PA Program Accreditation FAQ

How does the temporary status of probation affect the MGH Institute’s PA program?

The MGH Institute’s Physician Assistant program remains accredited during the temporary status of probation. During this time, Institute PA students are able to fulfill requirements for program completion, graduation, and transition to practice, including placement at clinical rotation sites, sit for the national certification exam (PANCE), become licensed and credentialed, and practice medicine in the specialty of their choice. Every effort is being made by the Institute and the program to ensure full compliance with the accreditation standards set forth by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). We are committed to empowering students to go on to successful careers as physician assistants by selecting highly qualified applicants from diverse backgrounds, providing an outstanding education in clinical medicine using a team-based learning approach, and engaging students in unique interprofessional educational experiences.

Why was the MGH Institute’s PA program placed on probation?

Accreditation-Probation is a temporary status of accreditation, limited to two years, designated when the accrediting body determines that a program does not meet some of the required standards. The ARC-PA determined the program was not in compliance with a total of 10 standards. Below are the ARC-PA’s citations and concerns, as well as the program’s response to those concerns.

1. ARC-PA Citation/Concern: At the time of the site visit, the program was not able to provide evidence that the curriculum included instruction regarding credentialing (Standard B2.14) and the PA professional organizations (Standard B2.17).

Program response: At the time of the site visit, the program was able to demonstrate that students participated in in-class activities related to the four professional organizations (AAPA, PAEA, NCCPA, and ARC-PA) in PA720, The PA Profession, and were provided with information related to credentialing prior to beginning clerkships (PA800, Preparation for Clerkship). However, the course syllabi did not list learning objectives for these topics. The program has corrected this by incorporating learning objectives regarding credentialing and the PA professional organizations into academic year 2019-2020 syllabi.

2. ARC-PA Citation/Concern: Supervised clinical practice experiences should occur with preceptors practicing in family medicine (Standard B3.07a) and general surgery (Standard B3.07c). In the program’s application and at the time of the site visit, the program indicated there are a limited number of traditional family medicine practitioners and practices in the Boston metropolitan area and that Boston surgical settings have a focus on highly specialized care. The program acknowledged that students may be assigned to an internal medicine or medicine/pediatric rotation for their family medicine rotation and may be assigned to rotations in general surgery departments as well as surgical specialties for their general surgery rotation. It is the program’s responsibility to meet the standard or, in the case of a “should” standard, detail a compelling reason it could not. In the program’s application and at the time of the site visit, the program failed to present a compelling reason, acceptable to the commission, for use of preceptors who are not practicing in the disciplines of family medicine and general surgery.

Program response: The program has increased clinical education placements with board-certified family physicians or PAs working with board-certified family physicians with each subsequent clinical year (Clinical year 2016: 70% traditional placements, 30% IM/pediatric placements; Clinical year 2019: 84% traditional FM placements, 16% IM/pediatric placements) with a goal for all students to be placed in traditional family medicine settings for their family medicine rotation by clinical year 2020-2021. The program continues to ensure that the students not participating in a traditional family practice experience are exposed to a wide array of preventive, chronic, and acute visits with patients across the lifespan.

The program has increased placements in traditional general surgery practices or departments with each subsequent clinical year (Clinical year 2016: 40% traditional placements, 60% surgical specialty placements; Clinical year 2019: 78% traditional placements, 22% surgical specialty placements) with a goal for all students to be placed in traditional general surgery settings for their general surgery rotation by clinical year 2020-2021. The program continues to ensure that the students placed in a surgical specialty for their general surgery rotation participate in the care of patients in the pre-operative, intra-operative, and post-operative setting. Those students who are placed in a surgical specialty and their preceptors in primary care and emergency settings are encouraged to seek out experiences with patients presenting with common operative conditions seen in a general surgery practice, such as appendicitis and cholecystitis. 

