Season 1: Episode 18: Wake Forest School of Medicine - Brian Peacock, MMS, PA-C

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  0:25  
We still are a inquiry based learning curriculum. So we still utilize small groups as the primary delivery of all of our curriculum.

Unknown Speaker  0:33  
Well Hello, and thank you for joining us again. Today we speak with Mr. Brian Peacock who is the program director at the Wake Forest School of Medicine Physician Assistant Program. Ryan and I talked about his path to becoming a PA his time as a clinical preceptor and about his programs unique inquiry based curriculum. Ryan shares some great tips for applicants related to the personal statements, and for students related to preparing for the stress of PA training. As always, you can learn more about our guest and about the Wake Forest physician assistant program on our website at pa path podcast comm under the blog section for show notes. Well, Brian, thank you so much for joining us today, it's a pleasure to get to know you and Wake Forest. It's such a prestigious program, I noticed that you just celebrated your 50th year a couple years ago. And so you've certainly had a long track record as a program. But I've always been known to be doing innovative things. Before we get into the program, I thought we'd start talking a little bit about you in your path to becoming a PA. So if you don't mind sharing kind of how you ended up in the profession and where you ended up practicing clinically, and then moving into academia. That would be great.

Unknown Speaker  1:44  
Sure, and thank you for having me on your podcast. I really appreciate all you're doing for our profession and our future PDAs and hopefully future pa leaders. So my path is a little bit different. I grew up in a small mountain town in western North Carolina, and a family where my mom was a florist and a wedding planner. My father was a professor in the School of Business, and none of them had any interest in the sciences at all. So I was kind of the oddball in the family. I was always interested in science, always interested actually in animals. So early on in middle school, I started volunteering at a local veterinary office, except my afternoons after school on cleaning cages, walking the animals, watching them perform physical exams, and just was fascinated with the whole process. But I always felt like there was a little part of being a vet that was missing for me, I eventually realized it was the communication it was just the the connection you can make with with the patients and the people. But I went to undergrad at NC State graduated in a biology degree, trying to figure out what I wanted to do with my life. Still love science still had this kind of itch for medicine became a phlebotomist and an autopsy assistant at a local hospital and really loved it. I just loved all the aspects of it. The phlebotomy part really allowed me to connect with patients in the emergency room outpatient setting, in patient doing rounds and really drove my passion for just talking to patients and then being in the in the morgue doing the autopsies was just fascinating to me. Just seeing the anatomy and walking step process. I just absolutely loved my job and thought I can actually do this combo of jobs, the rest of my life was extremely happy. After a few years, I started to realize that working in the morgue was taking a toll on me emotionally I kind of felt this disconnect with my emotions in reality and lost some sympathy and empathy that I think is true to myself, and started wondering if there was something else I could do. One of my teammates at the time who was a phlebotomist have left the team to go to what was PA school. And being from a small town in western North Carolina, I'd never heard of the PA profession, or seen a PA before. So we've talked about it for a while. And then she went off to school. I continued working in the morgue as a phlebotomist. And then when I started thinking, Maybe I should look into a different career. Maybe I'm missing something. And I had to get out and spend more time with patients face to face, started researching the PA profession and saw different programs at different styles of teaching, was interested in learning more. I saw Wake Forest at the time was using an IBM or PBL process as their primary driver of curriculum delivery. It was intrigued I'd never learned from that model in small groups, case based learning. So actually just call the school and talk to Jamie McDaniel. She said come on down. And so Jamie gave me a tour. The other school talked to me about what the PA profession was and met some of the faculty and they gave me some good insight and I got to sit in on actually some IBL groups just walked away at the end of the day thinking this is it. This is what I want to do. This is where I want to be you know, it'd be a wake force PA and so I did the one thing which I would tell applicants not to do Which is I only applied to one school, which was Wake Forest, and was lucky enough to get in. And I haven't looked back since it's been one of the best decisions I've ever made.

Unknown Speaker  5:08  
And so following graduation from Wake Forest, you ended up in surgeries, I understand. I did.

