In rural Montana, Rebecca Preston ‘20, MMSc, is about to bring the expertise she acquired in the Yale School of Medicine (YSM) Physician Assistant Online (Yale PA Online) Program to her local community. Preston, a graduate of the program’s inaugural class, grew up in Choteau, Montana and is raising her children there. She soon will join Benefis Teton Medical Center, a critical access hospital in Choteau, which has a population of around 1,700 and is located about an hour from the nearest city, Great Falls.
The hospital, which serves the town and outlying area, “is a crucial component in the viability of the community,” Preston says, as it is the first stop for many emergencies and provides access to regular care to many who may not otherwise be able to travel for appointments.
During the PA Online Program, Preston was able to complete most of her family medicine rotations there, as well as her Clinical Experience in Early Didactic (CEED), a unique and important part of the program, where students gain 120 hours of clinical experience to complement their coursework. Preston says that during these clinical experiences, she had hoped that she would one day practice there after graduation. “I am thrilled that the stars have all aligned for that to happen,” she says.
“Experiencing rural medicine as a student really confirmed for me that it was exactly the type of medicine that I wanted to one day practice,” Preston continues. “I loved the connection and longitudinal care I witnessed in the clinic, and combined with the faster pace of the ER, I knew that it would provide the challenge and relationships that I desired as a practicing PA.”
Reflecting on her family’s deep roots in the community she states, “it truly is an honor to be able to serve the people that live here in such a valuable and important way.”
For Preston, an unanticipated benefit of completing most of her rotations near where she will work is having “a lot of great connections and former preceptors to refer questions to.” Furthermore, “I found that my preceptors really seemed to invest themselves into my education knowing that I would likely be working in the area and possibly be sending them referrals in the future. I felt like I was not just a student in their eyes but rather, a future colleague.”
Preston describes a circuitous path to becoming a PA. “Having grown up in a rural area where PAs are highly utilized, I had an intimate understanding of the important role that they fill in underserved areas.” She started her career in exercise physiology but kept finding herself wanting to know more and be able to do more, and “finally came to the point that I needed to dive completely into medicine.” Because of her family situation and the lack of PA schools nearby, Yale PA Online “really was my one opportunity to be able to pursue this professional goal at this point in my life.”
Preston exemplifies a central element of YSM’s objectives for launching the PA Online Program. With the nationwide shortage of primary care physicians growing, YSM wanted to make becoming a PA more accessible, by structuring the program so that students could train to become patient-focused clinicians in their own communities.
Yale PA Online alumna Caraline Risinger ‘20, MMSc, Preston’s classmate, similarly exemplifies these goals. Risinger, who has lived in Arizona since elementary school, says that, “by the time I was ready to pursue PA school, I had a family that I couldn’t uproot.” Her husband was licensed to practice law in Arizona and she had two young children. “I knew I would need the help of my friends and extended family to survive PA school. Moving wasn’t an option for me.”
Yale PA Online has multiple four-week rotations in the same discipline – three in family medicine, three in internal medicine, and two in pediatrics. Although some students complete each of these rotations in a different location, Risinger spent 12 consecutive weeks at a federally-qualified health center, Neighborhood Outreach Access to Health (NOAH), early in her rotations, learning to provide primary care services to the underserved populations in her own community. NOAH has nine locations throughout the Phoenix area, the majority in the inner city and near hospitals, to care for patients who seek emergency hospital services and then need follow-up, but have no primary care physician.
Risinger says, “prior to rotations, I didn’t think I would become a primary care PA. But rotations taught me that what I valued most in a prospective position was the ability to practice medicine at the peak of my potential, patients for whom I could truly make a difference, and an employer who valued patients, staff, and providers.” She continues, “NOAH had checked all these boxes that I didn’t even realize I wanted until I moved on to other places that weren’t addressing them. So, when I was offered a position at NOAH after graduation, I gladly accepted. I’ve now been practicing several months and am thankful to be there every day.”
Because of COVID-19, many of Risinger’s patient encounters have been through telemedicine. Risinger believes the problem-based learning (PBL) sessions, which students participated in during the didactic year of the PA Online Program, prepared her for telemedicine. “It forced me to focus on developing a strong diagnostic framework and differential diagnoses, which directed my questions.” Although sometimes patient encounters are through a video platform, “other times, it’s just over the phone and I have to dig deep to didactic year, when I learned the OPQRST mnemonic (onset, provokes, quality, radiates, severity, time), and create my differentials sight unseen.” And similarly to how she used to discuss cases with classmates on Zoom, she now runs ideas by co-workers using Skype.
Risinger adds, “as uncomfortable as I was building up my patient caseload in those first few days/weeks/months, doing telehealth was never a concern. I started practicing medicine in a pandemic, helping to pioneer advances in telehealth. I feel like Yale PA Online prepared me to do so during the entirety of didactic year.”
Another way Risinger is benefiting from her experience at Yale is her connection to classmates. For example, when she had an uninsured patient who could not afford a specialist, she reached out to a classmate in that specialty. “My classmate took the time to provide some guidance on lab tests and medications that have helped me help my patient.”