Transcribed from the recording and lightly edited for readability. The speakers' views are their own and do not represent ARC-PA. Confirm specifics against the current ARC-PA Standards and Compliance Manual.
0:00 — Welcome: who we are and why this session
Scott Massey: Welcome everyone. This is a this is kind of a collaborative webinar. And we'll get into who we are and what we represent. So I want to welcome all of you to coming out on a Friday afternoon at noon to spend some time with us as well. So I'm Scott Massey and Starr, just kind of briefly.
Starr Newman: Oh, hi, I'm Starr Newman, and I am the Clinical Advisor here at AMO. And for those of you who may not be familiar with AMOpportunities, we partner with healthcare education programs and clinical sites across the country to help create high quality clinical training experiences.
We work closely with many academic institutions and preceptors handling the logistics, contracting, compliance, scheduling and administrative support so providers can focus on teaching and students can focus on learning. Our goal is to make clinical education easier, more efficient, and a great experience for everyone involved. And it is now my pleasure to introduce someone who likely doesn't need an introduction. So here's Scott Massey. Thank you, Scott.
Scott Massey: Thank you, Starr. So I'm Scott Massey. I think some of you in the audience know who I am. I'm the owner of Massey & Associates Consulting Solutions. And I've got the honor and privilege of working with programs throughout the country in regards to accreditation cycles of all sorts. And I've also been fortunate to have begun collaborating with AMO. And AMO has provided a number of different opportunities for my clients.
And we'll go we'll go into some detail about some of the dynamics of why we're having this, this webinar today. So I'm not going to spend too much time about me. You can always look me up.
2:12 — Qualifying statement: we do not speak for the ARC-PA
Scott Massey: So I just want to say I always do this in webinars qualifying statement because we are talking about standards that we don't speak for the ARC-PA. Okay. And we're doing this really for you as the members of the educational community to enhance understanding of the new changes that you're facing in the sixth edition standards. And obviously, within the webinar, there's going to be some context that we bring to the table.
And we want this to be kind of a little bit of a conversational webinar as well. So we'll kind of bounce back and forth a little bit on some of these topics.
3:01 — Why clinical capacity is the number one challenge
Scott Massey: So let's talk about the problem that we that's being faced and it's being faced in medical education in general. It's not just PA education, for example, but really the ability to secure and maintain sufficient clinical training capacity. I think it's the number one challenge. And secondly, it's actually recruiting faculty, I believe overall. And again, from our perspective and we see this of all types the common challenges, the implications of insufficiency.
And then facing that in terms of the, the implications for ARC-PA compliance. So Starr.
Starr Newman: Yeah we've seen a lot of an increase problem with working across different strategies. Good. Sorry. Yeah. So what AMO is really working on right now is looking at different strategies to help these programs find these clinical sites. And we work together with them to make sure that it's easier
Scott Massey: And it's more proactive. And so what would you say would be one of the areas that really helps the program in terms of labor and time.
Starr Newman: Yeah. So at AMO we're able to take some of the admin work off of their plate for the, the clinical directors. And, and it helps them understand some of the nuances with where you're going with the accreditation or paperwork and getting in. We have a lot of relationships with hospital systems. We're in there already. We're able to make that happen quicker.
The transition into not just knowing the hospital system, which we have the relationship with, but introduction to them and making it easier across the board.
5:05 — Learning objectives and what Standard B3.01a requires
Scott Massey: So these are the learning objectives folks. I'm not going to read those to you, but like any session that you might claim Category 1 CME. We can't give you Category 1 CME not yet certified for that at this point. But we're looking at the kind of the overarching is Standard B3.01a, which is about sufficiency of clinical sites. So we're going to dive into various aspects of that and some different angles. So let's talk about this for a second. This is something that
5:47 — Where developing programs run out of runway
Scott Massey: I mentioned the greatest challenge facing both developing and established programs. You know, the standard itself includes more than just securing sufficient number of clinical preceptors and clinical sites. There's more nuanced aspects, but we're going to focus on really a component.
I think today the most and some of the things that I see of late, Starr, as well is that often programs in the developing phase find themselves six months away from application submission, and they're just not able to get to the finish line in terms of clinical sites. Starr what's been your experience with that?
