The Special Value of PA Programs in a Time of Change: Christina Robohm, Texas Tech University Health Sciences Center

Shiv Gaglani: Hi, I'm Shiv Gaglani, co-founder of Osmosis. Physician assistant remains one of the fastest-growing professions in the U.S. and perhaps reflective of that, Texas Tech University Health Sciences Center recently announced a major expansion of its PA program. On Raise the Line today, we're going to find out what's happening with the profession, the Texas Tech expansion, the impact of COVID-19 on medical education, and much more with our guest Christina Robohm, who is a Regional Dean at Texas Tech. Christina is a distinguished fellow of the American Academy of Physician Assistants and has been with Texas Tech in various roles since 2014. She started her career as a PA at the University of Colorado, Denver Health Sciences Center. So Christina, thanks for taking the time to be with us today. 

Christina Robohm: Absolutely. Thank you.

Shiv Gaglani: I'd like to start first by learning more about you, and what first got you interested in healthcare and then the PA career. 

Christina Robohm: Well, what originally interested me was likely what most people would say: I enjoyed learning about science, and I wanted to help people. Like many young adults, I looked at a lot of different careers in my areas of interest. At first, I had dreams of going into music and business, and journalism but that was short-lived after starting college. So, I began looking at some other fields and that included healthcare. I ended up choosing to become a PA after exploring a few different career paths in medicine and nursing. After I shadowed some physicians, it was suggested that I consider the PA profession. I shadowed a few PAs and I knew that it was the profession that I wanted to pursue. Being able to practice medicine, make autonomous decisions, concentrate on patient care, and have that shorter path than medical school was what I really was considering when I considered the PA profession and after so many years, I would have never dreamed in that time of seeing how the PA profession has grown and evolved and where this journey would actually take me being here at Texas Tech. 

Shiv Gaglani: Even in the time since we started Osmosis, I've been very impressed with how many more schools, and even at those schools, how big the enrollments have grown in the PA career as well as how international the profession is now -- not just in the U.S. but also in the UK, Canada, Australia, and several other countries.

Christina Robohm: Yes. When I started PA school, there were less than 50 programs and now we've grown to far over 250 programs. 

Shiv Gaglani: That's incredible. I track Bureau of Labor Statistics data from the U.S. and PA has always been in the top 20 fastest growing professions including nurse practitioner and wind turbine repair person and certainly a good bet to go into. So, how did you make the transition from a 100% clinical practice to going into administrative roles including your role at Texas Tech? 

Christina Robohm: I was in full-time clinical practice for three years in private practice. First for a year in family medicine and then in general pediatrics for a couple of years. I knew early that I ultimately wanted to be in PA education and at that time, the master's degree was optional. So, I started on the pathway and completed my master of science degree in Child Health Associate Studies at the University of Colorado, and that was two years after I earned my PA certificate. A year later, a faculty position opened at the University of Colorado PA program and I threw my application in for consideration. It was a bit surprising that I was hired on that path. I started on faculty at CU in the CHAPA program where I was for 12 years and ended there as an associate professor and associate program director. I then left and worked at Carroll University as a program director for a little over a year before coming to Texas Tech University Health Sciences Center in 2014 as the program director. Since then, I've been afforded many opportunities for growth and leadership development, accepting the role as Regional Dean for the School of Health Professions and finishing my Doctor of Medical Science degree in education at the University of Lynchburg about two years ago. 

Shiv Gaglani: You’re wearing a lot of hats and you've obviously been very busy over the past seven years, probably much busier now because of the significant expansion of the PA program that was announced just this spring. Can you tell us a bit about Texas Tech's Health Sciences Center and then specifically what's prompting the PA program expansion? 

Christina Robohm: Sure. So TTUHSC is the largest producer of health profession graduates and it covers all of West Texas and that's the largest producer in Texas. We have five schools in our institution -- the main campus is in Lubbock, and we have regional campuses throughout West Texas including Midland, Odessa Abilene, Amarillo, and Dallas. In addition, TTUHSC Managed Care provides healthcare services for more than 32,000 of the state offenders in correctional healthcare across West Texas. Working at TTUHSC has been truly an amazing experience. This is likely due to the value-based culture with the core values integral to our purpose and vision at the Health Sciences Center. Those values are one team, kind-hearted, integrity, visionary, and beyond service. It's through the integration of those values in our daily work that the strategic vision of innovation and collaboration set by our president continues to grow, and together, we move forward that mission of the institution to improve health throughout our communities. 

As for the expansion of our PA program, it was originally started twenty-one years ago with the vision of our leaders in the community to improve healthcare access in this region and the initial investment from the state of Texas started the PA program here at Midland College campus, which is about 130 miles south of Lubbock. Now, fast forward twenty years, the state of Texas again saw the need to continue working on the issue of healthcare access and affordability and made the investment of $20 million towards the expansion of the building, and an additional $10 million was needed and the community of Midland stepped up to help with that. So, with large gifts from the Midland Development Corporation, Permian Strategic Partnership, the Scharbauer Foundation and a few others, we started construction just a couple of months ago on the 24,000 square foot addition that's going to include a gross anatomy cadaver lab -- which will be the only anatomy cadaver lab in this region -- a collaborative learning classroom, and additional student space.  We’re also renovating the current 27,000 square foot building to improve the classrooms and add a standardized patient simulation center and also improve all of our other classroom spaces. This is pretty amazing for a PA program, and I've never seen another facility like this that is 100% dedicated to a PA program. We have applied to our accrediting agency to increase the maximum class size from 60 to 72 students when the project is completed in May of 2022.

