Scaling Clinical Reasoning in PA Education: Insights from the Latest PAEA Data

PA education continues to expand across the United States, with more than 280 programs now training future clinicians nationwide.¹

This growth reflects both the increasing demand for healthcare providers and the strength of the PA education model. At the same time, it introduces new challenges for educators working to deliver consistent, high-quality clinical training across increasingly complex environments.

As PA programs grow and clinical environments become more variable, the challenge is no longer confined to delivering high-quality education within a single program. It now includes maintaining consistency and quality across larger cohorts, distributed clinical sites, and more variable learning experiences.

A Growing Landscape with Increasing Complexity

With the rapid expansion over the past decade, PA programs are distributed nationwide with most programs being based in urban or suburban environments, where competition for clinical placements is often highest.¹ At the same time, programs are managing increasing enrollment. Longitudinal data from the most recent PAEA Program Report shows steady growth in both program capacity and class sizes over time.¹

This growth brings clear benefits, but it also introduces variability across:

• Clinical training experiences

• Faculty availability

• Student exposure to patient populations

As more students enter the system, the demand for clinical sites, preceptors, and faculty time will continue to increase.

From Knowledge to Clinical Reasoning: A Critical Transition

PA education is intentionally structured to move from didactic instruction into immersive clinical training, typically across a ~27-month program with roughly equal time spent in didactic and clinical phases.¹

This model is effective and well-established. At the same time, this transition point from didactic to clinical can be challenging for many programs as learners navigate from building foundational knowledge to applying practical clinical skills.

While some programs incorporate early clinical exposure, only about 23.5% report offering clinical experiences during the didactic phase, and those experiences tend to be limited in duration.¹

That structure is largely effective, but it does mean that many students begin clinical rotations with limited prior opportunities to practice applying clinical knowledge in a structured, low-risk environment.

Once in rotations, learning becomes highly dependent on:

• Site availability

• Preceptor style

• Patient mix

In other words, the development of clinical reasoning can vary significantly from student to student, even within the same program.

Faculty Capacity and the Need for Scalable Teaching Approaches

Faculty are central to PA education—and also one of its most constrained resources. The PAEA Program Report highlights that faculty salaries alone cost programs, on average, more than $1.1 million per program annually, making faculty the single largest expense category for PA programs.¹

Programs are navigating hiring challenges, increased administrative and teaching demands, and the growing need to support larger and more distributed cohorts, all while ensuring consistent and high-quality education opportunities are available to their students.

Most programs rely heavily on tuition revenue, with tuition and fees representing a significant portion of program funding.¹ This creates a tension where programs must scale while preserving the quality of instruction and faculty engagement that defines PA education.

Assuming programs can do this independently may be overly optimistic. This is where our work has been intentionally focused at Aquifer.

Individual faculty bring deep expertise and real-world experience to their teaching. However, translating that expertise into comprehensive, well-structured learning experiences, aligned to learning objectives and accreditation standards, is difficult to do consistently across cohorts, courses, and programs. Aquifer addresses this gap by extending what is possible through individual instruction, allowing programs to scale access to high-quality, structured clinical learning without over-relying on any one setting or experience. Our virtual patient cases are built from the collective expertise of PA and healthcare educators across the country.

Our approach allows programs to extend the reach of their faculty, so educators can spend less time recreating core teaching content and more time doing what only they can do: coaching, mentoring, and guiding students through their medical education.

Supporting Consistency in an Inherently Variable System

Clinical education will always be variable. While that variability is part of its strength, it does create real challenges. Not all students will encounter the same conditions, patient populations, or decision points during rotations.

The PAEA report highlights the growing complexity of clinical placements, including increased use of distributed sites, remote placements, and barriers to certain clinical environments.¹ As programs navigate these realities, ensuring consistent exposure to core clinical experiences becomes more difficult.

Structured, case-based learning plays a complementary role by reinforcing clinical reasoning across standardized scenarios, preparing students for what they may encounter in rotations, and ensuring exposure to essential conditions, regardless of placement variability.

Looking Ahead: Strengthening the PA Education Model

PA education has always been grounded in strong clinical training and educator-led instruction. As programs and cohorts grow, the challenge has become about how to do so in a way that preserves what makes this model effective. From Aquifer’s perspective, it is increasingly clear that programs don’t need to solve this alone.

Scaling clinical education today requires a combination of thoughtful program design, intentional practice, and the right partnerships to support both faculty and learners. It also requires a shift in how faculty time is used.

As programs grow, faculty cannot be the bottleneck for every learning experience. Their role is too important—and too specialized. The opportunity is to ensure faculty are spending their time where it matters most.

Aquifer’s approach is rooted in this belief. By capturing and sharing the collective expertise of health professions educators, we help programs scale access to high-quality clinical learning while preserving the central role of faculty in teaching, coaching, and mentorship.

As new tools, including AI-enabled feedback and assessment, continue to emerge, programs have additional opportunities to scale aspects of learning while maintaining educator oversight.

Conclusion

PA education continues to evolve in response to workforce needs and program growth. As that evolution continues, maintaining consistency in clinical reasoning development will remain essential, particularly in a system where clinical experiences can vary widely. That means recognizing that scaling your program and resources cannot rely on individual effort alone. It requires shared approaches, thoughtful design, and partners who understand the realities of PA education.

When clinical learning reflects both the depth of individual educators and the collective expertise of the profession, programs are better positioned to extend the impact of what already works—reaching more learners with greater consistency. Furthermore, when faculty are supported, not stretched, and students are given consistent opportunities to learn and apply what they know, programs are better positioned to prepare the next generation of clinicians. 

 ¹ Source: PAEA Program Report 36 (2021 Survey Data)