1 Introduction – a shortage of PA educators

The PA profession, created to address a shortage of medical providers in the United States, has become an indispensable part of medical practice. Thousands of PAs now matriculate into 309 programs across the US annually, according to The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) [1]. With this growth comes a new shortage of qualified educators to meet the training demand [2]. As of this writing (June 2024), there were 113 faculty job postings at paeaonline.org, a popular PA faculty recruiting job site, with others likely available but listed elsewhere [3]. Undoubtedly, these PA programs would prefer hiring well-trained faculty with a wealth of classroom experience. The reality is, based on data from the Physician Assistant Education Association (PAEA), that about 80 percent of new faculty come from clinical practice, and almost half of all PA educators have less than five years in academia, and the majority come with no academic training [2, 4]. Most will find this new career to have a significant learning curve. There is no uniform, expected pathway for PAs wanting to transition into academia. However, several institutions have developed formalized training opportunities in recent years, and most of these are full-time employment opportunities or are offered in addition to the participant’s existing full-time employment obligations [5,6,7,8].

1.1 The RMUoHP academic residency

Without a uniform or expected training model, several academic institutions have created different models to provide new faculty with the teaching knowledge and skills necessary for an academic career. Particularly important, educational methodology has changed and will continue to change; thus, knowledge of best practices in teaching and learning is vital [6]. Rocky Mountain University of Health Professions (RMUoHP) was one of these institutions. In 2017, the faculty of the PA program at RMUoHP created a structured academic residency program to assist with recruitment and create a pathway for PA educators. The program includes post-graduate didactic courses and practical application in classroom and lab experiences. A Residency Coordinator was designated to work with the Director of Didactic Education to oversee the residency program. This program trains and mentors new education professionals in the principles and practices of academic teaching, scholarship, and service. The overarching goal is to prepare new PA educators for principal faculty roles in ARC-PA accredited programs [Table 1].

Table 1 RMUoHP PA Academic Residency Outcomes
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1.2 Method – a part-time solution to a full-time problem

The initial idea was to establish a one-year, full-time academic appointment for an academic resident. However, due to cost constraints, this idea could not gain a foothold with the university administration. This type of difficulty was also met by earlier training programs. Herrick et al., evaluating those programs, suggested that more condensed, shorter training programs might overcome financial barriers [9]. However, they did not appear to consider the option of part-time work. RMUoHP’s administration was amenable to a part-time option. It was determined that the training program's outcomes could be met with the resident working one day per week (0.2 FTE), though those hours could be worked in a variety of combinations throughout the week Table 1.

1.3 Residency prerequisites

The minimum requirements for prospective residents include graduation from an ARC-PA accredited PA program and clinical experience as a Physician Assistant with current NCCPA certification and Utah licensure. Prior teaching experience is optional. Because of the nature of the work required, applicants should have enough flexibility in their clinical and personal schedules to meet the minimum logistical requirements of the residency program. As such, most successful applicants will reside near the university campus in Provo, Utah.

1.4 Results – RMUoHP residency: first semester

In the first semester, the resident enrolls in two online courses of a postgraduate certificate in Health Professions Education (HPE): Instructional Technology: Design, Theory, & Application, and Learning Theory & Design (Table 2). The rest of the semester is spent in teaching activities and serving on the Program Admissions Committee. Teaching expectations in the first semester are modest because of the didactic demands on the resident. The resident begins developing a teaching portfolio, writes a teaching philosophy, prepares at least two to four classroom lessons to teach, facilitates at least two to four small group activities, and assists with several labs. Admissions committee duties vary but include application review and scoring, interviewing candidates, and assisting in final admission decisions. The resident is also expected to submit a proposal for a podium or poster presentation for a professional conference, just as most post-graduate academic training programs also require [9].

Table 2 RMUoHP Health Professions Education Certificate
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1.5 RMUoHP residency: second semester

The resident enrolls in an online Learning Assessment and Evaluation class in the second semester. Expectations for teaching increase during this time with at least four to six lessons assigned, a minimum of two to four small group activities, assisting in lab experiences, and serving on the Program Curriculum Committee. If accepted, the podium or poster presentation proposed in the first semester may occur during this semester.

1.6 RMUoHP residency: third semester

In the final semester, the resident will choose between two classes depending on a desired focus: Curriculum Design for Healthcare Professions or Clinical Education Experiential Design & Application for Healthcare Professions. The teaching expectations for this semester are a minimum of four to six assigned lessons, two to four small group activities, assisting in labs, and serving on the Program Review Committee (charged with ARC-PA standards compliance and program policy management). During this semester, the resident also serves as an assistant course director for a course determined by the Residency Coordinator and Director of Didactic Education. In this capacity, they work with the course director to analyze and refine the course design. If not completed earlier, the podium or poster presentation proposed in the first semester will occur during this semester.

2 Discussion

The university continues to support the residency, and this institutional support has been helpful in the success of the program. Those who have completed the residency at RMUoHP have gone on to become full-time principal PA faculty, part-time faculty, adjunct faculty, and clinical preceptors. Additionally, some residents have completed a Doctorate of Medical Science (DMSc). These observed results match the experience of other post-graduate training programs [9]. The didactic coursework of the residency is included in and will transfer to fulfill credits in RMUoHP’s DMSc program, with a concentration in Healthcare Professions Education.

While RMUoHP has the benefit of offering graduate healthcare certificates and graduate degrees to any healthcare professional, the structured format and dedicated space for an academic resident within the PA program have successfully introduced more clinically practicing PAs to PA education. This strategy is something that many PA programs could likely implement, with or without didactic coursework, although it does provide an added benefit.

The low cost of the program to the university, combined with the extra faculty help each week, has resulted in a perceived positive net return on investment, anecdotally speaking. Given the difficulties other programs have faced trying to fund full-time positions, this is a strong point in favor of the part-time model [9]. Despite rounds of cost-cutting, which seems to be the common lot of education programs from time to time, this position has always been preserved. This aspect of the program is more difficult to measure but merits mention [2].

As previously discussed, most new faculty are drawn from practicing clinicians. Sadly, the data indicate that about a quarter of new faculty eventually return to clinical practice for one reason or another [2]. For the RMUoHP academic residents, this part-time yet structured introduction to academics provides a low-risk exploration of this potential career shift without leaving clinical practice.

3 Conclusion – from resident to principal faculty

After completing the residency program, the resident’s teaching portfolio is finalized with additional student evaluation data, updated curriculum vitae, transcripts from the university, a certificate of completion of the HPE certificate, a certificate of residency completion with the university seal, and a letter summarizing the accomplishments of the resident during their appointment. These items, together with the resident’s teaching philosophy and the lessons developed by the resident, are strong evidence of the achievement of program outcomes and the instructor's readiness for a Principal Faculty position in an ARC-PA accredited Physician Assistant/Associate program.

While acknowledging the challenges of building an effective faculty team, we present this part-time approach to training clinician colleagues considering an academic career. Anecdotally, it has been effective for our team as a part of our overall recruitment and retention strategy, and we recommend it as a low-cost, high-yield solution with minimal barriers for other programs to consider.