As a student in Seton Hall University’s physician assistant (PA) program, Natalie Guirales alternates between libraries, study rooms, and her own backyard when she needs a place to log in to a lecture. Ms Guirales never imagined having to absorb and retain information presented to her from a remote location, but the risk of exposure to the virus that causes COVID-19 makes in-person instruction a complicated endeavor.

For PA students and professors, preserving the collaborative, hands-on nature of PA programs has been an ongoing challenge since March. Each university has a different approach to keeping students and faculty safe, but educators across the country have made it clear that PA students are expected to adapt and meet the same expectations as that of their peers who completed PA school in person.

“If you’ve seen 1 PA program, you’ve only seen 1 PA program because we do a variety of things,” Dennis J. Brown, DrPH, MPH, PA-C, DFAAPA, Program Director & Department Chair of the Department of PA Studies at Quinnipiac University told the Clinical Advisor. Dr Brown explained that at Quinnipiac, students are separated into cohorts; they all receive the same lecture at the same time, but approximately one-quarter are in the classroom while three-quarters tune in remotely.

Ms Guirales’ experience at Seton Hall is similar; she is currently enrolled in the last semester of the didactic portion of her program, and most of her classes take place virtually. She also belongs to a rotating cohort of students and has to take turns with her peers to attend lectures in-person vs watching the lecture online contemporaneously.


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At Quinnipiac, some lectures are asynchronous. Dr Brown stated that some professors post pre-recorded lectures in advance, then use scheduled class time to conduct discussions and review exercises. The rotating cohort model allows students to enter the classroom safely; Dr Brown noted that due to social distancing, lecture halls that previously held more than 50 students can now hold less than 20.

Some in-person instruction is necessary due to the nature of the program, according to David Asprey, PhD, PA-C, Chair of the Department of PA Studies at the University of Iowa. In this particular program, students learn physical examination skills, conduct small group sessions, and clinical rotations in person.

“We have elected to continue having students come to campus for small groups in part because it is one of the best ways we have to both instruct and assess our students related to issues of professionalism, which are more difficult to assess online than in person,” said Dr Asprey in an interview.  “Obviously, our students are going to need to have skills in effectively utilizing personal protective equipment [PPE] in their roles as health care providers, and these activities also allow them to develop these important behaviors in a setting that is more easily controlled than direct patient interactions.”

Ms Guirales and her classmates at Seton Hall University perform mock physical examinations on each other once weekly while wearing PPE. She also attends on-campus clinical skills lessons, where she has learned techniques for phlebotomy, suturing, and intubation, among other topics.

Quinnipiac has chosen to have students complete all skills labs prior to Thanksgiving so that students do not have to return to campus after the holiday, according to Dr Brown. Students will have their skills verified prior to Thanksgiving and will attend virtual lectures for the remainder of the semester.

Without proper technology and PPE, these recent changes to PA programs would have been impossible. Dr Brown notes that investments in remote learning tools may shape the future of the PA school experience.

“We have had ongoing planning since March. This summer, when the University was putting forth all of their plans for the upcoming semester, they made some major investments in technology,” he said. “I think we are going to look at this and realize there might be things that we do not need to have people sitting in classrooms for.”

Some students, however, feel there is a long way to go before remote learning can be fully embraced as an option beyond the confines of a pandemic.

“Technology is not perfect, and it has its drawbacks,” Ms Guirales said. “Lectures tend to take longer, and some information is lost in communication. Professors struggle to adapt to different methods of presenting the information to the class in a way that is different than many of them have been doing for several years. For the most part, I feel that I am still receiving a good education considering such unprecedented times and the major adjustments that everyone has to make.”

From behind her computer screen, Ms Guirales feels she has missed out on the sense of camaraderie and motivational atmosphere sparked by collaborating with classmates in person. This collaboration, she said, is a fundamental aspect of the PA profession.

“A large part of the PA career is working as a team to determine a diagnosis and decide on the best possible treatment plan,” Ms Guirales said. “I feel that, academically, the school has done their best to make the most out of the circumstances.”

The threat of students or faculty contracting COVID-19 and spreading the disease on campus made closures and modifications to PA programs necessary. This necessity, Dr Asprey said, will foster innovation in both education and the PA profession as a whole.

“These changes that have been forced on us as educators and health care providers are likely here to stay in some format. Without the pandemic creating a need so compelling that we had no choice but to adapt our strategies, the changes would have taken much longer to actualize,” he said.

The pandemic has caused PA students to have to relinquish control of their circumstances in a way that has never been asked of previous students, Dr Asprey noted. This lack of control can be a challenge for students who have been behind the driver’s seat for all of their academic life. Dr Asprey added that as students adjust their mindset and adapt to curveballs the pandemic throws their way, perhaps the broadest lesson they are learning is one of resilience.

“Our students are pretty resilient and have adapted to the changes that have been required of them,” he said. “One of the more challenging things for a lot of our students to deal with is the uncertainty and lack of control… which can be anxiety producing. As their mindset has adjusted to this fact, they have found ways to continue to be very engaged and successful. They have come to realize that many of the things they are required to learn can be accomplished in more than one single way.”