Introduction
Timi: Good morning! Welcome back. Thank you very much for promptly getting started. We wanted to give you a little more information about the process of how we got here. It would be good to give some context about how this came to be.
In late 2007 there was a motion passed to ask the board to look at the doctorate. If you know some history of PAs then you know that when we started down the Masters road it was consumer and student driven process and there wasn't a large national effort from the profession driving that.
One of our members recommended InnovationLabs to us and within that year we went to the academy and asked if they wanted to partner with us. Within the PA world there is one accreditation body, one certification body, and one professional association - so we can communicate and coordinate well.
The Academy's response to partnering was enthusiastic. We looked at some of the things that we wanted to have in this process - we wanted it to be timely and transparency was important as well. How can we make this a process with a lesser degree of influence so the profession could act quickly without bureacracy behind it? And how can we create some confidence in our members about the process? There are four members of the sponsors and four staff members that have been supporting this.
Typically in the PA profession when an issue arises we assemble a group of experts and we come out with a recommendation. We also needed a new model for doing this. We're hoping this process accomplishes the transparency and the evidence based approach and we can move quickly with whatever we come up with.
Some of you might have been shocked when you were invited. There are about 25% external stakeholders here. The sponsor group looked at the different perspectives we needed to have in this room and we started developing a list. It was not a one for one shot. We wanted people that could represent different perspectives and some people represent many perspectives at the same time.
We started casting a net to get the people with expertise in the room. A lot of people contributed to that informally. We didn't do anything scientific but we wanted a broad based perspective in the room.
Where we were missing perspectives we went out and interviewed people to get their point of view to include in the session. We also did a large survey of members. The survey and the blog lead us to today.
Bob: I want to be sure I thank you for being here. All of you are taking time away from your families and those PAs are taking time from your practice. Thank you for being here.
Everyone has your own voice. We are looking to tackle this with the information we have and to think big thoughts and to help guide the profession.
We're going to have a series of activities to focus on the charge for this group. We're going to evaluate if there is a role for an entry level doctorate, if there is a role for a post-graduate doctorate or if there is no role for a doctorate at all.
What we are talking about is a PA specific clinical doctorate. People get confused about PhDs - we're not talking about that. There are other terms - EDD, PsyD or a PhD - we are not evaluating those. What we are talking about is a PA specific clinical doctorate. What form should it take or if there is a role at all?
Everyone has a perspective. You all have multiple perspectives to bring to this particular problem. Some people have perspectives that are in conflict.
A good half of the people that sent in feedback felt this is a terrible idea. The other half said we need to do it. What everyone said in addition to their opinions was "thanks for having the dialog." Our colleagues think this is important. This is a not an official function. This is a group that is independent of organizations and no one has been appointed as an official representative.
We can do things that are outside of organizational and mission boundaries. Our job is to develop recommendations - based on the information we have - what do we want to recommend to the profession?
It could be bold to say do it or it could be bold to say not to do it. Either way we need to be bold.
Thank you all for being here. Thanks to the sponsor group for thier role in preparing this workshop.
Models Talk
Michael: I'm going to be introducing you to the process and how we'll be working together. But first. What's this?
It's a brain.
It's a model of a brain. Thank you.
It' a projection. It's a visualization.
What are some charactersictcis of models?
It's plastic. It shows relationships. It's an abstraction. A model is a representation of something, and we could have an hours long conversation about whether that is reality, but for the sake of this conversation we can say that a model is a representation of something else.
Why do we make and use models? To experiment. We may be able to do things to the model that we may not want to do to the thing it represents. We also do it for cost savings. There is value in experimenting with models.
Access. It might be easier to access something in the model than from the thing it represents.
You can do things to this brain that you may not want to do to the thing it represents. So we can mitigate risks, and experiment in ways we may not want to do.
You can try a wide variety of things, including things that will fail. So we make and use models to learn. And how do humans learn? By making mistakes. But how do we as a culture deal with mistakes? Not well! We know that humans need to make mistakes to learn, but as a culture we're not so good at this.
What are examples of models we use every day? Patient history and physical. Simulations. Molecular models we use in drug discovery. Medical imaging. An image is a model - all images are models. Is that fair?
Does a model contain all the information of the thing it reprsents? By definition, it must contain less. If it contained all the information of the thing it represents, it would be the ... thing itself.
Lab tests are models. The home itself is a model. GPS. So are maps. How we dress is a model.
We use ourselves as models. And other people as models. What kind of models are those? Role models. And mental models. Projections, pictures, stories.
What about this? [Shows a credit card.] Is this a model? Yes. What about money? What about a calendar? ID cards. Business cards.
Mass communication. Everything on TV is a model. Newpapers. TV. Music. Telephone calls.
Are words models? Yes. If words are models, then what's actually happening when people are talking to one another? Confusion! Interpretation. For the sake of this conversation, I call this 'model conflict.' My models are bumping into your models. I call this 'conflict.'
What are the ways we can resolve conflict? Communication.
How does that resolve conflict? If I'm really good at communicating ideas, and you really get it, have we resolved conflict? Yes.
What are some other ways to resolve model conflicts?
I take on the idea of the model and I own it.
The second is that I just accept it.
And the other one is compromise. I'll take some of that and add it to my model.
Or you can agree to disagree. If you do that there is no longer a conflict.
Are there any other ways to resolve conflict?
Yes, come up with a third model. A new model.
Destroy the opposition! War is a way of saying that my model will dominate your model.
If we simplify it, we can call 'expectations' models as well. Not only do we have a model, but we have models imposed on the model. It complicates things.
And are there traps in models and model making? Bias. Skewed modeling that doesn't include all the information.
So how do you know that the model is complete enough? Another trap is that you model the easy thing instead of the important things. So you model what you know, and miss a lot of stuff. Misperception or misinformation is a trap. Dishonesty. Maybe I hold information back.
