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Can online PA programs reduce the cost of PA education?

Dehn, Richard W. MPA, PA-C, DFAAPA

Journal of the American Academy of PAs: June 2015 - Volume 28 - Issue 6 - p 25–26
doi: 10.1097/01.JAA.0000465228.28890.60
Commentary
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Richard W. Dehn is a professor in the College of Health and Human Services at Northern Arizona University's Phoenix Biomedical Campus, and chair of the university's Department of Physician Assistant Studies. The author has disclosed no potential conflicts of interest, financial or otherwise.

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Of course, it was only a matter of time before it happened, and quite honestly I'm surprised it didn't happen sooner. In March, the Yale School of Medicine announced plans to launch an online physician assistant (PA) program in the fall of 2016.1-3 The online program would be the same as Yale's current on-campus program in cost and length—$83,162 for a 28-month curriculum. The online program would enroll three cohorts per year, eventually increasing annual admissions by more than 300 students. It would include clinical rotations available throughout the United States, and on-campus time at three points: at the start of the program, after the didactic year, and at the end of the program. The cost-saving potential for students in the new program consists of saving the housing costs associated with being a resident student at Yale, minus the cost of the three on-campus experiences.

However, at its March meeting, the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), rather than approving Yale's enrollment increase request, decided that Yale must accredit its online program through the lengthy and time-consuming provisional accreditation process. Although not totally killing the online PA program idea, ARC-PA's actions will significantly slow down the program's implementation.4,5

As one would expect, reaction to this announcement in my neck of the PA education community has been generally critical. Most of the criticism has been a variation of a familiar theme: how can a program add more than 300 PA students to its current enrollment when national clinical rotation capacity is already at or below meeting the current demand for PA student clinical sites? Most PA education administrators have realized that providing didactic curriculum for increasing PA enrollments is a challenge (given a national shortage of qualified PA faculty) but not an insurmountable task. However, the real limit to increasing PA enrollment is the shortage of clinical rotation sites. Until the clinical rotation site shortage conundrum is solved, increasing PA student enrollment will likely be a sum-zero operation—every additional rotation gained for a PA program may come at the expense of another PA program, medical student, or nurse practitioner student.

However, if one ignores the clinical site shortage, several other interesting issues remain. I've always been optimistic that technologic teaching methods might lower the cost of education while increasing consistency and quality of outcomes. Many programs use technologic methods to teach some part of their curriculum and have compiled data that demonstrate the effectiveness of these methods. Substantial parts of PA curriculum, especially in the didactic portion of a typical PA program, are knowledge-based courses that for the most part are still taught via lectures. This type of curriculum can easily be taught by technologic methods, possibly with better and more consistent outcomes. In the list of PA competencies, this curriculum generally fits into the medical knowledge domain, although other domains such as practice-based learning and improvement and systems-based practice are often taught by lecture.6 Yale likely can evaluate students' interpersonal and communication skills during those short visits to the main campus; these skills typically are evaluated on a day-to-day basis in traditional programs as students interact with other students, faculty, staff, and patients.

My biggest concern would be in the professionalism domain, where despite my enthusiastic bias toward supporting technologic change in education, I am challenged to find a way to evaluate this domain if a student is spending most of the didactic year isolated from personal interaction with faculty, staff, and fellow students. I think faculty in traditional programs are struggling to teach and evaluate students in the professionalism domain, and I suspect this domain will be even more challenging to teach and evaluate when using a distance-education model.

Another concern I have with technologic methods of teaching has nothing to do with effectiveness or quality. Given that online education is clearly much less expensive to provide than traditional brick-and-mortar models, I would expect that those cost savings, or at least a substantial portion of them, would revert back to the students. Otherwise, the motivation for this process is at best a wash for most students and a financial windfall for institutions. If a trend toward online PA programs does not result in substantially lower tuition, the critical skepticism this announcement has generated will be vindicated. In the current seller's market of PA education, strong leadership is needed to make sure that the cost savings from online curriculum delivery are distributed fairly. Thus, online PA programs will have many complicated issues to address; however, their most important potential contribution is a simple one—can they significantly lower the cost of becoming a PA?

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REFERENCES

1. Stannard E. Yale to launch online physician associate program. New Haven Register. March 10, 2015. http://http://www.nhregister.com/general-news/20150310/yale-to-launch-online-physician-associate-program. Accessed April 1, 2015.
2. Newman LH. Yale is starting an online physician assistant master's degree program. Slate. March 11, 2015. http://http://www.slate.com/blogs/future_tense/2015/03/11/yale_partners_with_2u_on_online_physician_assistant_master_of_medical_science.html. Accessed April 1, 2015.
    3. Yale University to offer online master's degree program. University Herald. March 12, 2015. http://http://www.universityherald.com/articles/16771/20150312/yale-university-to-offer-online-masters-degree-program.htm. Accessed April 1, 2015.
    4. Straumsheim C. Online expansion held back. Inside Higher Ed. April 14, 2015. https://http://www.insidehighered.com/news/2015/04/14/accreditation-snag-delays-yale-us-hybrid-physician-assistant-program. Accessed April 20, 2015.
    5. Lewin T. Yale Medical School's request to expand campus program online is denied. New York Times Online. April 14, 2015. http://http://www.nytimes.com/2015/04/15/education/yale-medical-schools-request-to-expand-campus-program-online-is-denied.html?_r=1. Accessed April 20, 2015.
    6. Accreditation Review Commission for Education of the Physician Assistant. Competencies for the physician assistant profession. http://http://www.arc-pa.org/documents/CompetenciesFINAL.pdf. Accessed April 1, 2015.
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