Starr Newman: Yeah. Right. So a lot of times when they come to us when they're at that point we look at their learning objectives. We help them sort through what their what they're really looking for. And then we can get them over the hump with some of the knowledge that we have of where certain sites may be proficient and being able to meet their needs. So we have a lot of relationships with preceptors.
And we know that we talk through like, let's talk about your mission statement. Let's talk about what your learning outcomes say. So then we look at to see if we can find qualified and vetted preceptors that we can bring to them and talk through how that would assist with getting them over that hump into the finish line.
7:16 — Travel cost, geography, and keeping students close to campus
Scott Massey: Just kind of another, I think, topic of conversation that maybe there's often concerns about can programs keep their students relatively close to their campus. And I think there's always a concern as far as cost and travel and, and how do you when you engage with the program, what's some of the strategies that are used to kind of look at regions of clinical sites?
Starr Newman: Right. Yeah, we really work with the programs to when they come to us and say we'd really like to keep our students close to home. And we understand that. We understand the travel cost of students they want to keep them close. But then we also look at what?
If we were to create another area in the, in a, maybe a geography where there are all the clinical rotations that are available and the students could go there and complete all of their clinical rotations in one setting and not have to move around. So we also look at that with them and think about what about that option.
It's it's a strategy that we bring to them to allow them some of these areas, these geographical regions as well as I do are just saturated with a number of medical programs. And so we look at it and we say, hey, what if we were to look at this another way and keep your students in one area, but develop this little mini ecosystem that will allow the student to get the best educational experience without having to move around.
And we really dive deep in with the clinical team and the program director to understand what are their needs in that area. And if they're willing to look at that look outside think outside the box, think about, oh, I can put the students here instead.
So that's been really one of the things that we've been looking at more and more to help some of these programs, beginning programs or programs that have been able to get some of their rotations in their areas, but they just haven't hit that magic 20% over the number that they actually need. So anyway, that's. Go ahead. Thanks.
Scott Massey: Thanks for that. Yeah.
9:33 — The focused questions from the Compliance Manual
Scott Massey: So some of the questions and I we use the compliance manual as the Bible these days in terms of sixth edition. But I'm just like looking at this from the perspective of what does ARC-PA expect and what do you need to achieve. Right. So what number one is what are your required elective and clinical. So obviously you have the seven mandatory rotations and then electives as well. You know how many sites and preceptors or slots have you secured.
So again that is the number. It's all about the math right. The students depending upon your class size. Right. Are there enough clinical slots placement for the current clinical cohort. And then is there an overlap. Okay. So I think all of these things can cause some issues at times with programs. And again I'm not just speaking about developing programs,
10:34 — Filling discipline gaps: women's health and pediatrics
Scott Massey: But maybe if you have a maybe some experience with one, like an example of where a program has an overlap and they need to secure some additional sites to, to ensure that they're compliant or they have specific areas like one of the, one of the core seven that they just can't seem to fill.
Starr Newman: Right. Yes. So a lot of times we help these programs some of these gaps along with Scott. And then we when we see that gap, maybe the gap is in women's health or pediatrics. And we all see then maybe that program doesn't need all of the their rotations. They just have a gap in women's health or pediatrics. So then we are able to look at their geography, their mission, their learning outcomes.
And then we're able to say, hey we have some preceptors who we would like to introduce you to. You know, we've vetted them, brought them on our platform. And we can see if they have any capacity to take more students.
So we really work to facilitate bringing those types of providers to these schools where we've identified the gaps or they've identified the gaps and come to us and say, we would like to just do this a few rotations in women's health, few rotations in pediatrics. I really feel like we have a number of different ways that programs can utilize AMO, and it makes it so we kind of create each individual way to help these programs.
Scott Massey: Excellent. Thank you so much.
12:22 — Essential evidence, and who owns preceptor vetting
Scott Massey: You're welcome. So essential evidence. Let me just like dive into a couple of these things. So obviously there's you have to have a list of active sites in numbers and then documentation that identifies the numbers of students. And I'm going to talk about initial provisional, some of those nuances separately here. But then accredited program sufficient clinical places for the current number of students and then documentation. Okay.
So one of the things I'm sorry I wanted to ask about is that when you engage with programs the ultimately the rotations must become the program's rotation. So can you speak about the documentation that AMO provides the program? And then where does where do the programs pick up from there.