Unknown Speaker  5:13  
I guess the anatomy still drove the whole kind of drive for cutting and sewing and procedure based things. And, uh, one of my rotations actually was here at the primary academic hospital. In surgery, my primary preceptor was a colorectal surgeon. And at the time, he was the only colorectal surgeon for the entire institution. And they had no APS on the staff. And so as a student rotating through, we were extremely busy, I was free rounding at 430 in the morning. And then he was operating till seven or eight at night, we'd around go home, and it was just fall on the bed, wake up, come back in the next morning as early as I could. And by the end, we'd developed a really good relationship. And I started just kind of asking, Can I help you? Can I help you with these hours? Can I take care of some of the people in the clinic and around the floor, to keep you from having to do all this and I thought it was a good idea. And so they hired me on the team. And that service now has three surgeons and three APs.

Unknown Speaker  6:13  
That's fantastic. So So you planted a seed, you saw a need in his day to day grind, you planted a seed that resulted not only in your hiring, but ultimately three abps. That's, that's fantastic.

Unknown Speaker  6:26  
And I still work with him one day a week in the clinic, and we have a great relationship and just trust each other and have a good bond.

Unknown Speaker  6:33  
So how did he take it when you decided you wanted to move into education.

Unknown Speaker  6:39  
He supported me, he's always supported in everything that I wanted to do. So I give all the credit to him. I was started precepting, after about a year clinical practice. And taking students which really ignited my passion for teaching again, my father was a professor. And I think it just kind of picked up from there, I got this bug to teach and loved precepting. It allows you to push students outside their comfort zone that come up with this wealth of knowledge. And they're trying to figure out how do I put it all together, I have the puzzle pieces. But what is the big picture look like? And you can really watch them mold their style, and how they're going to practice medicine. And you really got to impact the way that they sort of working with their own kind of clinical styles, if you will, and always had always heard, you know, after graduation, the first six months of independent clinical practice was going to be the most difficult time you have just all the things to learn. And I found it to be true. But the thing that I wasn't really expecting was it wasn't the medicine. It wasn't the clinical reasoning process or the treating of the disease that was so difficult. It was treating the patient that was so difficult. It was all of a sudden you have to figure out who is social work, what does social work do? What if they can't afford the medicine? What if they can't get transportation to come back to get a wound check? What if you know you're supposed to have your staples out and they can't get here, navigating just the nuances of clinical practice and taking care of people took up the majority of the time. And so I started imparting that on the students as they were coming through on rotations and being like, outside of the medicine, what should we be talking about, it really took the focus of I had some preceptors in school when I went in when I was going through that if they were gonna go have a really difficult conversation, or they knew it was gonna be a really challenging procedure because it was a child or someone who wasn't able to control themselves or understand fully what was going on. They would say you don't want to be kind of a part of this. I was the opposite. As a preceptor, I said, you need to hear this tough conversation. And I'm not an expert on this. I'm still figuring out how to have these conversations. We work in a cancer center one day a week. And so we were having difficult conversations about life, life expectancy with family and friends about poor outcomes about wounds. And I said, come be part of this watch, listen, we'll debrief it afterwards. And what did you learn? What can I do better as part of the process to hopefully impart that on them as they get into practice, which eventually led to me, you know, I was precepting 1011 12 students a year, I started wondering, What if I could have this impact on more? What if I could teach or be part of the process of training 100 students a year. So it got me interested in maybe I should look into teaching more and more and so a job opened up at Wake Forest PA program and remember shark was the chair of the department that time Zack Carter was a program director so I reached out to them, they encouraged me to apply. And I started off and on the clinical your team, actually with preset for site development and training and through time just kind of became part of the entire program and eventually program director.

Unknown Speaker  9:46  
So Brian, as a preceptor, you're you're out you're working in general surgery and you make the decision to start precepting students tell me about that decision and and how that experience was because in my, in my experience, so many PhDs are reticent To train PA students just a year out, they have this mindset that they need five years under their belt before they become a preceptor.

