ISSUE 9

By Jim Pearson and Dr. Scott Massey

Welcome back to PA Admissions Corner, where we discuss the many issues confronting directors of PA admissions programs across the United States. Let’s continue our four-part series on common struggles facing every PA admissions department. Part 1 covered grade inflation (Issue 7), and Part 2 addressed didactic preparedness (Issue 8). Part 3 examines competition. Competition among PA programs is a major factor affecting the admissions process and only will intensify in coming years.

Why is Competition Intensifying so Quickly?

• In 2010, there were 154 PA programs.
• By 2015, there were 199.
• As of September 2020, there are 268 programs—a 26% increase in five years.
• The ARC-PA projects 53 new programs by March 2023. In less than five years, there will be about 320 programs nationwide.
• The number of new provisional applicants to the ARC-PA has continued to climb. In 2018, there were 12 new provisional applicants. There were 23 in 2019, 25 in 2020, and 23 in 2021. This trend suggests continued growth in upcoming years.

More Institutions Means Fewer Applicants Per Program

Now let’s extrapolate. The continued growth of new PA programs tells a cautionary tale about the future of admissions.

1. PA programs will be competing for applicants more arduously as the number of applicants per program begins to decline.
2. According to CASPA, the average applicant in the latest report had 7.32 designations, which results in artificial inflation of PA program application data.
3. The exponential growth in PA programs has been predominantly in smaller private institutions, evidenced by 33 of the 43 applicant programs on the ARC-PA website being small private colleges.
4. The trend toward small private colleges increases the pressure on new programs to fill classes.

Program Faculty and the New Age

Consider this: new provisional programs—which constitute 40% of all PA programs—are often under-resourced with inexperienced faculty. These new programs will be the most vulnerable to failing to meet enrollment goals in the upcoming years. In fact, faculty nationwide have a significant lack of skills in data analysis.

However, this should come as no surprise. Before the rapid PA program growth over the last decade, a program’s admissions process was more passive. PA programs adopted a watch-and-wait process as the queue filled with applicants. There were plentiful pools of applicants and it seemed like everyone had the pick of the litter. Recruitment efforts felt unnecessary. Once the admission cycle deadline passed, programs began reviewing applicants and selecting candidates for interviews. Offers were extended with the assumption that you selecting an applicant for enrollment meant they would come. Programs enjoyed a high conversion rate once their students were offered seats in the program.

PA admissions departments can no longer sit around and wait for applicants and students to matriculate into their programs. With 60+ new programs working their way through the acceptance process, competition will get tighter, and a data-driven approach to admissions is not only desirable; it’s now a prerequisite.

Data-Driven Admissions

Our specialty. Programs must now adopt a more data-driven approach to selecting students more likely to attend their program, so we developed the PA Admissions Pre-Enrollment Risk Modeling Program. Our program was specifically designed to evaluate dozens of different data points within the application, interview, and post-interview admissions process. The goal is to provide help in recruiting, retaining, and graduating PA students who aligned with each program’s individual mission, while reducing attrition and remediation rates.

Here are just a few things we have learned when it comes to competition among PA programs to fill their cohorts with a decreasing share of the applicant pool:

• Specific data metrics must be assessed to identify ideal candidates, and these metrics are not uniform across programs. Programs have reasons why certain applicants shine brighter than others.
• Data metrics are important to determine at-risk remediation issues before enrollment (PA Admissions Corner Issue 4 details how to spot and quantify red-flag behaviors during the interview process).
• Undergraduate GPA is not a strong indicator of student success in PA education, and the weight it is given in decision-making must be balanced with other considerations.
• PA admissions directors must know the answers to these questions:
  • How is your current admission data ranked?
  • What is the reason for this ranking? Why is it done this way?”
  • How do you currently capture and evaluate your admissions data?

Competition Within Certain Geographic Areas

Your PA program’s geographic location and the competing PA programs within 150-250 miles (on average) of your institution is an important factor in how your applicants view and rank your program. Some areas of the country have a higher concentration of PA programs than others, usually leading to increased competition for the applicant pool in that region.

According to the 2020 PAEA curriculum report, there are:

• 48 programs in the Northeastern United States
• 51 programs in the South Atlantic States
• 36 programs in the Midwest
• 15 programs in the East South-Central United States
• 17 programs in the West South-Central United States
• 15 programs in the Mountain West State and
• 20 programs in the Pacific Region States.

In each of these regions, there are PA programs that have a superior reputation to their competition. This doesn’t equate to these better-regarded PA programs doing a better job of teaching and graduating their students, it’s the marketplace’s external perception. It may not be correct or fair, but you must accept it and tailor your admissions practices to it to better maintain the competitiveness of your PA program’s admissions department.

