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What is Duke’s physician assistant program looking for in applicants? [Show summary]
April Stouder, Associate Program Director and Chair of the Admissions Committee for Duke’s PA program, explores what’s unique about this top-ranked program and what applicants can do to be competitive.
A focus on primary care makes Duke’s PA program unique [Show notes]
Are you preparing to become a PA, or even just considering the field? Are you wondering how to apply successfully? Our guest today is the Associate Program Director at the first US PA program, and she’s going to tell you all about it.
April Stouder earned her bachelor’s at Manchester College and her master’s of Health Science in Duke University’s PA program in 2000. From 2002 to 2012, she worked as a PA at Duke. From 2012 to 2018, she was Director of Clinical Education at Duke, and she has served as Associate Program Director and Chair of the Admissions Committee since June 2018.
Can you give us an overview of the Duke PA program, focusing on its more distinctive elements? [1:53]
Most PA programs are two years in length, and ours is no different. Perhaps what distinguishes us a little bit is our primary care-focused mission. Not every PA program is distinctly focused on primary care, but that is a big part of our mission, training primary care PAs. We are one of the programs that’s been around the longest. We were the first, established in 1965. We had a class of four graduates in 1967, and then the profession took off from there. That’s part of our proud history and always something that we like to bring up, but we’re definitely not a program that rests on our historic laurels; we’re definitely a program that likes to evolve and improve along the way.
We are one of the larger programs in the country. We have 90 students per cohort, a total of 180 students at any given time, and approximately 40 faculty and staff. As my program director always says, we’re like a giant cruise ship, a big vessel in the ocean chugging along. We’re a big program, and that does distinguish us from a lot of programs out there. We’re also housed at an academic medical center. There are other programs at academic medical centers, but that does distinguish us from some of the programs out there as well.
The curriculum includes one year of didactic instruction and one year of clinical. Is that pretty typical for all PA programs? [3:08]
That is pretty typical. There’s a few programs out there that are a little bit longer in length; maybe they’ll start someone in their junior or senior year of college, and then they go straight into the PA program. But the more typical thing now, because the terminal degree is the master’s degree, is that most folks have finished their bachelor’s studies and then come to PA school as a graduate program, which is two years in length.
How has COVID affected the Duke PA program, both the didactic portion and the clinical portions? [3:45]
COVID really did a number on medical education across the country, and we were certainly no exception to that. In the spring of last year, we had students out on their clinical rotations, and we had a first year cohort of students that were used to coming into the classroom, into our labs, every day. In roughly the beginning of April, we had to pull students off of their clinical rotations. The community at large was dealing with an influx of sick patients, and so we did that for the protection of students and also just to spare personal protective equipment that had to be prioritized for practicing healthcare professionals.
Our second year students came off rotations, and we kind of hit the pause button as we quickly figured out, what we could do to help them continue to move through the program. We created several virtual electives that they could participate in, focusing on things like public health, leadership, and getting extra training on substance abuse disorders. Students could opt into whatever elective kind of piqued their interest. In the first year, we had to quickly pivot our largely in-person curriculum to a virtual curriculum. We had to get up to speed very quickly with Zoom and other technologies and pivot our curriculum to either live synchronous sessions on Zoom or prerecorded sessions.
Incredibly, our second year students were able to get back out on rotations and actually finish the program just a couple of weeks past their original completion date in August. It was amazing. They were incredibly grateful to not be really, really delayed, and those virtual electives did help them continue to complete coursework and move along in the program until they could get back out on clinical rotations.
Our first year students actually started their second year in July, on time. They had been out on rotations in a pretty normal fashion. Many of our clinical rotation sites came back onboard pretty quickly and were willing to take our students back. Then we started a new cohort of students, the Class of 2022, in August, and they have been for the most part virtual, but we are doing a hybrid curriculum and prioritizing in-person activities such as our anatomy lab and physical diagnosis lab.
When do you think the didactic portion will be in-person again? [6:06]
I would love to say that this fall, when we have a new cohort coming in during August, that we can have a lot more in-person activities. I think it just depends on what COVID activities are doing in the state of North Carolina. A number of our students are starting to get vaccinated. Our clinical year students were prioritized for that. First year students have actually been volunteering in Duke’s COVID vaccine clinic, and if they volunteer, they were eligible (if they had supply) to get vaccinated. We’re still waiting for direction from the institution and from the state and the Governor’s office to see what’s feasible come August, but we want to get back to some more face-to-face activities and back in our building. That normalcy — we’re just dying to get back to it.