Unknown Speaker  10:09  
Once you graduate, you're, you're really armed with the tools you need to go take care of patients, and some of the difficulties can be in just that confidence in growing and becoming efficient. I think students benefit from seeing you grow and develop. I think one of the core values of being a PA, one of the big parts is being able to say I don't know. And you can't be afraid if a student asks you a question to say, I don't know. But let's look it up. Encourage them to look it up and teach you about it. They'll love that. Have them do presentations, have them participate in Grand Rounds, they're going to ask questions that you won't know the answer to whether it's your first year out or whether it's your 10 year anniversary, and there's going to be times where the prompts if you think I don't remember, that's a great question. It doesn't mean they can't look it up and teach you about it. And then go refresh yourself. And so it's lifelong learning, you're entering a field that's lifelong learning. Being able to say I don't know, is one of the strongest qualities of PA can have

Unknown Speaker  11:06  
my supervising physician for many years. Dr. Scott Co Baba had this great saying that I'll never forget knows that medicine is a continually humbling business. And when you have that, that sense of humility every day, then you're right. It doesn't matter if you don't know the answer, because it's there's too much to know. So I appreciate that. I think we, as program directors really struggle with clinical training sites. And at least data from maybe five years ago suggests that only about 25% of our colleagues actually trained PDAs. So we certainly could make a dent in that if more P is rolling to step up.

Unknown Speaker  11:40  
And I encourage all graduates to teach, whether it's from your school or a different school, you'll actually find that it's enjoyable, it's fun, it pushes you there's a global concern about does it slow you down? Does it impact what you do? I always found that it energized me and made me really want to push myself and push them and it made me a better PA.

Unknown Speaker  12:04  
So what was the entry to the leadership role.

Unknown Speaker  12:09  
Just kind of happened as I started off with the with the preceptor development, and then got into more teaching in the classroom giving lectures, I became a course director for our clinical year prep block, which is a series of four weeks where we teach a lot of hands on procedure based training, and then became a clinical director, and just kind of sort of navigating the team and talking about different courses and how I wonder to roll out preceptors and what to do with different situations, different learning environments, and just enjoyed watching kind of a shared leadership role and working with everyone on the team. And then we have a campus in Boone also a campus in Winston sub became the Associate Program Director for the Winston campus to kind of help navigate and kind of shared leadership with the entire Winston campus first year and second year. And just I've really enjoyed every minute I've had.

Unknown Speaker  12:57  
And you talked about in terms of leadership and mentorship that the program has always had such a rich history of leaders reamer Zack Janie, Robert Wooten Sue Reich, Gail Curtis, tell me why, why wake has always had such a great path for leadership development.

Unknown Speaker  13:18  
leadership of the world core values we have for our students, we started up a ELP program, which is dual degree, it's a sequential degree program for our students, if they're interested in being here for three years, we have one with the School of Law at Wake Forest and one with the School of Business. They come in and spend the first year either getting a Masters of Science in Management, or masters of studying law, and then roll right into the PA program and that the schools have been very generous and helpful in meeting our timelines and our goals. And really try and provide them with the tools that they need to graduate and not just take care of patients. But to impact the healthcare system as a whole. We want our graduates to become leaders in the hospital and the clinics, in their communities in their states. Whatever we can do to have them improve the PA profession and patient outcomes. It's been a goal of ours for 50 years.

Unknown Speaker  14:17  
So essentially, when your students start after that first year in law or in business, when they come into the classroom, they're contributing a totally different perspective, I would imagine to the regular curriculum that most students experience

Unknown Speaker  14:28  
they do and we use the we still are a inquiry based learning curriculum. So we still utilize small groups as the primary delivery of all of our curriculum. And so they're put into groups of eight students with one faculty facilitator for eight to 12 weeks depending on which unit we are in. And they work through cases. And having those students who have done the extra year really drives some of the bigger questions. How are we going to pay for that? You know, what, how's that funded and when the prompts come up to discuss things like Medicare, Medicaid, But things come up about legal rights, things come up about consent and those sorts of things. They really drive those conversations. And so it's allowed us as the faculty to step back and make sure the conversations are happening. But the students are now driving some of those deeper, really patient based questions versus just the soul. How do we diagnose that disease? How do we treat that disease?

Unknown Speaker  15:23  
So a fair amount of PA schools use a small group format, case based format in part of their curriculum, but your school is one of the few in the country that actually uses it as, as I understand the main driver of your curriculum. So would you help us understand exactly how that looks like day to day and throughout the course of your entire curriculum?