Why One Program Wins Over Another

From a competitive perspective, what could cause an applicant to choose another PA program over yours? There are many variables to consider:

• Tuition. According to the 35th PAEA annual report, 58 public universities reported that the mean tuition was $52,585. 154 private institutions reported that the mean tuition was $95,058. Cost can be a consideration for applicants when considering offers from private institutions versus public. This necessitates effective recruiting and outreach strategies to enhance conversion rates.
• Matriculation speed. A student may be able to matriculate faster at a competitor’s program.
• Interview/Acceptance speed. Students may be interviewed more quickly by another program, or they may receive an acceptance letter from another program sooner. If your program uses a fixed admission process, you may be waiting far too long to select students for interviews or inform them that they are accepted into your program. Converting from a fixed to a rolling process can decrease that time span and increase conversion rates. (PA Admissions Corner Issue 3 comprehensively covers admissions cycles.)
• Reputation. Your competitor’s reputation may be perceived as better, but improving your customer service and increasing your admission department’s focus to its ideal candidates can dramatically raise your reputation.
• Available jobs. Your competitor’s region or city may have more healthcare employment opportunities.
• Proximity to home. Your competitor may be closer to home for your candidate. A factor that strongly determines your ideal candidate is whether they live within 150 miles of your campus.
• Applicant preference. Your competitor’s location may be a “destination” area for young people. The idea of moving to a big city could sound more exciting to some, but a smaller-town environment has its own appeal.

Some of these considerations are outside of your control, but not all of them. It is important to exercise what control you have and emphasize what is different about your program and how that can be highly desirable to certain applicants.

NEXT TIME…
In the next Issue of PA Admissions Corner, we finish our four-part series on Struggles in Admissions Practices across the United States. Continuing the discussion on competition between your program and others, there are 11 relevant questions to ask yourself. How will you interpret the answers to refocus your admissions practices and rethink the way you interact with your applicants?

To your admissions and program success,

Jim Pearson, CEO
Exam Master

Dr. Scott Massey Ph.D., PA-C
Scott Massey LLC

If you are in need of admissions support and services for your PA program, we can help.

Jim Pearson and Dr. Scott Massey have helped hundreds of educational institutions and programs improve their admissions outcomes.

Exam Master supports Physician Assistant Educational Institutions with the following services:

• Admissions Support Services
• Student Progression Services
• Data Services
• Accreditation Services
• Board Services

Learn more about Exam Master’s products and services and how we support PA education by reaching out to [email protected]

ISSUE 8

By Jim Pearson and Dr. Scott Massey

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 gave 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. Whereas Clinical learning occurs in a laboratory or field setting where students are actively engaged in a process. And 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 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 graduate health education like 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 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 six to eight weeks, with no breaks between.

Among the hundreds of PA program directors we have interviewed through the years, 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 who require extensive remediation support, and unfortunately students who you must dismiss from the program, causing attrition issues for you and your administration.

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 strong upper-level 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 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 writ large 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 and program success,

Jim Pearson, CEO
Exam Master

Dr. Scott Massey Ph.D., PA-C
Scott Massey LLC

ISSUE 7

By Jim Pearson and Dr. Scott Massey

Welcome back to PA Admissions Corner. Last time, we took a look at statistics regarding the physician assistant education industry. We provided some insights into the nature of the applicant pool and where your PA program fits into the bigger picture.

In that issue, we touched on applicants’ average non-science and science GPA. Of course, GPA is one of the primary metrics used in accepting or rejecting applications.

With the average PA applicant GPA at 3.5 (non-science) and 3.3 (science), many of your applicants are certain to have some impressively high numbers, leading your admissions committee to believe that these bright bulbs have studied hard and worked diligently to achieve what few others could. Unless, of course, they have been the beneficiary of grade inflation. Grading is a relative measurement, subject to plenty of tampering and interpretation from those doing the measuring.

What is Grade Inflation?

Grade inflation has become a major concern over the last decade or so in undergraduate education. It means exactly what it implies: that better grades are being handed out overall, not because students are getting smarter but because schools and teachers are expecting less. Unfortunately, a large percentage of undergraduate institutions grant their students high grades (3.4 GPA and higher) in individual courses even if the competency level of many of these students does not accurately reflect that high grade.

For example, a Forbes article published October 30, 2019 cites evidence of a crisis level of grade inflation among colleges and universities: “In the early 1960s 15% of all college grades nationwide were A’s. Unfortunately, as of 2019 now 45% of all grades awarded by colleges in the United States are A’s.”

In a paper published in 2014 by the Center for Higher Education (“Combating the Other Inflation: Arresting the cancer of college grade inflation”), there were several key points raised about the impact of this alarming development. Conclusions drawn from the article include:

1. Differences in grading practices between instructors cause biases in student evaluations of teaching.
2. Student evaluations of teaching are not reliable indicators of teaching effectiveness and account for only a small proportion of the variance in student learning from student to student and course to course.
3. Higher grade distributions cannot be associated with higher levels of student achievement.
4. Differences in grading practices have a substantial impact on student enrollments and cause fewer students to enroll in fields that grade more stringently.
5. Grading practices differ systematically

This phenomenon of inflated grades for undergraduate students has been demonstrated in public and private institutions alike. Even highly selective elite colleges like Dartmouth have demonstrated an increase in overall GPA in undergraduates from 3.04 to 3.25 over the past decade.

