Season 1: Episode 15: University of Iowa PA Leadership

Unknown Speaker  0:08  
Welcome to this episode of the PA path podcast. I'm your host, Kevin Lohenry. We are glad you could join us as we seek to better understand the PA profession.

Unknown Speaker  0:24  
And we chose to go all in. We take the same first 18 months the identical didactic curriculum that the medical students do. We add a summer block as well for PA only during that 18 months. And then as the medical students bought the clinical training, our students bought the clinical training.

Unknown Speaker  0:44  
Well, welcome to episode 15. And our conversation with Dr. Dave Asprey and Mr. Tony Brennaman, who served as the department chair and program director respectively, for the University of Iowa, his Carver College of Medicine PA program. Year after year, their program is ranked at the top of the US News and World Report rankings for PA schools. And they share good reasons why they continue to shine, including a nearly perfect certification pass rate, a very low attrition rate, and a unique curriculum that is shared with the medical students for the first 18 months of their education. As always, you can learn more about these two leaders on our website, at pa path podcast.com under the blog section for show notes, but stick around and you can hear directly from them, and why the Hawkeye nation is so proud of their bas. Well, Dave, and Tony, thank you so much for joining us today. Before we get into the University of I was PA school and what I think is a really unique curricular aspect because of your joint program with a medical school at the Carver College of Medicine, could we first talk about your individual paths to becoming TAs and whoever wishes to go first can start?

Unknown Speaker  1:58  
Sure, I'd be happy to share my journey into this profession. So I grew up in southern Minnesota on a dairy farm. And I had three other brothers. So there were the four of us and first generation to go to go to college. This is where the the truth comes out. That's a little less glamorous, but I really went to college originally, not for any great aspirations other than to play football. And so I went off to college and played football that first year. But it was also becoming evident that with two older brothers who are working on the farm already that that probably was not going to be a job opportunity for me. So while at college decided that I should probably think about this a little more carefully. And so I was very interested in the sciences in high school and traveled down the biology degree pathway. But about sophomore year decided, you know, if you're going to be a biology major, you probably need to have an you know, a plan going forward with that. In other words, are you going to DNR route or are you going something healthcare, and so I was intrigued by the healthcare idea. But again, having not had anyone in my family who was in medicine, not having had other family members who had gone off to college really was a little uncertain about what to do but continued down that path for a while. Until literally I stumbled across the brochure that had been posted on a bulletin board outside one of the professor's offices that said physician assistant and I had honestly never heard of that profession at that point. So very much intrigued by the idea of practicing medicine didn't really, you know, as I looked into actually going to medical school thought there's no way I can afford to do that, you know, I would be so far in debt that it just was staggering for me to think about that I could buy a house for the cost of tuition, etc. So I began to explore the PA profession. And it really started to resonate with me that I could be out in practice much, much earlier with much less debt, but doing many of the same things that a physician would do that I thought I would derive a lot of satisfaction from. And so I began to explore that, you know, there were at that time, there were no PA programs in Minnesota, where I was from. So I began looking at neighboring states and eventually landed at the University of Iowa and came down and interviewed with Dr. Oliver and his office. And from there the rest is history.

Unknown Speaker  4:16  
That's Daniella are correct. That is correct. One of the legends of our profession. What position did you play just out of curiosity. So I was a pre safety, toll free safety. Actually,

Unknown Speaker  4:29  
the guy when I started at Northwestern college in the Twin Cities, the guy who was actually the starting free safety was a guy named Sherman Augustus and he was from California. And he went on to be actually an actor who was had had some fairly significant work out there. So he was taller than I was.

Unknown Speaker  4:52  
So after you graduated from Iowa, what did you do from the graduation on?

Unknown Speaker  4:57  
Yes, so when I finished the program Here, I had a couple of opportunities. One was to go back to Minnesota and work at the Mayo Clinic, which was just about 25 minutes from home. And I also had an opportunity, and that was an adult cardiology position. And I also had an opportunity in pediatric cardiology down here at the University of Iowa. And one of the things that certainly intrigued me or that I was found very interesting was this notion that when many of the patients that I had taken care of, that were farther along in life advanced in life, you know, I felt that it was really unfortunate that they didn't have an opportunity to to address those problems earlier and prevent them. And so pediatric cardiology began to resonate with me and that, obviously, there was hope that, you know, in many of those cases, you might be able to not only address some of their medical needs related to their congenital heart defects, but also advise and counsel them and hopefully establish healthier habits for them that would prevent some of the other adult disease that we see many of our citizens acquire over time. And so that was something that really, I found intriguing and really enjoyed pediatric cardiology. It's a fascinating discipline,

Unknown Speaker  6:05  
I would imagine. And Tony, how about you what led you to this illustrious path of becoming a VA

Unknown Speaker  6:12  
I took a little bit of a Securitas route getting here. When I went off to college I was thinking pre med and after my freshman year I changed directions and focus more on the mental health kind of categories. I got my undergraduate degree in psychology and also a degree in piano performance from Linfield College in McMinnville, Oregon. I grew up out in in Oregon, and and lived out there until I was about some 29 or so before I moved to Iowa.

