Preceptor Handbook - September 2017 by Hofstra University

PRECEPTOR HANDBOOK September 2017

TABLE OF CONTENTS Contact Information Clinical Year Calendar Mission Statement Function and Tasks Technical Standards Curriculum Design Didactic Year Clinical Year Research Semester Program Curriculum Preceptor Information Introduction The Clinical Year The Preceptor Role Student Learning Objectives Preceptor Responsibilities Preceptor Student Relationship Social Media Policy for Students Preceptor Contact Orientation and Communicating Student Expectations Preparing Staff Supervision of the PA Student Informed Patient Consent/Patient Care and HIPAA Patient Rights and Confidentiality Documentation Preceptor Review and Countersignature Medicare Policy Expected Progression of PA Student Student Evaluation Student Feedback Clerkship Work Schedule CME for Physician Assistant Preceptors CME Forms Student Policies Health Insurance Health Clearance Identification Liability Insurance Work Policy Universal Precautions Exposure Policy and Incident Reporting Clinical Year Attendance Clerkship Attendance University Policy Related to Absences for Religious Observance 1

3 4 5 6 7 8 8 9 9 11 12 12 12 13 13 13 14 14 14 15 15 16 16 17 17 17 18 18 18 19 19 20 21 24 24 24 24 24 25 25 25 25 26 26

Tenets of Professional Conduct 27 Dress Requirements 28 Sexual Misconduct and Other Unlawful Harassment 29 Academic Honesty 29 Typhon Tracking System 30 Clerkship Specific Patient Encounter Requirements 30 Clinical Year Patient Encounter Requirements 30 Procedure Logging 31 Student and Clerkship Monitoring 32 Mid Clerkship Evaluation 32 Student Evaluation of Program Clerkships 32 Assessment of Clinical Sites 32 Clinical Year Syllabi 33 Family Medicine 34 Internal Medicine 43 Obstetrics/Gynecology 53 Surgery 63 Emergency Medicine 73 Pediatric 83 Psychiatry 93 Elective 103 Clinical Year Forms 111 Preceptor Evaluation 112 Mid Clerkship Evaluation 114 Student Evaluation of Program Clerkships 115 Student Preceptor Review of Clinical Objectives 116 Blood Borne Pathogen Exposure 117 Clerkship Schedule 118 Evaluating a Peer-Reviewed Scientific Article 119 Family Medicine Clerkship: Health Promotion Project 120 Clinical Documentation Grading Form 122 Elective Interesting Case Presentation Evaluation Form 123 Interesting Case Presentation Form 124

DEPARTMENT CONTACT INFORMATION The main PA Program office is located in Monroe Lecture Center, room 113. Chair and Program Director / Assistant Professor Carina Loscalzo, MS, PA-C (516) 463-4412 Carina.Loscalzo@hofstra.edu Monroe Lecture Center, room 218 Associate Director / Assistant Professor Mark L’Eplattenier, MPAS, PA-C (516) 463-1353 Mark.S.Leplattenier@hofstra.edu Monroe Lecture Center, room 112 Clinical Coordinator / Assistant Professor Shannan Ricoy, MS, PA-C (516) 463-4233 (516) 509-6470 (Program cellular phone) Shannan.Ricoy@hofstra.edu Gallon Wing, room 236 Academic Coordinator / Assistant Professor Kelly Porta, MS, PA-C (516) 463-4381 Kelly.R.Porta@hofstra.edu Monroe Lecture Center, room 106

Medical Director Samuel Sandowski, MD (516) 463-4074 ssandowski@snch.org Monroe Lecture Center, room 113 Dual-Degree Coordinator / Assistant Professor Mary Banahan, MS, PA-C (516) 463-4161 Mary.K.Banahan@hofstra.edu Gallon Wing, room 244, room 108 Clinical Coordinator / Assistant Professor Christine Zammit, MS, PA-C (516) 463-4380 Christine.Zammit@hofstra.edu Gallon Wing, room 237

Research Coordinator / Assistant Professor Christina Ventura-DiPersia, MPH (516) 463-4042 Christina.M.VenturaDiPersia@hofstra.edu Gallon Wing, room 138 Clinical Secretary – Part Time Karen Forman (516) 463-4074 Karen.S.Forman@hofstra.edu Monroe Lecture Center, room 113 Advisement Coordinator Gia Raponi (516) 463-4043 Gia.R.Raponi@hofstra.edu Monroe Lecture Center, room 110

Secretary – Part Time Sharon Poulson (516) 463-4074 Sharon.Poulson@hofstra.edu Monroe Lecture Center, room 113 Senior Assistant-Full Time Marie Sorrentino (516) 463-3271 Marie.Sorrentino@hofstra.edu Monroe Lecture Center, room 113 Physician Assistant Department Main Office Department Office Number: (516) 463-4074 Department Fax Number: (516) 463-5177 Department Address: Hofstra University Department of Physician Assistant Studies 113 Monroe Lecture Center Hempstead, New York 11549-1270

Academic Coordinator / Assistant Professor Amy Roberts, MS, PA-C (516)463-7728 Amy.L.Roberts@hofstra.edu Monroe Lecture Center, room 108

2017 - 2018 Clinical Year Schedule Rotation # 1:

9/5/2017 – 10/11/2017

CBD: 10/12/2017

Rotation # 2:

10/16/2017 – 11/21/2017

CBD: 11/22/2017

Rotation # 3 Part 1:

11/27/17 – 12/22/2017 VACATION 12/23/2017-1/1/2018

Rotation # 3 Part 2:

1/2/2018– 1/11/2018

CBD: 1/12/2018

Rotation # 4:

1/15/2018 – 2/22/2018

CBD: 2/23/2018

Rotation # 5

2/26/2018 – 4/5/2018

CBD: 4/6/2018

VACATION 4/7/2018 – 4/15/2018 Rotation # 6

4/16/2018 – 5/24/2018

CBD: 5/25/2018

Rotation # 7

5/29/2018 – 7/5/2018

CBD: 7/6/2018

Rotation # 8

7/9/2018 – 8/16/2018

CBD: 8/17/2018

MISSION, VISION, VALUES AND GOALS OF THE HOFSTRA NORTHWELL DEPARTMENT OF PHYSICIAN ASSISTANT STUDIES Program Mission The mission of the Hofstra Northwell Department of Physician Assistant Studies is committed to the interprofessional development of Physician Assistant leaders who demonstrate clinical excellence, compassion, and the promotion of health to the diverse communities they serve.

Program Vision The vision of the Hofstra Northwell Department of Physician Assistant aspires to be an innovative global leader in the preparation of the next generation of Physician Assistants.

Program Values • •

•

• •

•

Life-long Learning The program is committed to promoting the ongoing professional growth and betterment of clinical practice through self-directed learning activities. Innovation We facilitate learning with a multimodal approach that is creative, interprofessional, collaborative, and student-centered using the most advanced medical resources and technologies that will provide the student with the tools for life-long learning. Collaboration The program is committed to fostering a learning environment where students partner with members of an interprofessional healthcare team to promote excellence in patient-centered care. Compassion We embrace a patient-centered, caring, empathetic approach to the delivery of healthcare. Excellence We are committed to preparing clinically competent Physician Assistants that excel in their ability to critically think and problem solve in order to provide comprehensive patient care. Leadership We inspire our students and faculty to positively influence their professional, institutional, and patient care communities. Diversity We instill awareness of and respect for individual cultures by educating our students on the importance of understanding the unique needs of a diverse patient population. Professionalism We challenge our students to become exemplary Physician Assistants by exhibiting respect, integrity, honesty and ethical behavior in all circumstances. Scholarship We foster an environment that encourages the use of evidence-based medicine in clinical practice. We also promote the student and faculty’s contributions to the advancement of scientific knowledge for the betterment of the profession. 5

Program Goals • • • • • • •

Train highly qualified physician assistants to practice medicine Develop effective oral and written communication skills Develop the skills necessary for life-long learning Promote professionalism through respectful, compassionate and responsive interactions with patients, peers, and supervisors Reinforce collaborative learning and working styles needed in order to participate in the team approach to medicine Cultivate pride and leadership skills within the profession, institution, and community Instill a desire among physician assistants to serve populations with limited access to quality care

GRADUATE PHYSICIAN ASSISTANT FUNCTIONS AND TASKS Graduates of the Hofstra University Physician Assistant Program will be expected to demonstrate competence in the following functions and tasks: Medical knowledge • Determine the etiologies, risk factors, and epidemiology for medical conditions. • Identify signs and symptoms of medical conditions. • Elicit a detailed medical history, perform appropriate physical examination, and accurately record all pertinent data. • Identify and formulate an appropriate assessment and management plan. • Select and interpret appropriate diagnostic or lab studies. • Identify pharmacologic agents and other relevant treatment modalities as they relate to general medical conditions to include understanding the indications, contraindications, side effects, interactions, and adverse reactions. • Determine the normal and the abnormal in anatomy, physiology, laboratory findings, and other diagnostic data. Graduates will demonstrate competence by the successful completion of the following: • Didactic coursework; specifically Human Anatomy, Physiology, Physical Diagnosis I & II, Medicine I, II, and III, Pharmacy I, II, and III, Epidemiology, Correlative Medicine and Diagnostic Modalities. • Supervised clinical practice experiences (rotations). • Successful completion of summative examinations Interpersonal & communication skills • Use effective interviewing skills to elicit a detailed history. • Use effective basic counseling and patient education skills. • Work collaboratively as a member of interprofessional healthcare team. • Accurately and adequately document medical information. • Effectively complete oral presentations. Graduates will demonstrate competence by the successful completion of the following: 6

• • •

Didactic coursework; specifically, Physical Diagnosis I and II, PA and Society, Correlative Medicine and Health Psychology. Supervised clinical practice experiences (rotations). Successful completion of summative examinations

Professional behaviors • Demonstrate empathetic and respectful behaviors. • Exhibits reliability and dependability. • Exhibits an understanding of the physician assistant profession. • Demonstrates and identifies appropriate ethical behavior and attitudes. Graduates will demonstrate competence by the successful completion of the following: • Didactic coursework; specifically, PA and Society and Health Psychology. • Supervised clinical practice experiences (rotations). • Successful completion of summative examinations. • Successful completes professional development evaluations. Clinical reasoning and problem solving ability • Utilize critical thinking and problem solving skills to identify and manage medical conditions. • Synthesize and analyze clinical data correctly. • Locate, appraise, and apply evidence from scientific studies Graduates will demonstrate competence by the successful completion of the following: • Didactic coursework; specifically Physical Diagnosis I & II, Medicine I, II, and III, Evidence Based Medicine, Research Design and Analysis, Research Project, and Correlative Medicine. • Supervised clinical practice experiences (rotations). • Successful completion of summative examinations Technical Skills • Performs procedures safely and at an appropriate skill level. • Identifies the indications and contraindications of technical procedures. Graduates will demonstrate competence by the successful completion of the following: • Didactic coursework; specifically, Diagnostic Modalities. • Supervised clinical practice experiences (rotations).

HOFSTRA UNIVERSITY DEPARTMENT OF PHYSICIAN ASSISTANT STUDIES Technical Standards A physician assistant student must possess a number of abilities and skills. The use of a trained intermediary is not acceptable in many clinical situations in that it implies that a candidate’s judgment must be mediated by someone else’s power of selection and observation. Therefore, each student must be able to: •

Observe a patient accurately, at a distance and close at hand, with or without standard medical instrumentation.