Shiv Gaglani: That's awesome. It's pretty impressive in terms of the amount of growth and the fact that not just the state but the specific community in Midland also stepped up and hopefully, it'll show up in terms of increased access and quality of care in the region. Looking back over the past year and a half, I'm curious what your assessments have been about how Texas Tech specifically has responded to the pandemic and what do you think the lasting impact will be of the COVID-19 pandemic on PA education or medical education in general?

Christina Robohm: Well, under our president's leadership, I believe our institution did a tremendous job adjusting to education delivery and patient care during these unprecedented times. There wasn't a manual for this. We all had to do our best as a team to pivot and find the best solutions on very short notice. On the educational side of things, we quickly learned how to deliver education online and rethink how students could complete their clinical rotations and their coursework and keep everyone safe at the same time. For our PA program, we were lucky that we did not have to completely suspend our rotations. We still had clinical instructors and preceptors willing to have our students continuing in their clinical rotations. Then everyone stepped up across our institution to help educate our students find PPE -- which was a major challenge because our students needed to bring their own PPE to most of their rotations due to the shortages -- and then everything else we had to do in the process of that as well. There were some specialties that we had to get creative and have some additional online activities to supplement because we were not seeing the normal types of patient conditions. 

It was amazing in reaching out to other PA programs. We all really bonded together and tried to give ideas and resources across the board so that all of the PA programs could be successful during that time. Now, as we're looking back at how the pandemic changed us, in some ways, we evolved and found better ways to teach. TTUHSC was always a leader in telemedicine and we are learning how we can expand that education across all of our programs and working together to do so. In other ways, we are happy to be returning to what we were doing previously, especially this fall being able to get all of our students back face-to-face again because we really do miss having the students and the interaction on a daily basis. Overall, we learn together and I believe the values of TTUHSC helped us through a very difficult time.

Shiv Gaglani: Yeah. That's what they say, some organizations get stronger as a result of crises like what we've all been through. So, you preempted my next question which is about topics that you would focus on as an educator that you think this next generation of healthcare professionals should be focused on. For example, you mentioned that even before COVID-19, you all had been engaged in telehealth and telehealth education. Obviously, telehealth is a huge boom out of necessity over the past year and a half and much of that will be here to stay. In addition to telehealth, what other knowledge gaps or recommendations do you have for PA programs and other health science programs all across the country to focus on their curriculum? 

Christina Robohm: Well, I think one thing I really appreciate about Osmosis is that we have learned that everybody learns differently and as we've been working through our curriculum and looking at individual students, we feel that this is a platform that gives us another resource and method for students to learn and practice different things that they are learning through the rest of our program. In terms of other things that COVID-19 revealed, I would say really in my area of expertise, that comes to healthcare access and as you talk about telehealth and telemedicine, that's one piece of that in addition to all the improvements we're making with our program in order to have more students and ultimately more graduates providing care. In West Texas especially, we lack healthcare providers and that's part of the reason our program is expanding It's a place the PA profession can be part of the solution because of our ability to educate people in 27 to 36 months depending on the program, and those graduates ultimately come out and provide very high quality and affordable care to our patients. We also have the ability within our profession to quickly pivot in our educational programs because of the
short-term nature of our education program. We can set the competency and quickly change curriculum in areas such as telemedicine or team-based healthcare to help improve that access. 

Shiv Gaglani: I think it's a really key insight. The PA programs we work with and people we know tend to be very innovative as well, and the shorter cycle of the curriculum means that it can be tweaked not in real-time -- obviously these things take time -- but when I started medical school myself at Johns Hopkins, they were still talking about the Flexner Report which came out more than a century ago, and so the whole two-year preclinical to clinical has been the dominant form of medical education and it's not been as susceptible to changes as quickly as we'd like given how the profession itself is changing from fee-for-service to value-based and all sorts of other changes we're seeing. So, as you know, we have a massive audience of current and future healthcare professionals.  Many of them are obviously just beginning their careers in healthcare. What advice do you give your students at TTUHSC and what advice would you give our audience about entering their career in the health profession? 

Christina Robohm: Well, I'd say my advice would be to follow your passion, identify your strengths and set your goals. Being a PA might not be the perfect thing for everybody, but if it is among your strengths, it's a great career to follow. I love being a PA. I will never trade it, but there's a lot of other professions and careers in healthcare. Shadow those professionals, talk to them about the good and the bad parts of their daily jobs, because there are good and bad parts to every job, and you'll be able to identify that specific role and that right path for you that you will be able to follow your passion and make a difference in the years to come. 

Shiv Gaglani: Now, that's excellent advice.  Is there anything else you want to be able to share with our audience before we let you go back to your day job as Regional Dean? 

Christina Robohm: No. I just thank you for the opportunity to talk a little bit more about TTUHSC and our PA program and the exciting things that are on the horizon for us. 

Shiv Gaglani: Well, thank you Dean Robohm. I really appreciate your time on the Raise the Line podcast and more importantly the work that you do to raise the line and educate the next generation of healthcare providers. 

Christina Robohm: Thank you.

Shiv Gaglani: With that, I'm Shiv Gaglani. Thank you to our audience for checking out today's show and remember to do your part to flatten the curve and raise the line since we're all in this together. Take care.