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Direct Patient Care Experience

(Guidelines for pre-PA students)




Start By Reading This

If you feel daunted about having to acquire direct patient care experience, it's okay! Most people do find acquiring direct patient care to be one of the most challenging aspects of being pre-PA, but it is do-able. HPPLC advisors are happy to talk with your about your pre-PA timeline, including when and how to work direct patient care into your own process. Read through the PA Timeline page, and then feel free to schedule an appointment if you would like to discuss short term and long term pre-PA plans.



Defining "Direct Patient Care"

All physician assistant programs require or strongly recommend that applicants garner direct patient care experience. "Patient care" is not the same thing as shadowing / clinical observation. Shadowing is watching, providing care is doing. Direct patient care is thus exactly what it sounds like: you are literally providing healthcare of some kind to patients. Often, even basic healthcare experience such as taking vitals is acceptable, though what is acceptable to a given program varies. That is where careful program research comes into play. (Don't worry: HPPLC supplies guidelines and tips for that part of your process as well!)


To repeat: programs vary in what kind of experience they will accept as "patient care." It is safe to say that filing, stocking shelves, or helping residents with their cleaning is not the kind of experience PA programs are looking for. Some will accept experience like scribing, some will not; some accept pharmacy tech or patient transport experience, some don't. The bottom line is that, for your purposes, "direct patient care" is defined as whatever experience most interests you and is acceptable to your programs. Therefore, review program requirements, consider options you discover on this page and elsewhere, and then confirm with each of your programs that the direct care opportunity you have in mind is acceptable to them.


At the same time, many different kinds of experience can still be helpful to your professional development, as long as you also garner actual direct patient care experience. Ultimately, to learn what sort of direct care would be best for you to garner, we urge you to utilize the resources on the HPPLC Researching Accredited Programs page, since the only way to confirm a program's patient care requirement or preference is to check their webpage, and call them if you need clarification. That's one reason getting a start on program research during freshman spring or summer is a good idea.


First, however, read the rest of the direct patient care guidelines.


When To Begin Direct Patient Care

When the best time is for you to begin direct patient care depends very much on your circumstances. Everyone's timeline is different. Never put patient care or other responsibilities ahead of your academics! You can always get more shadowing and direct care, but grades are written in stone. (Retakes do not erase previous grades from your transcript, despite what you might have heard!)

Therefore, during freshman year, we strongly suggest that most students focus on their transition to college by establishing a healthy social support network, building excellent academic and time management skills / habits, and (during freshman summer) researching programs to identify the 10 or 12 you will apply to. Consider deferring getting a start on patient care until the summer after freshman year (while trying to work in some shadowing during freshman year breaks or weekends).

  • Maximize your academic performance by using the time and stress management tools and resources linked from the HPPLC Professional Development page.
  • Consult the pre-PA timeline page to learn constructive ways to spend the summer after freshman year, which could certainly involve direct care.


If you became pre-PA sometime after freshman year, then just exactly how your own pre-PA timeline should best unfold will depend on your unique circumstances. Always focus first and foremost on academics, but begin clinical observation and direct patient care as soon as possible after freshman year.

We can't stress enough the importance of establishing excellent time management and academic habits from the very beginning, as your academic performance will have a profound impact on your graduate school applications. Academics should never take a back seat to other activities, preprofessional or social. After freshman year, and once you are more certain you wish to pursue the PA profession, you can work additional patient care experience into your semester schedule. (The preprofessional timeline guidelines can give you a sense of what you should be doing right now, and also help you with longer range planning.)


Direct Patient Care Guidelines

The amount and type of patient care necessary for admission to PA programs varies greatly - from 0 hours required, to 3000 hours, or anything in between, depending on the program.