•

Acquire information from written documents and to visualize information as presented in images from paper, film, slides or video.

•

Comprehend X-ray, EKG and other graphic images with or without assistive devices.

•

Speak, hear and observe patients by sight in order to elicit information, describe changes in mood, activity and posture, and perceive nonverbal communication.

•

Communicate effectively with patients and their families in both written and oral modalities.

•

Possess motor skills necessary to perform palpation, percussion, auscultation and other diagnostic and therapeutic maneuvers, basic laboratory tests and emergency therapeutic procedures, including airway management, placement of intravenous catheters, cardiopulmonary resuscitation, application of pressure to control bleeding, and suturing of wounds.

•

Measure, calculate, reason, analyze, integrate, synthesize and comprehend three-dimensional relationships and understand spatial relationships of structures according to standard medical care.

•

Exercise good judgment and complete all responsibilities attendant to the diagnosis and care of patients promptly. Develop mature, sensitive and effective relationships with patients.

•

Tolerate physically taxing workloads, function effectively under stress, adapt to changing environments, display flexibility and learn to function in the face of uncertainties inherent in the practice of clinical medicine.

Where a candidate’s ability to observe or acquire information through sensory modalities is compromised, the candidate must demonstrate alternate means and/or abilities to acquire and demonstrate comprehension of essential information. Costs of necessary accommodations should be reasonable and will be properly borne by the University when not the responsibility of the student or otherwise funded. Students wishing to receive reasonable accommodations must first follow all registration procedures through Services for Students with Disabilities (SSD).

CURRICULUM DESIGN THE DIDACTIC PHASE The didactic phase is comprised of classroom and laboratory instruction in basic science, behavioral science, and clinical medicine. Classes will be held, for the most part, Monday through Friday from 8:00 am - 5:00 pm. Some classes may require evening, early morning or weekend sessions. Students are expected to attend all classes. Students should have no other commitments during these hours.

At the beginning of each course, students will receive a syllabus and course outline describing the purpose of the course, the format, the objectives, and a booklist. Students will also receive instructional learning objectives for each course, which will guide the student in studying and will provide the basis for examinations. Students are responsible for each objective regardless of whether or not it is covered in class. Faculty members will determine the method of teaching and evaluation for the courses they teach. Some evaluation methods will be traditional, such as written tests, and others will not. Students are expected to meet the competencies determined by each instructor, in the manner required. To appropriately prepare students to practice as physician assistants, the course load during the didactic year is very heavy. As much as possible, the curriculum is integrated so that students study aspects of an organ system in several courses at the same time. For example, diseases of the lung might be studied jointly in medicine, anatomy, and physical diagnosis. The curriculum of the three pharmacology courses corresponds with the organ systems studied in the medicine courses. The case-based course, Correlative Medicine, synthesizes and integrates previously learned material and promotes critical thinking skills. Other courses address the social aspects of medicine. Health Psychology focuses on the formulation and improvement of student interpersonal and communication skills, especially as it relates to difficult patients or clinical encounters. The Physician Assistant and Society course explores the role of physician assistants within medicine, the legislative and legal realms. Diagnostic Modalities provides education in the practical areas of medicine such as EKG interpretation, procedural skills, and radiologic study interpretation.

THE CLINICAL YEAR The clinical year is comprised of eight clerkships comprised of approximately 2,000 hours of hands-on patient-care experience. Mandatory clerkships include: internal medicine; pediatrics; obstetrics and gynecology; psychiatry; family medicine; emergency medicine; and, surgery. Students are also required to complete an elective clerkship in an area of special interest of their choice. Clerkships are completed off campus in various clinical settings such as hospitals, private offices, and clinics. Clerkship locations also vary, with many, but not all, housed within the Northwell Health System. Students are not required to obtain and secure their own clinical sites or preceptors. Students are required to report to the site as instructed by their preceptors. Some rotations will require students to work during weekends, holidays, overnight, or late into the evenings. Students will return to campus or to Northwell Center for Learning and Innovation for â&#x20AC;&#x153;call backâ&#x20AC;? days, which are held on the last day of each clerkship. These day-long sessions consist of oral presentations, PAEA end of rotation examinations, standardized patient encounterâ&#x20AC;&#x2122;s with debrief sessions and special lectures related to clinical medicine. A separate handbook is distributed at clinical year orientation at the end of the 9

didactic year detailing the specifics for the clinical year.

RESEARCH SEMESTER The research semester synthesizes didactic and clinical knowledge in the application of epidemiology, evidence-based medicine, and research design and analysis. The Epidemiology course explores issues related to health and illness within communities rather than individuals. This course will provide an indepth understanding of the design and conduct of research studies, including causal inferences, measurement, major study designs, threats to validity, and urban public health applications. Students will examine interventions to prevent illness in the interest of improving public health and bridge the gap between clinical medicine and the evidence-based research by which it is driven. The Research Design and Analysis course provides the framework in which data can be analyzed and presented. Students will learn how to critically read and evaluate the strengths and limitations of health research literature from a methodologic perspective. Students will practice qualitative and quantitative techniques and well as perform data analysis using statistical software.

The Research Project course provides guidance in the collection, analysis, and written presentation of data. The Research Project is a culmination of the research curriculum, and a summation of cumulative knowledge gained in medical science, health care objectives, and community-based health care. Using skills learned in Epidemiology, Research Design and Analysis, and Evidence-Based Medicine, students will collaborate with a community organization and complete a Master's thesis assessing a specific dimension of health at the population level. Students will be given the option to work individually or in small groups. Students will choose from several clinically relevant topics outlined by the Research Coordinator at the start of the semester, and can either conduct qualitative or quantitative data analyses to address their research question. The project will culminate with a formal research paper and poster presentation of significant findings. Students will present their research to their peers, professors, and the scientific community in a conference-style setting.

PROGRAM CURRICULUM First Semester

16 credits

Anatomy Physical Diagnosis I Pharmacology I Physiology Medicine I

4 credits 2 credits 2 credits 4 credits 4 credits

Second Semester

15 credits

Health Psychology Physician Assistant and Society Pharmacology II Physical Diagnosis II Medicine II Evidence-Based Medicine Preventive Medicine

2 credits 2 credits 2 credits 2 credits 4 credits 2 credits 1 credits

Third Semester

PHA 216 PHA 200 PHA 221 PHA 220 PHA 225 PHA 202 PHA 235

13 credits

Pharmacology III Diagnostic Modalities Medicine III Correlative Medicine Fourth â&#x20AC;&#x201C; Sixth Semesters

PHA 223 PHA 215 PHA 217 PHA 212 PHA 224

2 credits 2 credits 7 credits 2 credits (Clerkships)

Family Medicine Internal Medicine OB/GYN Surgery Emergency Medicine Pediatrics Psychiatry Elective

27 credits 4 credits 4 credits 3 credits 3 credits 4 credits 3 credits 3 credits 3 credits

Seventh Semester

PHA 234 PHA 219 PHA 227 PHA 223

PHA 250 PHA 255 PHA 260 PHA 265 PHA 270 PHA 280 PHA 285 PHA 290

8 credits

Epidemiology Research Design and Analysis Research Project

2 credits 3 credits 3 credits

Curriculum Total

PHA 218 PHA 301 PHA 302

79 credits 11

PRECEPTOR INFORMATION INTRODUCTION The Preceptor Guide outlines the policies and procedures of the Hofstra University Department of Physician Assistant Studies regarding expectations for student performance in clinical clerkships. Furthermore, this handbook contains the objectives and discrete subject matter to which the student will be held responsible on a written examination. As physician assistant education is constantly evolving, this guide is reviewed and updated annually. Therefore, preceptors are encouraged to forward comments to the program on any portion of this guide that merits reexamination. Additionally, this handbook can be found on our program website at http://www.hofstra.edu/academics/colleges/nursingphysician-assistant/physician-assistant/physician-assistant-handbooks.html. The faculty of the Hofstra University Department of Physician Assistant Studies would like to take this opportunity to express our sincere gratitude to our preceptors for their hard work and dedication to this program and our physician assistant (PA) students. The clinical experiences the student will obtain in your office; clinic or institution are of critical importance to a successful learning experience in the program. The clinical setting synthesizes concepts and application of principles for quality health care delivery. You, as a clinical preceptor, are the key to successful learning experiences in the clinical setting. The PA student will work closely with you, learning from your advice and example. Through your supervision, the student will progressively develop the skills and clinical judgment necessary to become a practicing PA. Thank you for your commitment to PA education and for your support in helping to educate the next generation of health care providers. At any time, should you have any questions, comments or feedback regarding our students, please feel free to contact the program.

THE CLINICAL YEAR The clinical year takes students from the theoretical classroom setting to an active, hands-on learning environment to prepare them for a lifetime of continued refinement of skills and expanded knowledge as a practicing PA. To this end, the goals of the clinical year include: • • • • •

Apply didactic knowledge to supervised clinical practice Develop and sharpen clinical problem-solving skills Expand and develop the medical fund of knowledge Perfect the art of history taking and physical examination skills Sharpen and refine oral presentation and written documentation skills 12

• • • •

Develop an understanding of the PA role in health care delivery Prepare for the Physician Assistant National Certifying Exam Develop interpersonal skills and professionalism necessary to function as part of a medical team Prepare our students to deliver high quality care to patients and individuals with developmental disabilities

DEFINITION OF THE PRECEPTOR ROLE The preceptor is an integral part of the teaching program. Preceptors will serve as role models for the student and, through guidance and teaching, will help students perfect their skills in history taking, physical examination, communication, physical diagnosis, oral presentation, problem-solving/critical thinking, and plan development.

STUDENT LEARNING OBJECTIVES The specific minimum learning objectives for each clinical experience can be found in each discipline’s syllabus in the back of this handbook. Preceptors use the objectives by helping students accomplish basic clinical competencies. They are also used as a guide to evaluate the clinical acumen of physician assistant students when completing the Preceptor Evaluation Form, a sample of which is found at the end of each syllabus. Students are encouraged to review the objectives for their clerkship with the preceptor on the first day of the clerkship. In addition, students are asked to have their preceptor sign the Student/Preceptor Review of Clinical Objectives Form so that both student and preceptor have a common understanding of what is expected during the clerkship. Once reviewed and signed, it is the students’ responsibility to assure that the objective form is faxed to the physician assistant program office at 516-463-5177 by the end of the first week of their clerkship. Failure of the student to fax in a signed copy of the student/preceptor review of clinical objectives form will result in a (3) three-point reduction off the students overall clerkship grade. A copy for your reference can be found at the end of this handbook.

