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Struggles in Admissions Practices Part 2: Didactic Preparedness

Welcome back to PA Admissions Corner. Last time, we delved into the troublesome trend of grade inflation, how it can adversely affect your program, and how to reduce its impact on your applicant selection.
In this issue, we continue the series on Struggles in Admissions by looking at didactic preparedness, that is, the general lack of didactic preparedness among applicants. Your program and others like it welcome new students each year who boast high GPAs and give great interviews. When faced with the real rigors of a PA program, however, these students may falter. Why does this happen? How can we prepare ourselves and our students to avoid or diminish this distressing development? 
What is Didactic Preparedness? 
There are several types of learning which occurs in a laboratory or field setting where students are actively engaged in a process. Didactic preparedness, on the other hand, is a question of an individual’s ability to learn in a classroom setting where:
  • Knowledge is imparted by an instructor in a lecture format.
  • Students are expected to absorb that knowledge.
  • Students are expected to considerably supplement that knowledge with reading and study outside of the classroom (sometimes as much as 80%).
  • Students are expected to remember to apply, synthesize, and interpret that knowledge, especially in the face of novel situations and problems.
Students who excelled in high school settings are still prone to struggling in a college environment. High school learning sometimes only requires regurgitating facts, most of which were presented in the classroom. College-level courses usually require unguided study and expect incorporating facts into new scenarios; students who were never taught how to study on their own or apply their knowledge to new situations must “re-learn” their learning process if they want to succeed.
Moving from undergraduate-level education into a PA program reapplies the same pressure, and the learning process must adapt to an even stricter regimen. Sometimes, even the strongest didactically prepared incoming students are not adequately prepared for the rigors of they will face in the 11- to 13-month portion of their didactic education in PA school. Instead, they are accustomed to taking four or five courses every semester over a period of about 3.5 months, often with significant breaks between semesters. Now, they are in individual masters-level courses (with usually no upfront prep or review) over an intensely focused four to eight weeks, with no breaks between. 
Among the hundreds of PA program directors we have interviewed, we rarely heard anyone say they had worry-free cohorts of excellent students year after year. They invariably encounter well-meaning and motivated students who are quite simply “in over their heads.” What can they do? 
Letting students deal with the problem on their own—the “sink or swim” approach—may work for the more resilient among them, but it sours the experience for others. The result is defeatism and real problems for your program: students you must dismiss from the program or increased attrition— causing others to outright quit from hopelessness.
Why Do PA Students Struggle with Didactic Education?
Unfortunately, there is a general lack of prerequisite didactic preparedness from most of your applicants’ undergraduate programs. Most of those same hundreds of PA program directors say their enrolled students primarily struggle with anatomy and physiology  early on. Grade inflation is often responsible for these misaligned expectations. These struggling students often fail to grasp the key concepts that enable them to connect the dots instead of just regurgitating scientific and medical facts. 

The data we analyzed from dozens of PA programs shows significant evidence that PA students’ undergraduate academic grades fail to correlate sufficiently with performance in the didactic portion the PA curriculum. Research done at the PA program level has demonstrated no statistically significant relationship between prerequisite science GPA and student performance in the PA program. Without any such relationship, PA programs are left with one less predictor of future performance. 
What Can My PA Program Do about It?
Aside from letting students sink or swim, you and your program have options to minimize the impact for students lacking didactic preparedness.
  1. Know that it happens. Take another look at our deductions from Issue 7, in which we discussed the problem of grade inflation. We emphasized the need for your admissions program to acknowledge that factors other than GPA should be used in choosing qualified applicants. Students with healthcare backgrounds, for example, have probably already learned how to apply one type of knowledge to multiple situations. Taking that skill into the classroom is a natural progression for them. Awareness of these problems (grade inflation, lack of didactic preparedness) and knowing that successful students aren’t always those with stellar GPAs goes a long way toward ensuring that your chosen applicants are better prepared to succeed.
  2. Set proper expectations. There is no need to be vague or cagey about your program. Orientations, Q&A sessions, and information on your website can assure prospective applicants about what they’re getting into. Let students know what course requirements will be like. Give them reading lists. Inform them that a strong background in certain subjects (anatomy, physiology) and the ability to apply and interpret that knowledge will  significantly benefit them in their studies. Provide blogs or articles on your website: “Five Things Instructors Want Students to Know Before Entering the Classroom”—Clickbait headlines work! A better-informed student is a better-prepared student.
  3. Incorporate academic remediation procedures. Regardless of the reason for needing remediation, support for the students who do need it is necessary and cannot be taken lightly. Incorporating best practices in academic remediation should be integral  to your PA program’s admissions process. You spend critical time and energy to select the students that you believe are the best fit for your program, but some students are still not as well equipped to handle the rapid pace of the professional program as you would like. The ability to identify which students may struggle is challenging in the best case given that the lack of a strong predictor of future success continues to confound PA program directors and faculty nationwide.

    PA programs seeking to enhance diversity and inclusion may also choose to admit more disadvantaged students or those who are burdened by academic risk factors. The risk can be mitigated by incorporating a comprehensive, integrated, and protocol-driven remediation process to readily identify students early who may require additional assistance. Consideration should be given to a pre-matriculation program to provide additional basic science foundation for students identified as at-risk.

    PA programs in general need more expertise providing early remediation for their students. Most graduate health science programs are neither designed nor equipped to remediate more than a handful of students each semester, and most PA faculty are not trained to provide the critical early intervention to students who struggle academically. With some faculty training and standardization, however, an early intervention program can be implemented in your program. We will cover this topic more thoroughly in an upcoming Issue of PA Admissions Corner.
Tackling Didactic Preparedness
We believe in the power of preparedness for PA programs and for their students. Enhance your admissions procedures to focus on experiences and traits that support didactic preparedness. Provide applicants with thorough knowledge of what will be expected of them. Engage proven academic remediation procedures that will solve preparedness issues before they become serious problems. By implementing these steps, you will increase the quality of your program’s graduates and their positive experience within your program.
Next time…
In the next Issue of PA Admissions Corner, we continue our four-part series on Struggles in Admissions Practices by examining the competition among PA programs all vying for the top applicants. Regardless of how you stack up to the competition, you can learn to identify qualified candidates who fit your program’s strengths and can accept its weaknesses.
To Your Admissions Success,
Dr. Scott Massey, PhD, PA-C
Jim Pearson, CEO Exam Master
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