 eventually do you think that it will replace the GRE as an entrance assessment exam for PA school? I was reflecting on when I took the GRE when I was going through my PhD, before my PhD program. It's like, I felt kind of thumped by that, but the GRE is a very different exam. Welcome back to my channel. Thank you guys so much for joining me today. So as proud with me today, one of like the driving forces of the PA cap. And so I know you guys have a lot of questions about it and we're gonna get right into it, but before we do, I wanted to give you the history on Dr. Massey. And I guess how he's able to talk about the PA cap and I guess why it would be valid for you all to listen. So Dr. Massey has a PhD and a PAC. He has practiced for 27 years in PA education, including holding leadership positions in four different PA programs. Currently he holds the position of a tenured professor and director of the Central Michigan University Physician Assistant Program. Dr. Massey has worked clinically in the area of family medicine, emergency medicine, and international third world medicine, which is so cool. Dr. Massey is also an accomplished researcher and author having presented nationally and internationally more than 75 times. Dr. Massey has published more than a dozen research articles and textbooks published by F.A. Davis and used by PA students to prepare four certification exams. Dr. Massey has served as the co-principal investigator of the PA cap research project since early 2018. So he has done a lot and he is actually qualified to talk about this. So I've given him a list of questions that I've come up with and some of you all have asked and we're gonna just kind of get right into those questions that you all have been asking about this PA, C-A-T and how I like to call it the PA cap. So thank you so much, Dr. Massey, for joining me today on my YouTube channel. Thank you, Adana. Oh, you're welcome. I just really quickly just, could you briefly tell me about the third world medicine because I have not heard about that and I think it's a really interesting... Sure, absolutely. During my career, I've worked both clinically and educationally in the country of Haiti and Belize. I spent a year working in Haiti developing a physician extender program there. So I've had some experience in those two countries. I've also gone to Costa Rica. So it's been one of my passions along the way. And what, I guess, are they called? Are they called a physician extender in Haiti? Is that what their title would be? They're not actually there. Well, it depends on the institution, but there's different names for them. I did travel to Africa a couple of times in the last three years. And in Africa, Ghana, for example, I'm involved with the project there. They call them physician clinical associates there. In South Africa, it's clinical associates. So it depends on the country. There's analogs of PAs throughout the world now, which is something us Americans don't realize that the first true physician extender program was actually in Catambo, Ghana in 1959. So it's an interesting concept. Giving us some history here. Yeah, yeah. All right. Well, let's get into the first question. Can you briefly share the history of this exam? So like the who, what, when, where, why? First of all, I joined exam master as the co-principal investigator in early 2018. I know that before that, exam master staff and executive staff have looked, we're looking at the PA, the admissions exam concept for probably at least five years. So they were studying it, looking at it. There's been some call and some discussion about it among different circles previous to that. And in 2018, it was still kind of in the conceptual stage. And I was asked to jump on the project because of my research work involving predictive factors. So for example, I've done some research involving how to predict Penn's performance. So it was a logical kind of, you know, step for me. And so the CEO of exam master asked me to step on to the project. And so since then, we've added several, like for example, a psychometrician, other people involved with the project. And the first analog of the exam was launched during the research phase, which actually began in summer of 2018. So really it was the first time that the exam was offered to actual PA students. So during the last two years, the exam has been researched, it has been stress tested. And so it's gotten to the point where it has enough statistical validity to be able to begin offering in 2020 this year. So that's kind of like a very brief overview of the process. I mean, Matt Bader, the executive director of exam master could probably give more detailed, like, you know, historical perspectives prior to that, but that's been my involvement. So I'll wait for the other questions, but that's kind of like the who, what, where, why of the process as far as the PA cat? And you said that it was tested with PA students, so in 2018, so was this like first year PA students, second year PA students, how could you all test this? There's actually the research protocol for the PA cat actually is online. It can be found if you Google it. I know there's been probably almost 1,000 reads of that. And so the research protocol describes phase one, phase two. So phase one actually was testing the exam on newly matriculated PA students. So during that phase, students who began the program during the first week, usually during orientation were offered the exam at that time. Realize that when you research an instrument like this, obviously you can't administer it to prospective PA students because again, there's ethics involved with that. And there's an institutional review board that had to approve this process. Phase two of the exam or the research protocol was actually to what's called stress test exam. And that was to test the exam on students who were interviewing in PA programs. So between the two phases now we're approaching probably 2,200 students who have taken the exam. Part of the concept of what's called a psychometrician and