PRECEPTOR RESPONSIBILITIES Preceptor responsibilities include, but are not limited to, the following: • Orient students at the onset of the clerkship with the practice/site policies and procedures and review the expectations and objectives for the clerkship • Provide ongoing and timely feedback regarding clinical performance, knowledge base, and critical thinking skills. This can be done with the student informally each week or at a designated time and can be formally reported to the clinical coordinator by submitting mid-clerkship and end-of-clerkship evaluations • Supervise, demonstrate, teach, and observe clinical activities in order to aid in the development of clinical skills and ensure proper patient care • Delegate to the student increasing levels of responsibility for clinical assessment and management as appropriate to the student’s experience and expertise • Participate in the evaluation of clinical skills and medical knowledge base through the following mechanisms: 13

• • • • • • • •

o Direct supervision, observation, and teaching in the clinical setting o Direct evaluation of presentations (including both oral and written) o Assignment of outside readings and research to promote further learning Dialogue with faculty during site visits to evaluate student progress and assist the learning process Audit and co-sign charts in order to evaluate the student’s ability to write appropriate and complete progress notes, histories, physical examinations, assessments, and treatment plans Complete and promptly return the evaluation forms provided by the program reflecting on student knowledge and skills as well as their improvement throughout the clerkship Promptly notify the PA program of any circumstances that might interfere with the accomplishment of the above goals or diminish the overall training experience Maintain an ethical approach to the care of patients by serving as a role model for the student Demonstrate cultural competency through interactions with patients Spend a few minutes each week in a candid summary discussion with the student as to whether each is meeting the other’s needs and expectations, and what changes need to be made in the roles and relationship Provide timely feedback to the student and the program regarding student performance

THE PRECEPTOR STUDENT RELATIONSHIP The preceptor should maintain a professional relationship with the PA student and at all times adhere to appropriate professional boundaries. Social activities and personal relationships outside of the professional learning environment should be appropriate and carefully selected so as not to put the student or preceptor in a compromising situation. Contact through web-based social networking sites (e.g., Facebook, Twitter, LinkedIn, Instagram) should be avoided until the student fully matriculates through the educational program or completes the clerkship where the supervision is occurring. If the preceptor and student have an existing personal relationship prior to the start of the clerkship, a professional relationship must be maintained at all times in the clinical setting. Please consult the clinical coordinator regarding specific school or university policies regarding this issue or additional questions. For more detailed information on this policy see the Hofstra web site at http://www.hofstra.edu/pdf/senate/senate_fps_43.pdf

SOCIAL MEDIA POLICY FOR STUDENTS Maintaining professionalism is of utmost importance when using social media. It is recommended that you assume all postings are visible to program faculty, future employers, and patients. It is strictly prohibited to discuss patient related matters, take photographs of patients and cadavers, including in the operating room, even if the patient is not identified. Similarly, the posting of diagnostic images or any form of patient data on any social media platform such as YouTube, Facebook, iTunes, LinkedIn, Twitter, and blogs is strictly prohibited. Posting on Facebook or any other form of social media regarding program personnel, including faculty and fellow students is strictly prohibited. Violation of this policy will result in being called before the Academic Standing Committee and possible dismissal from the program. Witnessing any violation of this policy should be immediately reported to the program director. 14

PRECEPTOR CONTACT Students are required to contact preceptors at least one week prior to the start of the clerkship. Preceptors should provide the clinical coordinator with updated and preferred contact information. This allows students an opportunity to communicate with preceptors to discuss student expectations and logistical information.

ORIENTATION & COMMUNICATING STUDENT EXPECTATIONS Orientation of the student to the clerkship site serves several purposes. Orientation facilitates a quicker transition in allowing the student to become a member of the medical team. It also establishes a feeling of enthusiasm and belonging to the team as well as helping students develop the functional capability to work more efficiently. On the first day of the clerkship (or when possible, prior to the clerkship), the student should address any administrative needs, including obtaining a name badge/security clearance and computer password, and completing any necessary paperwork, EMR training, and additional site-specific training/orientation, if needed. Early on in the clinical clerkship, it is recommended that the preceptor and student formulate mutual goals in regards to what they hope to achieve during the clerkship. The preceptor should also communicate his or her expectations of the student during the clerkship. Expectations can include: • Hours • Interactions with office and professional staff • General attendance • Call schedules • Overnight/weekend schedules • Participation during rounds and conferences • Expectations for clinical care, patient interaction, and procedures • Oral presentations • Written documentation • Assignments • Write-ups • Anything additional that the preceptor feels is necessary Students are expected to communicate with preceptors any special scheduling needs they may have during the clerkship — in particular, when they may be out of the clinical setting for either personal reasons or program-required educational activities. If students anticipate missing clinical time due to personal reasons, it needs to be discussed and approved by the clinical coordinator well in advance of the clinical absence. Many sites find it helpful to create their own written orientation manual, which is given to the student prior to the first day of the clerkship. This helps the students quickly become more efficient. Creating such a site-specific orientation/policy manual can be delegated to the students you host, with each “subsequent” student adding to a document that you as the preceptor maintain and edit. 15

PREPARING STAFF The staff of an office or clinic has a key role in ensuring that each student has a successful clerkship. By helping the student learn about office, clinic, or ward routines and the location of critical resources, they help a student become functional and confident. Students, like their preceptors, depend on staff for patient scheduling and assistance during a patient’s visit. Students should communicate with the staff about procedures for making appointments, retrieving medical records, bringing patients into examination rooms, ordering tests, retrieving test results, and charting.

Preceptors should not assume that receptionists, schedulers, and nursing staff automatically know what role the student will have in a practice. The preceptor should inform the staff about how the student will interact with them and with patients. Consider having a meeting or creating a memo with/for staff in advance of the student’s arrival to discuss: 1. Student’s name 2. Student’s schedule (when they will be in the office) 3. Student’s expected role in patient care 4. Expected effect of the student on office operation: Will fewer patients be scheduled? Will the preceptor be busier? 5. How patients will be scheduled for the student

SUPERVISION OF THE PA STUDENT During a student’s time at the clinic or hospital, the preceptor must be available for supervision, consultation, and teaching, or designate an alternate preceptor. Although the supervising preceptor may not be with a student during every shift, it is important to clearly assign students to another MD, DO, NP or PA who will serve as the student’s preceptor for any given time interval. Having more than one clinical preceptor has the potential to disrupt continuity for the student but also offers the advantage of sharing preceptorship duties and exposes students to valuable variations in practice style, which can help learners develop the professional personality that best fits them. In the case where supervision is not available, students may be given an assignment or may spend time with ancillary staff (x-ray, lab, physical therapy, etc.), as these experiences can be very valuable. The preceptor should be aware of the student’s assigned activities at all times. Students are not employees of the hospitals or clinics and, therefore, work entirely under the preceptor’s supervision. Students are not to substitute for paid clinicians, clerical staff, or other workers at the clinical sites. On each clerkship, it is the student’s responsibility to ensure that the supervising physician or preceptor also sees all of the student’s patients. The preceptor can provide direct supervision of technical skills with gradually increased autonomy in accordance with the PA student’s demonstrated level of expertise. However, every patient must be seen and every procedure evaluated prior to patient discharge. The preceptor must document the involvement of the PA student in the care of the patient in all aspects of the visit. The preceptor must also specifically document that the student was supervised during the entirety of the patient visit. Medicare laws are slightly different in terms of what a student is able to document, and this is explained further in the following “Documentation” section. The PA student will not be allowed to see, treat, or discharge a patient without evaluation by the preceptor.

INFORMED PATIENT CONSENT REGARDING STUDENT INVOLVMENT IN PATIENT CARE & HIPAA 16

The patients are essential partners in this educational endeavor as well. All efforts will be made to observe strict confidentiality, respect patient privacy and dignity, and honor their preferences regarding treatment. All students complete HIPAA training prior to their clinical year. However, patients must be informed that a physician assistant student will participate in their care, and the patient’s consent must be obtained. This may be done through standardized forms at admission or on a person-by-person basis. The students should be clearly identified as PA student and must also verbally identify themselves as such. If the patient requests a physician and refuses the PA student’s services, the request must be honored. Patients must know that they will see their regular provider, and they should have an explicit opportunity to decline student involvement.

PATIENT RIGHTS AND CONFIDENTIALITY All students have been HIPAA certified prior to entrance into clinical clerkships. All information regarding a patient’s health is privileged information. All students must strictly adhere to each institutional policy governing patient rights and confidentiality and to all federal, state and local governances. Students must not discuss any information regarding a patient in a manner or location that might reveal the identification of the patient to individuals not directly involved in that patient’s care. For this reason, all students must complete HIPAA training and provide proof of completion before entrance to the PA Program. Patient charts, inclusive of progress notes or lab reports, must not be removed from the clinical site by the physician assistant student. If photocopies of a patient’s record are needed for site evaluation, all information that might identify the patient must be removed, omitted or deleted to protect patient confidentiality.

DOCUMENTATION If allowed by the preceptor and/or facility, PA students may enter information in the medical record. Preceptors should clearly understand how different payers view student notes as related to documentation of services provided for reimbursement purposes. Any questions regarding this issue should be directed to the clinical coordinator. Students are reminded that the medical record is a legal document. All medical entries must be identified as “student” and must include the PA student’s signature with the designation “PA-S.” The preceptor cannot bill for the services of a student. Preceptors are required to document the services they provide as well as review and edit all student documentation. Although student documentation may be limited for reimbursement purposes, students’ notes are legal and are contributory to the medical record. Moreover, writing a succinct note that communicates effectively is a critical skill that PA students should develop. The introduction of EMRs (electronic medical records) presents obstacles for students if they lack a password or are not fully trained in the use of one particular institution’s EMR system. In these cases, students are encouraged to hand-write notes, if simply for the student’s own edification, which should be reviewed by preceptors whenever possible for feedback.

PRECEPTOR REVIEW, COUNTERSIGNATURE AND PRESCRIPTION WRITING Preceptors must evaluate all patients seen by students. It is the responsibility of each student to ensure that the supervising preceptor examines each patient seen by the student. The supervising preceptor 17

must review, critique and countersign all notes written by the student. The student will sign each note with “PA-student” and not “PA-S” to prevent confusion. The supervising preceptor must countersign the note immediately. The student is not authorized to initiate any orders for a patient without the consultation and the signature of the supervising preceptor. Students may transmit prescribing information for the preceptor, but the physician must sign all prescriptions. More specifically, the student’s name is not to appear on the prescription. For clinical clerkship sites that use electronic prescriptions, the preceptor MUST log into the system under his/her own password and personally sign and send the electronic prescription. These guidelines must not be violated by the student or the preceptor. However, students are encouraged to practice writing unofficial orders and prescriptions and present them to preceptors for review. Similarly, if hospital policy does not allow students to write clinical notes in a patient chart, unofficial notes should be reviewed by the preceptor. Students may transmit prescribing information for the preceptor, but the physician must sign all prescriptions. More specifically, the student’s name is not to appear on the prescription. For clinical clerkship sites that use electronic prescriptions, the preceptor MUST log into the system under his/her own password and personally sign and send the electronic prescription. These guidelines must not be violated by the student or the preceptor.

MEDICARE POLICY Medicare reimbursement requires limited student participation in regards to documentation. Students are allowed to document only aspects of the history that include the past medical history, family history, social history, and review of systems. The preceptor must document the History of Present Illness (HPI), Physical Exam (PE), and all medical decision-making for proper billing. Following is a link to the Center for Medicare and Medicaid Services (CMS), which provides direct access to CMS rules regarding student documentation. https://www.cms.gov/Outreach-and-Education/Medicare-LearningNetwork-MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN006764.pdf

EXPECTED PROGRESSION OF PA STUDENT PA students are trained to take detailed histories, perform physical examinations, give oral presentations of findings, and develop differential diagnoses. As the year continues, they should be able to more effectively come up with an assessment and plan, though this will involve discussion with the preceptor. If the preceptor deems it necessary, students initially may observe patient encounters. However, by the end of the first week, students should actively participate in evaluating patients. As the preceptor feels more comfortable with the student’s skills and abilities, the student should be allowed progressively increasing supervised autonomy.

