Preparing PAs for Their Increasingly Important Role On the Healthcare Team - Michael Moore, Clinical Assistant Professor in the Physician Assistant Program, University of Michigan-Flint

Michael Carrese: Hi everybody and welcome to Raise the Line. In this special episode, we'll be talking to one of the winners of the 2022 Osmosis from Elsevier Raise the Line Faculty Awards, who was chosen from over 1,000 nominations we received from 377 institutions around the globe, with their students and colleagues submitting videos and testimonials telling us how they embody the six Osmosis core values. Today we're joined by Michael Moore, who is the overall winner for the Physician Assistant category. Thanks very much for joining us and congratulations. 

Michael Moore: Thank you very much. Happy to be here today. 

Michael Carrese: So, instead of me reading a lot of stuff about you, why don't you tell us more about who you are and what you do there at the University of Michigan. 

Michael Moore: Happily. So, hi everybody. My name is Michael Moore, as was stated. I'm a PA faculty at the University of Michigan-Flint. It's a new program, so this is our third cohort that just started in January. So, we're still having the life lessons that we learn as faculty. I also taught at a program that was also a brand-new program in rural Indiana, near central Indiana, south of Indianapolis. So, definitely love getting programs up and running and seeing the excitement on the students' faces every day. 

Michael Carrese: What are some of the bigger challenges in launching a program? 

Michael Moore: For developing a new program, I mean, it's already a full-time job seven days a week just being a faculty, teaching and the administrative stuff that we have to do to keep the place open. But that's also doubled by...sort of the best analogy I've ever heard was building the plane while flying it. So, it's a fun job. We get a lot of reward out of it. It's a lot of work and I see it in my students every day. They're out there in the clinical rotations now and it's rewarding when I hear the stories of “I got to see this today” or “I did this procedure.” It all makes sense after seeing it and applying it. So, the thank-yous are long down the road, but we're here and happy to do it every day.

Michael Carrese: Yeah, that's great. So, tell us about your earlier background and how you got started in a career in education. 

Michael Moore: Yeah. So, my first job as a sixteen-year-old was a lifeguard at the YMCA in the city near where I lived. I was with them for about a decade. I could have taken better jobs at better hours and better pay, but I liked the community aspect of that. Started early on, wanted to just do a little bit more than was expected, took kind of a training role for CPR classes, lifeguard courses for staff, for the community. And every job I've had since then kind of had some educational aspect to it, whether it be working on an ambulance crew or a few other side jobs I did within swimming and coaching and things like that. 

Even before PA school, I thought I might end up in education in some aspect and didn’t even know about the profession until my sophomore year of college when my anatomy professor started talking about different career paths in education, in medicine, and things started clicking. So, very early on into my career as a PA, I'm like -- with any student I can find, even if they're not there for my particular specialty -- “Hey, do you have five minutes? Are you bored? Come see something cool.” I just ran with that full time. 

Michael Carrese: So, it sort of seems like in your DNA to want to teach. 

Michael Moore: I think so. I never call myself a teacher. I have plenty of friends that do elementary school, high school. They're teachers. I could never do it. I'm here for people that have worked a long time and chose to be here voluntarily, not because they were told to be here, and they're really excited to learn about the material. I could never be a math teacher. I'm not great at math myself. So, happy to have these students that have given up a lot themselves to be here and we can learn together. 

Michael Carrese: Who are some of the teachers that inspired you along the way? 

Michael Moore: Well, professionally, definitely with my leadership positions, I followed my director at my first institution. He was a big influence, the program director. I went to that job site unseen, had never been to Indianapolis before. But just talking to him on the phone, I'm like, this guy knows what's going on and what the needs are for PAs and for medicine just in general, especially for those underserved areas. 

Well before that, I mentioned my undergrad A&P professor, he was known as the toughest guy that there was and had pass rates that were lower than the other ones, but he really demanded a lot from his students and you could see, despite his kind of hard persona, that he really expected a lot from the students and because the responsibility is so awesome for potential, it was a pre-med kind of weed out class essentially. I don't like that term, but that's kind of how he taught the course. I take certain aspects of that. I don't want to weed anybody out, but I definitely love the high expectations of people that want to go into this career path that there will be sacrifices made. So he was instrumental in that. 