3. ARC-PA Citation/Concern: There were six citations regarding supervised clinical practice experiences, specifically related to the program’s learning outcomes expected of students (Standards B3.02 and B3.03a-d). The ARC cited the following specific concerns related to the program’s compliance with these standards:

1) having inconsistent Likert scales on the preceptor evaluations and

2) failing to address how it will assess student achievement of competencies if the preceptor rated the student as “not observed” or “unable to perform” for the following standards:

a) preventive, emergent, acute, and chronic patient conditions (Standard B3.02)

b) medical care across the life span to include infants, children, adolescents, adults, and the elderly (Standard B3.03a)

c) women’s health (to include prenatal and gynecological care) (Standard B3.03b)

d) care for conditions requiring surgical management, including pre-operative, intra-operative, and post-operative care (Standard B3.03c)

e) care for behavioral and mental health conditions (Standard B3.03d)

Program response:

1) The preceptor evaluations presented to the ARC-PA had an inconsistency in the Likert scale. Each discipline-specific evaluation showed a 1 to 5 Likert scale at the top of the page, but in the individual learning outcomes, the rating was listed as 1 to 4. The program identified this inconsistency in the preceptor evaluation rating scales and corrected the error at the beginning of the 2019 clinical year prior to implementing their use by preceptors.

2) The program longitudinally tracks student acquisition of program expected learning outcomes on an Excel spreadsheet. Preceptors must verify that they have observed and rated the student demonstrating acquisition of all skills noted on the preceptor evaluation forms. Preceptor evaluations are monitored at the conclusion of each clerkship session to ensure progress and completion of these requirements. For students who receive a “not observed” or “unable to perform” in required learning outcomes, the clinical team identifies and assigns future clerkships where the program can be certain the experience will be available to the student based on previous data collected regarding the site and/or conversations with the preceptor.

4. ARC-PA Citation/Concern: The ARC-PA noted that certain aspects of the clinical year assessments did not align with the program’s learning outcomes for a) preventive, emergent, acute, and chronic patient conditions (Standard B3.02) and b) medical care across the life span to include infants, children, adolescents, adults, and the elderly (Standard B3.03a). Each of the seven discipline-specific preceptor evaluations included assessments of the above skills, but some of the discipline-specific syllabi did not have learning outcomes related to those skills. For example, the pediatric clerkship syllabus does not include a learning outcome related to managing emergent patient encounters, but the preceptor evaluation has an assessment related to the student’s ability to manage emergent encounters. Likewise, the emergency medicine syllabus does not have learning outcomes related to caring for patients across the life span but asks preceptors to evaluate students on their interactions with infants, children, adolescents, adults, and the elderly.

Program response: Preceptor evaluations are used by the program, in conjunction with the student logs, to verify experiences available at each site as well as to track student acquisition of expected learning outcomes. This tracking aids in identifying sites where students are likely to be exposed to the patient encounters necessary for them to meet the program’s expected learning outcomes should they not have that opportunity in the rotation where the learning outcome is specified in the syllabus. For example, should a student receive a “not observed” for care of adolescent patients in their pediatric clerkship and the student’s emergency medicine preceptor observes the student in an encounter with an adolescent patient, the program has documentation of successful acquisition of this skill on the emergency medicine preceptor evaluation. Additionally, the program can use this data to track the availability of adolescent encounters at this particular pediatric site.

5. ARC-PA Citation/Concern: The ARC-PA citation related to Standard B3.02 (preventive, emergent, acute, and chronic patient conditions) also noted the following: While the revised learning outcomes provide evidence of learning outcomes related to preventive, acute, and emergent patient encounters, there was no evidence of learning outcomes related to chronic patient encounters.

Program response: In the revised internal medicine syllabus, the program used the terms “multiple co-morbid conditions” but did not specifically mention chronic patient conditions. This will be corrected in future iterations of the internal medicine syllabus.

6. ARC-PA Citation/Concern: Finally, the ARC-PA cited the sponsoring institution for not supporting the faculty in curricular planning (Standard A1.03c) related to the above issues noted with the clinical year learning outcomes and preceptor evaluations.

Program response: The process of revising and refining the clinical year syllabi and preceptor evaluations to comply with accreditation standards has been ongoing since the program’s provisional monitoring visit in April 2017. The most recent revision was rejected by the ARC-PA as not meeting the standards based on the issues noted above. The IHP has an array of resources available to programs and faculty related to curricular planning. Throughout this process, the program director has engaged the services of both in-house instructional designers and external consultants. The program will use the guidance of the IHP leadership, and the information provided in the recent ARC-PA citations to ensure these lingering issues related to clinical year learning outcomes and assessments are addressed to bring the program into full compliance with Standards B3.02 and B3.03a-d. 

What is the deadline for resolving these citations and when will the program be considered for transition to continuing accreditation?

The program has several deadlines across the next two years to address the above concerns and will be on the agenda for the ARC-PA’s June 2021 meeting for consideration of transition to continuing accreditation.