Unknown Speaker  6:47  
Okay. And then you moved to Iowa for PA school, I assume? Yeah.

Unknown Speaker  6:52  
Well, so after I got my undergraduate degree and was trying to figure out what do you do with a psychology and piano performance degree itself, you know, maybe counsel alcoholics in bars. I decided that I needed a different degree. So I went on and got my master's in social work. And I practiced in both emergency medicine for a period of time in Portland, Oregon, and then moved into rehabilitation care, and then decided it was time to make a move. So I have all places chose Iowa to move to actually had some family in the area. So that kind of helped with that. And while here, met my wife, and she had a best friend that graduated from the University of Iowa PA program, and he was the one that introduced me to the the PA profession, I'd never heard of it either, before I moved to Iowa, and so I started talking with him, I was really intrigued about the profession, especially as I'm now 3031. And I didn't want to do medical school at that point. So he did some real encouragement, I started meeting with Danny Oliver as well. And then Janet steenland Schultz long term people here at the university and, and they gave me some good directions on undergraduate courses. So I completed those and then applied and Dave was on staff at that point. And he he made the mistake of letting me on the program. So.

Unknown Speaker  8:22  
And what is really interesting is that you both went there, and you've never left. It's a cold. That is awesome. So Tony, when you you had this emergency medicine background from social work, and then the mental health background? How did you end up applying that into your PA career?

Unknown Speaker  8:41  
Interesting question. Because, you know, on surface level, I'm not sure that it appears that it's there. When I graduated, we had a teaching fellowship that was available. So I did a teaching fellowship and was working in family medicine during that time. And then after I completed that, I went on to adult bone marrow transplant where I have worked clinically for the rest of my career in clinical medicine, although that being said, I use those skills every day when I'm up on the on that unit with patients in various stages of life and the families that are going through some very traumatic periods of time. So it's really been a useful skill for me clinically. And now as the program director here at the program, I use it on a regular basis.

Unknown Speaker  9:30  
Yeah, I'm jealous that that has good background for your your typical PA program experience. So and I have to admit, this is the first time on the podcast, we've had a dairy farmer and a social worker. So it's always good to get some different perspectives, broadening your horizons. That's right. That's right. Dave, what would you say? What are the lessons you learned on the farm that that have carried through for you the rest of your career?

Unknown Speaker  9:56  
That's an interesting question, you know, I would say and it This was something that even as I reflected back, as we began to raise our own family, you know, teaching some of those same things that I certainly learned on the farm, not so much by choice, but by the fact that it was just, you were presented with it, and you had to find a way through it. So you know, on a dairy farm twice a day, every day, the cows do not take a break, they do not take a vacation. And so from that standpoint, just that perseverance, maybe some grit, that you just, you know, he may be sometimes didn't even feel terribly well, you might have had a cold or been otherwise sick. But guess what the work still has to somehow get done. And so I think that was a big part of it. But also, you know, a lot of teamwork both with our family in terms of just figuring out how we were going to cover all the things that needed to be done in a typical day. And the weather is what it is. And so you had to sometimes divide and conquer and activities, which is still very true in both healthcare as well as in PA education. And so that I think was a very valuable lesson. But even teamwork with like neighbors, you know, in many cases, we had limited resources. And we couldn't all afford the, you know, big fancy equipment that we only used a couple times a year. And so just partnering with neighbors in the area who maybe had a certain piece of equipment that we maybe could benefit immensely from for a short period of time, they would let us borrow that. And in turn, we would let them borrow things as they needed them from us. And so yeah, I think just a lot, a lot about perseverance, grit, working through things, they don't have to be perfect always. But you know, you still have to work through them and find a way to get to the other side. And then teamwork and certainly partnering with others to use the resources that they have a very true in PA school. I mean, you know, I had friends who were maybe a biochemistry major, and I was not that they could certainly help me out. And hopefully, in turn, I had a way to provide them with some information maybe that they were not as knowledgeable about and so that's definitely carried over into the PA profession.

Unknown Speaker  11:51  
I agree. I think PA school is a team sport for sure. And and it's a great place to develop those team skills for when you get out into practice. So so the University of Iowa's PA school is affiliated with the Carver College of Medicine, and you have a very impressive outcome related to your national certification exam scores. I noticed on your website is 99.99% have passed on their first attempt, your pass rates very impressive, and your attrition rates are impressive. What is it about your school's admissions process that has led to such great outcomes?