Unknown Speaker  15:42  
Yes. And so they come in, they start PA school in the summer, it's 24 consecutive months. And then they graduate. And that first four week block is a hit the ground running anatomy and physiology, kind of leveling the playing field. So everybody is required to have anatomy, physiology is a prerequisite. But their timelines are all different, we encourage lots of clinical hours experience to get into PA school here awake. And so sometimes it's been many years since they actually been in the lab. And so it's it's a four week really intensive experience in the cadaver lab at the School of Medicine, working through anatomy, physiology. And then as soon as a four week is over, they start the IBL process, they get a an intro to a case on Monday. And they'll work in their groups of eight, with the faculty facilitator to get part of the case, which is usually just a vague chief complaint, we start them right out of the gate with mechanistic hypothesis. So what kind of physiology or what kind of pathologic process could be going on to cause this symptom, and they develop these large mind maps. And as you can imagine, the very beginning, it's difficult, and they don't fully understand, but we focus on big concepts. And then as the year progresses, more and more details, and they work through the case throughout the week, and they're given some prompts are given some info. And as they request stuff, if they can justify why they need it, they're provided the information on the facilitator helps guide to keep them on a track for the objectives of the week. And then by the time Friday rolls around, they're really completed the case, they work on the final assessment plan and kind of follow up from there. Throughout the week, they get supplemental lectures, and some few labs such as physical exam labs, we have a full functioning clear proof lab here. So they do blood draws run blood tests. And that's part of the cases it's built into. So they're actually applying the stuff they're doing throughout the week as they go. And then we have some final wrap up lectures on Friday afternoons to kind of pull the case together. And sure everybody's on the same page, answer questions as one big cohort across both campuses. And then was on Monday morning to make sure they got it and onto the next case.

Unknown Speaker  17:47  
Wow. So that's really, you driving right through so so for a module like e and t, it might be one or two weeks, whereas cardiology might be the over the course of a month or month and a half.

Unknown Speaker  17:59  
It's broken up into four units in that first year. And so over an eight week period, they'll cover the first eight week period, they'll cover hematology, they'll cover dermatology, and they'll cover integrin. And they're all inter woven together, and the cases starting off kind of basic, and then more and more complex as it goes along. And we have a 12 foot block for gi cardiology and pulmonology. So

Unknown Speaker  18:23  
So you might start out with a simple anemia case in the beginning and then down the road, you might have TKI, related to some dermatologic finding related to some underlying pathophysiologic process. Exactly. That's really, really interesting. I'm just curious for the students, what are probably the key learnings that you've experienced over the years in terms of just them kind of putting it all together and how they kind of like goes off in their brain?

Unknown Speaker  18:48  
Initially, it's difficult and they come in, they love the idea of I don't sit in a classroom all the time. And we still have lectures, but it's the idea of I have time and group I have time then to go research and come back to the group but the questions that we came up with, and they like the idea, but when they come and sit down for the first few weeks, it's fun, it's different. It's that honeymoon phase and we tell everybody you will crash and the honeymoon phase will end typically, vacation system in the US is primarily a lecture learner based and tested on very specific things. They know what they're tested on. And they memorize. We talked about this, you know, historically, you go in, you're told next week, you have a quiz on Chapter Three, and they go home and they highlight they flashcard they memorize chapter three, they come in, they regurgitate it on the test. And then they say next week is chapter five, and they go home and they just forget all of chapter three, skip through chapter four, go to chapter five, and we kind of give them more freedom to be creative and think and it can be frustrating at times to say, you know, they will they will come out and just say just tell me what I need to know. We say just kind of trust the process. You will learn it all you just got to keep keep pushing along and they work together really well. They have very diverse backgrounds and stuff their backgrounds and dermatology They help drive long conversations around rashes and management, um, but hematology them out know anything. And so other members can help with that. In the end, it's just fascinating to see how well, they develop the clinical reasoning process, which is our whole goal is that we can't teach you everything. And if we taught you everything, within a few years, most of it would be out of date. And so we want to teach you to identify resources that are up to date, maintain that you know, how to find you know, how to quickly read through, and then apply it to your patients. And so it's about providing them different resources, allowing them to utilize those resources, come back, teach the rest of group talk through problems, and become just fascinating problem solvers with a good understanding versus memorizing medicine.