STUDENT EVALUATION The preceptor evaluation comprises 25% of the grade for the clerkship. If a student fails a preceptor evaluation the student fails the clerkship. The evaluation is designed to promote communication between preceptor and student. Preceptors are encouraged to discuss strengths and weaknesses so as to encourage students about their strengths as well as provide opportunities to improve upon weaknesses. The evaluation should also reflect on student knowledge and skills as well as their improvement throughout 18

the clerkship, and assess progress in comparison to other students at the same level. The preceptor's evaluation of the student is tremendously important. On required clerkships (i.e., core clerkships required by the specific institution for all students prior to graduation), a passing evaluation from the preceptor is mandatory. If deemed “not passing,” the student will need to repeat the clerkship. We encourage preceptors to review the preceptor evaluation with their students privately to get additional insight into the student’s performance, professionalism and effectiveness as a team player. These comments are helpful contributions to student evaluations. Additionally, staff feedback may enhance the student experience from one clerkship to another and can help to improve efficiency and flow while also maximizing educational opportunities. This evaluation should be signed by both the student and preceptor. This form should be returned directly to the program office in a sealed envelope with the preceptor’s signature and stamp across the seal. A faxed or emailed copy will be accepted only if the preceptor speaks directly to one of the staff beforehand. The program fax number is 516-463-5177. The clinical coordinator’s email addresses are: ShannanRicoy@hofstra.edu and Christine.Zammit@hofstra.edu. All preceptor evaluations must be turned in upon completion of the clerkship. Grades for the clerkship will not be posted until the evaluation form is received.

STUDENT FEEDBACK While students may have only one formal evaluation during the clinical clerkship, it is imperative that they receive regular positive and constructive feedback on a daily basis from their preceptors to help improve their clinical performance. Preceptors are encouraged to provide students with feedback throughout clerkships as identification of strengths and weaknesses is essential for student selfimprovement. A planned meeting with the student midway through the clerkship may be helpful. Suggested areas of feedback include weaknesses in clinical knowledge, history taking, physical exam skills, formulation of differential diagnoses, and management/follow-up. The preceptor can provide helpful feedback on oral and written presentation skills as well as issues concerning professionalism. If a preceptor feels that a student is not meeting the expectations of the clerkship they need to notify the clinical coordinator by either phone or email prior to the end of the clerkship. It is also advised that the preceptor meet with the student directly to discuss any issues or deficiencies noted by the preceptor.

CLERKSHIP WORK SCHEDULE Preceptors must sign all student clerkship work schedules. All students are required to fax or email a “Clerkship Work Schedule” form (See appendix) to the program clinical secretary by Friday of the first week of each clinical rotation (Fax: 516-463-5177). A new clerkship schedule must be sent if the schedule changes for any reason. Absences must be documented on the bottom of the clerkship work schedule. The time used to make up absences must be similarly documented. The form must be signed by the designated preceptor. All students must contact the clinical secretary via email within 24 hours to confirm receipt of their work schedule. Failure to submit a clerkship work schedule will result in a grade of “incomplete” until all forms are received.

CME FOR PHYSICIAN ASSISTANT PRECEPTORS The Hofstra University Department of Physician Assistant Studies can award up to 10 hours of Category 1 CME credit per clinical year, for clinical teaching. The credits are awarded by the American Academy of Physician Assistants (AAPA), made possible by collaboration with the Physician Assistant Education Association (PAEA). At this time, due to regulations from the AAPA and PAEA, this credit is limited to preceptors who are currently practicing physician assistants. The number of credits awarded is determined by the amount of time spent precepting students. Hofstra will award 0.5 AAPA Category I CME credit for each 2 weeks of clinical teaching. For the purposes of credit calculation, a week is defined as 40 hours of precepting. If a preceptor has more than one student at a time, that preceptor may be awarded an additional 0.25 CME credit for each additional student per 2 weeks of teaching. Sample Calculation: Number of Weeks 2 4 6 8

1 0.5 Credit 1 Credit 1.5 Credits 2 Credits

Number of Students 2 0.75 Credit 1.5 Credits 2.25 Credits 3 Credits

3 1 Credit 2 Credits 3 Credits 4 Credits

4 1.25 Credits 2.5 Credits 3.75 Credits 5 Credits

Each preceptor interested in obtaining CME credit for teaching, must provide their name and institutional preceptorship location, to the clinical coordinator at the beginning of the clinical year. The preceptor must keep track of students assigned to them and the number of weeks spent clinically teaching. August 31st marks the culmination of the clinical year, at which time the preceptor is required to submit the self-evaluation form and attestation of number of weeks spent. If there are multiple physician assistants precepting a single student, the PA should claim credit only for time spent actively teaching that student. If the clinical coordinator is not in receipt of these documents within one month of the end of the clinical year, credits will not be awarded.

__________________ Category 1 CME for Physician Assistant Precepting Self-Reflective Learning Evaluation Hofstra University Department of Physician Assistant Studies Dates of CME Activity: 9/5/17 – 8/31/18 Directions: Please complete the following evaluation form. Your written comments are greatly appreciated. For the purposes of this survery, CME activity means serving as a clinical preceptor and the self-reflective processes associated with clinical teaching of PA students which my include observing growth in student’s knowledge, skills and professionalism resulting from the student/preceptor interaction, as well as soliciting and analyzing student feedback to improve one’s own clinical knowledge, skills, and interpersonal relations that result from the teaching experience. Preceptor Name: ____________________________________________________________ Clinical Practice Affilication: __________________________________________________ Preceptor Learning Objectives: Upon serving as a clinical preceptor for physician assistant studies, clincially-practicing physician assistants should be able to: • Demonstrate core medical knowledge about medical conditions for the patients in their area of practice. • Demonstrate critical decision-making and lifelong learning skills. • Demonstrate effective communication with patients and their families, physicians and other health care professionals. • Demonstate high quality health care and a commitment to patient safety. • Demonstrate ongoing evaluation and improvement of their patient care practices • Demonstrate the ability to effectively interact with different types of healthcare delivery systems. 1. What was your overall opinion of the CME activity related to clinical precpting? ⁪Excellent

⁪Good

⁪Satisfactory

⁪Poor

2. Based on your experience of clinical precepting, please rate your relative acheivement related to the learning objectives listed above. I accomplished: ⁪none of the above ⁪most of the above

⁪some of the above ⁪all of the above

_____________________

_________________

3. What aspects of this CME activity did you find least valuable to your continued development as a physician assistant? ______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 4. Do you have specific suggestions as to how this CME activity might be improved? ____ ________________________________________________________________________ ________________________________________________________________________ 5. Would you participate in this CME activity again?

⁪Yes

⁪No

⁪Yes

⁪No

Would you recommend clinical precepting to a colleague?

Hofstra University is approved by the American Academy of Physician Assistants to award AAPA Category 1 CME credit to eligible physician assistant preceptors. This approval is valid for one clinical year beginning 9/5/2017. This program was planned in accordance with AAPAs CME Standards. Physician assistants may earn a maximum of 10 hours of AAPA Category 1 CME credit for clinical precepting during any single calendar year.

Category 1 CME for Physician Assistant Precepting Precepting Hours Attestation Report Hofstra University Department of Physician Assistant Studies Dates of CME Activity: 9/5/17 â&#x20AC;&#x201C; 8/31/18 Preceptor Name: ____________________________________________________________ Clinical Practice Affiliation: ___________________________________________________ Student Name

Clerkship Dates

Number of Weeks Spent Precepting

Total Number of CME Credits Requested:_________________________________________

STUDENT POLICIES HEALTH INSURANCE Health insurance is mandatory for the clinical year. All students on clinical clerkships have submitted proof of health insurance to the program. All student health insurance policies cover the students in the event of illness or injury that may result from patient care.

HEALTH CLEARANCE All students must be medically cleared as evidenced by a health care provider who has determined his/her fitness to perform physician assistant student functions. In addition, all students must be medically cleared by Student Health & Counseling Center (SHACC) prior to the start of the didactic, clinical and research semesters. https://www.hofstra.edu/studentaffairs/studentservices/welctr/incomingstudents.html Additionally, supplemental health clearance documents must be completed in order for students to participate in clinical year clerkships. Depending on research project location, health clearance documents may be required prior to beginning the research semester. The potential cost associated with health clearance is the responsibility of the student. As determined by the New York State Department of Health and as per CDC requirements, students should be aware that the influenza vaccine is now required for all hospital personnel including students. If a student declines to be vaccinated against influenza, a declination form must be completed and the student must wear a mask in all clinical arenas. Vaccination should be attained during each influenza season (fall semester) while enrolled in the PA program. Immunization requirements are in accordance with the most current Centers for Disease Control (CDC) recommendations for health care professionals. Students should be aware that some clinical or research site requirements exceed CDC recommendations. Student health records are confidential and must not be accessible to program faculty or staff with the exception of immunization and tuberculosis screening results which are maintained and released with written permission of the student. Therefore, students are required to keep their own medical information and present it at the beginning of each clinical clerkship or research site.

IDENTIFICATION Students must display their Hofstra University photo identification in an easily visible location while on clinical clerkships. All students must identify themselves as a â&#x20AC;&#x153;physician assistant studentâ&#x20AC;? to patients and medical staff. Under no circumstance should a student encourage or fail to correct the misconception that he/she is a physician or a medical student. Students answering pages or phone calls for clinical preceptors must use their title when answering.

LIABILITY INSURANCE Hofstra University holds malpractice liability insurance through Marsh Insurance Company, which covers each site with which the University has a contract. This is renewed on an annual basis. Copies of the insurance certificate can be obtained by contacting the clinical coordinator. Please allow two-four weeks to receive your certificate 24

WORK POLICY The program strongly discourages any type of outside employment during the course of studies in the program. Program responsibilities are not negotiable, and will not be altered due to student work obligations. Furthermore, working has been the chief cause for academic difficulty in past years. Students who choose to volunteer or be paid employees during the course of their physician assistant training cannot use their affiliation with the program in any aspect of that employment. Any activity undertaken by the student, independent of the program, is not covered by the liability insurance offered for clinical work associated with physician assistant training. Furthermore, students may not be required to perform clerical or administrative work for the program. Students may not substitute for regular clinical or administrative staff during the clinical year. Should such a request be made of a student, it should be reported to the program director immediately.

UNIVERSAL PRECAUTIONS All PA students complete a training session for healthcare professionals in infection control/universal precautions provided by the Medical Society of the State of New York and New York State Department of Health before entering the hospital setting. A certificate of completion is kept by the student and provided to any clinical site requesting a copy.

EXPOSURE POLICY AND INCIDENT REPORTING Should a student be exposed to the body fluid of a patient, he/she will immediately report the incident to the clinical preceptor. The student will follow the institutional infectious and environmental hazard policy, including completing all necessary documentation as required. Students should be aware that an infectious or environmental hazard exposure can adversely affect their overall health as well as performance in the Program. Additionally, the student must contact the clinical coordinator or program director within 24 hours of the incident. The student is required to complete an incident form (located in clinical forms section in the back of the handbook) and submit it to the clinical coordinator, program director and university within 24 hours of the incident. Health information of any kind concerning students, patients, or staff should not be included when filling out the exposure form. Following an exposure, the student must follow-up with his/her medical provider if in an out-patient setting, and employee health or hospital emergency room if in-patient. Should any expense be incurred as a result of an exposure, the student is responsible for all costs related to the incident.