Causes of Grade Inflation

Grades are theoretically meant to represent a bell curve of student performance. A, C is an average grade, a B or A roughly approximates one or two standard deviations up from that average, and a D or F should be around one or two standard deviations down. In that bell curve, most students would earn a C grade, a few would earn a B or D. An A or an F would theoretically only be earned by students who significantly overperformed or significantly underperformed relative to the class. Classes of human beings don’t conform perfectly to a bell curve, however, as theory is only theory and reality is something else.

Yet, at some point in undergraduate education, it was decided that an “average” grade was unacceptable. It seems that now, a C looks like failure, a B implies a lack of initiative, and As are often what students expect—and earn—for meeting a course’s minimum demands. There are multiple reasons for grade inflation, none of which seem to stand alone:

1. Parents assume across the board that their children must go to a 4-year university or success will elude them, and universities demand good GPAs. With this perceived requirement, students and their parents are seen as customers of the school rather than seekers of knowledge.
2. Schools compete with each other and tout their value by boasting their students’ excellent grades, applying pressure to ensure those grades stay high.
3. Departments of education arbitrarily raise standards or re-brand grades without changing the educational program. Performance that used to warrant a C now warrants a B. This might benefit departments where funding relies on student performance, but it has no benefits for anyone wishing to use those grades as a reliable measure of competence.
4. Teachers who are characterized as “hard graders” can be stereotyped as unfeeling and even cruel to their students. A bad grade is considered discouraging, as if the student doesn’t even have a fighting chance to succeed. But the concept of a “hard grader” is subjective and changing. To the schools, the “hard grader” is now the one who doesn’t pass all of their students; to the parents and students, the “hard grader” is the one who didn’t assign the desired grade.
5. Teachers give out better grades, often unconsciously, if they feel that they are teaching outside their expertise or if they are working in a disorganized program. They will bump grades up just to give students the benefit of the doubt or to compensate for a bad system.

The various reasons for grade inflation raise legitimate concerns about equivalency of student knowledge in basic sciences, which are intrinsically important subjects to incoming PA students. As PA program directors, can we really trust that A-grades in the basic sciences represent a student’s true competency? Unfortunately, we can’t.

Research in PA education has demonstrated that science GPA has little use in predicting student success, further indicating that a comprehensive holistic data-based admissions process is essential.

GPA Breakdown

Grade Inflation raises major questions about the role of GPA in the selection of PA students. There are several ways to look at an applicant’s GPAs. By specifying which grades, courses, or time periods matter more, we can get a better idea of where our applicants show their strengths.

GPA — A numerical value calculating the grade-point-average (GPA) for an individual student over a period of time that is usually classified in years or clock hours

GPA CASPA Science — The numerical value listed within the CASPA application system, which calculates only a student’s science-based undergraduate course GPA

GPA Last 60-Clock Hours — The numerical value that calculates the GPA of the student’s last 60 clock hours of their undergraduate education. This allows students to overcome a less-than-stellar freshman year, for example.

Your program may require a minimum GPA or science GPA for applications to be considered. But we discovered in our work with PA programs that most ideal candidates do not have “perfect” or even excessively high GPAs; they are more likely to have overall and science GPAs in the 3.3-3.5 range, and these are hardly the only components for success.

These traits are just as indicative of success:

• The student held a job throughout their undergraduate education.
• The applicant has overcome adversity.

And that’s not all – predictors of success can be as simple, and uncontrollable, as these:

• The student is 23 to 30 years old.
• The student lives within 150 miles of your PA program.

What to do About Grade Inflation?

The first and best way to deflect the perils of grade inflation is to be aware that it exists. Look at your PA program and ask if your admissions process relies too heavily on GPA as a potential measure of success. Adjusting your admissions rubric to account for more of the things that are really important to success will allow your program to pinpoint, interview, and accept applicants based on real-world knowledge and experience instead of subjective numbers alone.

NEXT TIME…
In the next Issue of PA Admissions Corner, we’ll continue our four-part series on Struggles in Admissions Practices by examining the lack of applicants’ didactic preparedness. What do we do when we find our applicants unprepared for the realities of a medical education? We’ll talk about how to avoid accepting students who are unable to handle the rigors of our program and help those students who need it.

To your admissions and program success,

Jim Pearson, CEO
Exam Master

Dr. Scott Massey Ph.D., PA-C
Scott Massey LLC

If you are in need of admissions support and services for your PA program, we can help.

Jim Pearson and Dr. Scott Massey have helped hundreds of educational institutions and programs improve their admissions outcomes.

Exam Master supports Physician Assistant Educational Institutions with the following services:

• Admissions Support Services
• Student Progression Services
• Data Services
• Accreditation Services
• Board Services

Learn more about Exam Master’s products and services and how we support PA education by reaching out to [email protected]