August 11, 2022

“Casper is beyond a product, it’s a public declaration that I care about [social intelligence and professionalism] traits other people do not. I see you.”

Dr. Mike Roscoe, Ph.D., PA-C, Program Director, Physician Assistant (MSPAS)

About the school

The University of St. Augustine for Health Sciences was founded in 1979. It has multiple campuses across the USA, including Austin, TX, and is headquartered in California. Their mission is the “development of professional health care practitioners through innovative, individualized, and quality classroom, clinical, and distance education.”

No. of applicants per year

1000

No. of matriculants per year

40

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Highlights

Challenges

• Creating a new admissions process and Physician Assistant (PA) program with social intelligence and professionalism at the forefront of the selection process
• Ensuring the limited number of seats in the program are given to applicants whose values align most with that of the PA program.
• Using a combination of measuring tools to assess competency and fit.
• Finding applicants who would be unique to this program as opposed to those who would “blend in”.
• With the high number of applicants, universities are raising their cognitive markers, leading them to miss out on applicants who may have exceptional social intelligence and professionalism skills.

Solutions

• The program plans on implementing Casper to equitably assess their applicants’ social intelligence and professionalism 
• Using Duet to ensure students align with the program values to enable them to thrive
• Keeping social intelligence and professionalism as top priority

Results

• Ensuring the reliable and valid measurement of social intelligence and professionalism

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Dr. Mike Roscoe, Program Director of the new Physician Assistant (PA) program at The University of St. Augustine for Health Sciences, moved to Austin, TX to build his admissions team because he wanted to make a difference. Specifically, he wanted to address the fact there was no PA program in the central area of one of the top 5 largest cities in Texas. 

Starting a new program can be challenging and can take longer than expected due to small details that can have a profound impact on the success of the program. The ‘butterfly effect’ is relevant here because details that may not seem important or trivial in a build can have a profound and untoward effect later on. Dr Roscoe finds it special to be able to create something new, away from old traditions. Creating a culture is critically important to developing a new program and he “would argue it is severely overlooked”. 

Building an admissions process is “a culture issue” to Dr. Roscoe. The program must determine several aspects when designing an admissions process, including:

1. What are the outcomes that matter to your program?
   1. Cognitive vs. social intelligence and professionalism
   2. Threshold values; why are you selecting them
   3. Core values
2. What type of applicant are you specifically looking to select?
3. How are you going to assess the used admissions markers against specific outcomes?
4. How to get buy-in from faculty, administration, and students?

After building the program for two years, the first class will matriculate in January 2024 with 40 students over 27 months over 7 trimesters and will align with the American new program procedures. With the accreditation for PA programs being specific to that field, the faculty must have a place in the admissions process and decision making alongside Medical Directors (MDs). This PA program will use approximately 40 people within the admissions process, including:

• Community members within the MMI stations and interview process to ensure the interview scores are community selected
• Someone from each department within the university and a faculty member within the MMI
• 4-5 Core faculty members will be a part of the holistic review of applicants

Dr Roscoe expects to have around 1000 applicants for his new program. However, it is difficult to know how many of those applicants are “unique” to his program given, on average, each applicant applies to approximately 7 PA programs. After using a variety of measures to assess each applicant’s social intelligence, professionalism and cognitive skills he will interview 100 of them.

Diversity lens

There is a current lack of diversity within the PA field as 88.5% are white. Dr Roscoe plans to make diversity a goal and stated, “I roll that into my pool list and I use it from a lens of ‘how holistically can this person in their profile help make us better as a program’, and so I can give a score internally.” However, he doesn’t want to select applicants based on achieving a certain percentage as he wants to maintain a fair admissions process. He wants to select the right person regardless of the color of their skin or socio-economic status, etc. One of his goals is to match the local population demographics because he wants to make sure the people who graduate from his PA program represent the patients they will serve.

Why Casper?

Admissions statistics and why students with strong cognitive abilities “fail” has always been an interest of Dr. Roscoe’s. Whilst working at another university he attended an admissions conference and saw a presentation about Casper and the importance of social intelligence and professionalism. This intrigued him and so did further research on it. When he started another program he led in another university, he implemented Casper. “It went swimmingly,” said Dr. Roscoe, “it did exactly what we thought it would do,” generating 100% first time pass rates and low attrition rates despite having students that other universities would consider having low GPA scores (under 3.5). 

Culture is paramount within this new program and Dr. Roscoe believes “Casper is beyond a product, it’s a public declaration that I care about [social intelligence and professionalism] traits other people do not. I see you.” Showing applicants why they should attend his program over what and how he can offer is important. It evidences his “culture sees you” over the applicant’s cognitive abilities, race, gender, etc. Casper supports the holistic approach and compliments MMI. The program plans to use Casper as a screening tool at the beginning of the admissions process, while they will use MMI to select students into the program.

