John Bielinski, MS PA-C 
I’m a huge fan of disruption. Disruption comes in many forms. It could be a personal disruption where you shake up the status quo. I’m drawn to people who are into personal disruption – people who look at their lives and decide what parts are unsatisfactory and work to change them. There are other people who love the status quo. They’re so attracted to certainty and security; they really don’t rock the boat much. I’m not interested in living in that mindset. I like people who shake things up.
There is disruptive innovation, where you bring something new into the market such as Uber or Airbnb. These companies disrupted industries that weren’t working as well as they could. Someone came in with a new idea that shook the foundation of these services.
There is sustaining innovation. These are companies that were once disrupters and grew within their industry. They constantly have to fight to stay new in the market. This is a struggle I think Apple’s having right now. Apple was very innovative with the iPod and the iPad. Right now, it seems like they’re having a tough time staying ahead of competitors in terms of innovation.
Finally, there’s efficiency innovation, where once you have a business running smoothly, you’re able to become more efficient in how you run your operations. I live this way and I run my businesses this way. I’m constantly questioning the status quo and asking myself, “Where can we do things better and where is there a need?”
This is also the philosophy of the National Commission on Certification of Physician Assistants. I’ll never forget hearing Dawn Morton-Rias speak at the North Carolina Academy of Physician Assistants. She said that when she came into her role, she wanted to disrupt our industry, and she did.
Initially, she addressed continuing medical education, making self-assessment and performance improvement a mandatory part of maintaining your physician assistant’s degree. I believed in the SA/PI system; I thought it was a really good way to learn. However, because of poor investment from PAs and companies that make CME, SA/PI became an optional program.
Morton-Rias also disrupted how PAs take the recertification exam with the pilot study and extended two-year testing period. I’m a huge fan of this disruption. There were some significant problems with the recertification of specialty PAs and this helps fill that gap.
This month, the NCCPA announced another disruption: the initial certification exam for physician assistants will be more difficult. I know this to be true; a major physician assistant school, which last reported a 97% pass rate, had their pass rate drop to approximately 75%. This is a really big deal. This is disruptive.
When I step back and look at this decision from the NCCPA, it is a good thing. This decision will make the PAs graduating from PA schools smarter, and that can only help our profession. This is a good thing – even if it came out of left field and, in my opinion, there was inadequate time for programs to adjust and re-prepare. We have to remember that progress happens from disruption. If people live by the status quo, nothing changes. I salute the NCCPA and their movement to better our profession.
My business provides courses that teach students how to pass their boards. So, this change presents a new challenge for me. As someone who thrives within innovation, I see this particular change as an opportunity to help my colleagues, PA programs and students study differently. Over time, I’ve realized that some people study in a way that doesn’t fit their learning style. These people are not successful; this is a recipe for failure.
In 2005, I completed the Lake Placid IRONMAN. If you know anything about triathlons, which is a swim, bike and run, you know the training is very intense. I found with running that I could just grind it out, even if I was tired and sore. The same was true with cycling; I just had to keep pushing myself. If I was getting tired, I could slow down my cadence cycle and coast a little bit more.
That was not the case with the swim. The swim had to do with grace in the water, how you balance the water and glide through the water. Form was very important during the swim. If you slipped into poor form, dropping your hips and dragging them through the water, you were basically practicing struggling.
You need to prepare for the PANCE in the same way you practice swimming for a triathlon. You have to practice to the point that you have optimal form. Your studying needs to be highly effective. There are people who think that the quantity of your study equates to the effectiveness of your study. This is not the case.
I’ve coached way too many people who say, “I’m going to study for eight hours a day for five weeks.” I tell them, “No, you’re not. That’s not possible.” That’s like saying I’m going to go to the gym and work out eight hours a day for five weeks. It’s not possible. You have to study to the point that you have really good, highly effective form.
How should you be studying under these new guidelines?
- Don’t do board questions. There are people making millions of dollars selling you test questions. They’re not good test questions. They don’t really relate to our PA boards because, typically, they’re med student questions. I almost made a business deal with a question bank company. They told me that they use test questions to identify a student’s deficiencies, but they don’t have tools to help students grow in those weak areas. After that experience, my mantra is, “Test questions are an assessment tool but not a learning strategy.”
- Think differently. Albert Einstein said, “The significant problems we face today cannot be solved at the same level of thinking you were at when you created them.” When we look at a problem, we need to think about it differently. I realized that after I gained experience as an educator, I could more easily dissect test questions. To prepare for the PANCE, practice writing good test questions, and ask your peers to answer them. They’re not answering them to get the right answer. They’re looking for valid questions.
- Apply the Questions of Mastery™. What I found when coaching students who failed their boards was that they knew medical topics – but not deeply. The technique I use with these students, and every PA student studying for the PANCE, is a technique I call Questions of Mastery™. With every disease, you need to ask yourself four questions:
- What is the pathophysiology? You need to know what’s wrong with the patient and why they’re sick.
- How do they present? How are these patients going to show up at your office, emergency room or urgent care center?
- How do you diagnose it? Here, we need to think about three buckets: physical exam, laboratory values, and images or EKGs.
- How do we fix it? What are the therapeutics?
I’m a big fan of disruption. There is no progress in the world without disruption. The greatest influencers of our day and days past disrupted the world. I challenge you to be a disruptor in your own life. Look for places where things are not satisfactory and make changes.