Unknown Speaker  20:45  
It's a really interesting curriculum. So I have a I have to imagine that there is some impact on the way faculty typically integrate into the curriculum, where they're teaching how they're facilitating. What does that typical work week look like for your full time faculty,

Unknown Speaker  21:00  
we have lots of meetings, I think all faculty have lots of meetings, I think it's just part of the job. But our favorite part, not our favorite part. But there are Monday morning meetings. First thing out of the gate fault facilitators, and they go through the case together, we have very specific objectives and bullet points they must meet as far as our objectives for the week that fit into our larger outcomes. And then they just help drive the conversations. And if they find them going down a rabbit hole, they can either say, make that a learning issue to look up and come back and talk to us about or that we've gone a little too far into this, let's let's table that and get back to the case. Because sometimes they'll find themselves kind of wandering down a path that's in the wrong direction, we just kind of help guide them along the week. And so the the facilitators are in all the small groups with the students, which are Monday, Wednesday, Friday, and then the labs to help them as well. So it was a lot of interaction with the students, which generates a very team based atmosphere, that's another one of the challenges the students can have is most of our students we find are very, you know, want to be great driven, like their entire life, it's, it's, I have to be the best I have to achieve this to get to this. And we really try and demystify that, and break it down early and say, you may not even know what your grades are for a little while. We really want you guys to work together, you have to learn to work together, this profession is team based, we're going to work in teams. And if you can't work together here, we don't even work together well out there. And so we push them to share resources, work together, have difficult conversations, uncomfortable conversations, work through problems together. And then just let them know you have advisors who are watching everything you do as far as your assessments, and we will let them know if we have any concerns. And in the beginning, it's difficult, because they're so used to getting that immediate feedback and knowing what did I miss learning to work on, but we drive it to continue to work together continue, we will talk to you about it. So they can struggle with that in the beginning. But typically, they just adapt, learn to like it. And by the end, they see the big picture.

Unknown Speaker  22:57  
So in your admissions process, you talked about the diversity of the perspectives in the small groups in your admissions process? Are you looking for that diversity in a mindful way to eventually place into those small groups? Or is it kind of happenstance and once you see the diversity after you've accepted a class, then you start to think about how to spread out those experiences,

Unknown Speaker  23:18  
that groups are actually randomly selected. And so we don't control for who goes into which group, each unit. But our admissions process is very much on interview day, can we get to know the person that met the criteria to get an interview? And so at that point, it's how well do they function in teams? How well can we get to know you as a person? Versus did you answer that prompt correctly, but more about who you are what you have learned from your experiences? Being able to say, Yeah, I was in this situation, I probably made the wrong decision, reflecting on it. This is how and so really trying to show that personal growth, and getting to know each applicant for who they are. And can they work together as a team more so than what have they accomplished? Or what can they do?

Unknown Speaker  24:01  
Not to give away any secrets. But how do you how do you assess that as a program on one admissions day to see if they are suitable for team based learning.

Unknown Speaker  24:11  
We put them through a few team exercises, we actually run them through a small group case, and help drive that discussion and see how they interact with each other more so than being right about what questions you would ask or what anatomy or what physiology, but how do they function together as a team. And then we do a series of group interviews where we have multiple faculty sitting in a room with several applicants and ask them more behavioral type questions and see how they respond. And that method has proved well for us for a little while.

Unknown Speaker  24:43  
Brian, given your unique curriculum, What's the best advice you can give applicants who are exploring your program and trying to determine if it's a good fit for them?

Unknown Speaker  24:52  
I would encourage all applicants to look at the program's websites attending the virtual open house they may have and really to try and figure out if the mission and vision of that program matches their personal mission and vision. If you try and go somewhere that doesn't align with who you are, you may be successful academically, but you want to enjoy your time there. PA school is hard enough as it is, no matter where you go. It's a lot to learn in a short amount of time. And you need to make sure the environment is going to be suitable to your learning style for where you are in your life. To make sure that you're successful, and enjoy it as much as you can, I would encourage applicants, once you figure out which schools match your your mission and vision to spend as much time as you can, on your supplemental application, as you do on your personal statement, we're finding that we get these really robust, rich personal statements that come through. And then they get to the supplemental for our program. The supplemental has specific prompts for those programs or schools. And there's two three sentences for each prompt versus the rich, robust. And so put the energy and effort into that supplemental, that's really what the program is going to look at to try and set you apart from the other applicants, I would encourage applicants to focus a little bit less on the number of experiences they have, and more on how those experiences tell their story, how did it impact them, and who they are. So we get a lot of applicants who say, for community service or for volunteering, we organized to put on your 24 hour dance a THON, which is a great thing, you can raise a lot of money for a lot of good charities or organizations. But the follow up is did that charity your organization have an impact on you? So after the dance a THON? Did you go volunteer there? Did you go reach out to provide more help besides just financial? Did you get engaged with what their missions are? If you went on a mission trip, I'm sure it was unbelievably impactful to who you are. But explain that impact and say, did you bring his characteristics back to you? Did you work in your local communities? You know, within the US? Did you go back on another mission trip less about the number of things you did you did, and more about how it impacted you. And what you did afterwards, is something we're really looking for is that long term commitment to serving others.