psychometrics of this exam is to look at basically how students perform and how they perform on each individual question and whether or not other factors such as prerequisite GPA, other factors might also correlate with this exam. We're also looking at data related to the end of first year PAC right now in terms of how well the two variables will correlate. The phase one, which is the research phase that I've mentioned before, will be concluding this spring in which we'll gather the last of the data. The first phase data which looks at the PA CAT and the admissions prerequisite GPA, science GPA, et cetera will be published in the Internet Journal of Allied Health Practice in April, if people wanna look at that. We plan to publish the second phase as well. Hopefully at the end of 2020 or early 2021. So that's kind of like the process. This in accordance with PAEA since it's PAEA education, does PAEA have any stake in this at all? Yeah, yeah, really good question. PAEA has been neutral about this. It's interesting, I've been involved with PAEA committees. I was on the board of directors at one point. So I've been involved for 15 years PAEA very closely. This is the first time there's been a project of this enormity that wasn't governed or administered by PAEA, okay? So the PAEA leadership, this is an external exam much in like the MCAT might be, much in like the GRE will be. So really it doesn't really impact the PAEA education per se. So it's something that among PAEA educators, the PAEA CAD has become well known and there's been much discussion. So at the PAEA conference this past year, we had a number of conversations with PAEA faculty. So the answer your question, it's not in accordance with PAEA because it wouldn't be appropriate to be to do so because it's not being governed by, it's not being administered by PAEA. Okay, will this test become mandatory? And again, much in like the other admissions exams that already exist, it will depend on the program, okay? So programs decide what admissions exam they want to use. There's some out there, there's one called the CASPER out there that exists. Of course the GRE as of a couple of years ago was about 51% of the programs used it. That's starting to drop a little bit. I think like less than 10% of the programs now require MCAT which isn't a good fit really because the PAEA students don't take all the prerequisites for it. So it's gonna be depending upon the program and much like other grassroots processes, I mean, it's gonna be like, how does it work in programs? And eventually the research is published from this process. I mean, we have conjectures and speculations but this year it might be less than 10% of the programs up in future years that might go up to 30, 40% of the programs but that's gonna depend on the program. How many schools are currently requiring or recommending the PAEA CAT this cycle and then next cycle? I know you mentioned about 10% but is there like a number that you have that you can give us? We're not gonna have the absolute number until probably the 1st of May because of the fact that we know of about, we know of 10 programs that are adopting for 2020 for this cycle but the process of adoption will depend on the CASMA cycle and what dates and that kind of stuff. So we'll have a better viewpoint of that around 1st of May about how many programs have adopted this year. Is there going to be maybe on like the PAEA CAT website a list of the programs that are there? Cause you know, as a pre-PAEA student it's already difficult as it is trying to source out like the requisite requirements for different programs. So just having a place for them to go to to see if I'm applying to like the University of Tampa or Central Michigan, do I need, is it recommended that I take the PAEA CAT? Yeah, that's a good question. And I think my guess is it will be. That's something that actually I will bring to Matt Bader, the executive, the CEO cause I think it's a good idea. So it's something that I think would make sense. Now I realize also that the websites of programs during the period prior to closing up the application phase will then start to post whether the PAEA CAT is required. And I know that's been some concerns by students like that's happening late in the game. But it's a phase in process. And there's no good time to adopt something new but you know, having been involved with PAEA admissions for, you know, this is the 29th year for me I can tell you that, you know, as long as you're not requiring a new class the last minute, you know, adopting a test where there's still months to take the exam I don't think that's too late in the game for most programs. So it's kind of like it's weighing that and also reaching out to individual students from that program that's being adopted. So with respect to that question this is this, you know, kind of like a subset I guess you can say. So for instance, the GRE has like several different dates that you can take the exam. Now when the PAEA CAT opens in May and since you guys are test, you know actually like rolling it out this cycle are there gonna be several different test days that it can be taken throughout the year even for like those later applications that are January or March. But my understanding Adana is that it's gonna be offered at the, it's gonna be offered at the Prometric Test Centers there's 5,000 test centers. And once it starts at the Prometric Centers it will be available ongoing. So I can't give you like, is it every day? Is it every week? But it's gonna be a number of different test dates available for prospective PAEA students. So it's gonna be numerous times. You know, much in like if you schedule some of the other entrance exams like the LSAT, GRE, et cetera. You have to sign up, you have to find the dates that are available for that center. But, you know, once it rolls out it should be offered multiple times. So it's not gonna be like once it's gonna be multiple times. So I'm asking if you can like just give a brief description on the details of the exam like how