CLINICAL YEAR ATTENDANCE Attendance is mandatory for all clinical year call back days. Clinical year students are required to follow the schedule set by their preceptor. Students should arrive at the facility before their scheduled shift and remain on the site until excused. Students are expected to take call as designated by the preceptor. Students are expected to work weekends, holidays and overnight. University holidays do not pertain to the clinical year. Snow days do not pertain to the clinical year. Students may not take vacations apart from those designated by the clinical year schedule. 25

CLERKSHIP ATTENDANCE Clinical year students are required to follow the schedule set by their preceptor. Students should arrive at the facility before their scheduled shift and remain on the site until excused. Students are expected to take call as designated by the preceptor. Students are expected to work weekends, holidays and overnight. University holidays do not pertain to the clinical year. Snow days do not pertain to the clinical year. Students may not take vacations apart from those designated by the clinical year schedule. Should a student be physically present on a site but away from the team, he/she will be considered absent. It is not acceptable to go to the library to study or to be away from the team without the preceptorâ&#x20AC;&#x2122;s knowledge and permission. If an absence due to an illness occurs the day before or the day after a holiday, the student must provide the clinical coordinators with a note from a medical provider documenting their illness. Any absence, for any reason, must be made up at the site. There are no personal days.

If a student is unable to report to or will be late to the clinical site for any reason, he/she is required to 1. Call and e-mail the clinical preceptor before the start of your shift. 2. Call and e-mail the clinical coordinators at (516) 463-4233 or (516) 463-4380 before the start of your shift. Failure to report an absence and obtain approval from the clinical coordinators will result in an unexcused absence. An unexcused absence, a pattern of multiple excused absences, extended absences, or chronic lateness are subject to disciplinary action including appearance before the Academic Standing Committee. It is unacceptable to leave a message with the program administrative assistant. It is unacceptable for a student to call on behalf of another student.

UNIVERSITY POLICY RELATED TO ABSENCES FOR RELIGIOUS OBSERVANCE For the purpose of the clinical year, class time as detailed below is equated to clinical clerkships and all related clinical year activities. Students should report absences as described under the clinical year attendance policy. Hofstra University recognizes that students and/or faculty may, from time to time, miss class due to religious observances. Students who anticipate missing class for this reason should notify faculty members in advance. Likewise, faculty members who anticipate missing class for religious observance should notify students in their classes. As per Faculty Policy Series 12 (B): â&#x20AC;&#x153;No student shall be expelled or refused admission to Hofstra University because he or she is unable to participate in any examination, study or work requirement because of his or her religious obligations and practices. However, all students are expected to complete all assignments and examinations. It is 26

understood that no adverse or prejudicial effects shall result to any student who avails him or herself of religious observances. The University, faculty, and student shall work together to achieve a reasonable accommodation concerning any conflicts between educational and religious obligations.” Faculty will publish notice of this policy in their syllabi and announce it during the first week of each semester, and will further make reasonable efforts to avoid scheduling exams and/or due dates of assignments that would otherwise interfere with religious observances of students. Additionally, in accordance with New York State Law, each student who is absent from school because of his or her religious beliefs will be given an equivalent opportunity to register for classes or make up any examination, study or work requirements which he or she may have missed because of that absence on any particular day or days.

TENANTS OF PROFESSIONAL CONDUCT Students must adhere to standards of professional behavior at all times. These standards are the ethical foundation of medical practice and of our integrity as physician assistants. Breeches in professionalism may result in appearing before the Academic Standing Committee. Professional behavior is expressed through respect for instructors and fellow students. In the clinical setting, it is expressed through respect for patients and colleagues. Professional behavior is evaluated throughout the course of study and is also formally evaluated during advisement sessions. Examples of unprofessional behavior include but are not limited to: • poor attendance or tardiness; • multiple excused absences; • unexcused absences or not following program protocol for notifying program personnel of an absence; • not following program protocol for reporting lateness or leaving early; • lack of preparation; • lack of involvement; • plagiarism; • falsifying documents; • falsifying Typhon procedure or patient encounters; • inability to accept constructive criticism; • lack of respect for the rights of patients to competent, confidential service; • lack of respect for others; • failure to follow protocol, or directions of supervising physician, physician assistant or program faculty; • performing unauthorized procedures or administering services not permitted by the supervisor, the facility, or the program; • endangering the health and welfare of any patient; • violation of the Health Insurance Portability and Accountability Act (HIPAA); • failure to perform all or part of assigned tasks and responsibilities; • leaving the clinical setting without permission from the preceptor; • performing any activity which is beyond the scope of the role of a student; • failure to identify as a physician assistant student; 27

• • • • • • • • • • • • •

failure to report all observed unethical conduct by other members of the health profession, including other students; engaging in conversation with others during a class or lecture; leaving the classroom during lectures; using personal e-mail, Facebook, or other social media while in class; posting inappropriate content on social media platforms or otherwise violating the social medial policy; Connecting on social media with faculty, preceptors or supervisors while a student in this program; exhibiting un-truthful behavior; lying to preceptor, faculty, or staff; failure to submit program evaluations in a timely fashion; neglecting to turn off cell phones, texting or talking on a cell phone during class, examinations, meetings, on the clinical site, or during any other professional functions; unacceptable dress; Failure to submit an incident report both to the program and the clinical site; Using scrap paper other than what is distributed by the program.

DRESS REQUIREMENTS Dress requirements must be strictly adhered to in the clinical year. One reason is safety – dress can increase or decrease the potential for injury. The second is that clinical year students represent both the physician assistant profession and Hofstra University. Therefore, students must look professional while interacting with patients and health professionals at clinical sites and related facilities. Both men and women should wear business attire while on clinical clerkships and at related facilities. Men should wear a dress shirt with tie. Closed toed shoes with socks or stockings as well as a short white uniform jacket must be worn by men and women, at all times. Each student should wear a watch with a second hand. Bracelets are not permitted on clinical clerkships or at program related facilities. Students should avoid wearing insignia, buttons or decals of a political nature while on clinical clerkships or at program related facilities. Unacceptable clothing includes: • • • • • • •

Revealing clothing Open-toed shoes Tight pants or leggings T-shirts, sweatshirts or sweatpants Any clothing made of denim Clothing that exposes the mid-abdomen Clothing that is soiled, in poor repair, or not well maintained

Students may wear scrubs only while in the operating room, emergency room or in the delivery room. Students may wear sneakers only while wearing scrubs as listed above. Students may not wear scrubs while outside the hospital, or while traveling to or from the hospital. All students are required to follow each facilities designated scrub policy. 28

Hair must be pulled back away from the face if it is longer than shoulder length. Fingernails must be less than ¼“long. Nail polish should not be worn while on rotations that requires the student to scrub. No artificial nails, wraps, multi-colored or designer nail polish or nail paintings are permitted. Some patients may be particularly sensitive to fragrances when ill. Students should be sensitive to the needs of patients and avoid wearing fragrances while in the health care setting. Only post earrings are permitted. All tattoos should be concealed. Other body piercings should not be worn during rotations.

SEXUAL MISCONDUCT AND OTHER UNLAWFUL HARASSMENT Sexual relations between a PA student and a patient are unethical, regardless of who initiated the relationship. Sexual relations between a PA student and clinical staff at a site are similarly unacceptable. As a result, no PA student shall engage in sexual relationships or conduct that may reasonably be perceived as inviting or encouraging a sexual relationship, with a patient or with clinical staff at a site. Violation of this policy by a PA student will result in dismissal from the program. Sexual harassment of a physician assistant student by a preceptor or other rotation site employee is a serious matter. Hofstra University has a Harassment Policy, found at www.hofstra.edu/harassment prohibiting sexual harassment and prohibiting harassment based on any characteristic protected by law. Any PA student who experiences sexual harassment or any form of unlawful harassment must report it immediately to the Hofstra clinical coordinator and/or to the University’s Equal Rights and Opportunity Officer (see Nondiscrimination Policy, www.hofstra.edu/eoe for contact information). Hofstra University policies, procedures and resources for those who believe they have experienced sexual or other unlawful harassment may be found in Hofstra University’s Nondiscrimination Policy at www.hofstra.edu/eoe. Retaliation against anyone who makes a report of sexual or other unlawful harassment is prohibited.

ACADEMIC HONESTY Cheating and plagiarism are grave infractions of academic and professional ethical behavior and are contrary to the purpose of any educational institution. They must be addressed seriously for student scholarship to have validity. Faculty are required to report all suspicions of academic dishonesty. Faculty may require students suspected of cheating or plagiarizing to confirm the originality of their work. Student breaches of academic standards may be subject to disciplinary or academic action. Please refer to URL: http://www.hofstra.edu/pdf/Senate/Senate_FPS_11G.pdf As members of Hofstra, we abide by the following honor code: HONOR CODE “As a member of the Hofstra community, I pledge to demonstrate integrity and ethical behavior in all aspects of my life, both inside and out of the classroom. I understand that I am accountable for 29

everything I say and write. I will not misrepresent my academic work, nor will I give or receive unauthorized assistance for academic work. I agree to respect the rights of all members of the Hofstra community. I will be guided by the values expressed in the P.R.I.D.E Principles. I accept the responsibility to follow this Honor Code at all times.â&#x20AC;?

TYPHON TRACKING SYSTEM In order for the program to ensure that each student has adequate exposure to a diverse mix of patients regarding demographics and type and severity of disorder, we use a web-based tracking system called Typhon. As each clerkship progresses, it is expected that the students level of involvement in patient care and the complexity of patients seen will increase as well. Students are required to log information regarding each patient seen daily. Typhon provides the opportunity for preceptors to review student logs, if desired. All patient logs must be signed and stamped by the preceptor.

CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Students must log specific types of patient encounters during each clerkship. The minimum requirements for the clinical year are presented in the table below: Discipline Pediatrics Family Medicine Internal Medicine Psychiatry Ob/GYN Prenatal Care Gynecologic Care Emergency Medicine Surgery Pre-op Intra-op Post-op Elective

Requirements 15 per week/90 per clerkship 15 per week/95 per clerkship 10 per week/60 per clerkship 10 per week/60 per clerkship 10 per week/60 per clerkship 15 per clerkship 15 per clerkship 15 per week/90 per clerkship 10 per week/60 per clerkship 10 per clerkship 10 per clerkship 10 per clerkship 5 per week/30 per clerkship

CLINICAL YEAR PATIENT ENCOUNTER REQUIREMENTS Typhon also tracks the types of patient encounters seen on student clerkships. The clinical encounters below are required to be completed by the end of the clinical year. These requirements may be met on any of the eight clerkships. Preceptors must sign off on patient encounters. The preceptorâ&#x20AC;&#x2122;s signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation. 30

Preventative Acute Chronic Emergent Developmental Disabilities

20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during clinical year

PROCEDURE LOGGING Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon System. Please make sure the student performs rather than observes or assists as many procedures as possible, as credit is given only for those logged as “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. It is the student’s responsibility to find opportunities to meet the procedure requirements. Each clerkship syllabi will provide suggestions on procedures that may be found within that discipline; however the requirements may be met on any of the eight clerkships. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS: Procedure Required Number ABG 4 Abscess I&D 2 Blood Cultures 2 Cardiopulmonary Resuscitation 1-assisted is acceptable on or at CLI* Foley Catheter Placement 4 IM/SC/ID-injections 10 IV Placement 10 NG Tube Placement 2 Splinting 5 Suturing 5 Venipuncture 10 Assist in Operating Room 5 Wound Care/Debridement 5 Breast Examinations 5 Pelvic Examinations 5 Rectal Examinations 5 31

*Center for Learning and Innovation (CLI

STUDENT AND CLERKSHIP MONITORING MID-CLERKSHIP EVALUATION Students fill out a mid-clerkship evaluation at the end of the third week of the clerkship. This tool is designed for the student to identify personal strengths and weaknesses as well as provide an opportunity to discuss his/her progress and expectations with the preceptor. Preceptors may approach the student at this time to initiate a discussion, if the student has not done so. This tool also provides the program with feedback regarding clerkship quality. Lastly, it allows the clinical coordinator to identify problems with a clinical site or with an individual student and provide early intervention should it be necessary

STUDENT EVALUATION OF PROGRAM CLERKSHIPS Students are required to complete an evaluation of the experience at the site at the end of each clerkship. A copy of this instrument can be found at the end of this handbook. Data collected from these forms are compiled and analyzed at the end of each year. These results are forwarded to the preceptor either during an on-site evaluation or via email/regular mail annually. This data is used to initiate a dialog with the preceptor concerning issues regarding clerkship objectives or student experiences.

