Wake Forest PA Students the First to Receive Innovative Heart Failure Training

Head shot of Lauren EyadielOn May 28, 2019, second-year PA students participated in the Acute Heart Failure Advanced Life Support Course (AHFALS). They were the first group of PA students ever to receive AHFALS training. The course is led by Dr. Barbara Pisani, the medical director of Advanced Heart Failure and Transplant at Wake Forest, and Lauren Eyadiel, PA-C ('16).

This half-day, four-hour training course provides a standardized, algorithmic approach integrating the latest guidelines for management of acute decompensated heart failure utilizing interactive patient simulation with manikins. The interactive training model teaches appropriate management of acute decompensated heart failure across the continuum of care, from the emergency department to inpatient and then outpatient care. 

This course was adapted from one created by Brazilian cardiologists in 2011 and is the first of its kind administered in the United States. In 2018, Wake Forest providers in Advanced Heart Failure and Heart Transplant were trained by the Brazilian cardiologists who created the course and have since adapted the course for American learners. 

Wake Forest PA Students Receive Highly Competitive Awards 

Head shot of Olivia RayOlivia Ray (’20) received the PA Foundation’s Timi Agar Barwick Scholarship for Humanism in Medicine. This award is given to students who identify as an underrepresented minority and/or an economically or educationally disadvantaged person. Nearly 650 U.S. PA students applied for one of 27 available PA Foundation scholarships in 2019; Ray was the only recipient of the Barwick Scholarship. 

“It is hard to put into words what it means to receive a scholarship like the Timi Agar Barwick Scholarship for Humanism in Medicine," Ray said. "My undergraduate education was funded by student loans and a part-time job. While that may have been hard, it taught me the value of an education and that I was making an investment for the future that I wanted. I am one of three children; and out of my immediate family, I am the first to receive a bachelor’s degree let alone a master’s degree. I may not have had anyone go before me on this journey, but it never stopped me from being driven to become a healthcare professional. As I am completing my PA education, I feel more and more confident that this is what I am supposed to do. It is an honor to be chosen as a scholarship recipient, and I am one step closer to becoming a physician assistant because of their generosity.”

Head shot of Geoff JonesGeoff Jones (’20) was welcomed into an interprofessional leadership development program called The Future KIPL Clinician Leaders College, as well as receiving the NCCPA Endowment Grant. The leadership development program focuses on teamwork, communication and career development through a series of workshops hosted at the NC Medical Society office in Raleigh, NC. The course prepares students for future careers with a focus on leadership by establishing a strong sense of purpose and direction through personal development sessions.

The NCAPA Endowment Grant was started in 1992 with a focus on promoting the future of the PA profession in North Carolina to improve health care. 

“In my didactic year, I participated in a similar program designed by the NCMS for Wake Forest specifically, so I’m really excited to build on that foundation," Jones said. "I’ve learned through my experiences that being a leader can look like a lot of different things and that it first and foremost begins with knowing myself and being authentic. I’m confident I’ll employ the leadership skills learned when working with patients wherever I end up after graduation. Beyond clinical practice, I hope to someday be an educator and hope that the leadership qualities I’m learning now will serve me in that role.

"The NCCPA Endowment Grant is given to one student from each North Carolina PA program entering the clinical year. I’m grateful and honored to have been chosen as the Wake Forest scholarship recipient for 2019. I’m a proud native North Carolinian and look forward to practicing in the area following graduation!” 

Students Appreciate PA and Chaplain Keith Stirewalt

Keith Stirewalt IV, PA-C, MDMBADeath, end-of-life care, and spirituality are challenging topics for PA students and experienced PAs alike. There is an innate tendency to shy away from these difficult-to-address topics for fear of offending someone or perhaps just fear of the subject itself. The Wake Forest PA program actively strives to integrate these topics into the innovative curriculum. Students are privileged to receive lectures on these challenging topics from PA-turned-chaplain-turned-PA-again Keith Stirewalt. His three-lecture series consists of the film Being Mortal with discussions on end-of-life matters, a case-based lecture on advance care planning, and a final case-based lecture on bias in patient care as it relates to spirituality and culture. 

Stirewalt eloquently discusses both the spiritual elements and medical aspects of effective end-of-life care, drawing on his unique and extensive experience in both realms. He currently serves as program director for FaithHealth at Wake Forest Baptist Hospital and practices clinically as a PA in palliative care, in addition to serving as a lecturer for both the PA students and the medical students. He finds great meaning in “meeting families for the one and only time when they are ready to lose a loved one or are about to lose a loved one—sensing their spiritual self and showing God is no less present in the really hard spaces than in the good spaces.” His goal as a chaplain and palliative care PA is to “bring a glimmer of the presence of their God to them [in these hard spaces].” 