I went to school in Detroit at Wayne State University for undergrad and for grad school, and so definitely my faculty were inspiring. They're all practicing physician assistants and still have time to teach us the ins and outs of medicine. My current faculty that I work with, as well as my program director I work with now, she was actually one of my teachers when I was in grad school. And then finally, from a more personal perspective, my mom has been there for forever inspiring me, and my grandparents were really instrumental. One of my birthday gifts was a stethoscope when they knew I heard about the PA program. You might need this in the future. My grandma was a nurse for a long time and so she was always very interested in what was going on in school.

Michael Carrese: Was your mother a teacher too? 

Michael Moore: Not so much a teacher. She had different jobs. But I think more so from the role of mother just teaching how to be a good human is what she does the best. But I do have some teachers in the family, so I'm sure somewhere in the genes it has been passed on.

Michael Carrese: Oh, that's great. So in order to win the award, you received a lot of nominations and testimonials from students and colleagues and I'm afraid I'm going to have to embarrass you now and read a little bit of that just so people get a flavor for it. “Professor Moore has been a phenomenal professor. He cares so much. He spends a lot of his time putting effort into his lectures and into his students. He stays after class to help. He provides us playlists on Osmosis for every module we're learning. He's kind, caring, and deserves to be considered for this nomination. He always recommends us to reach further and learn more. He provides us material we need to know and provides us with material that we should know because it will benefit us. He's intelligent and caring.” So what's your reaction to all that? 

Michael Moore: I don't take positive feedback well. It takes me a little while to accept it because I'm always hard on myself for things that could have gotten better or should have gotten better and it's a little humbling for sure. Most of the feedback I get after courses are things that people didn't like. So, it's always nice to hear that the process is working and sometimes we have to tell them to trust the process because you go twelve, sixteen months of just nonstop education, then you start seeing patients in your rotation phase, and you're like, “that actually starts making sense.” It's always retrospective. “Oh, that made sense why we did that in that order.” 

So, I like to hear that things are working, the students are learning, they appreciate the hard work that they have to do to get the knowledge base to serve their patients. I will always take it with a grain of salt. I'm like, “Oh, no, no, I could do better,” but the appreciation...it does not get lost on myself. 

Michael Carrese: That's great. So, is there an Osmosis value that you feel you embody the best and why? 

Michael Moore: Sure. I did look them up to see what those values were and I thought it was pretty cute. The body system approach as well. Naturally, you guys are all about the science. I didn't see one that specifically jumped out more than another. I think they're all sort of required for a good health care provider and a student learner in order to really be there for your patients. 

I did make a note -- so I could refer back to which one I thought resonated most -- in terms of start with the heart and really just caring for my student learners. Because again, there's a lot of jobs you could do that are easier and pay better money, but they're here for a reason, and that's really advocating for their patients. I appreciate that they're dedicating their time, their money, their mental sanity to be here and learn with us. 

As for the Osmosis value of spreading joy, certain topics are more fun to learn than others and trying to make something fun out of it -- whether it be a funny meme in a lecture or a video to something popular on TV that might be able to relate the content a little bit more -- is just better than me having to sit out there and talk at you for two hours. Maybe drawing up complex cervical or brain anatomy, things that make the concepts make a little more sense. 

As for imagine more, that’s about just new styles of ways of learning. It's not just lectures. Can you learn by doing aJeopardy-style review game, or can you learn by drawing? Can you learn by just teaching me what you know about the topics? 

For reaching further...medicine is all about lifelong learning. You're not going to walk out knowing everything. You'll know a lot, but there's much more to learn and I think that's a great thing that the job is not done. You see your patients, you do your work, but something happened that day that makes you think, “I could probably learn more about that subject. That’s my homework for tonight.” Being a good regulator of your own knowledge and your own journey is pretty rewarding. I learn something new every day. I still have to consult my book. That's a new disorder. I haven't heard that treatment plan or whatever it might be. That keeps me excited and looking forward to a long career in medicine and education. 