Dr. Roscoe selected Acuity over other solutions because he saw Acuity “cares about the outcome” and making admissions a better and fairer place. There is a meaning and a why before the product. He states Acuity does not push programs to use their products like others do. Dr Roscoe appreciates the authenticity and value brought into his admissions process through his relationship with Acuity.

Imposter Syndrome and Duet

“Imposter syndrome is ripping through the PA applicant world,” claims Dr. Roscoe as he explained how applicants with a 3.8 GPA score don’t think they are good enough to pursue a career as a PA. This can be due to one of many reasons, for example the program only takes 4.0 applicants, who have 10,000 hours of healthcare experience, or applicants feel they are too young. 

Many applicants get told by educators to have a ‘plan ‘” due to the high competition within higher education. However, the applicants can see this advice as ‘you aren’t good enough’ to go to college or university, when it is in fact the opposite. They may see a large percentage of applicants not attending higher education and believe they won’t get in either. This is not always the case.

“This is why Duet is powerful…for the student and the program,” expressed Dr. Roscoe. Applicants apply to programs based on geography, cost, and length of time which doesn’t always match up to where they would thrive the most. Programs can help the applicant to attend the right university, which aligns with their values, as well as accepting applicants that align with their program. Programs may decide to recommend them to go to another program or university depending on their preferences. He recommends applicants start caring about mission statements, core values, and goals to ensure they have a pleasant experience during their years of study in a PA program.

Duet is our values-alignment assessment, where various stakeholders within the program complete the assessment, creating a single Program Profile based on three categories of the program’s values and priorities. Applicants then complete the same assessment to show what values they prefer in a program. Lastly, your program will receive automatic scores showing how well the applicants align with your Program Profile. 

Admission markers

Casper and Duet

All applicants will take Casper and Duet. Dr. Roscoe plans to convert the z-scores from Casper to a grading scale and use them alongside the Duet scores to create a rank order. This program will use a minimum of -2 z to be eligible. He will generate a new rank order with the use of a GPA screener and holistic review. 

By prioritizing social intelligence and professionalism markers, Dr. Roscoe hopes to find the types of applicants that align well with his PA program, which can potentially translate into happier faculty, preceptors, and students, as well as reduced attrition rates.

Other requirements

In regards to cognitive variables, this program will use overall, prerequisite, and math / science GPA with a minimum threshold (3.0 or 4.0 scale) to which he will convert them to a scale to be able to use them in a rank order model. Evidence shows a minimum of a 3.0 GPA is a requirement to minimize attrition risk due to academics. Dr. Roscoe also plans to use a holistic evaluation of their application. The rank order list is then invited to a MMI where a combination of pre-interview screening and then MMI scores generate the final decisions.

Dr. Roscoe chose these admission markers as they directly select for the program’s mission, program culture, and core values. He hopes these markers lead to less professionalism and social issues, and in seeing the applicant as a person rather than as a number.

Advice for other new PA programs

Starting point

Start with the ‘why’:

• Why are we starting a new program?
• Why here?
• Why are we different from other programs?

Then move onto ‘how’ and ‘what’.

Save on time with design exercises

Everything takes more time than initially expected. Drafting and workshopping program policies and protocols with stakeholders can reveal pain points and potential solutions earlier on in the process.

Build backwards

Start with your program completion competencies and desired program learning outcomes, then reverse engineer. Establishing a clear goal first makes for better alignment between your desired outcomes and your program design and content. 

Get help

Understand what you don’t know and don’t be shy about getting help. No matter how much experience you have, there are new elements you can learn. It might be an institutional process or a different accreditation requirement for a developing program versus an established program. 

Be wary of confirmation bias

Confirmation bias creates conflicts and significant future pain points when accreditors come. It comes in two forms:

• Experienced faculty who can become over confident in their own knowledge or experiences in another setting
• Institutional – where the university might have other programs and processes that work for them and assume it will work for the new program as well.

Acknowledge emotions

Developing a new program takes significant time and energy. For leaders and most stakeholders, it becomes a personal endeavor. Understanding and acknowledging this can help your team guard against taking feedback the wrong way and inadvertently hinder positive changes. 

Collaboration

The relationships between the business side and the academic side need to work together rather than competing priorities.

Most difficult phase

The clinical phase is harder than the didactic phase. This is due to the reliance on community clinicians to train our students during the clinical phase. This means finding both clinical sites willing to have students and preceptors willing to train the students, as well as the American system of healthcare and getting compensated by the throughput of patients – many clinicians are resistant to having students as they feel that they slow them down and cost them money to have / train students.

Think ‘assessment’

Regular and continuous self and program assessment must be a part of your assessment process rather than a single event. Insights from these exercises are key to further refining your program and improving outcomes.

Simple is better

Resist the urge to make exotic curriculums and process on an initial build. New programs can be a bit overzealous with initial ideas which makes it more difficult.

Hold on to values in the face of adversity

Covid-19 confronted many institutions with unprecedented challenges. However, core values and outcomes don’t change; don’t lose sight of the values and outcomes during change. Be purposeful and embrace flexibility within your processes when change is required.