Unknown Speaker  27:12  
So it sounds like you probably experienced something that we experienced, which is there are the applicants who create a checklist and say community service check, but they lacked a depth to that story. And what you're looking for is really folks that were impacted by it to the point where they actually changed their lives, they started to really dedicate their lives to others in a deeper, meaningful way. Exactly. We have the same issue. It's it's not a Checklist Manifesto, right? We're not looking for a checklist of a yes, they got this to get that they have this they have that we're looking for somebody who culturally sociologically has a fit to our culture as a profession.

Unknown Speaker  27:55  
Exactly. And, you know, going through and saying I volunteered at 13 organizations is great, I'm glad you're able to help out. But almost rather you see, you know, spending those 13 days at one place, because it met you with where you are and what you really want to change in your communities.

Unknown Speaker  28:11  
Yeah, that's been a common theme over the podcast. So far, I think a lot of program directors have said the same thing. So it's good to know we're on the same page with let's talk about your toughest challenges that your PA students face. You alluded to some of them, I think there's an adjustment phase, given the historical educational system in the US. What are some of the other things you experienced as a program director, obviously, without breaking for but maybe more general issues that you see that you can help students who might be listening to your story,

Unknown Speaker  28:41  
let's say, coping with stress, think that school was hard. And high school was hard, undergraduates hard and you get to graduate level medical education and is extremely difficult. And there's a lot to manage and deal with. So I try to encourage all of our applicants who I get to talk to that if they haven't figured out how they need to manage and deal with stress or really stressful situations before PA school, spend that time figuring it out. If it's reading a book, if it's running, if it's yoga, if it's taking a nap, whatever it may be, because when it gets extremely stressful or you feel like there's just too much to do in a week you need to know what your outlet is, and not be trying to figure it out in the moment. I think the the world communities have enough external stress currently, and then once they're in school, and we start pushing to learn more, learn faster apply it, you can see students struggle and struggle with it. We also uncover several learning disabilities students may have they've been able to cope with and manage throughout their entire lives with whatever mechanisms they have. But once you put this volume and this intensity of material on there, they're just not able to cope with it. We created an office for academic excellence which is joint with the School of Medicine in the undergraduate campus, really help students identify those we give the resources they need, we've started putting a larger emphasis on a eventual graduation rate versus an on time graduation rate, I found that it's more important to identify someone who has a need, give them the time and space to work through that, and then come back and be successful than to try and push them through and have them not be successful. So ultimately, my goal here awake is that once you get accepted is I want you to graduate and pass the pants, and I'll do anything I can to help you achieve that. And if that means taking a little break, and we'll work with you to take a little break, that means finding some additional resources, we'll find those resources. But if you've worked hard enough to get here, I want to make sure we get you through and start helping take care

Unknown Speaker  30:48  
of patients. So I imagine that's resulted in a very low attrition rate.

Unknown Speaker  30:52  
And yes, it has. And so we have a few students every year who elect to decelerate to the next class. But I encourage that I say, you know, if you're on this teetering brink, because of, maybe it's the material, maybe it's the setting, maybe it's external, maybe it's a family relationship, maybe it's a community issue, maybe it's a big social issue, we have the space to help you with this, and we have the resources available to help you with this. And I want to make sure that you get through PA school on the past the pants and not just barely make it through or dealt.