Michael Carrese: Yeah. Let me ask you about how you have seen yourself grow and innovate as a teacher?

Michael Moore: It's kind of sad. We don't identify ourselves so much as natural educators or someone that went through a training. Most people go and get their teacher degree. Everyone I work with...we were just full time PAs that liked this aspect of the field and chose to be educators -- whether part time or full time -- and get more involved. It was tough to begin with because we know the medicine from the practitioner standpoint, but how do you educate that? 

So, we've taken a lot of the lessons that we learned ourselves from the student perspective: this didn't go great when I learned it; how could I learn this in a better way; and how can I teach it so you can learn it in a better way? We've taken the best parts of our old previous programs, our own experiences, and put those together into what we're pretty proud of for our curriculum. The best of the best. 

We either omitted things that didn't go so great, or we've transformed them in a way that, while they might be required, let's make them as beneficial as possible. But it's a growing process. My first year, I was just, again, building that plane while flying it. But part of being a practitioner of medicine is you need to be flexible and push out of your comfort zone a little bit and be able to accept the criticism. “Hey, could we do this a different way? Maybe EKG lecture this week before this topic might help a little better.” So we do a lot of feedback. The students will say they do a lot of surveys, and that's part of the incentive of being part of a new program is they do have a say in how this program will develop over the time and what might be better for future generations of trainees. 

Michael Carrese: Maybe you could educate us a little bit and help us understand more about the role of physician assistant, because it is a very fast-growing occupation in health care. What is it that you are preparing your students for in terms of the world they're stepping into and how they're going to have to function as a PA? 

Michael Moore: Sure. Definitely happy to answer the question because, like you said, it's a growing profession. In respect to medicine, it's a new profession. I mean, despite being known since the mid 60s, not everyone knows about it. PA is not a household name. Everyone knows, “Oh, that's my doctor,” but they might not know, “Oh, that's my PA.” As I think about preparing my students, I can go through what body systems we learn, how many hours you spend learning, but ultimately it’s about teaching them how to be critical thinkers, because I feel like in undergrad education, it's a lot of courses you take because you might have to, you test the knowledge, and you might not remember it. You didn't learn it in a way that was retainable and really teaching them how to be critical thinkers. 

They need to have the basic knowledge down of a medical disorder. Who gets it and why? What are the risk factors? How are they going to present? What is the basic pathophysiological process? That's where you guys come in. And how can I recognize this clinically? How can I recognize these disorders with diagnostics and how do I treat these people? But also, how do I educate them on how this happened? Or how can we prevent this from happening in the future? So those core staples of bedside medicine are installed in all of our lectures, in our contact for our students for the various disorders we go through, and it very much follows a traditional medical model, like what med schools would do. 

We’re body system based right now. The new class is studying hematology so we're learning all those anemias and heme-based malignancies and we'll carry that knowledge forward through the various different body systems. Essentially, I want them to go the clinical phase with the basic knowledge so they can start applying that knowledge to real life patient scenarios under supervision with their preceptors. Then, essentially, when they're done with that year, you're ready to be an entry level PA, see patients pretty autonomously. As you're learning, you will consult your collaborating physicians. They may oversee a certain percentage of your work or your charts. But essentially, you are taking the role of a physician helping them see more patients. 

I work in surgical specialty, and while my surgeons are in the OR, we're seeing the patients in the ER, the consultations, any ICU issues. If there's something that is above or beyond my scope, where I want to have it confirmed, they’re just a phone call away or just down the hall and I can go, “Hey, this is what's going on. Just wanted to keep you in the loop.” But really, the critical thinking aspect is what we try to do with case-based learning in real life situations, just because that's tough to teach and you can't learn that from a textbook. 

Michael Carrese: Yeah, for sure. So what do you think is next for you and for your program when you look down the road five years? 