But we’re also having conversations as a faculty about what we have learned, what about this hybrid curriculum delivery we want to keep. Because some of it’s been really great and really well received by the students, that extra autonomy and flexibility. These are adult learners, and so having students in the classroom all day long really doesn’t work for them. We’ll be having a lot of discussions this summer about what the next academic year is going to look like for our didactic students because it’s not going to look the same as it always has.
Out of crisis comes innovation. We had had resistance in the past to doing more virtual instruction from either staff or resource allocation or faculty saying, “I can’t learn yet another new skill.” We were all forced to learn new skills, and now we know we can do it. The question now is, where can we be really deliberate in where it makes the most sense to continue doing some of this hybrid or virtual curriculum delivery?
Duke is using the CASPA application. Can you review the timeline for applications and how they’re processed at Duke’s PA program? [8:08]
Every PA program has a little bit of a different timeline in terms of their start dates and their CASPA dates. For us, CASPA always opens in April. This year it’ll open on April 30th, and it’ll close September 1st. Along the way, when students complete their CASPA application and send it to Duke, we’ll send them a supplemental application that’s unique to our program. The supplemental is due by October 1st. Anyone who’s applying to our program, we have a deadline of July 1st to complete the minimum prerequisite of a thousand patient care hours.
Then the GRE deadline for our program is September 15th. They can apply before they take the GRE. They just need to get us their GRE scores by September 15th in order for their CASPA to be complete and that supplemental to be sent to them. The supplemental needs to be done by October 1st.
You have everything by October 1st, and then what happens? Do you wait till October 1st to start processing? [9:18]
No, we get way too many applications to wait. We have rolling admissions. Once we start getting completed supplemental applications, we have an admissions team that begins looking at those applications and making sure that they meet all of our pre-reqs, meet basic criteria that would allow them to move ahead and go into the reading pool. We have faculty and alums who help us with reading our applications. Each application that comes in gets reviewed by our program. It’s a lot of reviewing, and we need a big chunk of time to get through all of those applications.
4,000 was maybe our peak. The incoming class of 2020 was the most CASPA applications we’d ever received. It drops off after there because not everyone who submits a CASPA application submits a completed supplemental; usually about half the people who do a CASPA complete a supplemental. Last cycle, we were worried what COVID was going to do to our numbers, and we actually had more applications come in. So 2018 was the peak, 2019 dropped off, and in 2020 we went up, and we all just held our breath because we had no idea what COVID was going to do to our numbers. We had about 3,100 CASPA applications and we had about 2,200 completed supplementals. And of those 2,200, about 1,400 of them ended up going into the reading pool to be read by two faculty members and scored.
What’s the criteria for going into the reading pool? [11:00]
You have to meet our pre-reqs. If you don’t meet pre-reqs, we don’t even move it forward. Then we have some objective measures that sort of help us delineate those 2,200 applications because there’s no way we can really read 2,200 in-depth. There are some objective criteria based on academic performance, patient care experience, natural science credits. That sort of gives us a rough number, an objective score. Anything that’s above a certain threshold goes into the general reading pool. Again, that’s about 1,400 applications that make it into that pool.
What are the academic stats or background that you’d like to see, other than the specific requirements on the website in terms of GRE and GPA? [11:38]
We’re not a program that has hard cutoffs for GPA or GRE. We utilize a holistic approach to our admissions review, meaning that we are looking at academics in the context of someone’s life experience. We know there’s a lot of folks out there who may be a first generation college student, or they had big events that happened to them in college and so maybe they had a rough start to their freshman year or had a traumatic experience in college and they had a dip one semester. We really look at the evolution of the student over their college career. Do they have an upward trend to their grades? If somebody fails a course or doesn’t do well one semester, that’s really not a deal-breaker. Sometimes someone may have a little bit lower GPA, but their GRE’s great, or vice versa.