  • IMPORTANT - Regarding programs that do not "require" direct patient care, or have no set minimum requirement: Rarely, if ever, is someone admitted to PA school without having garnered direct patient care experience, even with programs that say they do not require it. In fact, we know of programs that don't "require" direct care but nonetheless have preferences about what kind they like to see on the application! Therefore, consider direct care mandatory, not optional. Programs that don't require it, or which have no set minimum, are usually looking for quality over quantity, including the applicant's ability to articulate their approach to patient care, and ability to self-assess and show strong self-insight in relation to their experiences.
  • Programs that do require direct care: Some such programs will accept voluntary direct care work, while others require or prefer paid experience. They will all have preferences about the kinds of settings they prefer or accept. Program web pages often do not have quite enough information in this respect, so it's perfectly acceptable to call or email to run your patient care ideas by each of your prospective programs.
  • Programs that "recommend" direct patient care but don't require it: Always consider direct care mandatory, not optional. Applicants with little or no direct patient experience put themselves at a serious competitive disadvantage. Equally important, those without such experience usually lack necessary practical skills, professionalism, and other competencies.
  • Some programs prefer or require more traditional direct care, such as experience working as an EMT, phlebotomist, CNA, and the like. Other programs accept a much wider range of experience, such as the more divergent examples of care in other settings listed later on this page.
  • Keep a list of every procedure you perform, a list of procedures you assist with, and a list of procedures you observe. You will want to include a high degree of detail on the application.
  • Beyond the lists mentioned above, though, focus on the quality of your patient care experiences, not merely the quantity. Direct care is not simply a check box on the application. It is the process of developing practical skills, professionalism, personal qualities, experience, and competencies crucial to A) your undergraduate professional development, B) your process of becoming the strongest applicant possible, C) your ability to thrive in the PA school clinical environment, and D) your future practice as a healthcare professional.
  • Keep a direct patient care journal in which you make time to reflect on the day's experience. Follow the journal guidelines below.
  • Do not perform any direct patient care that would not be legal and ethical for you to do within whatever level of official training or certification you might have, and in accordance with US law, even if you are providing care abroad (for example on a mission trip)! It does not matter if you are providing care in another country: if you can't do it here in the US, don't do it anywhere else. Only offer care within the parameters of US legal and ethical standards!
    • The Association of American Medical Colleges Association offers guidelines for premed which can be adapted to pre-PA.
    • The University of Minnesota also offers useful, clearly explained guidelines for ethical, safe global volunteering (Courtesy of U of M Health Careers Center, Global Ambassadors for Patient Safety: Learning Ethically While Abroad).
  • Professional Etiquette: It is critically important that you conduct yourself in a thoroughly professional manner during all contact with patents, healthcare professionals, admissions representatives, peers, and everyone else. Review the HPPLC information on professional etiquette and professional conduct, and adopt any of the guidelines you have not already incorporated into your own conduct.
  • Most healthcare professional programs require those admitted to earn Certification in Basic Life Support (BLS) for Health Care Providers prior to beginning professional coursework (though not necessarily prior to applying).



Patient Care Journal Guidelines

Your detailed direct patient care journal will play a vital role throughout your application process, including the processes of gathering letters of recommendation, writing your personal essay, hopefully prepping for interviews, and other admission components.


Before undertaking direct patient care, thoroughly consult the Journal Guidelines for Hands-On and Direct Patient Care Experience for important tips, guidelines,and time-savers.


Logging Your Hours

For tips and guidelines on how to log both your hands-on experience hours, as well as clinical observation hours, click HERE.



Examples Of Possible Direct Patient Care Opportunities For Pre-PA

Below you will find examples of some possible experiences that some programs might accept as direct patient care. You may in fact find other opportunities which better suit your needs and interests. Note the bolded qualifiers in the sentence above, always taking into account that what one program might accept, another may not. Begin by consulting program websites, and then contact them directly if you are not sure how they might look upon a given experience.