Unknown Speaker  31:23  
Brian, that's a really refreshing outlook on things. I think it's been my experience that in PA education, sometimes it's succeed or sync, you know, kind of the you're just not cut out for our profession if you if you have can't manage some major life situation. And I find that to be really kind of crazy, right? I think we're not, we're not going into combat where we're going to take care of people with compassion and be in a patient centered environment, a patient centric environment. So how do you kind of navigate that with your team, because surely the complexity of the chaos of a student being in a different phase, as they come back is not always ideal to your buttoned up approach. So you obviously have to have flexibility

Unknown Speaker  32:13  
when we do and we actually have to have some meetings with the students who who returned the next year, about the cases because sometimes the cases are very similar, or they go in a similar order. And we have to sit down with them and talk to them about remember this the team based approach, you can actually take on the facilitator role, be the leader of the group and ask the questions, you provide the prompts, and help guide their learning process and not be the one giving out the answers. And the facilitators are kind of aware and know that if there's a student who tends to be providing more answers or kind of driving the group, then we can meet with them afterwards and talk to you about the process. And true leadership doesn't mean that you grab the sorbara up the hill, and means you can help motivate the others and get them in the right place to and so it's about coaching them through the process of being a leader.

Unknown Speaker  32:58  
Yeah, well, we've talked about leadership a few times. So let's let's talk a little bit more about it, because you have two former presidents for the American Academy of Physician Assistants that have been with your school, Gail Curtis, who just recently was president a couple years ago. And you mentioned before we get on that she just retired, which is she had given to the profession for so many years. So we wish you the very best. And Robert wooden who's still with you who was president of APA when I was president, a PA he was the first African American president for our, for any of our national organizations, as I recall. So you have a deep tradition of leadership, you have a deep understanding of the American Academy of PA is and kind of where would the PA professions moving towards? So could you talk a little bit about how Wake Forest is gearing up for the changes that seem to be coming in our profession?

Unknown Speaker  33:49  
One of the one of the the bigger goals that that I have for not only our profession, but for the healthcare system in general, is there's been a lot of things published on burnout, and kind of pushing providers to the max. And I found that there's a lot of energy and effort. And it seems like money going into institutions figuring out how can they make their providers more efficient? How can we make them see more patients to take care of more people every day. And I have a different view than that. And I'm hoping that I can kind of push my students to go out there and make a voice is we have a long history in our country that has pushed some medical mistrust amongst amongst the communities that we live in. And I can't tell you how many times I continue to hear from big, large medical institutions throughout the country say our reputation allows for international people to fly in to come see us. They trust us they know about us over the over the sea. But my follow up question is typically how much trust is the community that your medical system As in have on you? And how much does that say about reputation versus what you're actually doing in the communities itself? A really want to generate this frame shift from how we can make our providers more efficient to how can our providers make a positive impact in our communities. And I don't have a great answer for this as why I'm encouraging our students to do the law degree and the business degree to help with some of the legal implications in the financial things. But instead of putting money into having me see two or three more patients a day, and getting burned out, and then transitioning, and then the retrain that goes into that, is there a way to actually just hire additional providers, cut back the patient load and then provide expectations as part of your effort as part of your energy is actually engaging in the community. It's maybe that's a day a week, if it's a half day a week, but that's part of your responsibility. And those organizations can be healthcare based. So local, local community care centers, mobile health clinics, providing medical health education, it could be reaching out to future students who could be interested in science. So volunteering at high schools, tutoring, reading, promoting science, middle schools, elementary schools, these kids need mentors. I think that if you have your healthcare professionals going to them when they're healthy, versus only coming to you when you're sick, could really help change some of that trust your relationship. And even outside of that, what's the Salem is around the edge of a really large food desert. And so engaging with those organizations that help with food deserts, understanding what they are, and giving back and I think the more that our clinicians and our providers can actually engage the community who's in need more than when they're just sick, the better the relationship and trust will be. And I think the overall health outcomes will improve health, health care outcomes will improve. And you'll see relationships not only across the ocean, but their local communities being supportive and promoting.

Unknown Speaker  37:00  
I'm totally dating myself when I say this, but and, and probably 95% of our listeners won't even know this but Lucille Ball, there's this classic episode of Lucille Ball working at a chocolate factory, where she is on a conveyor belt. And, you know, she's supposed to put the chocolate in a box or whatever it is, and the conveyor belt speeds up, and she just can't keep up. So she starts eating the chocolate burying it in her dress, you know, things like that. I think healthcare has become that where to exactly to your point, we just sit and wait for people to come to us. And then we're armed with a prescription pad, and diagnostic studies or a scalpel, and we fit, we fix it. And then we give him another prescription. And we wait for him to come back. Because now they're having polypharmacy issues that we don't seem to think through. And what you're really talking about is it sounds to me like a real public health focus, public health community based concept of wellness that might limit the resources coming to us because we're actually doing something about extending life and improving the quality of life on the other end.