ASSESSMENT OF CLINICAL SITES Upon acquisition of a clerkship site one of the clinical coordinators will do an initial assessment of clinical site to confirm that the site will satisfy program and accreditation standards. Every two years one of the clinical coordinators will visit the site to conduct a continuous assessment of clinical site. This meeting will involve both preceptors and/or site facility administrators. All parties will be contacted by one of the clinical coordinators to decide on a mutually convenient time to meet. This meeting will review the sites ability to meet the students learning objectives and program expectations. Suggestions and comments by the site are highly encouraged.

Clinical Year Syllabi

PHA 250 FAMILY MEDICINE CLERKSHIP

4 s.h. 33

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION: This is a six-week out-patient clinical experience where students work with family medicine preceptors to evaluate patients with a wide variety of illness in an office setting. Emphasis is placed on evaluation, management, health promotion, and preventive medicine. COURSE GOAL: The goal is to have students develop an approach to the evaluation and management of frequently occurring, complex, comorbid or ill-defined problems with a wide variety of acute and chronic presentations across the life span. INSTRUCTIONAL OBJECTIVES AND LEARNING OUTCOMES:

Instructional Objectives Assessment Tools Utilized By the conclusion of the family medicine clerkship, students will be competent in the following:

Evaluation of the acute, chronic and well patient by obtaining an accurate history, performing a physical exam, obtaining and interpreting appropriate laboratory and diagnostic studies and developing a differential diagnosis and/or management plan Determine the initial assessment in acute and chronic patients commonly seen in the office setting

Management of acute and chronic illnesses that are commonly seen in the office setting

Competency for each instructional objective is measured by successful completion of assessment tools listed below: • Preceptor evaluation • Preceptor assessment and sign-off of competency on patient and procedure logs • PAEA end-ofrotation (EOR) examination • Preceptor evaluation • Submission of clinical documentation • EOR examinations • Med-U virtual patient case assignment • Preceptor evaluation • Submission of clinical documentation • EOR examinations • Med-U virtual patient case assignment 34

• •

•

Use effective interviewing skills to elicit a detailed history Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data

Select and interpret appropriate diagnostic tests or lab studies Synthesize and analyze clinical data correctly

Utilize critical thinking and problem solving skills to identify and manage a wide variety of acute and chronic conditions

Accurately document the medical care rendered for patients in primary care

• •

Develop evidence-based recommendations regarding health promotion and disease prevention for the well-patient, and patient centered best practices plans for a wide variety of acute and chronic conditions

• • •

Completing technical skills competently

• •

Presenting patients to the family medicine preceptor in a concise and organized way Understand the value and role of multiple members of the clinical care team (e.g. pharmacy, specialists, physical therapy, radiology, and allied health) when providing care to primary care patients

•

Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Med-U Cases virtual patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Effectively complete oral presentations

•

Preceptor evaluation

•

• •

• • • •

Application of clinical reasoning and problem-solving to solve a virtual patient case

•

Med-U Cases virtual patient case assignment

• •

Adequately document medical information in history & physical notes and progress notes Use effective basic counseling and patient education skills Locate, appraise, and apply evidence from scientific studies

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

Describe the indications, contraindications, mechanism of action, adverse effects and drug interactions of medications commonly used in primary care

•

Drug Cards

•

Utilize the PAEA Core Tasks and Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the conditions outlined at http://www.endofrotation.org/wpcontent/uploads/2017/07/FamilyMedicine-Topic-List-2017.pdf

•

EOR examination

• • •

Identify pharmacologic agents and other relevant treatment modalities as the relate to various medical conditions to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for various medical conditions Identify signs and symptoms of various medical conditions Utilize critical thinking and problem solving skills to identify and manage various medical conditions

ASSESSMENT/EVALUATION CRITERIA The grade for the family medicine clerkship is based on the following components: Health Promotion Project 25% MED-U CASE P/F One complete H&P in Practice Fusion 15% Three Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% Developmental Disabilities Requirements- if P/F applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook

HEALTH PROMOTION PROJECT An important element of family medicine clerkship is to provide patient centered care by promoting healthy lifestyles, identifying risky behavior and preventing complications from chronic illness. Therefore, during the family medicine rotation, students will be assigned a health promotion project. The objective of this project is to explore ways to enable patients to increase control over risk factors, thereby improving health outcomes. This project provides a vehicle for students to counsel, teach and support patients about preventive measures for their disease states and to evaluate the effectiveness of their efforts. 36

The student will choose a patient with chronic illness or lifestyle risk factors and provide counseling. Afterward, the student completes the questionnaire found in the appendix. Question number 4 requires that the student follow-up with the patient. This can be accomplished via a follow-up visit or by telephone conversation. Should a telephone conversation be chosen, permission must be obtained from the patient, and the site preceptor. Question 5 requires that the student read and submit an academic article, no more than five years old that discusses the health promotion issues related to the patient. A one-paged, typed, double-spaced paper summarizing the article and discussing how to implement the recommendations is submitted and/or presented during the site visit or on call back day should a site visit not occur. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. MED-U SIMULATIONS FOR EDUCATING STUDENTS) MED-U is an internet-based virtual patient program addressing the core clerkship learning objectives. Each student will be assigned TWO (2) cases within the first two weeks of the clerkship. Both cases need to be completed by the designated due date. Failure to complete the Med-U cases will result in an incomplete grade for this clerkship. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one history and physical note while on their family medicine clerkship using Practice Fusion. The note should be written legibly, accurately and adequately. Please note: • H&P notes are to be a maximum of five (5) pages in length. • H&P notes are not acceptable on hospital forms. • H&P notes cannot duplicate the interesting case patient. • No identifying information may appear on any notes, as this is violates HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that particular note. All notes must be submitted to the clinical coordinator on call back day (see submitting call back day materials). A five (5)-point deduction from the note grade will result for each day it is tardy. If a passing grade is not achieved, the clinical coordinator will either ask the student to fax a clinical note to the PA program office every day of the following clerkship, or the student will be asked for additional notes to be submitted on the succeeding call back day. DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their family medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects and cost of medication. The student is required to present these cards on the day of a site visit, and be prepared to answer questions regarding the drugs selected. Students who do not have a site visit should bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day will receive a grade of zero for this portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of their general medical background, knowledge and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, propose a management plan, present cases, and demonstrate the ability to collaboratively work in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and 37

is posted on blackboard. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” The program fax number is 516-463-5177. In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. A failing preceptor evaluation at any point during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies. CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Clerkship logs are designed to help the Program track student clinical experiences and is completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum family medicine requirements for the clinical year are presented in the table below. Please do not stop logging once the minimum requirement is completed, as clinical encounters will increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their family medicine clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Family Medicine

15 per week/90 per clerkship

CLINICAL YEAR PATEINT ENCOUNTER REQUIREMENTS Although students must log specific family medicine encounters during the family medicine clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the family medicine clerkship. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation.

Preventative Acute Chronic Emergent Developmental Disabilities Preventative Acute

Types of Clinical Encounters 20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during clinical year 20 during clinical year 20 during clinical year

Medical Care Across the Life Span Encounters 38

Infants- less than 1 years of age Children- 1 y/o – 11 y/o Adolescents- 12 y/o – 17 y/o Adults- 18 y/o – 64 y/o Geriatrics- greater than 65 y/o

15 during the clinical year 30 during the clinical year 30 during the clinical year 100 during the clinical year 100 during the clinical year

PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. During your family medicine clerkship, it is recommended that you focus on procedures such as IM/SC/ID injections, wound care/debridement and breast examinations. It is the student’s responsibility to find opportunities to meet the procedure requirements, however, not all the requirements listed below need to be completed during the student’s family medicine clerkship. Difficulty in meeting these requirements should be brought to the attention of the clinical coordinator and a plan for meeting competencies will be formulated. The clinical coordinator reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

Required Number 4 2 2 1-assisted is acceptable or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the family medicine discipline, a 120-question multiple-choice examination is given at the end of the clerkship. This end of rotation examination is offered by the Physician Assistant Education Association (PAEA) and is developed by PA educators for use during the 39

clinical year. It is a peer-reviewed exam that incorporates current, relevant test items that follow the NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following Core Tasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to the following topic list of conditions http://www.endofrotation.org/wp-content/uploads/2017/07/Family-Medicine-TopicList-2017.pdf Student should also review the breakdown of the exam, which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2017/07/Family-MedicineBlueprint.pdf These end-of- examinations have the same format as the PANCE exam, and are good preparation for successfully passing the Physician Assistant National Certifying Examination (PANCE). In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she will be given the opportunity to take a make-up exam in exam master. A grade of 65 % or better must be achieved on the make-up exam in order to pass the clerkship. A grade of 65 % will be entered for this portion of the final grade, regardless of the passing grade earned for the make-up exam. Only one make up examination will be offered in any clerkship. A failure of the make-up examination will result in failure of the clerkship. DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, reflect on your experiences and write them in a journal. Entries should focus on self-critique of the interaction, communication with individuals and their families and personal reactions to situations. Commenting on internal struggles or feelings, comfort-ability with providing care to individuals with developmental disabilities and their families/caregivers and ways of improving care are also encouraged. Please journal on an electronic device. Title each journal entry adhering to the following format: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box on call back day 40

at the end of the 3rd clerkship, 6th clerkship and then finally, the 8th clerkship. To encourage deep-rooted, self-analysis, journal entries will only be reviewed to assure assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. Please be sure you click on the “developmental disability” box to capture your patients in the system. In addition, you must write about each clinical encounter in your reflective journal. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) on the last day of their clerkship for a day of activities. Call back day activities can include lectures, case presentations, clinical skills workshops and simulated patient encounters. All callback day activities are mandatory. Activities will vary throughout the year, however every student, except those on their elective rotations will take a Physician Assistant Education Association (PAEA) end of rotation exam. Should an absence be unavoidable, the clinical coordinator must be contacted PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a 5-point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a 10-point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully. Call back days at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. All patients are professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience. After each encounter, students will complete a SOAP note documenting the encounter on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she will receive two (2) points off their final rotation grade for each assignment not completed. Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three-point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not set textbook or resource that will address the specific needs of the learner or the clerkship experience. Course textbooks and resources should be tailored to student needs. Didactic textbooks can be utilized for the clinical year, however, faculty encourage students to utilize more advanced resources during their clinical year such as those found 41

through your access medicine and Up-to-Date accounts. DISABILITY POLICY If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University. Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate. Please note that accommodations may require early planning and are not retroactive; please contact SAS as soon as possible. All students are responsible for providing accommodation letters to each instructor and for discussing with him or her the specific accommodations needed and how they can be best implemented in each course. For more information on services provided by the university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075

