One Curriculum, One Faculty

One aspect I frequently encounter in PA programs is a divide between the didactic and clinical phases of the program.  This divide includes faculty members, as most programs designate faculty as either didactic or clinical phase based.  The reality is PA programs have only one curriculum and one faculty.

Every faculty member plays an integral part and both phases of the program are required to successfully prepare students for entry-level practice.  The didactic and clinical phases are meant to work together in one curriculum design, not as two distinct and separate ones.  Likewise, didactic and clinical faculty should also work together as a unified team. 

The purpose of the didactic year is to build the foundation of medical knowledge, skills, and professional behavior needed for students to function in the clinical year.  In essence, the didactic year prepares the students for the clinical phase of the program.  The clinical phase aims to develop and provide experiences where students can apply, engage and practice their didactic learning in clinical settings to prepare them for entry-level clinical practice.

However, what I commonly find when reviewing a program's clinical phase syllabi is a disconnect between these two phases of the program.  For example, when looking at an emergency medicine rotation syllabus, I see that the students are required to perform at least one bedside ultrasound while on the rotation.  My question to the clinical faculty is, where and when are the students taught how to perform an ultrasound in the didactic year?  I can get a myriad of responses such as I'm not sure, I think they do, I don't know or simply 'they're not.' What this illuminates is a lack of connection and collaboration between the didactic and clinical phases and the faculty members.  All faculty should be knowledgeable about their program's curriculum.  This includes didactic faculty knowing about the clinical phase and clinical faculty knowing about the didactic phase.  In fact, our accreditation standards clearly state that when we assess our students, they must be assessed against what is taught.  Therefore, we should not require our students to perform a lumbar puncture during a rotation unless they have been taught how to do one during the didactic phase.  Thus, it becomes essential for the clinical phase faculty to be part of the discussion and decisions made about the didactic phase content and vis versa.

In the process of the program's ongoing self-assessment, this collaboration between the didactic and clinical phases of the program provides important data that informs the curriculum and decisions to make changes.  For example, suppose the preceptors continually report that students are weak in developing a differential diagnosis.  In that case, this information should result in a detailed look at where, when, and how this skill is taught in the didactic phase.  Likewise, what students are asked to know and do during the clinical rotations should be directed by what was taught during the didactic phase.

Some of this divide, I believe, stems from the faculty in each phase of the program not having a full grasp of what each other do.  Although there are many similarities, there are also some clear differences in the roles and responsibilities of didactic and clinical phase faculty.

In considering the similarities, remember that most PA faculty come directly from clinical practice with little to no formal educational or teacher training (PAEA, 2016).  The learning curve is steep for everyone.  All faculty are role models, mentors, and teachers.  We all must develop, revise, and implement syllabi, and evaluate and assess students.  We all have to track the student's performance and report grades.  We are all responsible for the ongoing monitoring of students so we can quickly identify those struggling and provide support and interventions to help them succeed. 

One of the biggest differences between didactic and clinical faculty is that didactic faculty focus on day-to-day teaching and course directing with direct interactions with students.  Didactic faculty work on developing, revising, and implementing courses.  This includes all the components of the course and syllabus design and development – from determining class content and learning activities and creating a course schedule,  to prepping and delivering lectures (teaching),  finding, recruiting, and evaluating guest lectures, and writing and grading exams, papers, and projects. 

Clinical faculty focus on coordinating, managing, and tracking everything and everybody involved with student learning in the clinical setting, mainly through indirect and intermittent interactions. The major part of their work hinges on coordinating and overseeing all of the clinical year moving parts before, during, and after each rotation block.  It tends toward 24/7 responsibilities while students are in the field.  Many groups of individuals require engagement, management, support, and oversight, such as preceptors, hospital administrators, clinical site staff, student health, legal departments, and of course, the students.  Clinical site recruitment and retention are ongoing, as is troubleshooting the myriad of issues that can come up with coordinating all of these components and individuals.  Clinical faculty are also responsible for developing, revising, and implementing rotation courses and creating, administering, and grading exams. 

While didactic faculty tend to oversee predominantly the courses they teach each semester, clinical faculty are responsible for ongoing oversight of the entire clinical year.  Thus, both didactic and clinical faculty members are essential to student learning and success, albeit in both similar and different ways. 

Yet, all faculty are responsible and vital in effectively educating competent future PAs.  We are, after all, the gatekeepers of our profession.  It rests upon our shoulders to ensure that those students who graduate from our program and are permitted to sit for the NCCPA exam have the knowledge, skills, and professionalism needed to represent our profession competently and with integrity.  Thus, the importance of one curriculum and one faculty. 

Physician Assistant Education Association.  (2016).  By the numbers: Faculty and directors survey report  2015, Washington, DC: doi: 10.17538/fsr2015.001