long it is and how it's scored. Because those are questions that, you know as a student going in to take an exam you wanna know like, well, if I get this grade or you know this score where am I at? I guess in terms of- Right. So the exam is gonna have 225 questions. And just like, and I'm just gonna use the analogy of the pans for many years. So the pans used to be 360 questions and 60 questions were what's called field test questions. I was a test writer for NCCPA a number of years ago and that process, you know, took place. So the PA cat will be the 225 questions. The 25 of the questions will be field test questions. So 200 questions will count for the scaled score. So that's what's gonna happen with that. Is that what you wanted to know was the length that you want more details? I mean, I think I mentioned the length to them before. Is it, how many, is it a minute of question? How are they doing? It's a minute of question. Okay. It's based on this, you know it's based really based on the same formula in terms of how the NCCPA administers their exams. And the minute per question there will be accommodations available. So that that's something that students will have to apply for as far as if they need accommodations and that'll be on a case by case basis that they need double time, 1.5 time, so. Okay. Is there currently a fee waiver or a reduction program in place for applicants with a financial need? Yep. So exam master is pursuing that and they're pursuing at the state level and the national level. So working with APA, working with the state chapters that we're working on criteria for, you know for basically inclusion criteria for how the students can apply for the waivers. Okay. So it's something that in 2020 will be in place. Okay. So how should one prepare for the exam or can you even prepare for this exam? So from my perspective, the exam is based upon the typical prerequisites that PA students take. And I know I've heard concerns that some students don't take organic chemistries, you know there's different variations of that. So for that purpose, like the chemistry questions were made a bit more general to, so students who didn't take as much robust chemistry weren't necessarily penalized by that. Okay. As of right now, exam master as part of the price for the exam will offer a free practice exam. So that's one way you can see kind of like how you would score. There's also some free downloadable materials that has the outlines of the exam in terms of what topics. There's kind of taxonomies of the exam as well. And where would they be able to find that? If they go to the PA cat website and they go to resources for applicants for test takers, they will find them there. I also add to that that, much like other exams, yes, I mean, students can review the overall topics on the exam. They can go back to their textbooks. They can go back to their courses. I mean, by the time you get to that point, you're a junior or senior, it's been a while since general biology. They can kind of, you can review the concepts, but the belief is that it will not require a robust time like months of preparation because really it's meant to test what they absorb during their time in undergrad. So with respect to just the studying and the scoring of the exam, since it's new, how would I, as a student, know that I did well or didn't, is there an option for that? I mean, because I'm not even really sure, I guess, on the scale, what your scale is or how it scored in a sense. So how would I know if I get, I don't even know, like 300, that's a good score or where I sit with respect to other students that take things? So several layers for that, but I know you took, congratulations, by the way, you recently passed the PANs. Yes, I did, thank you. The scale system really mirrors the PANs, so the overall scale for the exam is 200 to 800. Then there's gonna be categories in the exam that are gonna be built in, anatomy, physiology, chemistry, et cetera. And the scale score is based upon how the student scored based upon the pool. So in 2020, the students will receive a scaled score for those categories and the overall, and they will also receive a percentile marker, which means that based upon 5,000 students that have taken it before you, you scored above X percentages of the candidates in the country. So much in like when you look at your own, like I think NCCPA reports as deciles, we're reporting it as percentiles. It's fairly simple that way. There is not a cut score right now. In other words, there isn't like, this is the score that you have to achieve. At the program level, it's gonna be organically used in terms of looking at, if the candidates are at this percentile in the country, how they might use that information. We have general recommendations, but it's not our responsibility, nor is it appropriate for exam master or the exam to dictate to programs how they use that information. What students will know ahead of time is that they scored what percentage points above, below of the test takers that they scored. And then the scaled scores are derived using, the same model, what's called rush model of test modeling, which is the same as the pans. I mean, theoretically, you could click on random questions and get a 300. Very few students will get an 800. Just because with central tendencies, most students will score within kind of a, somewhat of a narrow range with that kind of exam. And does this, are you all participating with CASPA? So are they able to send their scores through CASPA? Is that gonna be an option? Or do they just get their score and then they send it to the particular program like by themselves? So exam master is working out the same arrangement that the GRE has used, which is when students will click on which programs they're applying for, then it will be sent to CASPA and CASPA will make that available to the programs that they apply to. There's also gonna be like a transcript that will exist too. So it'll be made quite clear to students how that works. So when they go in to apply for the