February 21, 2020
A guiding light
Healthcare educator follows the PA path
By Nichele Hoskins
If you meet Kara Caruthers, MSPAS, PA-C, in her office right after she’s taught anatomy class, you’ll likely find the door of the windowless room shut.
“I’ll warn you,” she said, peeking through a barely opened door. “It smells like formaldehyde.”
The smell is strong, reminiscent of a high school biology class, with frogs splayed and pinned in shallow pans. But as an assistant professor in the department of clinical and diagnostic sciences at the University of Alabama at Birmingham (UAB), she’s used to it, commonly using cadavers and teaching workshops on how to sew sutures on the skin of pigs brought from a barbecue joint in town.
Caruthers is very hands on.
There are a few plastic anatomy models that were discarded by colleagues in her office. One torso on display, with dark red musculature and bright blue veins, sports a red, white and blue bandana on its half skull and an eight-inch black beard. Another, with its rib cage, tongue and eyeball exposed, wears a black felt wide-brimmed hat.
Caruthers has a healthy sense of humor, but the Nebraska native has long been serious about her healthcare ambitions. “I’d been saying I was going to be a doctor and deliver the world from juvenile diabetes since I was 8,” she said.
There was no reason to think she wouldn’t.
Caruthers was a smart and disciplined student. Her mother, Mary, who had only attended a semester of college, and Henry, her father, who had gone for a year, gave her strong support. But things fell apart in her first year of medical school. At 22, she flunked anatomy. Distracted by her mother’s failing health, she now knows that she also lacked the maturity and the humility to reach out for academic help.
“I struggled, but I really loved anatomy,” she said.
As an undergrad, she received some bad advice: She was told she didn’t need to take anatomy before med school, that she could learn anatomy, physiology and pathology at the same time. That advice would change the course of her education and her career.
“I was probably the only student in my med school class who hadn’t had anatomy,” she said. “The foundation of our knowledge is anatomy and physiology. There is no such thing as having too much exposure.”
She left med school in 2000 and took a job in her hometown of Omaha, Neb., managing nurses employed at 10 hospitals and nursing homes. It paid well, but it was stressful, highly political and not very fulfilling.
“I got a big girl job because I had big girl bills, but I hated it because it wasn’t my purpose,” she said. “I knew that it was right for me to do healthcare, but not from a management perspective.”
Finding a new path
By 2002, she had attended Southern Illinois University and earned a certificate in anatomy and a master’s from the school in molecular, cellular and systemic physiology. She was hired there to teach anatomy to PA students. That was when she began considering PA school. It wasn’t an easy sell at first.
“My first thought was: ‘My grandmother was a domestic, and I’m not trying to clean up and assist anybody to do anything,’” she said with a laugh.
And she had never considered any profession besides medicine. But then Caruthers learned of the surgery-focused program at UAB School of Health Professions (UAB) in Birmingham, Ala., and applied.
“I had always been on the pre-med route and had not explored other health profession careers,” she said. With her background in anatomy and interest in surgery, the UAB PA program was a perfect fit for her.
She liked Birmingham, but her mother remembered the city’s history and was not pleased.
“’You want to go to Birmingham?” her mother asked, with grave concern in her voice. Caruthers’ assurances were lost on her mother.
“I told her that Bull Connor [the segregationist commissioner of public safety in Birmingham in 1961], the water hoses and the attacking police dogs are all gone,” Caruthers said.
“But the devil is still there!” her mother said, promptly putting her daughter’s name on the special prayer list at the family’s church.
Caruthers was 30 when she was accepted to the UAB program and graduated in 2009. Her mother died in 2011.
Bridging the ER and the classroom
Caruthers is one of four PA instructors at UAB who split their time between the classroom and the emergency room. She is the first PA ever hired specifically to work in emergency room at UAB.
One of her mentors, Jacqueline Barnett, DHSc, MS, PA-C, an assistant professor of PA studies at The George Washington University (GW), puts that into context.
Most PAs and PA faculty have a primary care focus, she said. “Many of us can jump in and do a lecture on diabetes or asthma.” But if you asked a typical group of PAs to teach an anatomy course, you’re not likely to get any volunteers – unless Caruthers was in the room, she added. “It’s such a specific and different skill, and we don’t use it every day.”
But Caruthers does, said Howard Straker, MPH, PA-C, assistant professor of PA studies at GW. He’s another of Caruthers’ mentors. Barnett and Straker met her shortly after she entered UAB’s PA program.
“She has the ability to go back and forth, and to be very comfortable doing it,” he said.
In addition to her course load of anatomy and pathology classes, she works 4 or 5 12-hour shifts a month at UAB Highlands, a general acute care facility on the southern end of campus. She also works a couple 4-hour shifts at its urgent care clinic. She’ll treat 15 to 25 people per ER shift; their conditions range widely from a cough or a cut finger to broken bones, heart attack or stroke.
As is common in working in an ER, she sees people with a range of income levels as well. Her students–mostly future PAs and some first-year med school students—tend to come from privilege, so she relays what she learns to supplement texts that can be “a little outdated and academic.” Caruthers weaves awareness of cultural and economic differences throughout her lectures.