"Traditional" patient care settings

  • Become a Certified Nursing Assistant, Nurse Technician, or Emergency Medical Technician certification and pursue related work (voluntary or paid options are sometimes available):

    • Due to the nature of the Bloomington job market, CNAs in Bloomington sometimes garner direct patient care hours more easily on a paid or voluntary basis than EMTs in Bloomington. There tend to be more EMT positions available in larger cities like Indianapolis. In addition, EMTs in higher population centers tend to go out on more runs and hence acquire more direct care hours.
      • Note: The time an EMT spends waiting between runs does NOT fulfill direct patient care hours. If you work as an EMT, log your total hours but keep separate count of the time actually spent with patients.
    • For CNAs, area nursing homes or long-term care facilities (including in Bloomington) usually offer the best opportunities.
      • Jobs in assisted living or home healthcare sometimes require duties that are not direct healthcare, such as cleaning, keeping people company, or merely monitoring someone. Confirm with prospective employers that you would be spending the vast majority of your time providing traditional healthcare such as toileting, bathing, and taking vitals. In any case, also confirm with each of your prospective PA programs that they would willingly accept hours from these settings.
    • EMTs can sometimes garner direct patient care experience through the local Volunteers In Medicine clinic (see entry below), though these opportunities are more difficult to come by. EMTs and those with first aid certification can also volunteer for IC EMS (see IC EMS entry below).
    • "Nurse technicians" are more or less on par with CNAs, having similar duties and a similar level of responsibility. Some providers hire CNAs who then function as nurse techs, while other providers don't require CNA certification and instead hire and train their own nurse techs in a manner they feel best meets the needs of the facility and its patients. Note that to work in an Indiana nursing home you must be CNA certified (though nursing homes often provide volunteer opportunities that do not require any specialized training or experience). Most PA programs will accept the kind of patient care nurse techs provide, just as they would CNA experience.
    • Personal preference is also important in choosing patient care experiences, but bear the above points in mind if you are thinking of earning your CNA or EMT. Many students earn one certification or the other, but many do not.
    • For details about how to acquire CNA or EMT training, including lists of Indiana certification programs, click HERE.
  • Volunteering at local health clinics such as Volunteers in Medicine (VIM). If you pursue VIM, you must fill out the application as early as possible, and make sure they know you are seeking patient care experience. If you have any certifications, such as CNA or EMT be sure to include it on the application. (Note that VIM often has more applicants than available positions in direct patient care.)
  • Patient care technician (paid). On-site training by employer. May not work with course schedules of most currently enrolled undergraduates. That said, IU Health Bloomington has hired undergraduates into these positions.
  • Medical assisting (paid). More formal training such as a certificate program is usually required, though there are online options. Medical assisting commonly requires a greater commitment of time and tuition money, and is not feasible for current undergraduates. It may be a postgraduation option worth considering for some who plan to defer their PA application and use gap time to garner patient care experience.
  • Phlebotomy (paid).In some settings, training may be offered on-site. There are also programs offering formal training over a number of weeks or months. Phlebotomy can require a greater commitment and may not be feasible for everyone, though many people garner much of their direct patient care experience over summers. (Double check that your prospective PA programs will accept phlebotomy experiences as direct patient care.)
  • IMPORTANT note about medical scribing: Medical scribes do not usually supply direct patient care! Scribe experience can potentially benefit certain pre-PA students under certain circumstances - scribes can learn a lot about the healthcare system - but many PA programs do not consider scribing alone as a substitute for hands-on direct patient care experience! Med scribes record information pertaining to the care that others are providing. Pre-PA students sometimes misunderstand how and whether scribing can serve their application. Before even considering it, first check with each program to which you plan to apply and ask whether they will consider medical scribing as an equal substitute for direct patient care. Given a choice between scribing and actual hands-on direct patient care, in which you yourself are caring for the patient, the latter is usually the best choice. An additional word of caution: online scribing jobs are mere data entry positions. As such, they are thus even more divergent from direct patient care than on-sight scribing, during which scribes are at least with the healthcare professional and his or her patient in the clinical setting, instead of alone with a computer.