Unknown Speaker  12:28  
What? Well, that's a great question. I mean, you know, I will start by saying that we are definitely a unique PA program, unlike, you know, many others, perhaps by the very nature that you were alluding to, which is that, you know, we do have our students come in and take coursework, they you know, identical coursework with a medical students. And so we recognize that, in many respects, we have to be cognizant of that fact. I mean, it would be there's nothing more disheartening than potentially having a student come in, that's just not a good match or a good fit for any number of reasons. And if they are not successful, if we cannot help them, find the resources and help them with getting plugged into all the things that would benefit them and make them successful, then we potentially have kept somebody out of the profession who otherwise perhaps at a different PA school, that might have been a better match or fit with them could have been become a great PA. And so we work very hard, I think, to really recognize what are the unique characteristics and features about our particular program, and then how we identify those students who will do well, we're obviously very fortunate from the standpoint that we have had, over most of the years a pretty robust applicant pool, that gives us an opportunity to be reasonably selective. And so we look, you know, obviously, for evidence that they have certainly been able to demonstrate the ability to do well on upper level science coursework for some period of time, certainly, we have plenty who have gotten off to a rough start, then maybe have found their way at a later point in time to be able to demonstrate that they can can do that when they are focused and motivated and have all the right things in place. So we definitely look for that aspect of it. But there's also just amazing resources that exist here that I think in a college of medicine, whether it's our counseling office, whether it's learning specialists, whether it's just the ability to plug in and get connected with lots of other PhDs who are in practice here. So yeah, I think the success is in part, we are a relatively small class size, we can be somewhat selective. We have a strong applicant pool and can look for the right combination of academic ability, perseverance, grit, sort of a, you know, I think, generally speaking, we're looking for individuals who just really have a heart for medicine in terms of being able to get back and take care of patients and really just value that aspect of the career that we have. And so we've been fortunate, I'm not sure there's any special sauce per se. It's just similar as we were talking about before, a lot of hard work, really just trying to make sure that we pick people who are going to be the right fit for our unique program.

Unknown Speaker  14:54  
And Tony as the program director, you manage the day to day operations I would assume internally and As a department chair, you're more of an external focus. Is that accurate? Yeah. Okay. So 20, from your perspective, I'm intrigued, and I think the PA educators listening might be interested to know, how do you manage that in conjunction with the medical school? Are you as faculty involved in teaching medical students as well?

Unknown Speaker  15:18  
Yeah, that's something that has been, for me just really exciting part of being part of this faculty and part of the team that is Carver College of Medicine, back in 1972, when our first class was admitted to this program, and I should say, even a few years before that, as they were imagining a PA program here at the University of Iowa, they, they really came out with the understanding that we are teaching medicine to people to practice care in communities, sometimes very, very rarely, without a lot of supervision or, you know, resources available to them. So how are they going to do this? And so the people that were at the table, primarily physicians at that time, well, I would say all physicians at that time, or PhDs, said, well, they should be learning medicine. So let's get this these people involved in the College of Medicine early on. And that's really been their attitude for the last 50 years. And we've only continued to increase our involvement and our students involvement within the Carver College of Medicine over that period of time. And they have approached the faculty in much the same way. You are excellent teachers, we want you involved in teaching both the PA and the medical students. So I'm sure we'll talk about this as we move forward. But as Dave alluded to, where we're unique in that we're highly integrated with our current medical school. And our faculty are also highly integrated in that educational process. I am a course director for one of the major courses that runs through our curriculum. So I teach our 25 students as well as the 150 Plus medical students. And there is no discrepancy between me as the as the course director or another physician, as a course director or a PhD as a course director. And the students learn at the same rate, the same level. And and the faculty also want us there. And if we're not at the table, they ask where we are. And so it's been a really synergistic process for both sides, I think through this 50 year history that we have.

Unknown Speaker  17:25  
One of my observations of working at USC over the past 10 years is, I think that medical students are open and respectful to PDAs. And understanding, but there is a definite, I may have maybe it's grown over the last decade, but at least early on, there was definitely a lack of understanding about what pa czar, how do you as an institution, kind of orient them to this concept of a team approach to healthcare? And have you noticed the attitudes of the medical students over the years changing towards accepting your role in in the team based care?

Unknown Speaker  18:00  
Yeah,

Unknown Speaker  18:01  
that's an interesting question. And so yeah, as Tony has mentioned, we certainly have had increasing levels of integration with the college of medicine, the medical student curriculum, and being careful to make sure that, you know, that matches up with what we're trying to accomplish in terms of graduating great PhDs and what things work well, and how do we have to modify it a little bit to make sure that it aligns with what we're trying to accomplish for our program goals, etc. But but for sure, I would say that we have had opportunities to have our students in the classroom side by side and they perform comparably, well, when we've done the studies and looked at it, their performances, statistically, you know, no significant difference between their performance. And so from that standpoint, you know, they're demonstrating that they're very talented, very capable people who are learning medicine. Alongside them. It's kind of the grand, you know, experiment in terms of interprofessional education, you know, learning to from and about each other. They do it every day, whether they're at the anatomy table, or whether they're in the classroom, or whether they're in a small group together, or learning history and physical exam skills with each other. They're just completely integrated in that respect. And so that that certainly is a part of it. We do have and we do look strategically for other ways that we can try to ensure that I think there is both role modeling, as well as just a presence in the system that recognizes pa so as Tony mentioned, he's been a course director for several years. In that first semester for the medical students in PA students then here is a PA faculty member who is in charge of the course and is responsible for it. I serve as the chair of the medical Arts and Science Committee, which really oversees the first three semesters of the medical school curriculum. And so they see see us there, they provide us an opportunity to to lecture and in the first couple of weeks, with the medical students and PA students about the two professions and just what are the similarities? What are some of the differences and how does that benefit us? I think the really great thing too, is that as Tony also had referenced is that the College of Medicine, administer ration and the College of Medicine, folks who are in charge of the education and the curriculum, really do want to find ways to make sure that the TAs are at the table and are upfront in some of those roles. So that again, medicine, as we mentioned, is a team sport for sure. And having those examples and those cases there, so that everyone gets a chance to see that, indeed, they're going to be out in practice shortly working alongside people in the conference rooms, and in the exam rooms, etc. Where that relationship is really critical to providing great high quality care. And so there have been considerable strides made, I think, in terms of just recognizing the role of PA play here at the College of Medicine. And fortunately, they have gone to great lengths to make sure that that shows up in our