Michael Moore: So five years. Every day, we're working toward that steady state. This is the beginning of our third year, and our cohort sizes have grown and we have students that have just started. We have students like fourteen months in, and then we have students that are about to graduate, so we’re keeping them all on track toward graduation and learning while also trying to establish our roots here in the community. 

I think getting our curriculum at a steady state, which it’s pretty much at now, will give us more time to focus on scholarship and research. We're part of the University of Michigan, which is a research-heavy institution. So that'll be something that we're going to look into, one, for betterment of our own knowledge as well as toward promotion and getting more PAs involved in research, because PA is not a research-heavy specialty. 

I think building more and more sustainable community involvement is a goal. We have our students going out to a community center where at-risk youth go after school and they can be mentored and taught things, take lessons, and just see people. It's ranges from elementary school toward high school age. So that has been awesome, and now that the COVID restrictions have been lessened, we have more and more ability to go out there and educate the community. So I'm seeing a lot more community involvement.

I don't know how familiar with you or the listeners are with Flint, Michigan, but it does have its issues as a poverty-stricken city that was once automobile heavy, and those jobs have shifted. So, there's been a lot of issues down there that we'd like to start from the ground up and really work on in terms of patient education and advocacy, community medical disease prevention, all these things that we can kind of long-term see improvements in our community here. 

Michael Carrese: Terrific. So, as you know, we're a teaching company and we love to fill knowledge gaps. We're just wondering if there's any topic that you'd like to educate us on that you think everybody ought to know. 

Michael Moore: Hmm. Well, I've definitely used the Osmosis features for each body system. It's a big part of our baseline anatomy and physiology education, as well as the pathophysiology component. Seeing an animated active learning for what we talked about in class is helping a lot of my visual learners. So I love that part, and I wish I had this when I was in school. It wouldn't make it easier, but it would have made more sense. 

In terms of knowledge gaps, I think the biggest one I had made a mental note to bring up was again, working on critical thinking. That's the hardest part of the job, I think. I can learn all the medicine and the facts of this disease, X, Y, Z, but when it comes down to it, it’s about applying that information. I think that the resources you guys provide are very helpful and kind of diving into that as much as possible is, “okay, you've learned how to diagnose hypertension, but how do you practically do this?” And that's by testing yourself with case situations and learning from every single clinical interaction you have. Even if you're seeing them for their gout on their toe, well, they have hypertension. What meds are they on? Does that make sense? And that's really backed by evidence-based decisions and really learning from every single encounter. 

So, I think if there's videos that can highlight critical thinking or saying, is this patient “big sick” or a “little sick?” Prioritizing tasks is a big part of how our exams and our board exams are focused. You recognize that this isn't a medical emergency. What is the next best step? That's a hard test question to answer because there might be more than one right answer on that test. The transition I see from undergrad to grad school is, “but there's two good answers.” Yes, but one is better than the other in this particular situation, because we are teaching you how to treat patients, not how to treat a textbook case. And that is something that I think we can work on, even the undergrad years, is more critical thinking, analyzing the situation and applying your knowledge with your best judgment to get to an answer rather than just plugging and chugging information and regurgitating it to me. That does you no good on the clinical side. 

Michael Carrese: Very wise words. Speaking of wise words, we also like to ask our guests for the advice that they give medical students. This is obviously a tough time to be in medicine. We're still in the pandemic and so much has changed in the last couple of years. How are you counseling them about approaching their careers at this time? 

Michael Moore: Sure. And definitely, yeah, still heavily involved in the pandemic and it has changed, I think, things forever in some in good ways and mostly in bad ways. But here we are still doing the good fight and the job. We're still here. People will still get sick, so we must continue on. 

I think my advice was the same before the pandemic: just be flexible. This is a job that you want black and white. You want the diseases to make sense, black and white. What is the treatment? There are different options. Okay, that's not how I learned in school. There's supposed to be an answer for this question. So be flexible, be flexible in the transition from undergrad to grad school.