That leads us back to the conflict resolution point. How do you know if you've really come to any agreement whatsoever?
When you go to implement it, and it falls apart you learn that you had different perceptions of the model. When you apply it in real life you see that over and over again.
There's no such thing as a perfect model, and some models are useful.
The only way to learn is to try it. What I was saying about mistake making, now take it further. Try something and see what happens. Getting the right answer up front is virtually impossible. We are a society of right answers - I call it the right answer syndrome.
So another trap is that we mistake the model for the thing it represents. If I say love... if I say chocolate each of us has a different perception of what that is. It's love!
Everyone of us has the same exact model as you!
Mistaking the model for the thing it represents is a trap. There's another trap. People get so invested in the model that they force it. I call this model fixation. This model is the right model; there is no other model. When the brain gets fixated on a model, it literally shuts down. We are literally deaf, dump, and blind.
What about our fear of failure? As the value we place on the model increases, the level of risk changes. It could kill someone...
So we have to manage risk, we have to learn how to manage risk.
So what?
How do you know a model is a good model? In some cases you want a model to be adaptable and flexible; in other cases you don't. We have standards when we don't want the model to be flexible, for what money is, for example.
What does this conversation have to do with why we're here?
We're going to play around with models, and do some things with the model that we may not want to do outside.
Please keep an open mind. We all come in with models. We all might have a very strong perspective that is in conflict. Models are in conflict. And we can take risks here, and build trust. One of the most imporant ways to allow that to happen is to have honest conversations.
Models are in conflict, but humans are not. Let's let them bump into each other, and see what happens. Models are in conflict, not humans. No model is perfect, but some models are useful. How do you know? You've got to try something.
How are we going to work? This is designed around a set of activities. Your job is to come up with a set of recommendations; our job is to come up with a set of activities to help you have the conversations you need to have. In every activity you make something. Everything you make is shared in some way.
Not everyone will be involved in every conversation. Parallel conversations will be taking place, but you won't be participating in every one. We have the opportunity to iterate. We will address issues again and again, and see what bubbles up. What bubbles up will be a set of recommendations.
A couple things about mangaging your energy - there are no formal breaks. Please keep interruptions to a minimum.
Every activity is like asking you to solve world hunger, and giving you 45 minutes to do it. Do the best you can and get as far as you get, and then we move on. We will be documenting, and by Saturday we'll have a web site up.
You job is to keep your hands free, unless you are a kinesthetic person. If you need to have something in your hands please do that otherwise please leave your bags and computers here.
I'm done. Have a blast!
Discussion
Jay: Thank you again for inviting us to be involved in this conversation. My wife is a PA and we've talked about this together. My job is to let go - just like you. The blog had Matt's name first and a lot of comments were directed at him. This is a design process. We are playing what if with options for this clinical doctorate. Once we understand how this could work and how it would work then we can decide if we recommend actually doing it.
You have opinions on this matter but we want to look at the options first.
Last night we looked at the past and the future and we heard two great case studies and we came up with a list of big ideas. You've had a night's sleep - do you have any thoughts now about what you heard last night and the big ideas.
I think we need to separate training from a degree. I don't know if that's true that it needs to be the same - they could be separated and not necessarily the same thing.
I need a frame. I'm looking for a frame. I'm looking for a mission statement. What we are trying to do as PAs? Where are we starting from?
Bob: What is it that PAs do?
Answer: I take care of patients.
It's about what PAs do. In the future of what PAs do - how do we bring this model or set of models into the future of what we think the profession will be doing? In the context of providing patient care where does that fit?
If there were a change in the way healthcare is delivered that could have an impact on whatever models we consider. If we think of all those things that might impact on the profession...
I thought we would tabulate the information and see what the group is saying. It looks like some number thought bridge programs are something we can think about. Show me what the trends are.
What I heard was the Army understood what they needed and they worked with the PA community to solve that problem they had. I might have thought we would have some emergency physicians here to work with us to think about what might happen in the future and then see if the PA community thinks that is the right thing to do.
We don't have that much representation of the employer here. Where are we trying to go? What is the practice of medicine likely to look like?
To help with your question PAs are the future of cardiac surgery. They have requested that the PAs coming out of school get more education before they start practicing with the surgeons.
In January 2005 the American College of Emergency Physicians created a task force to develop a curriculum for people to work in the emergency setting. Ultimately it went no where and they made their conclusions in 2007. They wanted more educated PAs to work in the ER. The employer groups didn't want to educate them only to have them leave and go to other jobs.
I was not clear last night but in reading through this the piece that's missing is the forces outside this group that are moving in ways that we can't control and they will be creating systems that we will have to work in.
There are a large movement to produce a Flexner report of the 21st Century. Whatever goes into that report will have an impact on us.
The purpose of last night was not a scientific dig but a higher level orientation to the general topics. We're not done with the exploration and the context setting. I think it makes sense to jump right into the next assignment which continues that.
The next activity is based on a process called scenario planning. Royal Dutch Shell looked at variables to their business that would be important and highly unpredictable. Two variables they came up with were development of technologies (would that be slow or fast?) and they also picked the variable of oil and whether they would run out soon or if there would be plenty for 150 years.
They looked at the intersection of these axis and the four scenarios this creates. These are different worlds and each one has a different implication on the business model for Shell. When the oil crisis of the 70s hit they had gone through the scenario of thinking about this and they went from the 6th largest oil company to the 2nd.
Yesterday we worked with the sponsors and identified some variables that are important and uncertain to the PA profession. You have been assigned randomly into groups of 6 or 7 people. The basic assignment is to go through your matrix, identify the scenarios and then discuss the implications on the PA profession. Have fun!