Unknown Speaker  20:45  
education. It is not unusual to have leadership changes in medical schools at the dean level. How has the University of Iowa continued that when you have a dean coming in every presumably six to 10 years a change in leadership that maybe has a different philosophy about this?

Unknown Speaker  21:02  
Yeah, that's an interesting question as well, we certainly have had several Dean's who have come along and move through the system. And and there is a learning curve, to be honest about it. In some cases, you know, we are a relatively small number of students in the grand scheme of the number of, you know, medical students that are present here. But fortunately, again, you know, we have been embedded we have a proven track record of having students who have done well in the system. My think that we recognize that the national ranking system is not the be all and end all but that oftentimes with Dean's is something they do pay attention to. And so having been favorably ranked in the US News and World Report rankings has also I think, been another way that just earns us a little bit of credibility. When our colleagues around the country say favorable things about us. I think that helps us to just to earn some respect from the Dean's as they come in. And then usually over time, as they begin to interact with us and have more meaningful interactions with our students. And our faculty, I think we have been consistently able to slowly but surely win them all over. And I will add that David's being bit humble on this one as well, in that because we are a department he's on the same level as the head of Internal Medicine, or the head of Pediatrics as an example. So he meets regularly with those Deans and the dean that he's talking about that the dean that shifts on a regular basis. And so we have a direct conduit to representing our profession, our education and the models that have been in existence for a long time. So I think that is another key piece that they didn't highlight tonight.

Unknown Speaker  22:35  
I I'll do it for him.

Unknown Speaker  22:37  
So let's talk a little bit more about the program. You You're a 28 month program, as I recall, and this concept of cohabitation with the medical students and taking the same courses, it sounds similar to kind of the if you recall us several pa meetings ago. I remember Tony Miller needed Glick in, I'm sure there were others that talked about this concept of getting on the train at the same station. And then certain professions step off the train down the path, so to speak, is that the way this actually works to your students start with the medical students in the majority of the classes. And then at some point in time they step out and the medical students continue on in their basic science curriculum.

Unknown Speaker  23:19  
In 2012, the College of Medicine decided to relook at its curriculum. Prior to that they had been very discrete courses, you know, pharmacology, biochemistry, immunology, taken in sequences, in 2012, they we looked at their curriculum, and really looked at the model that's coming across, I think, across the United States a very integrated model of education. So you're not just taking discrete courses on a particular topic. They're integrated with physiology, pathophysiology, treatment, evidence based medicine, all of those things. And so they really want to look at how do we do this in a new curriculum format. And so they came up with this, what we'll call three plus five model for the medical students, so three semesters of didactic curriculum, and five semesters of clinical training. And then came up with these three major strands that run through through the curriculum, that three are predominantly well noted within the didactic phases, but they continue on in the clinical phases as well, because we moved from discrete courses where we as PHS can choose you know, I want this particular course or that particular course we need to decide, are we going to make our own program are we going to go all in and we chose to go all in. So we take the same first 18 months the identical didactic curriculum that the medical students do, we add a summer block as well for pH only during that 18 months, and then as medical students go off to clinical training, our students go off to clinical training. Some of those rotations are identical to the medical students, and we try to get our students outside of the university as much possible, we recognize you know that when you are in an academic health center, there's a lot of competing learners that are trying to get into those particular rotations. And we really do want to train learners to be able to practice in rural and underserved settings. And so getting them into those locations is ideal for that one, and to put some one on one with preceptors that can do that kind of regular education and give those learners great hands on experiences that they may or may not get at at an academic health center.

Unknown Speaker  25:35  
So historically, medical schools will often have their rotations for their students to be word based, they're going to be at the academic medical center for the majority with the exception of maybe a couple electives. Whereas you all have the majority outside of the academic medical center with a few exceptions. Is that accurate?

Unknown Speaker  25:55  
Yeah, that would that is accurate. You know, we have the fortune of being connected, obviously, with this academic health center. So when students want to do electives, you know, we have literally every kind of sub specialty and super specialty that's available in healthcare. So our students can tap into those, if that's an area of interest for them. And then we try to get them out for those core rotations in those in those more, one on one kinds of situations. Okay,

Unknown Speaker  26:25  
how did the pandemic impact your educational curriculum? And and what are you doing differently now that you didn't do before?

Unknown Speaker  26:33  
Yeah. My favorite quote from one of our students that has graduated was, well, now you have how to handle a pandemic in your handbook. And my response was, I didn't want one in my handbook. But

Unknown Speaker  26:49  
oh, my gosh, that is so true.