I have very good students that are pretty humbled on their first couple of exams, not because they're bad students, because it's a great quantity of information coming at you very fast. And we're asking you to critically think your way to an answer, not just tell me this is the most common disease cause. Why did they get that disease? Why are they presenting this way?  How do you manage it? These are difficult decisions to make for the new learners and even well down the line. You need to learn how to be flexible. What worked for the first six months might not work for the second six months. 

So, I recommend looking into what your learning styles are, how you might take advantage of things like these animated videos. Do you learn from test questions? And you can gauge your understanding of the conditions. So being flexible is probably the main thing, reminding yourself that you are good enough to be here. We don't pick people we expect to fail. I want to see you succeed because your success is our success, and it means better outcomes for your patients and my future patients. 

Sometimes you need that reminder, why am I here? And it comes down to the patients and really being there for the patient and sometimes you're all they have. If you're the PA in a rural town or small clinic, there may be no physicians that practice there, so you're it. You're really their best access to quality of life and counseling them, educating them, making them their own advocates as well. We're happy to do it for them, but they should take on some of the responsibility and ask the questions and sometimes they need some encouragement. Yes, you're on this medication. Do you know why? Or do you know how this works? 

I draw things on the patient bed all the time. This is how your heart works and this is what's this blood pressure pill is helping with your heart. I felt better. I stopped taking it. Well, then I failed you. I didn't educate you as to why you're supposed to be taking this medication. So, really reminding yourself why you're here. It's for the patients. Because burnout is tough. It's a tough time for any field, especially in medicine. We’re no less busy than we were before and oftentimes have fewer resources than we once did, and so like the burnout is real at the practice level. Students are tired. So, really focusing on kind of reminding yourself what you came here to begin with for. Those close relationships with your friends, your classmates, your family...take some time, breathe, and then repeat on Monday. Those would be the main things: remind yourself why you're here and be flexible to the learning process. 

Michael Carrese: Great. So as we wrap up here, any final thoughts or any other shout outs you want to give to folks you haven't mentioned yet?

Michael Moore: Hmm. Well, definitely a shout out, like I said, to my late grandparents. I appreciate all the lessons they gave me along the way, and I'm still learning from them. For my mother, she's my biggest cheerleader. I don't like to brag about anything, and she really has to pry information out of me. So she's like, “Oh, what's going on at school?” Oh, I got this award thing from Osmosis.” “Oh, what's that about?” And then I find out that in 24 hours, the entire family across the country knows about it. And I'm like, oh, geez, OK, well, that's embarrassing. But OK, thank you, thank you, thank you. 

I think a shout out to the students. They're the reason I get up in the morning. Education is more work than clinical practice was, even though I practice in neurosurgery. This job is harder because it's seven times a week kind of job. We're here for our students and we want them to succeed, and again, I'm very proud of them, and I'm excited to have a long career working alongside them in Michigan for those that choose to stay in the state and practice in Detroit or up north in the rural areas. It's an exciting process. I still have a lot to learn and I'm hoping for a nice long career as an educator, as a provider and hopefully as a mentor for students and future students. 

Michael Carrese: Well, Professor Moore, I have to say it's pretty obvious to see why you were nominated for this award and won it. We want to thank you so much for joining us and wish you the best in the coming year, and thank you for the work you do to train the next generation of health care professionals. 

Michael Moore: No, thank you so much for your kind words and just offering things like these for the other health care providers as well, PAs included, because it says a lot about the program and your respect for the medical professionals and the hard work that they're doing out there every day. Because the nurses, the PAs, the NPs, the docs...they're not getting enough of the thank-yous. We don't expect it. It's never expected, always appreciated, and so any recognition goes a long way besides a hospital inspired pizza party -- that gets old pretty quick. We appreciate these things. Again, it just reminds us of the big picture and why we're doing what we're doing. And we're happy to do it. 

Michael Carrese: Well, that's great. Thank you for that. I'm Michael Carrese. Thanks for checking out this special episode of Raise the Line. If you want to learn more about the other faculty award winners from 2022, you can check out osmosis.org/faculty-awards. As always, remember to do your part to raise the line and strengthen the health care system. We're all in this together.