Starr Newman: Right. So at AMO we secure all documentation like board certification and licensure and CVs. We present that to the program. You know we make sure that we have it all. But ultimately it is the program's ultimate duty. Or they need to vet every program that we bring to them and their licensure and their to become their preceptor. Because ultimately the ARC-PA comes to the PA program says, are these yours and have you vetted them fully? Have you completed a site visit?
And they can say yes to that. So we also help manage site visits for these programs. We help them facilitate coordinate making sure that they can get a site visit done before the ARC-PA comes and does their site visit.
Scott Massey: And there's creative ways for example, one of the nuances is that does the preceptor acknowledge that they can help facilitate the learning outcomes? So some of the creative ways that we've worked with clients is, is to have them use something like DocuSign and send the clinical learning outcomes and get attestations that they have received the learning outcomes, and they can fulfill them as well.
And so it definitely is a synergistic relationship when the program works with AMO. Absolutely.
14:49 — Section D: what developing programs must have in place
Scott Massey: So the last webinar that we did collaboratively, we talked about this a little bit more, but I, I want to go into this a little bit more today again, because I want to make a crystal clear that the developing programs around the United States understand what's expected of them. You know, so there's a number of things that are now expected. One is sufficient, appropriate and vetted sites and preceptors. So what does that mean to vet.
So as Starr said when they look when they are able to establish clinical sites and preceptors, the vetting process is a dual process. The program must then vet the clinical sites and preceptors. And the vetting process is like looking at qualifications and then making sure that the preceptor is able to meet the learning outcomes. And back in the old days and again, I went into PA back in 1991, that dates me a bit.
We can talk about how different the clinical year was back then. But now it's everything has to be documented, right? And the other thing is there needs to be evidence. And what we're we're talking about the evidence here. It can't just be futuristic plans or projections. And I remember in the fourth standards, there was a period of time when programs only had to have the first year developed for provisional, and then it was more like having a plan.
But now it's like an established program. Everything has to be in place. So that includes fully executed affiliation agreements. And I wanted to ask when you when AMO establishes affiliation
16:43 — Affiliation agreements and documented placement sufficiency
Scott Massey: Agreements, how does that work in concert with the program and the institutions?
Starr Newman: First, let me discuss with them. You know at first how they want to do. They want to use their agreements. So we discuss with them and then we take on that and we bring those to the preceptors or the systems and we, we make sure that we execute that with them. So we work in collaboration together. You know, if there's anything that we need to redline or talk about for the, the agreement. But you're absolutely right.
Like there has been that change where those need to be in place. So we work with programs to make sure those are placed and that they have those in hand before their accreditation review happens.
Scott Massey: The documented placement sufficiency. And this is like the rubber meets the road. This is the numbers. Right. So getting the numbers that have been dedicated by a clinical site for example can be an LOA. It could be different types of components. So many times programs will get this through. They can get through email. They can get through Exxat. They can get it through reaching out to their clinical partners.
But are there ways Starr that the number of commitments are done. So the program knows that site number A will take ten students right.
Starr Newman: Yeah. We provide that documentation to all of our academic or all of our academic partners. We have weekly meetings. We make sure that they know that this is the number, the capacity that this clinic will hold. So, yeah, we work with them very closely. So this speaks to the evaluation scope.
Scott Massey: And again this is the sites population
18:42 — Evaluation scope, attestations, and reaching the preceptor level
Scott Massey: Enable to students to meet learning outcomes site resources. So again this is the vetting of the sites. This is vetting of the preceptors and making sure that they are enabled to meet the learning outcomes. And that means and I think having attestations is something that is very important to get. There's one kind of notation that is in the compliance manual that talks about limited preceptor exceptions within large hospital systems.
We tell our clients, you need to have you need to come to the table with all this documentation at your site visit. And then at the time of the site visit placements that identified by the site visit. You know, many times programs will struggle because they will be able to, through their senior administration, be able to have conversations with senior administration and health systems.
But some of the barriers are for the program to be able to get down into, into the departments and actually contact the preceptors. And I have seen this as being something that AMO has been very good at, especially when programs are up against a stone wall. So how does AMO kind of navigate that challenge? Because it's truly a big challenge, right?