Other settings

  • Hospice (voluntary - training is required, and is usually free). A simple web search (e.g., bloomington indiana hospice) identifies several possibilities. Note that hospice work involves a bit more of a long term, consistent commitment than some other opportunities (oftentimes one year, a couple of hours each week, though this is often negotiable with regard to student schedules).
  • Volunteering as a "sidewalker" with People & Animal Learning Services, Inc., or the Horseshoes of Hope Equine Academy (HHEA). (Note that sidewalking is about the only role with these organizations that most PA programs would consider "patient care.")
  • Volunteering for summer therapeutic recreation camps at Bradford Woods. In this setting you would be working as something resembling a therapeutic recreation assistant, helping campers with their personal care needs: toileting, bathing, and during meal times; and helping campers keep on task during activities. (If interested, contact them for information about the summer camp schedule, mandatory background check and reference forms, and volunteer application.)
  • Working with developmentally disabled clients through Stone Belt. Visit their website and contact Stone Belt for more information.
  • Working with clients through LifeDesigns, which "partners with people of all ages and all abilities to lead meaningful and active lives." The Direct Service Professional (DSP) position appears to present client interaction opportunities that some PA program might consider to be direct patient care.
  • Working with developmentally disabled clients through AccessAbilities, Inc. Each client's needs are unique, but AccessAbilities fully trains its staff. In general, the job involves spending time with disabled people in their home environment, interacting with them and helping them as needed. Opportunities primarily involve helping people who have developmental disabilities, and the aged. AccessAbilities fills paid positions as needed. Part time and weekend hours are available, as well as overnight shifts, and students are often hired. You must have your own transportation, as the job involves driving from client to client within the given area. Currently, there are branches in Bloomington, Indianapolis, and Merrillville.
  • Indiana Mentor (formerly TSI)
  • Area 10 Agency on Aging offers a variety of opportunities for volunteers to work directly with older people in need of service. Examples include, being trained to instruct in a small group setting, with regard to helping people learn to live healthy lifestyles in spite of chronic conditions such as diabetes or arthritis; providing a variety of services to isolated individuals, possibly including friendly visiting and meal prep. (As always, try to work in a capacity which affords you ample opportunities to interact with the clients themselves. Working as a trained instructor as described above is an example of an Area 10 opportunity that may be more in line with what PA programs will consider an acceptable form of "healthcare," but you would want to confirm with programs.)
  • Comfort Keepers (Monroe County IN and surrounding areas) Paid, hands-on care opportunities, especially for those with their CNA, hospice certification, or EMT. Comfort Keepers accepts Medicaid. As such, those who work for Comfort Keepers will likely have the opportunity to work with underserved populations, which is the kind of experience many programs appreciate in applicants. If you contact Comfort Keepers for information, be sure to specify that you are looking for hands-on experience - what Comfort Keepers seems to designate as "Personal Care Services" and "Specialized Care Services." For pre-PA students, hands on experience with bathing, grooming, hygiene, mobility assistance, feeding, toileting, and the like, would be more beneficial than, for instance, providing "companionship care."
  • Working for Home Instead Senior Care, Bloomington. Paid part time positions are sometimes available, in which care givers provide in-home senior care and elderly home companionship. Training is provided, and hours are flexible according to student schedules.
  • Working with patients in nursing homes (paid and / or voluntary). Many PA programs will accept helping patients in the activity room or dining room as patient care. It may be difficult to find more medically-oriented patient care opportunities in nursing homes unless you have your CNA. If you do not have your CNA, try contacting nursing homes and specifying that you would like to assist patients during their meals, or assist in the recreation or activity room. (To locate local nursing homes, try a web search for "nursing homes bloomington indiana" or "long term care facilities bloomington indiana".)
  • IC EMS (Indiana Collegiate Emergency Medical Service) - Indiana University Bloomington's student-run emergency medical service (voluntary; IC EMS offers CPR and first aid training, or you can garner first aid certification by taking SPH-H 160 First Aid and Emergency Care, or through the American Red Cross or another provider).
  • Post-op or pre-op tech; out-patient tech (usually voluntary, sometimes paid). Usually on-sight training at the hospital or clinic offering the opportunity; usually no certification is required prior.
  • Rehabilitation technician (some voluntary, some paid). Usually on-site training working alongside physical or occupational therapists.
  • (Note that many programs, including the IU PA program, will not count life guarding as patient care experience - check with your programs to confirm. Depending on your specific experiences while life guarding, you could possibly make use of it in your personal essay, especially if you participated in any saves, back-boardings, or resuscitations. And certainly you would want to list any and all related certifications on your CASPA application, and on non-CASPA applications.)


