Almost a year after the Yale School of Medicine’s online physician-associate program failed to receive accreditation from the profession’s governing body, the medical school is still waiting to hear back on the program’s second application.

The online program, which was originally announced in March 2014 and encountered vocal opposition from P.A. students and alumni, was refused accreditation from the national Accreditation Review Commission on Education for the Physician Assistant in April 2015. In applying for accreditation, the medical school described the online program, which will accept up to 350 extra P.A. students a year, as an expansion in size of the original on-campus program, and the application was rejected due to a technicality that requires educational institutions to wait four years after their most recent application before applying for an increase in a program’s class size. According to James Van Rhee, director of the Yale P.A. program, the University is currently in the process of reapplying for accreditation for the online program as a program separate from the on-campus program, meaning that it will confer a separate but equivalent degree. The ARC-P.A. will make its decision in September 2017, and if the program is approved, Yale’s first class of students will most likely matriculate in January 2018, Van Rhee said. If accepted, the online P.A. class would accept up to 350 students a year. The existing on-campus program accepts only about 36 students a year.

In the most recent correspondence to the P.A. community on March 24, Deputy Dean for Education at the Yale School of Medicine Richard Belitsky said the School had submitted a formal request for the new program and had been notified that the ARC-PA would conduct an on-campus visit at Yale in June 2017 as part of the accreditation process.

He added that the goal of the program was to increase access to a Yale physician associate education and to “encourage careers in primary care to meet the growing needs of our society.”

Van Rhee said he believes the online program will enhance innovation in the medical education provided by both the medical school and the existing P.A. program.

“For example, the anatomy faculty at the School of Medicine are already developing and using video dissection to enhance the lab experience for both P.A. and medical students,” Van Rhee said. “Our goal is to provide a high-quality education to all P.A. students and assist with meeting the primary-care needs of patients around the country.”

Students and alumni expressed mixed views about the introduction of the online P.A. program. Their concerns included concerns over the quality of online teaching, lack of past engagement between administration and student body concerning the implementation of the online program and the devaluing of the existing P.A. program degree.

The most common concern among students and alumni interviewed was that administrators did not sufficiently engage with students on the subject of the online P.A. program, although many agreed that this engagement had improved over time.

Lauren Prince MED ’17, a current P.A. student, said she did not believe the medical school administration had adequately considered student perspectives in previous preparations for the online program, adding that it was unclear whether the opposition raised by the students had influenced the ARC-PA’s decision last April.

She said that the separation of the online and on-campus P.A. programs somewhat justified the administration’s lack of consideration for student opinion. She stressed, however, that the separation of the programs only happened after the ARC-PA rejected the proposal to accredit Yale’s online program as an expansion of the existing program.

“The fact remains that this program was initially proposed as a class-size expansion of our current program, and would have had significant impact on our current program if it had not been denied by the ARC-PA,” Prince said.

Prince said that although she never felt extremely supportive of the online P.A. program because she felt it constituted a “cheapening” of her degree, she feels less strongly opposed to it now than she did, given that the program will confer a separate degree and will involve separate faculty. She added that this development has alleviated her concern that on-campus P.A. students would suffer from lack of faculty attention, were the online P.A. program to go ahead.

President of the P.A. program’s class of 2017 Michelle Giwerc MED ’17 emphasized that despite the separation of the on-campus and online programs and the differences in training, the two programs will confer an equivalent degree, a Master of Medical Science.

“While the degree will be separate, it will be an equivalent degree,” Giwerc said. “It will actually be the same type of degree, which I think has important implications since our training will inevitably be quite different. It also remains to be determined if the online cohort will have to complete a thesis or even the same types of rotations that we complete, as discussed at [a town hall meeting on the online P.A. program hosted by Belitsky last August].”

Mark Volpe MED ’15, who graduated last year from the on-campus P.A. program, said he and the significant majority of alumni share the same oppositional views to the online program: the concern that it would devalue their own degrees. However, he added that because by now it seems to him a “foregone conclusion” that the program will go ahead, he felt it was important that the University, student body and alumni body work together to help the online program succeed.

Volpe said he thinks such a program has the potential to be successful because of the increased numbers of graduates it will yield. But he is not convinced that the graduates of the online program will be trained as well as those in the on-campus program.

Van Rhee said he has met with current students on several occasions since the August town hall meeting on the online P.A. program in order to share information from the ARC-PA. He added that the medical school is in the process of developing an advisory committee for the online P.A. program that will include P.A. students, alumni and faculty, as well as other members of the medical school community.

Giwerc praised the administration’s intentions to form an advisory committee for the online P.A. program, adding that she hopes the formation of the committee will demonstrate transparency to the P.A. community and “seriously consider” the concerns of all stakeholders in the process.

Volpe said the administration’s increased engagement with the student body about the online P.A. program made a “meaningful” difference to the student and alumni bodies. One of the major reasons for initial student opposition to the program was this indifference of the medical school administration.

“From a student perspective it appeared that the University made a decision to go forward with the program, prior to asking students their opinion,” Volpe said. “Rather than saying, ‘We are thinking of starting an online program, how do you feel about that?’ [the administration’s attitude] was, ‘We are starting an online program and have already signed a contract with 2U to be our partner, how do you feel about that?’”

Lindsay Novak MED ’14 said that despite some concerns, she sees many ways in which the program can have a positive impact. She identified the lecture-based element of Yale’s P.A. training as an area in which the online program could improve upon the residential model.

She added that during the lecture-based year of the Yale P.A. program, she had over 400 lecturers, many of whom did not coordinate with each other as to the material being taught, thereby disrupting the flow of instruction. Issues like these would likely be improved in an online program, she said.

“I think [by] doing an online program, they could probably get more quality instructors and have fewer people teach a course, and there’s a lot to be said for someone to be able to pause a lecture when they’re missing a point,” Novak said. “There are a lot of people doing flipped classrooms now, so I see a lot of potential for the didactic year to improve dramatically in terms of continuity and quality of lectures.”

Novak said she has concerns about the reasoning behind the online P.A. program, which she said was partially intended to help solve the national shortage of health care workers choosing to go into primary care. But most Yale P.A. graduates enter specialty care fields, making it difficult for Yale to justify an online program of the proposed size, she said. Novak also suggested that the high cost of the program, which is excessive, is at odds with the philosophy of making careers in primary care more accessible.

“Part of the rationale for this is [to attract] people who might already be in a rural community and may not be able to afford going to school in a new place, so it’s supposed to increase people going into the primary care profession,” Novak said. “The reality is, to me, you need to make the price lower if you actually think that’s going to work, and then the other thing to me is, Yale has not yet shown a history of being able to get most of their P.A. graduates to go into primary care … I can tell you that the majority [of the class of 2014] went into specialty care and about half went into surgery.”

Opponents of the online program have criticized it on the basis that online students’ clinical rotations can be completed in their hometowns rather than at Yale — a criticism Novak said she disagrees with because rotations at Yale are not necessarily of a higher standard than rotations completed elsewhere.

Novak added that some of the worst rotations of her time in the P.A. program were completed at Yale, while the best ones were those she sought out at other medical centers. She said she believes that on average, rotations completed away from Yale are likely to be just as good as those at Yale, because students are likely to receive more attention from their supervisors and have more responsibility.

Novak added that although she has not yet been approached by the medical school administration to be part of the advisory committee for the online P.A. program, she has volunteered herself in this capacity and is happy to work with administrators in their planning for the program.

Yale and Cornell are the only ARC-PA-accredited physician-associate training programs offered at Ivy League institutions.