Starr Newman: Yeah, a lot of times when we see we'll have programs come to us and they may have a handshake agreement or and then we work with them and say, hey, would you allow us to go in there and work with some of the preceptors? We have teams that go in and are able to find the quality preceptors within that handshake agreement. Or we work with leadership. We have a lot of relationships with leaderships and hospital systems and kind of vet that out as to where it's at.
But we do work very closely with the program to understand where their affiliation agreements are at, what the whether it's the handshake or they have it signed, but they may not be able to find those preceptors and we can help. We really use those to build the relationship between us, their affiliation sites, so that we know one, we can make sure that we don't disrupt maybe what they have going on, but also maybe build that relationship to be even stronger.
Let's say they have an affiliation agreement with the surgery group at a hospital system, and we may have the relationship with a women's health group that does deliveries there. So we can make that part happen synergistically with the program, work together with those affiliation agreements.
21:37 — How SCPEs get secured, and the barriers programs hit
Scott Massey: Perfect. Thank you so much. And so again, we're going to go back to like the state of affairs. And I go way back. But I've seen PA education evolved through three decades, right. As far as methodology, as far as how things are done. So how are SCPEs secured? So program staff and faculty solicit health care institutions, right. The sponsoring institution can use influence which is expected.
The as part of the A1 standards, the institution is responsible for helping find rotations. So this is where these conversations occur which hopefully then bears fruit to be able to get to the level of identification. Right. Programs offer significant stipends. This is something that's been going on really since the 90s. And I remember times where nobody wanted to really talk about it, but now it's more of a norm than it is anything else.
And, and kudos to the programs that are able to get health care systems to not do this. But unfortunately, many programs are required to incentivize their preceptors. And that's just part of the state of affairs. So what are some barriers I've seen exclusively being a barrier to a lot of programs. And that is they're trying to get into the creme de la creme health care system right next door.
And they can't get there because the osteopathic medical school, allopathic medical school and three programs already locked up, right. And limited access, again, the ability to penetrate. I mentioned it already, I think, and then the regional saturation. And I think this is worthy of some more discussion. This is once upon a time when there was 52 programs in 1991, I don't think there was much regional saturation.
But now with 300 and I lose track, it's 330 or so now. There are parts of the country where there is true saturation, and which means that programs have to look outside the box.
23:58 — Building clinical hubs in saturated markets
Scott Massey: So let's unpack that Starr a little bit. As far as what does the program do in a major metropolitan area that just simply can't get clinical sites, right?
Starr Newman: Yeah. A lot of times we're seeing just that we have programs that are ready to go in those highly saturated areas. And maybe when we're talking to them at the beginning, that's when we start talking. Hey, let's think about building a clinical hub in an area that may not be as saturated.
Let's talk about building a clinical hub for them in a rural community who has a hospital system, who's ready to be an anchor and provide some of the inpatient component rotations to them. And then we work on getting what we call the spokes of maybe a family medicine rotation, internal medicine pediatrics. We bring those all together as a hub.
And then we allow our we talk to the programs and say how would you like to present this to your students as we are going to provide you with this great educational experience. It may not be in our downtown metro area, but you are going to get the best clinical experience that you can get in this community, and you're going to be there for the entire year, your clinical year. We will work with you to for your end of rotation exams.
Everybody knows bringing students back to the campus. But we want them to know that we there are ways and strategically to work with programs who are in saturated areas. So we really are seeing more and more schools coming to us and asking us what can we do? We can't find we can't find the surgery rotation here. We can't find an emergency medicine rotation here. Well, we have a lot of those preceptors on our platform already.
And now we are effectively putting them together in clinical hubs or going out and buying, finding that last 1 or 2 that we need for that hub. And programs are coming on board. And I keep hearing this is a great idea. So when we're talking to them, it's it makes sense for the student to be in an area where they can gain strong quality preceptors and rotations because that's what we're going after. Right. Making the best rotations for the student.
Scott Massey: Absolutely. And just to remind everybody that when you do have to
26:44 — Travel-cost disclosure and how the environment has changed
Scott Massey: When students have to travel from campus and there is cost to the students, then that's transparently placed on the website per the fair practice requirements. And there's lots of good examples out there. Programs have really done a good job of, of developing cost models and estimations about how much it might cost to travel.