Remember: before committing to a care setting, confirm that you prospective PA programs will accept the experience you are considering.

More about EMT and CNA certification

Some pre-PA students choose to earn their Emergency Medical Technician (EMT) certification, whether through IU coursework or through another training program. Others choose to become a Certified Nursing Assistant or Aide (CNA), which might enable them to, for instance, secure a paid or voluntary position at a nursing home. Others undertake patient care in completely different ways.

The EMT and CNA options are just that - two options among many for patient care experience. Few PA programs actually require any such certification among their admission requirements.

CNA training: For a list of approved CNA training programs in Indiana, visit the site, This list includes community college programs and programs offered through long term care facilities like nursing homes. Regarding the latter, some nursing homes provide paid CNA training for new-hires, assuming the new-hire plans to work at that particular facility. This option can be an economical way to acquire training, as long as the training and job schedules will work well with your academic and study obligations

Just as Indiana does, other states will have listings of approved or certified programs on the state's Department of Health or similar site. Don't hesitate to call or email the state government if you can't locate the resource.


EMT training: Taking the IU courses listed in the grid below and passing the certification exam is one way to earn your EMT. For a list of other EMS training providers in Indiana, visit > IDHS Training Calendar (right hand menu) > EMS Core Classes. EMT Basic is often a better choice than First Responder, which is a lesser certification. The list is continually updated, and other states should have similar listings of certified programs on state's Department of Health or similar site. Don't hesitate to call or email the state government if you can't locate the resource. The cost of EMT courses in Indiana ranges from about $650-$1200 (which may or may not include course materials), and programs can last weeks or months depending upon how often classes meet.

IC EMS, the Indiana University Bloomington student-run EMS service, frequently offers first aid and CPR training and certification. For details, see their website or contact them.

IUB Emergency Medical Technician Certification (EMT) Credits

First Aid and Emergency Care (First Aid Certification): SPH-H 160 *

EMT Training: SPH-H 401 and 404, taken together 4 total

* First aid certification earned through IC EMS, the Red Cross, hospitals, etc. does not exempt students from H160. Only in rare cases will First Responder certification allow exemption from H160. H160 is the official prerequisite for H401 / 404 because it garners students a significant proportion of the training hours required for EMT certification.


IU PA Program Clinical Experience / Patient Care Requirement

All physician assistant programs require or strongly recommend that applicants garner direct patient care experience. "Patient care" is not the same thing as shadowing or clinical observation! Shadowing is watching, providing care is doing. Direct patient care is thus exactly what it sounds like: you are literally providing healthcare of some kind to patients. Often even basic healthcare experience such as taking vitals is acceptable, but this depends on the program.


The IU PA program will accept a combination of shadowing and hands-on direct patient care toward their clinical experience requirement. As of 2015, IU prefers that applicants acquire this experience in traditional healthcare settings (defined at the above link). They also strongly encourages applicants to gain experience working with underserved and/or rural populations, which reflects the program's philosophical and practical emphasis.





This information was prepared for Indiana University Bloomington students by the Health Professions and Prelaw Center. Please note that specific requirements and policies can change at any time without notice. Students are responsible for obtaining the most current information directly from application and testing services, and the schools and programs in which they have an interest. Refer to each program's web pages, bulletins, and other publications for the most current information. Students are responsible for understanding degree course requirements, as well as other requirements, policies, and procedures related to the degree(s) they are pursuing; for enrolling in appropriate courses; for understanding IU policies/procedures; and for following through properly with regard to all of the preceding.