU contact financial aid on behalf of all of your students? Advocate for them! Stay in contact with them!

I will continue to follow up on this. Word is, ARC-PA will soon make another statement. I’m not sure if that’s true, but hopefully it is. And hopefully they will follow suit with the AAMC and other medical professions who are finding alternative ways to work through this.

A petition is available for PA students who wish to express their frustration and charge ARC-PA with responding here.

I’ll be leaving the comments section open. Any suggestions or ideas to share for students, faculty and programs are welcomed.