PHA 255 INTERNAL MEDICINE CLERKSHIP

4 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This is a six-week clerkship experience that provides students with a clinical experience in the in-patient setting where students will work with preceptors to evaluate and formulate treatment plans for patients with a wide variety of illnesses. This rotation allows the student to become familiar with the “in-house” continuity of care of acute and chronic patients. COURSE GOAL The goal is to provide students with a working knowledge of the principles of internal medicine and to provide students with the opportunity to participate in the care of patients with multiple medical complaints. INSTRUCTIONAL OBJECTIVES AND LEARNING OUTCOMES

Instructional Objectives Assessment Tools Utilized By the conclusion of the internal medicine clerkship, students will be competent in the following:

Evaluation of the patient by obtaining an accurate history, performing a focused physical exam, obtaining and interpreting appropriate laboratory and diagnostic studies and developing a differential diagnosis and management plan Formulation of assessment plans for patients on the internal medicine service inclusive of geriatric patients

•

Use effective interviewing skills to elicit a detailed history Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data

Select and interpret appropriate diagnostic tests or lab studies

• • •

Development of management plans for patients on the internal medicine service inclusive of geriatric patients

• • • •

Accurately document the medical care rendered for patients on the internal medicine service

• •

Providing patient education and counseling for a wide variety of acute and chronic illnesses on the internal medicine service inclusive of geriatric patients

• • • •

Completing technical skills competently

• •

Presenting patients to the preceptor • or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patients on service Identify the members of the • interprofessional team and the roles that they play in the delivery of healthcare.

Submission of clinical documentation EOR examinations Med-U virtual patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations Med-U virtual patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Med-U virtual patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Synthesize and analyze clinical data correctly

•

Utilize critical thinking and problem solving skills to identify and manage a wide variety of acute and chronic conditions

•

Adequately document medical information in history & physical notes and progress notes Use effective basic counseling and patient education skills

•

Effectively complete oral presentations

Preceptor evaluation

•

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability

•

• •

• 44

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

• • •

Application of clinical reasoning and problem-solving to solve a virtual patient case

•

Med-U virtual patient case assignment

•

Describe the indications, contraindications, mechanism of action, adverse effects and drug interactions of medications commonly used in internal medicine patients inclusive of geriatric patients

•

Drug Cards

•

Utilize the PAEA Core Tasks and Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of conditions outlined at http://www.endofrotation.org/wpcontent/uploads/2017/07/InternalMedicine-Topic-List-2017.pdf

•

EOR examination

•

• •

Exhibit and understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning Synthesize and analyze clinical data correctly Identify pharmacologic agents and other relevant treatment modalities as the relate to various medical conditions to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for various medical conditions Identify signs and symptoms of various medical conditions Utilize critical thinking and problem solving skills to identify and manage various medical conditions

ASSESSMENT/EVALUATION CRITERIA The grade for the internal medicine clerkship is based on the following components: Interesting Case Assignment 25% Med-U Cases P/F One Internal Medicine History & Physical 15% Note Three Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% Developmental Disabilities Curriculum P/F Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook 45

INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the internal medicine clerkship. The interesting case will either be presented on a site visit or handed in on call back day. All interesting patient case assignments should include a focused H&P, a written summary of the pathophysiology of the disease state as well as one related journal article review utilizing the “Evaluating a Peer Reviewed Scientific Article” form. Journal article should be related to the chosen interesting case, current, less than 5 years old, and come from an academic, peer-reviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. MED-U CASES MED-U is an internet-based virtual patient program addressing the core clerkship learning objectives. Each student will be assigned TWO (2) internal medicine cases within the first two weeks of the clerkship. Both cases need to be completed by the designated due date. Failure to complete Med-U cases by the designated due date will result in an incomplete grade for this clerkship. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one history and physical note while on their internal medicine clerkship. The note should be written legibly, accurately and adequately. Please note: • H&P notes are to be a maximum of five (5) pages in length. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • H&P notes are not acceptable on hospital forms. • H&P notes cannot duplicate the interesting case patient. • No identifying information may appear on any notes, as this is violates HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that particular note. All notes must be submitted to the clinical coordinator on call back day (see submitting call back day materials). A five (5)-point deduction from the note grade will result for each day it is tardy. If a passing grade is not achieved, the clinical coordinator will either ask the student to fax a clinical note to the PA program office every day of the following clerkship, or the student will be asked for additional notes to be submitted on the succeeding call back day. DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their internal medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects and cost of medication. The student is required to present these cards on the day of a site visit, and be prepared to answer questions regarding the drugs selected. Students who do not have a site visit should bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day will receive a grade of zero for this portion of 46

the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of their general medical background, knowledge and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, propose a management plan, present cases, and demonstrate the ability to collaboratively work in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and is posted on blackboard. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” The program fax number is 516-463-5177. In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. A failing preceptor evaluation at any point during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies. CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Clerkship logs are designed to help the Program track student clinical experiences and is completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum internal medicine requirements for the clinical year are presented in the table below. Please do not stop logging once the minimum requirement is completed, as clinical encounters will increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their internal medicine clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Internal Medicine

10 per week/60 per clerkship

CLINICAL YEAR PATEINT ENCOUNTER REQUIREMENTS Although students must log specific internal medicine encounters during the internal medicine clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the internal medicine clerkship. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation.

Types of Clinical Encounters 47

Preventative Acute Chronic Emergent Developmental Disabilities Preventative Acute

20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during clinical year 20 during clinical year 20 during clinical year

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 during the clinical year Children- 1 y/o – 11 y/o 30 during the clinical year Adolescents- 12 y/o – 17 y/o 30 during the clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year Geriatrics- greater than 65 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. During your internal medicine clerkship, it is recommended that you focus on procedures such as ABG’s, I&D’s, Foley catheter placement, NG tube placement, blood cultures, rectal examinations and wound care/debridement. It is the student’s responsibility to find opportunities to meet the procedure requirements, however, not all the requirements listed below need to be completed during the student’s internal medicine clerkship. Difficulty in meeting these requirements should be brought to the attention of the clinical coordinator and a plan for meeting competencies will be formulated. The clinical coordinator reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 48

Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

5 5 5 5

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the internal medicine discipline, a 120-question multiple-choice examination is given at the end of the clerkship. This end of rotation examination is offered by the Physician Assistant Education Association (PAEA) and is developed by PA educators for use during the clinical year. It is a peer-reviewed exam that incorporates current, relevant test items that follow the NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following Core Tasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to the following topic list of conditions http://www.endofrotation.org/wp-content/uploads/2017/07/Internal-Medicine-TopicList-2017.pdf Student should also review the breakdown of the exam, which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2017/07/Internal-MedicineBlueprint.pdf These end-of- examinations have the same format as the PANCE exam, and are good preparation for successfully passing the Physician Assistant National Certifying Examination (PANCE). In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she will be given the opportunity to take a make-up exam in exam master. A grade of 65 % or better must be achieved on the make-up exam in order to pass the clerkship. A grade of 65 % will be entered for this portion of the final grade, regardless of the passing grade earned for the make-up exam. Only one make up examination will be offered in any clerkship. A failure of the make-up examination will result in failure of the clerkship DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this 49

assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, reflect on your experiences and write them in a journal. Entries should focus on self-critique of the interaction, communication with individuals and their families and personal reactions to situations. Commenting on internal struggles or feelings, comfort-ability with providing care to individuals with developmental disabilities and their families/caregivers and ways of improving care are also encouraged. Please journal on an electronic device. Title each journal entry adhering to the following format: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box on call back day at the end of the 3rd clerkship, 6th clerkship and then finally, the 8th clerkship. To encourage deep-rooted, self-analysis, journal entries will only be reviewed to assure assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. Please be sure you click on the “developmental disability” box to capture your patients in the system. In addition, you must write about each clinical encounter in your reflective journal. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY: Students return to campus or the Center for Learning and Innovation (CLI) on the last day of their clerkship for a day of activities. Call back day activities can include lectures, case presentations, clinical skills workshops and simulated patient encounters. All callback day activities are mandatory. Activities will vary throughout the year, however every student, except those on their elective rotations will take a Physician Assistant Education Association (PAEA) end of rotation exam. Should an absence be unavoidable, the clinical coordinator must be contacted PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a 5-point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a 10-point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully. Call back days at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. All patients are professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience. After each encounter, students will complete a SOAP note documenting the encounter on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or 50

she will receive two (2) points off their final rotation grade for each assignment not completed.

Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not set textbook or resource that will address the specific needs of the learner or the clerkship experience. Course textbooks and resources should be tailored to student needs. Didactic textbooks can be utilized for the clinical year, however, faculty encourage students to utilize more advanced resources during their clinical year such as those found through your access medicine and Up-to-Date accounts. DISABILITY POLICY If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University. Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate. Please note that accommodations may require early planning and are not retroactive; please contact SAS as soon as possible. All students are responsible for providing accommodation letters to each instructor and for discussing with him or her the specific accommodations needed and how they can be best implemented in each course. For more information on services provided by the university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075.

PHA 260 OBSTETRICS/GYNECOLOGY CLERKSHIP

3 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 DESCRIPTION This is a six-week clinical experience where students work with obstetric and gynecologic preceptors to evaluate women’s health, throughout the reproductive and post-menopausal years. Participation in common gynecological surgical procedures along with assisting in labor and delivery may be included in this clerkship. This clerkship may take place in a hospital, clinic or private practice setting. COURSE GOAL The goal of this clerkship is to provide students with general knowledge of the principles of obstetric and gynecologic care, and to prepare them to manage the healthcare needs of women, throughout their lifespan. INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

Assessment Tools Utilized

By the conclusion of the obstetrics/gynecology clerkship, students will be competent in the following:

Competency for each instructional objective is measured by successful completion of assessment tools listed below:

Evaluation of the obstetric patient by obtaining an accurate prenatal history, performing an appropriate physical exam, to include a pelvic examination, and obtaining gestation or condition specific laboratory and diagnostic studies Evaluation of the gynecologic patient by obtaining a thorough patient history, performing a physical exam, to include a breast

• •

• • •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation Preceptor assessment and sign-off of

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning and problem solving abilities: • Use effective interviewing skills to elicit a detailed history • Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data as applied to the obstetric and post-partum population • Elicit a detailed medical history, perform physical examination on a gynecologic

examination and a pelvic examination and obtaining appropriate diagnostic and laboratory data Utilizing information obtained from the history, physical and diagnostic data to formulate differential diagnoses for obstetric and gynecologic patients Develop evidence based, best practice, patient-centered management plans for obstetric and gynecologic patients

Accurately document pre-natal, obstetric and gynecologic care in patient H&P and SOAP notes Providing patient education, to include appropriate screening recommendations, disease prevention, family planning, prenatal care, and menopause to obstetric and gynecologic patients and their families Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient Communicating effectively and respectfully with obstetric and gynecologic patients and their families and members of the interprofessional team