We’re looking for people who have shown grit and tenacity and growth and evolution as a student and as a person. Oftentimes they can give us that context in their life experience essay. That helps us really take a look at their story. “What happened here their freshman year? But look, they’ve really grown over the course of their college.”
We don’t necessarily require that somebody is a science major. In fact, we have a lot of people who are not science majors, those maybe who are actually doing a second career or who maybe just have a lot of interests. It’s not unheard of that we have English majors or art history majors or philosophy majors who decide, “Hey, I want to go into medicine, and PA looks pretty good.” That’s all part of their journey and their evolution, and we love to hear those stories. Everybody has to have the pre-req science courses; those are outlined on our website and pretty similar to PA programs across the country. We love to see students who’ve been successful in upper level science courses, rigorous courses, but we’re also not looking for those people who are just the 4.0, straight A’s, peak GREs, because a lot of those folks don’t have some of the life experiences, work experiences. So there’s a lot of diversity in our classroom in terms of the educational background, the work history, and the life experiences, and that’s what makes our learning environment so rich.
What kind of clinical experience is the Duke PA program seeking? I know that you want a minimum of a thousand hours, and I was very impressed by the fact that your students have multiples of that. [13:58]
The average is about 18 months, but we certainly have people who have 10 years of clinical experience. If somebody has just the thousand hours, they may be less competitive, and it might actually benefit them to wait a year to apply and get another year of clinical experience under their belt. We’re looking for applicants who have hands-on clinical experiences. Particularly attractive are those clinical roles where maybe they had to get some extra education or licensure like an EMT, a certified nursing assistant, or an RN. There are a number of roles where there’s just sort of advanced responsibility in terms of patient care and decision-making; that’s always very attractive. But you can’t beat a clinical experience where you really have had to get into the nitty-gritty of taking care of somebody. A tech in the hospital, a CNA in a nursing home, a medical assistant in a clinic, those are all very popular patient care roles and are really attractive to us because it allows somebody to evaluate, “Is patient care truly for me?”
What about scribing? Or is that not hands-on enough? [15:16]
We do actually take scribing. I think there are some programs out there who don’t. We’ve actually seen kind of an evolution of the scribe role to more of a hybrid medical assistant role. That’s fantastic, although we do count just straight-up scribing, even though it’s not hands-on. Those students actually tend to do really well in their medical knowledge or medical documentation; they really know their stuff because they also have been right in the thick of it and actually communicate a lot with the provider about their medical decision-making, so they’ve been exposed to a lot.
What about non-clinical community service? Is that relevant? [15:52]
We love community service and a record of volunteerism; that actually aligns a lot with our mission. We’re really looking for applicants who have demonstrated leadership, involvement, or service in their community, that they value diversity and inclusion either through their volunteer experiences, their lived experiences, or their educational experiences. All of those things are really important to us. Someone who has a demonstrated record of service in the community. There is a place on the CASPA for you to record your volunteer or service hours. Particularly if you have a record of service with underserved communities or populations, that very much aligns to the mission of our program and actually the mission of the PA profession and why it was created. We love to see that as part of an application.
4,000 gets winnowed down to 1,400 based on objective criteria, and then you interview about 250. That’s about 20%. Ultimately, you’ll matriculate 90. How do you winnow it down? [16:49]
There’s the objective score based on some of those objective criteria, and then the readers have a rubric and they evaluate as well. They’re really taking that context into consideration, reading the essays, looking at the letters of recommendation. Looking at the whole picture, their community service. Have they been exposed to the PA profession, either through shadowing or working with PAs? Do they know what they’re getting into? Do they talk about that in their essays? We’re evaluating folks on whether or not they’re making an informed decision. Do we think that this person would bring value as a cohort in the class, either through some of their work experiences, life experiences? Those scores get combined with the objective score, and then an overall score is created. We have a certain number of interview slots based on that final score, and then we fill our interview slots. We interview about 250 people.