Unknown Speaker  26:52  
So like most programs, we did a modification to online, certainly for the didactic phases, many of the courses were delivered through zoom, we always had used an opto, or recording device for capturing lectures for students to then review later at a later time. So we continued with those kinds of things, some of the challenging pieces were, you know, how do you teach Physical exam, you just cannot do that, successfully, in my opinion, through a remote process. And, and we were very fortunate to be given the opportunity to still have our students do some of that training in person. And we did modify the way we did that training. So prior to the pandemic, we were using pitas physical exam teaching associates, that the students got to practice the skills on and learn from because we train our PTS how to do the physical exam as well. So their teaching and learning from those individuals with the pandemic, we had to move to students doing them doing those exams on each other, and we put what we called PETA on poles, we had our pitas zooming in on an iPad, they were on a roller, students could tell the iPads so that they could see what was going on. So that we had individual trainers in each of those rooms. When the students were there, and and learning on on each other. We've now been able to go back with vaccination rate in this area and on how we're performing, always, you know, fully masked and doing those kinds of things.

Unknown Speaker  28:28  
I don't know about you guys, but for me, like the stress on us, as leaders, for the safety of our students and our team members, and particularly when we also get back to teaching in person was was immense. And I was just so thankful that we got through this to date, without any loss of life, but it's been so many of our students are living in multi generational homes, and they're terrified to bring these things back home. So it's not without significant stress for all of us.

Unknown Speaker  29:00  
And I think one other notable thing about it too, is that delivering a high, high quality, graduate level, healthcare education is challenging enough when everything is going relatively smoothly. When you put something in place, like the pandemic that I felt like we were kind of just ultimately in the crosshairs of this pandemic, from the standpoint that we had many of our faculty and others who were provide still providing health care at least part time, you know, trying to continue to carry their part of the load. And that was obviously immensely impacted. Whether they were going to virtual visits, whether they were you know, shifting over and doing the COVID screening, you name it. And education could not have been more in the crosshairs from the standpoint of how it turned us upside down in terms of how we delivered a lot of our curriculum. So we really did find ourselves I think, you know, in a very stressful and challenging time and then when you add to that the other piece that has been very notable to me is that people respond incredibly different to the pandemic. So personality types, backgrounds, you name it all come into the mix. And well two people might look at the exact same proposed event, the response to that it could be could not be any different in many cases. And so I thought I found that to be just the other piece that was a real challenge as an educator is trying to strike a reasonable balance, where we did everything we could to reasonably mitigate the risks, but also recognizing that there are just certain elements, as Tony was mentioning about, you know, the physical exam, finding ways to still do the necessary pieces in person, and also helping them to realize that, you know, this is a part of medicine, you're entering a profession, where you will have those instances where you're going to be putting yourself in at risk, in some cases as you interact with your patients and the conditions they have. So it has been, you know, certainly a stressful time for educators, but also an incredible sort of learning mill you if, if you will, where that's just where the rubber meets the road as a provider today.

Unknown Speaker  31:02  
Yeah, yeah, I think that the students for my experience were, you know, they're paying tuition. So they're frustrated that they're being locked out of the classrooms, and they preside, at least initially as a very different experience. But then talk about the staff and the non healthcare providers who support your work. And it's a it's a very different fear factor for them. And I think even us as clinicians were, were very concerned. But also, as you said, date, we are around infectious disease in our careers. So we're used to the risk, and how to mitigate it with PPE and things like that. Let's talk a little bit about your illustrious careers and leadership. You too are given your background so you both kind of picked a different angle a little bit. Dave, you've been president of PA or was it a PAP at the time? It

Unknown Speaker  31:50  
was a PAP at that point? Correct? Yeah.

Unknown Speaker  31:52  
And you've also been the editor in chief for the journal for PA education. You're a scholar and often a gentleman. Scholar in the gentlemen, what led you to want to do more leadership? Was that through mentorship with Danny Oliver, or what was kind of your initial foray into going into leadership and serving the profession? Yeah. So

Unknown Speaker  32:15  
I mean, again, I literally sort of stumbled into the profession in terms of finding a brochure and going down that path without any great assurance as to what that would really look like. I guess I have always had some predilection, if you will, to leadership roles, you know, and so whether it was being captain of a sports team, whether it was taking a lead role in the class, in high school, or whatever. So I think I had some of those natural inclinations along the way. But once I got into the PA profession, ultimately got into a faculty position, I can remember very clearly receiving one of the, you know, publications that came out and it was advertising a position at that time with the American Academy of PDAs for the Education Council. And Kate, you teary bird was the been the chair of that particular Council. And I thought that sounds like an awesome thing where, you know, you'd have an opportunity to use the skills that you may have developed as an educator, but then speak into the profession on a on a larger role. And so I don't recall exactly which conference we were at. But the aapa conference that year, I thought, I'm going to find Kate teary bird and introduce myself to her. And I'm going to see where this goes. And so applied for the position ultimately got on the Education Council had a great opportunity to work with a lot of other individuals in a leadership role that just sort of fueled that passion for being able to use use my skills, but also give back to a profession that I felt like was just that I was super fortunate to be a part of. So that kind of fueled the fire a little bit for me, Tony Miller, came on from the PA pap side at that point. And so we'll get to work with Tony early on in those years, got to be introduced to lots of other individuals and just recognize that there is a really important role for PA and Pa educators to play in terms of preparing others to, you know, have both maybe an easier opportunity to get involved in the profession, to just provide better services to each other to give resources to each other. And so, I was fortunate enough to just find myself I think, surrounded by people who were smarter and wiser than me that often made me look better than I perhaps really am that little unknown secret. But it's yeah, it's been it's for me, it's been a passion to give back to a profession that I just really feel blessed to be a part of.