Unknown Speaker  38:07  
Exactly.

Unknown Speaker  38:09  
Yeah, that's, that's brilliant. But you're right. It's a complex thing, right? Because there's a lot of people with their hands in the pot, but are paid and their their salaries based on our current model of healthcare, which many would say is flawed.

Unknown Speaker  38:24  
Yeah, it is flawed. And there are people who will say, you know, I think that our system is broken, I think in a lot of ways. It's almost shattered. I think we provide great health care, I think that PDAs make a huge positive impact in the healthcare community, and treat patients better than any other profession out there. I truly believe that. But I think that if we don't start improving the overall health of our patients, in the communities we live in, continues to spiral and that we need to see more and more people more and more people. And we don't have enough resources

Unknown Speaker  38:56  
to do that. So Brian, the concept of the ELP, that you have the Emerging Leaders Program, you have them doing that extra year on the front end, and they get a dual degree after three years with a PA degree. I would, I would expect you in your curriculum. It's tough to throw in extra content around public health in the two years that you have them other than is it part of your typical case each week where there's a public health component.

Unknown Speaker  39:23  
Every week, we have social drivers, the health, public health, embedded into the case itself. There's always something that's embedded into the case from to discuss. And then we have recently, within the last year started actually blocking off portions of days for community outreach. And so the faculty have a little taskforce together, and we organize events at our local food desert company called Hope helping other people eat. It's a phenomenal organization. It's almost as simple as the term sounds like an ice cream truck that takes fresh fruits and vegetables to kids. Wow. They go down, they play the music and the kids run up. And they have little bags of fruits, vegetables and homemade bread from the local farms. Brilliant volunteering there, the Community Care Center, even if it's stocking and cleaning and not taking care of people, but just being part of the process. We're not trying to work on developing a path for our recent our alliances with the Afghani people who are being relocated actually have that area around us with the being relocated, and we're trying to get engaged in and help them acclimate to the community, whether it's just taking them to schools, whether it's just getting them acclimated with a provider, I'm talking about what we do here. And so we're trying to get our students in chunks of time blocked off to say, this is your time to make a difference. I get connected with the community in hopes that they'll want to stay in the community, stay engaged with organizations, and make a positive impact on all those around them.

Unknown Speaker  40:51  
That is amazing. That's really great to hear. So Brian, is there anything else that you're hoping to talk about that we hadn't had a chance to discuss today,

Unknown Speaker  40:59  
I just hope that the PA profession continues to grow. The popularity is there. We have lots of schools out there. I hope that the interest is still there to help take care of patients, I have people who have concerns about applying because they have a low GPA or a low GRE. Don't worry about that. It's more than that. It's more than numbers of the profession is about working in a team to better the health care for all. And don't be afraid to apply just because you had a bad grade or bad score bad course. Everybody makes mistakes. But put it out there put it up front. If we're reviewing and we see hey, you had a semester where things didn't go the way you probably want them to go. Own it. Describe what happened, how you grew from that experience. What's happened since that time. And so the admissions process is a daunting one. It can be expensive. I also encourage you to ask the schools about waivers. Some places have ways to waive the fee to ensure we want everybody who is interested in being a PA to be able to apply to be a PA

Unknown Speaker  42:05  
pretty good. Well, Brian, thank you so much. This has been a real pleasure learning about the program and hearing your vision for the future. And I look forward to watching your school continue to shine.

Unknown Speaker  42:14  
And thank you for putting this together. I think you're making a positive impact on the profession. And I appreciate it. And thank you for inviting me.

Unknown Speaker  42:22  
Yeah, thanks. Thanks. We want to thank Brian for taking time to educate us about the unique curriculum at the Wake Forest School of Medicine PA program. And for those great tips for applicants, students and for the general public about burnout as well. I have always been impressed by the commitment of their institution to supporting pa leaders as they represent our profession in a wide variety of roles. And now we know why given the emphasis they have in their culture. Tune in next week as we speak with Dr. Jackie Barnett, the program director for the Duke University School of Medicine Physician Assistant Program. We speak with Dr. Burnett about the history of our profession, with its start at her institution. The current approach or program is taking to educating students and her lifelong focus on diversity, equity and inclusion for the world and for our profession. Until next time, we 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.