FEBRUARY 2017 --- In January 2016, UNC School of Medicine started the Physician Assistant (PA) Program, funded in part by a generous donation from Blue Cross and Blue Shield of North Carolina, the Kenan Foundation, and UNC. One year later, the first class of PAs begins its clinical year and students Curtis Carr and Riti Shah have started their rotation at UNC Family Medicine.
UNC’s PA program is an exception in comparison to other programs. Nationally, the average age of a PA student is 26 and UNC’s is 33. Typically, students enter a PA program with between 3,000 and 4,000 hours of clinical experience, but UNC’s PA program director Paul Chelminski reports an average closer to 13,000. This number is due to the program’s mission to recruit and train veterans.
Nine out of 20 of last year’s class are veterans—that ratio remains true for this year’s recently recruited class. “Veterans often come in with 30,000 to 40,000 hours,” says Chelminski. “Yet there’s no certificate that enables them to work higher than a nurse’s assistant. An undergraduate straight out of school can work as a nurse’s assistant.” UNC’s PA program is dedicated to retooling these individuals for civilian medical careers.
The students undergo a year of in-class didactic training and a year of clinical rotations. They rotate through a number of clinical sites including several other UNC departments such as Internal Medicine, Surgery, Psychiatry, Emergency Medicine, OB/GYN, and Pediatrics. “There is extra emphasis on generalism,” Chelminski adds. While most rotations are four weeks, Internal Medicine and Family Medicine are six weeks, giving the students three months total of training in general, non-surgical medical problems.
Riti Shah and Curtis Carr started their clinical rotations at Family Medicine on Jan. 17. Dr. Yee Lam, a UNC faculty member, coordinates their curriculum as the Clerkship Director. Family Medicine provides a unique and rich experience as the clinic offers a patient-centered medical home setting with weight management services, tobacco cessation counselling, sports medicine and a pharmacy.
“We’re really fortunate to have so many resources,” Lam said.
While it is relatively easy to give students the didactic training they need, high-quality training sites are in high demand. Chelminski said that the program is grateful to UNC Family Medicine, as well as to other UNC clinical sites, for their enthusiasm to fill this need. He credits the collaborative spirit of UNC.
“It aligns perfectly with the philosophy of the University that people have said ‘yes’,” said Chelminski, whose first job was with the Department of Family Medicine in the Chatham Primary Care department in Siler City. “I’m pleased, but I cannot even say surprised that Family Medicine and others have stepped up, and enthusiastically, to prepare our learners.”
The director hopes that the PA program’s presence at places like Family Medicine will also be a development tool, a reciprocal relationship that residents and faculty members gain from as well.
Dr. Lam agrees that this relationship will be a learning experience for both the PAs and the faculty who train them. “Interestingly enough, the residents and medical faculty haven’t had much experience working with PA students,” she said. “And there’s not much literature about it. In fact,” she motioned to papers on her desk, “these are the two papers I found.”
Inter-professional education is a hot topic in medical education as medical teams – made up of Physician Assistants, Nurse Practitioners and physicians – have been shown to improve work flow and reduce provider burn out. “We’re going to have to work in teams,” Dr. Lam added. “It’s simple. Teams have been shown to improve outcomes for patients.”
Dr. Tim Daaleman, Professor of UNC Family Medicine and Medical Director of the Physician Assistant program, echoed this sentiment. “I practiced in a PA- NP team model when I was in rural Kansas and it is an effective model. I think it’s an area where we need to grow.”
Over the next few years, Dr. Lam and other Family Medicine leadership will continue designing and improving curriculum for the PA students rotating through the clinic. The variability of experience poses a hurdle. All PA students have some clinical experience, but the type and quality varies widely. Some may have more clinical research experience, some will come with experience as medics. Those trained as military medics may have greater familiarity with trauma wounds than formal clinic environments.
“Their previous experience places the students on somewhat unequal footing when they begin their rotations,” Dr. Lam said. “So we’re also trying to come up with an orientation to help with that.”
Chelminski’s hopes for the future of the program are two-fold. First, the program must graduate competent PAs. But the director also hopes the program will develop an academic dimension. “There’s only one constituency for that,” he said. “And that’s your faculty.” Ultimately Chelminski hopes that all the PA program faculty who want advanced degrees beyond their masters will be able to get them.
He also imagines that, with success, the program will expand. In four or five years, the program may expand to forty or fifty per class. “And, once again we’ll be knocking at the door of family medicine,” Chelminski said.