March 2008
PAEA Networker

Vision, Leadership, and Curricular Change — Musings of a Past President

Anita Duhl Glicken, MSW
Past President

More than 10 years agoand three months before he was diagnosed with terminal cancerDr. Henry Silver and I stood in an old corridor of the University of Colorado School of Medicine deeply engaged in what was a frequent topic of conversation: the future of PA practice and education. Henry stopped abruptly mid-sentence: “Why don’t we share an office?” he said. “Some of my best ideas have come from taking the time to vision with others. Sharing an office, it will be easier to spend a part of each day reflecting about the future.”

In this way, Henry introduced me to the importance of taking time to think about tomorrow, no matter how entrenched we are in the work of today. Understanding the future gives meaning to the work we do today, just as our work today helps define what we do in the future. In this column I invite you to take some time with me to dream about the future. Although the vision isn’t totally clear, within these musings lays a defining leadership role for PA educators as change agents in curricular innovation and in our practices.

Global Health
In the past several years, interest in the PA profession has grown exponentially. Fifteen international guests accepted an invitation to attend the PAEA Annual Education Forum last October. Much like Henry Silver, Dick Smith, and Eugene Stead, these individuals are pioneers, attempting to institutionalize the PA profession in their own countries to improve patient access to quality care. PAEA and its member programs have an important role to play in promoting global partnerships for PA education. This will ensure that we will continue to grow as a profession and learn not only about those things we are doing well but also about those things we might change as we move toward addressing the medical challenges of a global health care community.

Interprofessional Education and Practice
Several recent reports have noted the importance of interprofessional education and practice in promoting patient safety and quality care. As partners in medical education, PA faculty need to be ready to embrace efforts that promote these concepts as opportunities present themselves at their institutions and in their communities. Changing the way health care professionals are educated is a key to implementing change in practice. Interprofessional practice requires sharing, partnership, interdependency, and a distribution of power. Strengthening the collaboration between health care professions and patients through these characteristics implies that the roles and responsibilities of health care providers are evolving; an evolution that is critically important if we are to create a health care system that is truly responsive to the needs of patients and communities. Collaborative patient-centered practice has been the core of PA education since its inception, and PA educators are positioned to lead this change nationally and at their own institutions. 

Complementary and Alternative Medicine
Research documents that more than 80 percent of patients use some form of complementary medicine, yet less than 35 percent bring these treatments up with their mainstream health care providers. Traditional allopathic medical schools have been slow to adopt an integrative medical approach to education and patient care, in part due to the historical structure of their curriculum and a lack of buy-in from primary faculty. In contrast, PA programs have historically been responsive to changes in the practice environment (i.e., the integration of evidence-based medicine into our curriculum in the mid-1990s) and as a result, can incorporate new information as it becomes available for this important delivery model. Building on a strong foundation of evidence-based practice, PA educators can help their students understand the potential benefit of alternative and complementary treatments currently described in anecdotal case studies or scientific literature, while at the same time paying particular attention to those treatments that might prove harmful or dangerous.

Over the past year we have seen a dramatic increase in the number of discoveries filtering down to clinical practice from basic science research on the human genome. This “translational” research has a tremendous potential to change not only the way we practice medicine, but the basic science upon which we frame our clinical judgments. As noted by Dr. Francis Collins, director of the National Human Genome Research Institute, PAs have an exciting role to play in the future of medicine. Our abbreviated training provides us with the distinct opportunity to quickly transfer this translational research to clinical practice and promote our students as change agents in the health care arena. Programs that have the ability to quickly integrate new knowledge and information across their didactic and clinical curricula will find themselves best equipped to take on leadership roles in this emerging field.

Shifting needs in patient care, societal changes, advances in education, knowledge, technology, and science all require constant evolution in our PA program curriculum. So how do we get there? It’s not enough to merely envision a different future. As many great leaders in our profession have shown us, changing our curriculum requires the dedicated efforts of multiple change agents as well as cooperation from our administrations, faculty, and students. Multiple authors who have described successful curricular change in educational programs note the importance of a process of planning, implementing, and institutionalizing their efforts. Interestingly, the most common feature of programs demonstrating successful curricular change appears to be visionary leadership. And although leadership repeatedly appears in articles about successful curricular change as a necessary element, by itself it is not sufficient.

Defining a new vision ― or curriculum ― is a collaborative process that links the program’s shared educational outcomes to institutional and professional goals. Successful changes in our program curriculum are also based on selecting the innovations and implementation strategies that fit our programs’ varied missions and goals. The diversity of PA educational programs, based on shared standards of quality, provides a rich resource with which to continue the important task of building a culture to support educational innovation and change ― a culture that will ensure that the PA profession remains responsive to changing societal needs and a strong leader in medical education. Just imagine what we might accomplish together, if we were to take a few moments each day, either alone or with others, to dream about the future.