Quote from Keith Stirewalt 'We need to treat their spiritual being as well as their physical entity.'

Stirewalt’s journey to his current position has been fascinating. After graduating from the Wake Forest PA program, he started his career as a PA working in a general family practice in rural North Carolina, where he saw both wealthy and poor patients. He later transitioned to an administrative role at Novant Health after obtaining his MBA. Feeling unfulfilled, he returned to Wake Forest to attend divinity school and then completed an internship and two years of residency in chaplaincy, also at Wake Forest. Stirewalt was a Baptist minister for three years before realizing that he missed clinical practice, and he returned to Wake Forest to specialize in end-of-life care as a chaplain. This decision ultimately led him to his return to clinical practice in his current position as a PA in palliative care and to becoming the program director for FaithHealth. 

His lectures are well-received and much appreciated by students, who find the case-based lectures immensely valuable for learning to approach difficult subjects in a way that isn’t often covered in traditional lectures and is often missing from many discussions in medicine. Students walk away from these lectures having gained a better understanding of their own perspective on end-of-life care, as well as more informed about how to hold hard conversations in a culturally competent manner.

Close-up view of man in white shirt holding unseen person's hand in both of his hands“The lecture on death and dying did a really good job of promoting conversation," said Sara Horvath, a first-year PA student at the Winston Salem campus. "Thinking about death is something that providers have to do all the time, but talking about death with patients is really hard to do well.”  

If there is one thing Stirewalt hopes students take away from his lectures, it is “an appreciation of the patient as someone whose spiritual being is an integral part of who they are and how they see their health. We need to treat their spiritual being as well as their physical entity.” 

Stirewalt is currently working on a series of podcasts for medical professionals in which he talks with faith leaders, and he is working to create faith centers as centers of health. The information he provides will no doubt be as valuable to the entire community as his lectures have been to each of his students.

Early Hospital Visits Give PA Students an Edge

At many PA programs, the first time a student obtains a comprehensive history on an actual patient will be during clinical year. One of the most unique and valuable components of the Wake Forest PA curriculum is the early integration of patient experiences into the curriculum. In addition to practicing with classmates and with standardized patients at the beginning of the didactic curriculum, first-year students get to see real patients in the hospital shortly after the second unit begins. After the initial lectures and labs on history taking and documentation have been completed, Wake PA students enter the hospital. These initial patient encounters allow students to practice taking a comprehensive history and writing notes.

Open drawer with medical supplies such as alcohol swabs, scissors, gloves and bandagesPA students really appreciate the break from the books and the opportunity to apply concepts from class early in the didactic year, especially after completing the challenging basic sciences unit. Kayla Belvin, a first-year student at the Winston-Salem campus, said, “It was a nice experience because it made me feel excited again; we had just finished unit one where it was sometimes hard to see where we were going. Seeing the patient in the hospital helped reinvigorate my passion.”  

Students feel that these early clinical experiences are valuable both for educational purposes and for inspiration – they allow students to see real-world applications of lectures and book learning while remaining focused on the ultimate purpose of didactic year. Students can sometimes lose sight of the reasons they applied to PA school. Becoming overwhelmed with chapters to read and assignments to complete is not uncommon in such a fast-paced program. However, time spent outside of the classroom applying textbook concepts provides the necessary motivation to continue studying hard and learning as much as possible while also providing a clinical framework for the concepts learned in class. 

A trip to the hospital is not only a good learning experience for many students, but also an opportunity to shake out some nerves and continue developing the communication skills obtained prior to PA school. Although each member of the class of 2021 came to PA school having worked extensively in healthcare, it was an exciting and somewhat anxiety provoking experience when the students donned their white coats and took a comprehensive history from a patient in the hospital for their first time as PAs in training. 

First-year student Rana Asfour said about the experience, “I thought it was going to be scary, but it wasn’t. It felt more casual almost because it was real, and the experience was very helpful. I thought it was refreshing since I had hospital experience and felt comfortable in the hospital. It was comforting that it wasn’t a 100 percent new experience.”

The class of 2021 still has much to learn before clinical rotations begin. These early clinical experiences will ensure that they are better prepared when second year starts as well as provide some much needed inspiration to continue hitting the books during didactic year.