School/Programs
There are many excellent programs from which to choose. The
following three are among those with a special interest in
recruiting and supporting indigenous students and providing
health care to underserved populations.
University of Washington MEDEX
Northwest
One of the
oldest PA programs in the United States, MEDEX Northwest
has a long, successful tradition of preparing PAs to
practice primary care in medically underserved areas,
particularly in the Northwest and Alaska. More than
one-third of the program’s approximately 1,500 graduates
are working with the underserved. Most of the Indian Health
Service facilities in the Northwest have MEDEX graduates.
Ruth
Ballweg, Director of
the MEDEX Northwest program, says, “The mission of serving
the underserved is woven into every cell of the program.”
Most of the people who help select new students are PAs
from underserved health care facilities. During the
screening process, they explore the candidates’ knowledge
of health care disparities as well as the candidates’
commitment to helping to end these disparities. Significant
attention is given to health care disparities during the
didactic part of the program. In the clinical phase of the
program all students work for at least four weeks in a
clinic for underserved people. In addition, the students’
projects typically focus on the underserved.
MEDEX Northwest actively recruits indigenous and other
minority students as well as medical corpsmen. MEDEX staff
members sometimes work for years with candidates who have
great promise but need to take extra courses and/or resolve
challenges in their lives before they can enter a PA
program. “Many programs would write these people off,” says
Ballweg, “but we believe in high risk, high gain.”
The MEDEX curriculum helps equip students to be life-long
learners who can meet the ever-changing health care needs.
The program leaders are continually looking for new niches
for PAs as a way of expanding health care access.
To date MEDEX has 58 American Indian graduates with 5
current American Indian students. The program has 23
Alaskan Native graduates with 3 current Alaskan Native
students. A large percentage of these graduates are working
in American Indian health centers in Washington, Oregon,
Montana, Arkansas and Oklahoma. Others are working in
community health aide training programs or Native
corporations in Alaska. Most tend to be in primary rather
than specialty care.
University of North Dakota PA
Program
American
Indians are well represented at the University of North
Dakota (UND) PA Program.
Since January
2000, 32 American Indian students have graduated from the
program, receiving the master of physician assistant
studies degree (MPAS). On average 12% of the class have
been American Indians. Students come from tribes throughout
the United States.
UND is committed to educating health professionals who
serve rural and underserved areas. The unique curriculum
makes it possible for all students to do the first half
year of work online, spending no more than four weeks at a
time on campus, and completing all their clinical work in
their home area.
For many years, applicants to the program needed to be
registered nurses (RNs) with several years of experience.
Now a pilot program is accepting other licensed health care
workers with extensive clinical experience. On average
students are 42 years old.
Unlike most other PA programs, candidates must identify a
primary care physician who agrees to serve as the
applicant’s preceptor for the clinical portion of the
program. During the application process, UND faculty visit
the applicants and their identified physician preceptors in
the physicians’ clinical settings. Faculty seek to ensure
that the physicians and the sites can provide what is
needed for the candidates’ education.
After the first 6 months of online learning, students begin
a pattern of spending a few weeks on the UND campus working
on knowledge and skills that they subsequently practice
using for the next couple of months or so in their clinical
setting under the supervision of their physician
preceptors. While in their home clinical setting, students
are in touch with a faculty advisor from the UND campus,
and they continue doing online courses as well as a
research project. In the final 10 weeks of the 22- month
long program, students take individually-tailored
clerkships in settings that enable them to work on
knowledge and skills that they could not easily learn in
their primary clinical settings. While on the UND campus,
students are evaluated and given instruction in office
practice and management.
In 2004 the PA faculty invited Elders from two nearby
Indian communities (Turtle Mountain Band of Chippewa and
Spirit Lake Nation) to identify the health care needs of
Elders. Leander McDonald, Spirit Lake, PhD, facilitated a
group of 25 Elders who identified and later prioritized
their health issues. These issues were incorporated into
the teaching cases in the curriculum. In addition, some
Elders serve as “standardized patients” in the experiential
examination that the students must pass in order to
progress in their studies. As standardized patients, the
Elders simulate real patient problems that the students
have to identify and solve. The grandparents of PA
student Audrey
Bercier, were among
the Elders who contribute to the UND program.
Arizona School of Health Sciences, A.T. Still University
The 26-month
long physician assistant studies program, which leads to a
Master of Science degree, has a Native American Physician Assistant
(NAPA) track
dedicated to increasing the number of Americans Indian,
Alaska Native, and Native Hawaiian PAs who provide
health care in Indian Country.
All of the PA students, including the NAPA students, spend
the first 14 months of the program in didactic studies.
During their clinical year, NAPA students spend several
rotations in Indian Health Service hospitals, tribal
clinics, and other sites that serve indigenous people,
including, if possible, the students’ home communities.
Students are encouraged to do their master’s project on an
Indian community health issue.
Since 2003, when the NAPA Charter Class graduated, 28
American Indian people have graduated from the program.
Most of the graduates are caring for indigenous people or
plan to do so as soon as possible. For example, Kirby
David, Navajo, works at Sage Memorial Hospital and its
clinics, which serve the Ganado area of the Navajo Nation
that includes most of his relatives. Heidi Morgan,
Cherokee/Creek, works for the Creek Nation of Oklahoma in
the same clinic she visited as a child. Brandy Tiger,
Cherokee,
lives at the
Navajo Sage Complex where she works in family practice and
assists with appendectomies, caesarean births, and
emergency trauma.
Amanda Carey is providing
primary care back home in a tribal clinic in Muskogee,
Oklahoma. Shanna Geiger
is also
providing primary care in a facility where she and her
family received care, namely Native Health, a small,
urban clinic in Phoenix, Arizona
This
article was originally published in the Winter 2007 issue
of
Winds of Change.