"Like Drinking Water Out of a Fire Hydrant" Medical Education as Transformation: A Naturalistic Inquiry Into the Physician Assistant Student Experience

Abstract

Physician assistants are medical professionals educated in an allopathic medical education model in the United States. In order to successfully matriculate, educate and graduate safe and effective health care providers in a 2-year time frame, the 4-year M.D. curriculum has been abbreviated and condensed leading to an intense, full-time cohort educational experience that taxes physician assistant students to their limits. The demanding workload can lead to fluctuations in mood and morale along with increased levels of psychological distress. This dissertation explores this under examined student experience by first introducing the physician assistant profession and the process by which it educates its members. The cohort patterns of mood and morale observed by faculty during the educational process are described using the conceptual and theoretical models of transformative learning, transition, change and cross-cultural adaptation as explanations for the observed experience. A retrospective naturalistic research paradigm utilizing focus groups elucidated the student perspective of the cohort medical education experience over the course of the didactic curriculum, and study results highlight a threestage experience consistent with stages-of-change theories from multiple disciplines. In addition, a prominent pattern of emotional subthemes provide a window into the psychological significance of this transformative experience. A better understanding of the effects of this academically rigorous and psychologically challenging medical education process on physician assistant students clarifies opportunities for amelioration of student challenges while simultaneously enhancing the ultimate goal of developing safe and effective health care providers. To my esteemed colleague, Bob DeBarge-your unwavering dedication to excellence has been an inspiration and I value our partnership in guiding students through the didactic year of our program. Thank you for willingness to share your personal time during the data collection phase of this project and for your valuable editorial expertise with early drafts of this work.