What is the interview day at Duke’s PA program like, especially in the time of COVID? [18:16]
COVID definitely pushed us to our technology limits. We had to virtualize our admissions process, as did almost every program in the country, I think. It was a big topic of conversation at the National PA Education annual meeting, which was also virtual, talking about how people did that. This is also another thing that we’re looking at in terms of what we keep for our next cycle. It’s actually very cost-friendly for applicants to be able to do virtual admissions interviews. We got great feedback from our applicants, and they said, “We really feel like we were able to get to know the program, get to know the faculty, get all of our questions answered.” Particularly since we are interested in recruiting students from disadvantaged or underrepresented backgrounds, we know that travel and costs for interviews are very expensive. So we’re keeping that in the back of our mind as we make our decisions about the coming year and what format we’re going to keep.
For the virtual interview week, the applicants were assigned a specific day to interview: Tuesday, Wednesday, or Thursday. Monday late afternoon we had an information session. We sent out pre-recorded videos that went over highlights of our curriculum, both the first and second year. Then we held a Q&A session. They were supposed to watch those videos and come ready with their questions, and they always have lots of great questions. That’s hosted by our faculty representatives from both the first and second year teams. Monday night there was a student-hosted Q&A session on “What’s it like to be a Duke PA student?” There’s no faculty or staff there so they can come and get their questions answered.
They showed up on their interview day virtually, and they had two individual interviews. That could be with a faculty member, that could be with a preceptor that sees a lot of our students, an alum. We have a variety of folks who come and help us with interviews. There are two one-on-one interviews, and then there’s a team process exercise, which is a small group scenario, usually about four to five applicants in a group. It’s facilitated and observed by one faculty or alum or preceptor and then one currently enrolled student. They’re given a scenario and then they’re meant to chat and talk through it. We purposely choose ethical scenarios or maybe something that’s a little controversial. It’s not meant to rate their knowledge of the topic; it’s meant to really look at their team skills, their interpersonal skills. It’s really interesting sometimes how people behave in that scenario. So there are three main components to our interview day. This is true also in in-person interviews.
There’s one thing that we added this year, because they’re virtual admissions. On Thursday night, we added a diversity and inclusion discussion. Again, this was hosted by students and it was an opportunity for applicants who really wanted to know what it’s like to be a student of color or a first-generation student who’s coming to Duke. What kind of learning environment is Duke, and how is Durham as a place to live? What is it like to be a parent, or what kind of resources are there for veterans? That was very well received by our applicants and I definitely think we’ll be keeping that as a component of our admissions weeks moving forward. I think applicants appreciate that time with students to really get into the nitty-gritty of what’s it like to be a student here, but also just get all their questions answered from faculty and feel really supported and get a feel for our culture.
Did you use the MMI before COVID? Did it get put to the side? [21:59]
We don’t do MMI. It’s that team process exercise. We just virtualized that, and we’re able to do a breakout room in Zoom, and it still worked beautifully.
Is there anything that you look for throughout the application process, not just the interview but in the essays or the supplementals or the letters of rec, that you didn’t look for one, two, five, or 10 years ago? [22:34]
In the last five years, we really have honed in on the focus of our program match to mission. Again, looking at applicants who have demonstrated leadership, have demonstrated grit and tenacity in overcoming obstacles in their life. People talk about that in their essays a lot. Sometimes their letters of recommendation reveal things like, wow, this person really overcame a difficult time and came out on the other end of that really positively. I think we’re looking for maturity and how they respond to difficult situations. Some of our interview questions can get to that.
The profession was built off of the backs of military veterans who were corpsmen in the Vietnam War, so veterans are really an attractive potential student for us and for other PA programs across the country, so we love that. Anyone who is a North Carolina native, we’re a North Carolina-based school, so we really like it when we get North Carolina applicants, because we know that they’re more likely to stay and help meet the healthcare needs of this local area.
Also, does somebody have a record of volunteer service? Have they worked or done volunteer work with underserved populations or communities? It really sort of gets to the heart of, has this person (either because of their life experiences, work experiences, volunteer experiences) developed empathy and an understanding of some of the challenges that their patients are likely to face? Our patients come from all different backgrounds. We have an aging population in the US. We have an increasingly diverse population in the US, and we want to help train future PAs that reflect that diversity and will go and be able to make connections with those patients in those communities because they understand what that’s like themselves. That’s important to us, and I think we look at that a lot more now than we have in years past as part of that evaluation.