Unknown Speaker  34:36  
And you just recently stepped down after many years as the editor of the journal tell us a little bit more about the journal pa education.

Unknown Speaker  34:44  
Yes, so actually, technically speaking. I will actually finish up at the end of the calendar year and so have I apologize for months left to go here. But yeah, it that has been an amazing opportunity that I have just really been fortunate. Be a part of as well, as you probably both are familiar with. Don Peterson really kind of got this whole process with the journal going at used to be called perspectives. And I can remember when it was a stapled set of papers that came out to us in the mail. And then eventually he had created an opportunity to make it a little more fancier and worked internally in his place. And he eventually passed it off to then a pap, who took it over and began producing it in house and Jean Jones then became the next Editor in Chief. And he did a great job of really, I think, advancing the journal for several years. My first foray really into it after doing publishing a few manuscripts was that gene was looking for a new abstracts and brief report editor. And the the really fun thing about that particular position was that we recognize that there were many of our colleagues who were not formally trained in research who were not formally trained and doing a lot of publications are preparing manuscripts. And so here was an opportunity for people who maybe had made a implemented some kind of intervention in their program to prepare a manuscript and share that with their colleagues around the country. And so it was both scholarship, but also an opportunity to share that new thing that they were doing. And there was a fair amount of hand holding to be honest about it in many of those cases, where you really just did come alongside them, to really help them prepare the manuscripts and maybe give them a little more feedback and a little more mentoring than they otherwise would receive from a traditional submission of a manuscript. So that abstracts and brief reports role really helped me just recognize what a great thing this was to give our colleagues and opportunity to share the great things they were doing in our programs around the country, with a wider audience. And that led them obviously to an opportunity to ultimately served as the editor in chief of the journal P education for the last almost nine years now. And so again, just very humbling to see people who are really passionate and interested in sharing their good work, and submitting it to our journal, where they have a chance to have it reviewed by their peers who give them feedback, sometimes valued, sometimes maybe not so valued. Just because it's always difficult to have your own personal work put on display in a way where people will provide feedback on it. That can sometimes it's hard not to take it personally, in some cases. So, but very fortunate to work closely with a lot of great people on the editorial board, lots of great feature editors who have just really advanced the journal, probably in spite of

Unknown Speaker  37:34  
me, somewhat Dutton, Tony, your path, you and I had the pleasure of serving on the board for PA for many years. So I know of your your PA roles, maybe talk a little bit about that. And also, you've been really involved in accreditation, too. And as I recall, you're involved with the academy at one point, what was your interest for that, and what has been maybe your most enjoyable part so far?

Unknown Speaker  37:57  
Yeah, I was fortunate to be our student ALR when I was going through the program, and that's what really gave me the initial was jazz, whatever you want to say about leadership and to bring home that as what Dave was talking about that passion for, for this profession, and really wanting to move the profession forward. And seeing that we can, you know, as pa depending on the roles that we that we hold can move our profession forward. And so that initial taste got me really excited. And then coming on to our faculty and having the mentorship of Dave and Rick Dean, and others that really encouraged leadership opportunities really, really continued to to foster that in me and the desire to do more, you know, led to being president of our state association, as you said, the PA board, all very, very exciting opportunities. I was on a PA in there, what was then called CSAC or there's clinical and scientific Council and had a lot of great opportunity to work with through that council and the journal because we were writing articles for that particular from that particular Council and and then now shifting over into our accrediting organization and being a commissioner within the the accrediting body. It's just been another great opportunity to learn more about our profession and to advance our students. You know, I think being a program director, I understand the pain and the agony that goes into being getting ready for and having a site visit done. There's a significant amount of work and I and I always approach it. As you know, this is for our patients and for our students. And we need to at least meet the floor just the accreditation of a program And how do we exceed that floor that being asked for us to at least meet, because it's going to pay off for our students, it's going to pay off for our patients, and then it's ultimately going to pay off for our profession. So it's really been a nice for me, it's been a nice overview of being able to see the entire organization at work. And it

Unknown Speaker  40:17  
sounds like the two of you been able to carve out ample time to support these external organizations that have helped the profession grow. Because you have an institution that really embraces leadership, and you also have this integrated model. So it sounds like there's enough flexibility in your schedules to make it work, even though we all know, it's a lot of extra work beyond our usual.

Unknown Speaker  40:39  
Yeah, don't don't ask either one of our wives.