exam and take the exam, it'll show how that articulation with CASPA will work. So can you share with us how the PA cat differs from the GRE and eventually, do you think that it will replace the GRE as an entrance assessment exam for PA school? I was reflecting on when I took the GRE when I was going through my PhD, before my PhD program. It's like, I felt kind of thumped by that, but the GRE is a very different exam. It's actually even changed now than the PA cat. The PA cat is based on the basic sciences and social sciences that students take during their program. So the GRE approach, the analytic approach, it's a very different exam. I mean, it can't really be compared. So it's really more of a basic science, content-based exam versus a process exam or analysis of verbal, et cetera. What about eventually replacing the GRE that you see happening in the future? I mean, if I had a crystal ball, I would say over time, I think more programs will probably adopt it than not in the future. Again, that's gonna be up to the program. Programs will use admissions variables in various ways. And I'll tell you how I've used admissions variables is that you correlate the student's score with the academic performance in individual programs. You correlate those admissions variables with say, background, end of rotation exams, summative exams, and eventually PANs. So I think that some programs might continue with both. I'm not sure if they will or not, but it's the same process. I mean, they'll decide whether the GRE is not able to provide that information. And yesterday I went on and just kind of reviewed some of the research literature about GRE and PA education. And what it's demonstrated has been inconsistent and it hasn't been very strong in terms of the relationship with academic performance. So it's been a bit wanting. You know, there's probably about a dozen articles written by PA educators and a dissertation I just read that looked at how well it worked. So at the end of the day, it's kind of like, what kind of tools can we as PA educators have in our arsenal to make the best selections of the candidates? And I can tell you that it's not about weeding out students, it's about making sure the students in your program have the ability to be able to perform well in the program. And I can get into issues such as attrition, remediation with you if you want. But I can tell you that from my viewpoint, I mean, I've spent the greater part of my career building remediation practices and finding ways to predict performance and intervene so students can be successful. And to me, it's about, that's kind of an extension of that conceptual framework because we want the students to be able to be successful and having worked with many students that got into the program and then just weren't able to get over the hump in terms of their first semester or two or they struggled through the program and then they struggled in the second year and then they ended up failing pans once or twice or more, you just don't want that to happen. And programs, despite best efforts, can't make that different sometimes. So I believe in the exam, I believe it'll be a positive move forward. It'll be another tool for PA educators. And that's just my personal perspective. So with respect to that, I guess, how does the PA CAT measure prepay academic ability needed for the successful completion of PA school? Cause I know that is like, that's what you all intend for it to do. So I mentioned before in the interview about the first phase of research and so I'll kind of give you a little bit of what we found so far. If you look at how well the PA CAT score corresponds with, for example, PA, academic GPA and the end of PA or end of deductive care PACRAT, it's been pretty strong. So again, if you're familiar with Pearson correlation, that relationship, the relationship between the PA CAT score and the end of deductive care PACRAT is about a 0.55 to 0.6 depending upon the sample size. And if you compare at the program level, GRE is probably in the range of a 0.2 to 0.3. So it's a stronger relationship. I have personally, because Central Michigan was one of the first programs to administer the exam to our students. I personally analyzed my students in the second year now, their performance in the first year and looked at those variables and very delighted to see that the exam did have a very strong correlation with students' performance. So that's kind of how it works. It happens on a macro level because you look at research and I would guess that down the road, there are probably multi-program studies because again, there's only so far you can get with a piloted study, it's gonna have to be research among PA schools. If people wanna go into my Google Scholar page, which they could just Google me, Scott Massey PhD, I did some research with multi-program study involving PACRAT and summative exams and that kind of collaborative process will take place. And so that's a long answer to your question and that the ability to use it is gonna be at the program level and it's gonna be on the collaborative level. And that's pretty much the same as how PACRAT was used, the end of rotation exams were used and I'm sure originally how GRE had been used because it has to be pilot tested, it has to be used over time. So anyways, I apologize for going too deep on that but I wanna give you- Okay. So with respect to, I know this is about performance in PA school but with respect to attrition rate, like just looking at the report that comes out from like PA, EA, attrition rate is not really that high. So what I guess, like how, are you trying to have like no attrition at all because it's maybe like two to three students that like come out of PA programs each year. Yeah, remember you're looking at the means, okay? And some programs who have special missions, we'll admit more at risk students, okay? So the attrition rate might be higher. As far as I'm concerned, there should be zero attrition. So I think the philosophy of PA educators is we want all of our students