How does the PA program respond to update letters or waitlist letters? Say somebody submitted a supplemental and they don’t hear back from you. The silence is driving them nuts, and they have something they’d like you to know about. Should they send an update? [24:49]
We get those a lot in all of those scenarios, and we absolutely encourage applicants to keep us updated if there’re changes to their applications, something new, something updated. Whatever they have submitted at the time of application completion, that’s really what we’re looking at. But it’s not uncommon that someone may have a prerequisite course that’s in progress. Applicants can have two prerequisites still in progress at the time that they apply. They might send us updated transcripts or things like that.
Sometimes we get external letters of recommendation from someone, and we just add that to our file of recommendations. People do give us updates that either they’ve accepted a seat somewhere else but they’re still interested in us, or it’s “Where am I on the waitlist and when am I going to hear about possible interviews?” We’re very used to communicating. They just email us through our central email address that’s located on our website, PAadmissions@mc.duke.edu, and someone typically responds to them within 24 hours. We’ve got a whole team that helps man that inbox.
On a forward-looking note, what advice would you give to PA applicants who want to apply this cycle, starting April 30th? What would you like listeners this cycle to know? [26:15]
One thing that we often tell potential applicants is that they want to submit the best application that they can, and sometimes that means waiting a year to apply. That is not always easy advice for someone to hear who’s really excited about applying and really excited to start PA school and jumping into the profession. But keep in mind that applying to PA programs is expensive; it is an investment in and of itself. So I really encourage people to take a hard look at some of the data that’s on our website, what the middle 50th percent is for one of the past cohorts. Really take a look at patient care experience, number of natural science credits, GPAs, GRE. Take a little self-assessment. “Am I in range here, or do I have a little bit more work that I need to do? Maybe I need to retake that GRE or maybe another year of patient care experience that would sort of give me that bump up and make me a little bit more competitive. Maybe I don’t have a record of service or leadership or anything like that.” So take a comprehensive look.
Sometimes it’s hard to be discerning of your own application because of your enthusiasm. Use the criteria we have on the website and really ask, “Is this the most competitive application that I can submit?” Because keep in mind, of PA programs across the country, this is very competitive. There’s only a certain number of seats, and we get lots of applications. PA was just rated number one healthcare profession in the country. The interest is tremendous, and the capacity can’t meet all the interest. You need to really have an application that makes you stand out in some way. Sometimes that means waiting a year and getting additional life and work experience or boning up on your academic credentials a little bit to make sure that you’re the most competitive applicant at the time you’re paying all that money and submitting your CASPA.
Med applicants are not expected to have had a “real” job when they apply, but my impression is that most PA applicants are expected to have had a job in healthcare. It’s fairly rare that volunteer experience is sufficient. Is that correct? [28:39]
That is correct. Most programs do require patient care experience. I think the average age at our program for our matriculating students is about 25 or 26, which is distinctly different from the typical 22, 23 year old that’s starting med school. That’s not to say that we don’t have students who fall into that age category and in each of our cohorts; we do. But they’ve been really proactive in getting patient care experiences while they were in college, maybe they got EMT-certified or worked in a nursing home, etc. They knew what the requirements were ahead of time and were actively working to get those patient care hours. But typically people take a gap year. They work for a year or two after college and get that really valuable experience and make sure that they’ve got a good chunk of life experience and work experience before they apply.
Thinking ahead, what about those planning to apply for matriculation in 2023 or later? [29:44]
My advice is similar. Hone in on submitting the best application that you can. The other thing is to make sure that you understand what you’re getting into. By that I mean, do your homework. Maybe talk to somebody who is currently in a PA program and get an understanding of the rigor and the fast pace of PA education. By all means, seek out opportunities to talk to practicing PAs, and not just one, but maybe PAs that work in different fields. The work of a PA looks very different if you work in an emergency room or if you work in an outpatient pediatrics office or if you work as a hospitalist doing internal medicine in the hospital all the time, if you’re a surgery PA versus critical care, etc. Understand the diversity of the profession and different scopes and roles. Really get a sense of what, would life be like to do that job and what does it mean to take care of patients? Get a good hands-on patient care job and make sure it’s for you.