In her end-of-semester pathology course review, she prepped students at a brisk clip for their exam with PowerPoint slides, allowing plenty of time for questions and clarifications. In one part of the review, her lecture moved smoothly from the toxicology of smoking to images of 1970s-era cigarette ads targeting African-American communities, to data released the previous day by the U.S. Centers for Disease Control and Prevention about decreases in the prevalence of tobacco use, to a brief definition of a “loosie”–a loose cigarette sold individually–and why it’s important to have smoking cessation information in the PA arsenal.
“Part of our job is to think about where people are and their exposure and why they do certain things. You don’t have to like it, but you do have to be mindful,” Caruthers said.
Across ethnicities, people of lower economic status still tend to smoke in higher numbers, she added. “In every ethnic group, the number one thing they say when asked why they smoke cigarettes is, ‘Doc, it calms my nerves.’ People who smoke have levels of anxiety. Find out what’s going on right now. Refer them to online sources and 1-800-Quit-Now. There are a lot of tools out there.”
Her students are secondary beneficiaries of her work in the ER. “It actually helps me teach better because I have to keep up with current practice, she said. “I know theoretically that a drug is optimal for treating for X, Y and Z. But I also know some patients are uninsured and the drug costs $75. I look for a lot of free drugs. I use the $4 list at Wal-Mart. I play social worker a lot of times.”
And she assumes the role of mentor. Of the 70 people in UAB’s PA program, 10 have shadowed Caruthers in the ER.
“I try to share little tidbits and nuggets like that because it makes it more applicable, and helps students understand why we’re beating them down with so much information.”
From the clinic to the classroom
UAB PA student Ellen Rehme understands. Like Caruthers, Rehme started the PA program when she was in her early 30s.
Rehme, an Indianapolis native, worked as an emergency room paramedic for two years before PA school, and prior to that, she was a strength and conditioning coach. She appreciates Caruthers’ accessible teaching style and insights on treating people across race and culture.
In one class, Caruthers debunked the myth that people of color don’t get skin cancer. “She told us that Bob Marley died of skin cancer,” Rehme said.
Caruthers’ academic foundation is solid, Rehme said, but she takes instruction beyond the texts. “She doesn’t teach a book. She teaches how to be a PA. I think that’s real cool,” Rehme said. “She spends a lot of the class time going over what we learned in class and how to apply it in the field. She gives us scenarios, differential diagnosis and really goes through the thought process. She teaches us to think not to regurgitate.”
In another class, someone asked a question about a Wound VAC, used to clean and aid healing of serious wounds. That instructor didn’t know much about it.
“Those are everywhere, yet in his class we were not going to learn about them,” Rehme said. “I tell you what, if we’d asked the question in Ms. Caruthers’ class, she would probably know about it, but if she didn’t, I’m sure she would have called somebody and emailed us the next day.”
Her own mentors are equally impressed with her ability to move comfortably from clinical application to the classroom.
“Her teaching is what led her to be a PA, Straker says. “As much as we use stuff as clinicians, we don’t use that depth of knowledge. To be both a clinician and teach and focus that she actually wants people to learn and do well and draws on her own experiences.”
Everything happens for a reason
In 2012, Caruthers was awarded the faculty appreciation award from the Black Student Awareness Committee at UAB. It is given to a faculty member who has gone above and beyond to ensure the needs of others and promoting lifelong learning. She has also been nominated for the Physician Assistant Education Association’s new faculty award and the UAB president’s diversity award in the faculty category. In 2009, she earned the faculty of the year honor from the Southern Illinois University School of Medicine. A year later Caruthers won the school’s teacher of the year award.
She performs community and professional service, from high school STEM programs to serving as vice president of the Alabama Society of PAs.
And at UAB she administers a $1.2M Health Resources and Services Administration grant for PA training in primary care medicine and dentistry.
Caruthers stays busy, so her mentors also advise her on prioritizing. Barnett also urged her to take on another project: develop a “plan B” strategy.
It’s happened in many other fields—your personnel, funding or priorities can shift, leaving even the best and brightest without a back-up plan, said Barnett, who has strongly suggested that Caruthers, “not get so comfortable early in her career.”
Not that she’s ever gotten complacent, Barnett said. “But I wanted to stick that in her head early.”
Caruthers is working on a Ph.D. in nutrition. And she’s working on plan B. “I haven’t fully figured that out, but I know that I want my professional legacy to be one where I have facilitated positive change in our profession and in the educational training of future PAs,” she said. “The experiences that have gotten me to this point have helped me realize the need for more culturally competent and compassionate healthcare providers and educators. I would love to be in a position to make that a reality.”
Ask her if she ever went back to the person who gave her the bum advice about not taking anatomy and Caruthers will say no. The adviser’s gone, the program is gone, and she believes that if it hadn’t been for that turn 17 years ago, she probably wouldn’t be an anatomy instructor.
“It’s like my mother always said: ‘Coincidences aren’t coincidences. Things happen for a reason.’”
This article was originally published in March 2015 issue of PA Professional.