to succeed. So if this exam helps to lower attrition from 6% to 0%, that's great if it's a tool that helps with that. The other thing that to consider is that this exam could actually provide some assistance to programs that have a mission-specific focus where they wanna admit students who have disadvantaged backgrounds where it could lead to a pre-matriculation program where they could be assisted if their scores are lower. So if in other words, try to preemptively help the students to help ensure success. So again, I know that programs have sometimes struggle more in years than others. I've seen attrition rates as high as 10% in my career. I've seen attrition rates as low as 2% in my career. So it's gonna vary. Okay, so this is the last question. It says, can you address the concerns of those who feel that this exam may reduce the diversity of PA students? As they believe that standardized exams disproportionately disadvantages people of color, those with low socioeconomic status and those with disabilities. That's an excellent question. It's been a concern of the test committee and the research team all along. And the best way that that can be addressed is within psychometrics. And so I'm just gonna apologize if I go too deep into this, but I wanna say when the exam is analyzed and that will be now an ongoing, that the psychometrics will look at performance based upon those parameters. Like it depends on how much information we have about the test takers, but they will look for differences in performance. They will be looking for differences in performance within questions to see if there's any questions that might be potentially an issue for that. I'm also gonna say that that whole concept about diversity and everything we mentioned is a hot topic in PA education now because of the fact that programs, they struggle with that. And some of the issues that programs faces that we have, the pass rate on the pans is something that our accrediting body, the ERCPA, does not look kindly if the pass rates drop. So programs are kind of between a rock and a hard place with that. But back to the discussion about the pre-matriculation concept. If you have students in those categories that say their scores are lower, there's an opportunity for programs to adopt a pre-matriculation process, which that's something that we've also talked about offering as part of this in the future is that, can that be a way to bridge the gap? Rather than just looking at it's like, it's not meant to eliminate any candidates. And that's gonna depend on how programs choose to use it. But to the best of the ability in looking at how the exam performs, that's where those types of concerns will be addressed. All right, well thank you so much, Dr. Massey, for just taking the time out to sit down with me and answer all of these questions you did amazing. And so now I wanna give you the opportunity, just if you have any last words of encouragement for those that are like chittering their teeth that this test is coming or anything that you wanna address that maybe we didn't have time to address or ask the questions, the floor is yours. Absolutely, I've taken some time to go into some of the blogs and look at some of the questions, both on yours and others. And I think some of the students are concerned about, I think there's been comments about money, there's been comments about the cost to students and the cost of the PA CAD, I mean, the center fee is wrapped into the cost. So it's not significantly more than GRE. I guess that's an issue that, I guess you have to look at the big picture. And I'd ask that students kind of, or prospective students try to look at that in terms of how might that exam be helpful to you in the future? I believe that we're trying to address some of the issues that you mentioned before. We're human beings, we're trying our best. And at the end of the day, this is about trying to promote success in students. It's not about eliminating students, okay? Realize that, this is my 29th year in PE Education and when programs are faced with, say hundreds of applications, is there a way when you have so many applications with almost the same credentials? I mean, what do you do? And that's hard because programs have limited resources. They can't interview every single candidate. So I think that it's better to use something like PA CAD rather than GRE to make those discriminations. So it's a little bit of a better tool, I think, because some programs have used GRE for that purpose in the past. So I think just keep that in perspective. That's really the key things I wanted to say. You know, myself, my career in PE Education has been about, like I said, it's been about student success and I wouldn't be involved with this project if I didn't believe that it was going to be a positive towards student success. So that's my last comments. Thank you again. Thank you so much for doing this interview. I really appreciate it. And I know that all of the subscribers and followers will appreciate it as well as getting some of the nitty-gritty information that's not on the surface of the website. So thank you so much. Awesome, thank you for the opportunity. Oh, you're welcome. Special thank you to Dr. Massey. I really appreciate you sitting down and answering these questions for all of us who are interested in just learning more about the PA CAD. If you have any other questions that were not addressed in this video, please leave them in a comment section below. I know that again, this can be very nerve-wracking. It's a new assessment that's coming in, but just encouragement that you guys will get through it. It is things that you're already aware of in terms of your undergraduate degree. So if you go to the website and look at the resources tab, there will be information that will help you study or refresh your mind for the content areas on this exam. Thank you guys so much for watching. Please like this video if you liked it. Subscribe and follow me on Instagram at AdanaThePA. And I will talk to you guys next time. Bye.