Unknown Speaker  40:45  
But you just make a good point, I think, in that, you know, we do have some flexibility in our scheduling with with the fact that we do partner with the College of Medicine, and the larger curriculum. And so I have great appreciation for many of our colleagues who work in a setting where they really are the face that's really every pretty much every morning or every day, up front in the classroom or sitting in on the lectures, even if guest lectures are coming in. And so, you know, that is I think an area for potential growth in our profession is continuing to find ways where our colleagues have a little bit of bandwidth, where while yes, they're still primarily educators, they also have those opportunities for scholarship and leadership. Because I think that does advance our individual programs, it does advance our profession. And ultimately, I think we have a lot to offer to just other health educators in general around the country. Yeah.

Unknown Speaker  41:35  
So given your leadership perspectives, you certainly read the tea leaves of the profession for a long time. And there are a lot of changes coming along in our profession, the name change that was voted on upon the American Academy of PDAs House of Delegates last spring, we there's always this this kind of underlying conversation of the doctorate, what are your thoughts about the future of our profession, what makes you excited, and what gives you pause.

Unknown Speaker  42:02  
So I still remain very optimistic, for the most part, very excited about the future of the PA profession, I at the same time, recognize that we're going through a really rapid period of change in a lot of respects. So for those of us who have been around the PA profession for a long time, I think that many of us have sort of prided ourselves on being a unique healthcare provider group, from the standpoint that, you know, we often were individuals who had worked in some capacity and sort of the frontlines doing, you know, I was an orderly, lots of people were EMTs, or nurse aides, or you name it. And so we had sort of seen healthcare from that vantage point. And I think that gave us a great appreciation for the many different roles and how they inter interact with each other and how they can help make sure we deliver great care, looking at some of the other health professions and particular providers. So whether it's MDs, or nurse practitioners or others who are in those similar roles. You know, I think some of us are concerned that perhaps we're becoming a little more like some of our physician colleagues, not that our physician colleagues are bad people by any stretch. But I think there have been some unique elements about the role of the PA, that we would really like to hold on to as we continue to move forward. But also recognizing that there are some some areas where continued growth and improving our educational system as we train RPAS is very valuable. So I think that, for me is the real at the crux of us being successful going forward, is really being thoughtful, deliberate, purposeful about the areas and aspects of our profession that have been successful for us. And we can carry forward. And at the same time, recognizing the new settings that we're practicing in the new expectations that are provided to those of our graduates who go into practice, and really, you know, making sure that we do a really good job of keeping those things that have been very valuable and very successful to us as a profession, but also adapting to the new reality in which our providers are finding themselves.

Unknown Speaker  44:05  
Tony, how about you?

Unknown Speaker  44:06  
Yeah, I absolutely agree with everything that Dave has said, and I am very mixed on you know, this, this move of the degree Crete, um, you know, I think that there are some legitimate reasons why a person would want to consider a higher degree for their practice for their profession, for the setting that they find themselves in. And I'm very concerned about what kind of barriers that adds to our profession, for those that are first time attenders to college or for those that haven't had the same advantages of others in going through this and for the potential increase in debt load that can go along with higher degrees. And so I understand reasoning behind the discussions and desire for it. And as Dave was talking about earlier, that we really need to be very thoughtful and very introspective about what's driving this. Is this best for our profession? Is this going to serve our patients in a better way than we are today? Is the genie out of the bottle? Yum. Yes, it is. And how are we going to navigate this in the best way for our patients and for our students moving forward?

Unknown Speaker  45:22  
Yeah, and I both of you talked about this patients, right. It's really about the patients, what makes the most sense. For the patients, we as a profession have always existed because we were able to cover gaps that were not being met for our patients related to access to healthcare and my own experiences with my father, watching PDAs, nurse practitioners, pharmacists coming to his bedside after a head injury, the physicians were there for two minutes, they're very important in the process, because they're the ones who drilled the hole in his head to help relieve the pressure on the brain. But the rest of the healthcare team were present much more frequently. And it really, I think, contributed to really great outcomes, because again, it's about the team in my mind. So you two are at a program that's well established, you obviously have an applicant pool that is driven to apply to your school with a few seats. So a lot of your applicants are well qualified candidates who end up going elsewhere. What are some of those go to tips that you love to share with applicants so that they can be successful in their journey to become PA is

Unknown Speaker  46:28  
certainly for our program. But I think this applies to most PA programs that are out there is all of us are looking for certain grade points. But are you able to take on several science courses at a time or you know, a couple of science courses and you're an athlete or you are having to work your way through college? Are you able to balance life along with the coursework that you're doing and still achieve at a certain level? You know, I think one of the big challenges is always looking at applicants that, yeah, they have a 4.0. But they took one science course at a time or they were taking only 12 credits in a semester at a time. And so stepping into any PA program, where you're all of a sudden now asked to do maybe 20 to 25 credits in a semester and predominantly all science at one time, can you balance all of that? Can you achieve and feel successful, even if you're not at a level that you think that you've learned to be at prior to this in an undergraduate setting? So I think that's some of the things that I think I look for when I'm trying to I really do try to look at each applicant holistically. And what are the other things that they're bringing to the table? What were the other experiences that they were dealing with, as they were going through that undergraduate experience in order to demonstrate that they that they have that grit that David mentioned earlier, are that resilience that will pay off for them astronomically through a PA program, but also, as you're caring for patients from all walks of life, and all levels of understanding and emotional output that's occurring because of that disease? process that there for sure.