Taking care of people is messy, physically messy sometimes, and can be emotionally messy. People are complex. Make sure that you’ve done your homework and that you know for sure that medicine and being intimately involved in your patient’s lives is something that’s for you. It seems like a no-brainer, but you’d be surprised by people who apply and they’ve never met a PA, never worked with a PA, never talked to a PA. They’ve only done their research online. It blows my mind that they’re willing to invest that much money on education and not really have totally done your homework on what it means to be a PA. They think it’s the fastest path, two years and you’re done. There are people who definitely fall into that category, and we sort them out pretty quickly.
Are there any misconceptions that you would like to dispel about the Duke PA program in particular or PA programs in general? [31:56]
We’re a large program, so we always get questions every year in those Q&A sessions, and I know our students get questions about this: That’s a really big program, 90 students per class, so am I really going to get personalized attention? Am I going to get the support that I need? Are people going to know who I am? And I would say yes, absolutely. I think our students would too. They always do because as we have grown over the years, we have built in support structures to make sure that students are known by faculty, that they get to know each other.
We do a lot of small group work in the curriculum and we shift those small groups every semester, so they get to know a subset of their class. We have advising small groups, so every student has an advisor. In the second year they have a clinical coordinator, a faculty member. They basically have two faculty supports once they move into the clinical year. Students can build relationships with whichever faculty they have a connection or maybe a similar clinical interest. We work really hard to make sure that culture feels very inclusive and that students feel known and accepted and appreciated for whatever they bring to the table.
The other thing is that sometimes our name and the fact that we’re one of the top-ranked programs in the country perhaps works against us because there’s a bit of an intimidation factor. People say, “Oh, that’s one of the top programs. I won’t even apply because I don’t think I’d get in because some aspect of my application is imperfect. I don’t have a great GRE. I don’t have a perfect GPA.” We have students who sit in our class every single year who have imperfect GREs and GPAs. It’s that holistic approach that we look at. Things happen in people’s lives that impact a GPA, and that can be hard to dig out of, but we’re looking for those trends and improvement. We’re looking for that grit and resilience.
Keep in mind what our program mission is. Take a look at our social media accounts on Instagram and Facebook. Our students run our Instagram social media, and they talk about the culture and what it’s like to be a student at Duke. If you personally, as an applicant, feel like you strongly align with our program mission, with our values, we want to see your application. Don’t be intimidated by our name or our ranking, and don’t make an assumption that we’re only accepting people with 4.0s and perfect GREs because that is not the case.
What would you have liked me to ask you? [34:46]
I would have loved a question about diversity. Diversity and inclusion has been a huge hot topic, particularly in the last year or two with major national events. We are also wrestling with some of those issues with systemic racism in our own program, at our own institution, and having really frank talks about that. We have revised parts of our curriculum to really focus on that. Our PHS course, Practice in the Health System course, was completely overhauled this past year, so that there were small group discussions about how race and ethnicity and socioeconomic factors and disability play into health disparities.
Some of those are really hard conversations to have, but they’re really necessary to train these students to go out and be competent PAs, to be able to meet their patients where they are and understand that there’s a whole host of things that are impacting their world outside of that clinic or that hospital that may get in the way of that perfect treatment plan. Their life sometimes gets in the way of that. How can we train PA students to be cognizant of that?
We’ve been really intentional. We’ve got some things on our website and our social media accounts that really speak to some of the work that we’re doing. That’s never-ending work. I want to acknowledge and thank the leadership of our Program Director, Dr. Jackie Barnett, who has done a lot of that work over her long career and her life and who’s been a phenomenal leader through all of these challenging and tumultuous times with COVID and so many of the events that have happened this past year.
Where can listeners learn more about the program and about earning a master’s of Health Science at Duke? [36:36]
They can always email us at PAadmission@mc.duke.edu. That’s our general admissions email. We also have our general PA program website at FMCH.duke.edu. Look for the physician assistant program and our department. Follow us on Facebook and Instagram. Our Instagram handle is @DukePAStudnets, and again, that’s our student-run fun Instagram. We’ll be having admissions events and Facebook live events, and we always have students take over Instagram for admissions as well, and so look for those announcements coming soon.
Related links:
- Duke Family Medicine and Community Health PA program website
- The Ultimate Guide to Becoming a Physician Assistant, a free guide
- Interview with a New PA
- Accepted’s CASPA Application Package
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