But I think the Starr was saying is trying to hub these will reduce the cost of traveling and having to locate multiple times during the clinical year. So I think we can all agree that the environment has changed over time. You know, in many cases, direct engagement to preceptors is forbidden. You can't you can't just call preceptors. And it depends on the health system. And again. Gone are the days that you can just simply cold call and just randomly find folks.
Maybe some places that can still happen, but it's it's just not the same way it was. And I also say about the ability to, to be nimble securing a clinical site requires an affiliation agreement, it requires vetting and all of that. So you can't just call a person in a week later, they're on the clinical site. It takes a lot more than that. And it takes oftentimes months or even a year or more to develop a, say, a cluster of clinical sites or a hub of clinical sites.
Right. And the model that was existing ten years ago is really unrecognizable in many cases in many parts of the country, good or bad or indifferent, it's kind of the world we live in, unfortunately.
Starr Newman: Yeah. You're right. Ten years ago when I was developing the PA program, you're right. You could call somebody. But today you're with all the systems you're going through the central edge the education department, you're going through legal, there's onboarding and credentialing. So that's where AMO really helps because we know all the ins and outs of that. You know what's going on now. You know how to angle ourselves. And who do we need to talk to.
That's that's where we're at right now.
Scott Massey: We know who we need to talk to for some of these rotations.
29:09 — There is no margin for error
Scott Massey: And I think that we all agree that there's no margin for error. We've talked about the fact that not having adequate clinical sites is a very serious issue. And if you find yourself not having adequate clinical sites to place your existing class as an established program this could be a solution if you just simply say you lost an entire clinical site where most of your women's health is located, that may be irreplaceable. Okay.
And again, the deal breaker situation for developing programs, you're not going to get initial provisional unless you have all those elements in place. So it's it's it's one of those things that you have to have everything as we have spoken.
29:56 — The alternative: partnering with a third party
Scott Massey: And I think that the title of this webinar really is an alternative solution. Okay. So in looking at third party, and I think AMO is the most prominent one in the country, they have developed a niche of helping programs in a way that really helps them to be more effective in finding clinical sites and also, to be honest, to be able to achieve accreditation when they would have otherwise not been able to do so. So I don't know.
I'm sorry if you have any kind of some passing comments about, but we haven't talked about.
Starr Newman: Well, I think one of the things that I find when I work closely with these programs is I really like to be a facilitator with them and really work with them. So that's what an AMO does. We get to know our programs and we don't want to replace what they are doing.
We just want to strategically help them maybe expand their capacity to be able to take a look at what we are doing, how we are winning in certain areas and maybe work together and building out their clinical preceptors, providers for their SCPEs, helping them build them out, but doing it together. So I think that's really important part of what AMO does. We don't just go out and find a transactional preceptor to fill one of their slots.
We really want to make sure that we are listening to them. We know what provider they need. We want to know where they're at every step of the way. So we create timelines. And we're meeting every week, sometimes twice a week. You know, I think that's the most important thing too, is that we are we're an extension of their clinical team. And it makes it so much easier to be able to work together to find those placements when it's a collaborative agreement, teamwork.
You know, I just I can't say it anymore. I've had so many programs now that we've worked with that they got accredited and now they're calling me back and hey, we're doing this now. And that worked. Or hey, I want to let that this worked for us. Or maybe this didn't work for us. You know, we talk about that too. This one. You know, maybe that wasn't exactly.
But it's really about the relationship between the programs and AMO right now that we're finding is making a huge impact on finding those clinical rotations and getting them, like you said, over the hump and to the finish line. That's what it's about.
33:02 — Summary and conclusions
Scott Massey: Absolutely. Yeah. I think that, folks the conclusions that we can take away from our discussion today is we really want to provide with the most current information about evolving, evolving standards. And my firm, MACS does webinars sometimes twice a month. And we view that as our responsibility to educate them not just our clients, but really PA programs across the country. And we are here, both Starr and I, is to give you some solutions about.
How to avoid observation, citations or even so, we already talked about the initial kind of reinforce some of these components and gave you some different perspectives, hopefully. And this is simply if you want to connect with either of us please do. And I want to say thank you so much to AMO to allow me to collaborate with this webinar. So I will go ahead and stop, share and see if there's questions from the audience.
34:25 — Q&A: virtual site visits for distant clinical sites
Starr Newman: I think there was a question in the chat, Scott, about what is a creative way to do an acceptable site visit for clinical site that is a far distance from your program. What have you had programs doing?