Unknown Speaker  48:18  
So what I hear you saying is there are that applicants do encounter typically some challenges in life. And when that happens, it is a benefit to them to actually articulate in their application, what was going on? And how they overcame it. Absolutely. Okay. How about you, Dave? Any, any go to tips?

Unknown Speaker  48:40  
Yeah, I think, as Tony was also mentioning, that we do look for individuals who have had a breadth of experiences, both life experiences, as well as educational experiences or other types of experiences. There are lots of talented people who can go straight through undergraduate and maybe have very few academic, if any academic blemishes on their record. But when we also then look at some of the other elements that we think helped to make sure that they have great qualities and traits that will make them successful in a medical profession. Those can be things that, gosh, maybe you have been in a sport that just requires incredible discipline, you've got to get up early and go to the swimming pool, or you've got to get up early and go lift weights, or you've got to do those other things that you know are not glamorous, but that you just recognize that over the long haul are going to benefit you immensely as you continue to advance them and make yourself ready for a profession like this. So we do we do look to see, you know, have they been involved in those kinds of activities? Did they also work a job while they were going to school so it could be that, you know, they were trying to acquire their healthcare experiences along the way. And so they worked as a CNA on the weekends or they worked on an EMT route for a while to just either pay bills or just to make sure that they got all the experiences that they needed. Life happens to you while you're going through a very rigorous training. And for those students who have something in their background that sort of gives them a perspective and says, Yes, I did poorly on this one exam. But I know that doesn't define me that you know that if I am willing to reach out and ask for help, and recognize where I can improve, if I am willing to, you know, partner with some of my colleagues to learn maybe an area that they have a particular good grasp of, if I'm willing to reach out even to the counseling office to maybe help me with some test taking strategies, whatever that might look like, if they have that background that has prepared them well to be able to deal with adversity when it comes up, and know that they can persevere through this if they reach out and ask for help if they look for ways that they can continue to improve. So those are important things, you know, we definitely take a number of students who maybe even just when they started in their academic career, were not focused did not really know what they wanted to do. And so their grades reflect that. But at some point along the way, they a light bulb went off for them, and they realized, gosh, I would really like to be in, in health care. And if I'm going to do that, I'm going to have to demonstrate that I can do these science courses and do them well. And so they do sustain over a year or two period of time and demonstrate the ability that they can really do that. Again, those are those are people who I think have life lessons that are really valuable to giving them the total package, not just being a you know, really good student in the classroom, but are going to be those people who can relate to a patient very well establish rapport easily relate to adversity and difficulty that maybe their patients are experiencing, and just really come alongside the patient and be a great provider.

Unknown Speaker  51:39  
I was actually one of those students, I went to college wanting to be a PT, because it seemed cool, but also didn't do very well. And, you know, early on, and then I did well after that, but it was you gotta find your passion, your why and then suddenly you you shine. So that's great that you're, you're open to that,

Unknown Speaker  51:56  
you know that that'd be an interesting thing for some of us to eventually do would be to go and look at the PA educators around the country who have some of those checkered past, honestly. And instead of instead of burying them in a file or a closet somewhere, we ought to actually celebrate some of those and highlight the fact that for some of those applicants who maybe did get off to a rough start, like some of us did, that you know what that that doesn't mean that you cannot accomplish what many others have done if you're just willing to keep putting one foot in front of the other and reaching out and asking for help when you need it.

Unknown Speaker  52:30  
I agree. Well, gentlemen, thank you so much for your time today. It has been a real pleasure to have you on and what an impressive institution you're working at. And the work that you two have done professionally has been very inspiring for all of us. And I wish you the very best in your future.

Unknown Speaker  52:45  
Thanks, Kevin. I appreciate the opportunity. Yeah,

Unknown Speaker  52:48  
thank you very much.

Unknown Speaker  52:51  
Well, I'd like to thank Dave and Tony for sharing their insights about the University of Iowa PA program, and about their contributions to the profession. These two model for every aspect of a strong pa educational program, including accreditation, teaching, curriculum design, faculty development, leadership, research, scholarship, and service, and we have a lot of fun catching up today. Tune in next week as Stephanie and I speak with Mr. Matthew McQuillan, the newly appointed department chair for the rector School of Health Professions department of Physician Assistant Studies and practice will talk with Matt about his new role, his program and his insights on the profession. We'll also talk with Matt about his doctoral work in the medical humanities. And of course, leadership matters yet another example of how PDAs contribute to the world through their leadership to the profession, their institutions and to their communities. Until next time, I wish you success with whatever path you are walking in life. And thank you for joining us. The purpose of this podcast is to provide news and information on the PA profession and is for informational purposes only. The views and opinions expressed in this podcast are those of the speakers and guests and do not necessarily reflect the official position or policy of the University of Southern California.