Scott Massey: Yeah you can do FaceTime walkthroughs. I've seen that done a lot as a matter of fact, I would say that pretty much gone are the days that clinical directors are going to every site around the country. I remember those days. But there's really no reason. You can do virtual site visits, right? Yeah.
Starr Newman: I, I remember the days to that we were required to go visit them and make sure they had the fire extinguisher attached to the wall. But yeah, you're right. I think that we are seeing more and more programs doing virtual site visits. And especially when we're developing those hubs, they can knock out 3 or 4 virtual site visits in one day. Right. As opposed to okay, I got to travel here to this side of the coast or to the other side of the coast. Yeah. You're right.
Scott Massey: The virtual visit just makes so much more sense these days. I see a lot of you still here, so either you're eating lunch or you're waiting to ask a question. So. I see people are starting to go, oh, I see the question there.
36:20 — Q&A: agreements at the site visit, the 20% buffer, portal capacity
Scott Massey: So in terms of developing programs, the program must have sufficient preceptor SCPE contracts and affiliation agreements by the time of the site visit. That is correct. Now you're welcome. Our pleasure. Thanks for coming on. Yeah. Thank you. There's a question about the 20% more consulting recommendation. It is I think you can go with does not have like 120% requirements to the standards. I think allopathic does.
But having some additional I would say some buffer is really necessary because there's always going to be some melt. And I think that's kind of the rationale behind having strategic plans that way. I see Michael does AMO help with placing for the entire clinical year or month to month if month to month, how do you accommodate needing to have capacity on the portal for the entire clinical phase? So I don't know. I'm sorry able to see that.
Starr Newman: Yeah, I see that we do help for both the entire clinical year or month to month. I'm not sure how you, how you do that on the portal, Scott. Like, how would you do that?
Scott Massey: Well, you have to demonstrate on the portal that you have full capacity for your existing clinical class. Okay. So I know that when ARC-PA does audits, if they find that there isn't sufficiency, they will contact the program and they'll give them sometimes like 21 days to fix it. So yeah. So and it's kind of it's similar if it's month to month when programs may have that one off that somebody taking one student. Right. Is that similar to that. Yeah.
38:33 — Q&A: student housing, hubs, and written vs. verbal attestations
Scott Massey: So the question is how does housing work for students if using AMO we the academic programs
Starr Newman: And the students they're responsible for their housing. But we do have coordinators that work with you, programs that may have assist you with guidance on where the student could live. But ultimately it's up to the program or the students.
Scott Massey: I've seen some programs that have used hubs that have coordinated with long extended stays, those kinds of things for discounts. And one institution actually purchased some housing for students. So there are some solutions sometimes for the hub in the hub process as well. Yeah, we I have heard that too.
Starr Newman: We had a, an academic program that bought a row of houses, and that's where they were housing all of their students near 4 or 5 sites that were actively taking students every rotation.
Scott Massey: So, so, Michael, you mentioned written attestations from preceptors regarding being able to provide learning experiences — would a verbal attestation suffice? I still believe that having a signature is and having a piece having some kind of a piece of paper of attestation is more valid than a verbal unless, unless you took a verbal and in the site visit you the when you did the site visit, you wrote down that they gave their. Basically that they would fulfill them.
But I think having them sign having something easy for them to sign, I've seen during site visits in real life, in real time, having like a document sign here. But, but the DocuSign thing. I've seen programs send that to all their preceptors and within two weeks time and gotten signatures that way. Yeah, we helped with that. Yeah.
Starr Newman: In one area, two at the university, we helped them. You know, they were lacking that and we were working with them and they were like, oh, we didn't know we needed this, or we didn't know that. They didn't have all the verbal either. So we're able to help them get that. All right.
Scott Massey: And the comment I would follow up with any verbal confirmation with an email. So like an email would say per your comment that you would provide please acknowledge receipt. So that's great. Yeah. That is good. There's questions about whether it be possible to access review
Scott Massey: A recording of this session as well. And I believe everybody does get a recording. I want to say thank you to Starr in AMO for the experience. And thank all of you for spending time with us at noon.
Starr Newman: And please don't hesitate to reach out. You know, you can reach out to either of us
Scott Massey: Or both of us or whatever you would like. Happy to answer more questions about this. Yeah. Thank you everyone. Good.