• • • • • • • • • • • • • • •

competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Interesting patient case assignment

patient, accurately record all data

• • •

• •

Select and interpret appropriate diagnostic tests, lab studies or screening tools Synthesize and analyze all clinical data correctly to aid in diagnosis Utilize critical thinking and problem solving skills to identify and manage pediatric care Locate, appraise and apply evidence from scientific studies Accurately and adequately document medical information

•

Use effective basic counseling and patient education skills

•

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Effectively complete oral presentations

•

Preceptor evaluation

•

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability

• • •

•

• 53

• • • Search for relevant information, • utilizing appropriate data sources, and critically appraise to make evidence-based decisions in patient care Describe the indications, • contraindications, mechanism of action, adverse effects, drug interactions, and pregnancy risk category of medications commonly used in obstetric and gynecologic

Interesting patient case •

Drug Cards

•

Utilize the PAEA Core Tasks and • Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the pediatric conditions outlined at http://www.endofrotation.org/wp content/uploads/2017/07/Women s-Health-Topic-List-2017.pdf

EOR examination

•

• •

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment One obstetrics/gynecology SOAP Note Three obstetrics/gynecology Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements End of Clerkship Examination Developmental Disabilities Curriculum Requirements- if applicable Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable

25% 15% 25% P/F P/F 35% P/F P/F

Exhibit an understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

Identify pharmacologic agents and other relevant treatment modalities as they relate to pediatric patients to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for obstetric and gynecologic conditions Identify signs and symptoms of common obstetric and gynecologic conditions Utilize critical thinking and problem solving skills to manage obstetric and gynecologic patients

*All assessment and evaluation tools are located in the back of the handbook INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the obstetrics and gynecology clerkship. The interesting case will either be presented on a site visit or handed in on call back day. All interesting patient case assignments should include a focused H&P, a written summary of the pathophysiology of the disease state as well as one related journal article review utilizing the “Evaluating a Peer Reviewed Scientific Article” form. Journal article should be related to the chosen interesting case, current, less than 5 years old, and come from an academic, peer-reviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one SOAP note, using while on their obstetrics/gynecology clerkship. The note should be written legibly, accurately and adequately. Please note: • SOAP notes are not the same as progress notes. Progress notes will not meet this requirement. • SOAP notes are to be a maximum of one (1) page in length. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • SOAP notes are not acceptable on hospital forms. • No identifying information may appear on any notes, as this is violates HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that particular note. All notes must be submitted to the clinical coordinator on call back day (see submitting call back day materials). A five (5) point deduction from the note grade will result for each day it is tardy. If a passing grade is not achieved, the clinical coordinator will either ask the student to fax a clinical note to the PA program office every day of the following clerkship, or the student will be asked for additional notes to be submitted on the succeeding call back day. DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their obstetrics/gynecology clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects and cost of medication. The student is required to present these cards on the day of a site visit, and be prepared to answer questions regarding the drugs selected. Students who do not have a site visit should bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day, they will receive a grade of zero for this portion of the clerkship grade.

PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of their general medical background, knowledge and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, propose a management plan, present cases, and demonstrate the ability to collaboratively work in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and is posted on blackboard. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” The program fax number is 516-463-5177. In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. A failing preceptor evaluation at any point during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies. CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Clerkship logs are designed to help the Program track student clinical experiences and are completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum obstetrics/gynecology requirements for the clinical year are presented in the table below. Please do not stop logging once the minimum requirement is completed, as clinical encounters should increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their pediatric clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Ob/GYN Prenatal Care Gynecologic Care

10 per week/60 per clerkship 15 per clerkship 15 per clerkship

CLINICAL YEAR PATEINT ENCOUNTER REQUIREMENTS Although students must log specific pediatric encounters during the pediatric clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the obstetrics/gynecology clerkship. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation.

Preventative Acute Chronic Emergent Developmental Disabilities Preventative Acute

Types of Clinical Encounters 20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during clinical year 20 during clinical year 20 during clinical year

PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. During your obstetrics/gynecology clerkship, it is recommended that you focus on procedures such as IM/SC/ID injections, venipuncture, IV placement, Foley catheter placement, suturing, breast examinations and pelvic examinations. It is the student’s responsibility to find opportunities to meet the procedure requirements, however, not all the requirements listed below need to be completed during the student’s surgical clerkship. Difficulty in meeting these requirements should be brought to the attention of the clinical coordinator and a plan for meeting competencies will be formulated. The clinical coordinator reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 57

Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

10 5 5 5 5 5

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the obstetrics/gynecology discipline, a 120-question multiplechoice examination is given at the end of the clerkship. This end of rotation examination is offered by the Physician Assistant Education Association (PAEA) and is developed by PA educators for use during the clinical year. It is a peer-reviewed exam that incorporates current, relevant test items that follow the NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following Core Tasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to . http://www.endofrotation.org/wp-content/uploads/2017/07/Womens-Health-Topic-List-2017.pdf Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2017/07/Womens-Health-Blueprint.pdf . These endofrotation examinations have the same format as the Physician Assistant National Certifying Examination (PANCE), and are good preparation for successfully passing the PANCE. In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she will be given the opportunity to take a make-up exam in exam master. A grade of 65 % or better must be achieved on the make-up exam in order to pass the clerkship. A grade of 65 % will be entered for this portion of the final grade, regardless of the passing grade earned for the make-up exam. Only one make up examination will be offered in any clerkship. A failure of the make-up examination will result in failure of the clerkship. DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this 58

assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, reflect on your experiences and write them in a journal. Entries should focus on self-critique of the interaction, communication with individuals and their families and personal reactions to situations. Commenting on internal struggles or feelings, comfort-ability with providing care to individuals with developmental disabilities and their families/caregivers and ways of improving care are also encouraged. Please journal on an electronic device. Title each journal entry adhering to the following format: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box on call back day at the end of the 3rd clerkship, 6th clerkship and then finally, the 8th clerkship. To encourage deep-rooted, self-analysis, journal entries will only be reviewed to assure assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. Please be sure you click on the “developmental disability” box to capture your patients in the system. In addition, you must write about each clinical encounter in your reflective journal. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) on the last day of their clerkship for a day of activities. Call back day activities can include lectures, case presentations, clinical skills workshops and simulated patient encounters. All callback day activities are mandatory. Activities will vary throughout the year, however every student, except those on their elective rotations will take a Physician Assistant Education Association (PAEA) end of rotation exam. Should an absence be unavoidable, the clinical coordinator must be contacted PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a five (5) point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a ten (10) point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully. Call back days at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. All patients are professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience. After each encounter, students will complete a SOAP note documenting the encounter on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or 59

she will receive two (2) points off their final rotation grade for each assignment not completed. Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not set textbook or resource that will address the specific needs of the learner or the clerkship experience. Course textbooks and resources should be tailored to student needs. Didactic textbooks can be utilized for the clinical year, however, faculty encourage students to utilize more advanced resources during their clinical year such as those found through your access medicine and Up-to-Date accounts. DISABILITY POLICY If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University. Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate. Please note that accommodations may require early planning and are not retroactive; please contact SAS as soon as possible. All students are responsible for providing accommodation letters to each instructor and for discussing with him or her the specific accommodations needed and how they can be best implemented in each course. For more information on services provided by the university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075.

PHA 265 SURGERY CLERKSHIP

3 s.h.

COURSE COORDINATORS Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This course is a six-week clinical experience where students work with their surgical preceptor to gain proficiency in treating surgical patients. The student will participate in the evaluation and monitoring of patients, perform diagnostic procedures and assist with surgical management. The students will work as a member of the surgical team and be involved in all aspects of surgical care, to include pre- and postop care as well as hands-on experience in the operating room setting. COURSE GOAL The goal is to provide students with a working knowledge of the principles of surgery and to provide students with the opportunity to participate in the care of patients with surgical complaints. INSTRUCTIONAL OBJECTIVES AND LEARNING OUTCOMES

Instructional Objectives

Assessment Tools Utilized

By the conclusion of the surgery clerkship, students will be competent in the following:

Competency for each instructional objective is measured by successful completion of assessment tools listed below:

Evaluation of the potential surgical patient by obtaining an accurate history, performing a focused physical exam, obtaining and interpreting appropriate laboratory and diagnostic studies and developing a differential diagnosis and management plan Assessment of the pre-surgical and post-surgical patient.

• •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation

Elicit a detailed medical history, perform appropriate

•

• • Provide intraoperative care of surgical patient.

• •

Formulate assessment plans for surgical patients

• • •

Develop management plans for surgical patients

• • •

Accurately documenting surgical care in patient SOAP notes and progress notes. Providing patient education and counseling for surgical patients

Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patients on service

• • • • • • • •

•

Preceptor assessment and sign-off of competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs EOR examinations Preceptor evaluation Submission of clinical documentation EOR examinations Preceptor evaluation Submission of clinical documentation EOR examinations Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

• •

• • •

•

physical examination and accurately record all data Identify and formulate an appropriate assessment and management plan

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures Select and interpret appropriate diagnostic tests or lab studies Synthesize and analyze clinical data correctly Utilize critical thinking and problem solving skills to identify and manage surgical conditions Accurately and adequately document medical information

•

Use effective basic counseling and patient education skills

•

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

Communicating effectively and respectfully with members of the interprofessional team, patients, and their families

•

Preceptor evaluation

• • • • •

Participate in a form of continuing medical education Describe the indications, contraindications, mechanism of action, adverse effects and drug interactions of medications commonly used in surgical patients

•

CME Project

•

Drug Cards

•

EOR examination

•

Utilize the PAEA Core Tasks and • Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of surgical conditions outlined at http://www.endofrotation.org/wp content/uploads/2017/07/General -Surgery-Topic-List-2017.pdf

• •

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Continuing Medical Education Project One surgical SOAP Note Three surgical Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements End of Clerkship Examination Developmental Disabilities Curriculum Requirements- if applicable Call Back Day Longitudinal Patient Participation, Reflective Journal Entry &

25% 15% 25% P/F P/F 35% P/F P/F 63

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability Exhibit and understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning Identify pharmacologic agents and other relevant treatment modalities as the relate to general surgical conditions to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for surgical conditions Identify signs and symptoms of surgical conditions Utilize critical thinking and problem solving skills to identify and manage surgical conditions

Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook CONTINUTING MEDICAL EDUCATION PROJECT During the surgery rotation, students will be assigned a CME project focusing on a surgically related topic. The purpose of the project is for students to emphasize the need for life-long learning and introduce students to an item necessary to maintain certification. This project may be either web-based or found in a peer-reviewed journal article. Students must submit proof of completion of the CME project either during a site visit or on call back day if a visit has not occurred. A 100% will be awarded to students who complete the project and display a good understanding of the CME topic. If the student has a site visit, he/she should be prepared to present the CME project on the day of a site visit, and answer questions regarding the project. Students who do not have a site visit should bring the CME certification at call back day. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one SOAP note while on their surgery clerkship. The note should be written legibly, accurately and adequately. Please note: • SOAP notes are not the same as progress notes. Progress notes will not meet this requirement. • SOAP notes are to be a maximum of one (1) page in length. • SOAP notes must contain pertinent patient history, physical examination findings, assessment and management plan. They should also include health care maintenance and patient education. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • SOAP notes are not acceptable on hospital forms. • No identifying information may appear on any notes, as this is violates HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that particular note. All notes must be submitted to the clinical coordinator on call back day (see submitting call back day materials). A five (5) point deduction from the note grade will result for each day it is tardy. If a passing grade is not achieved, the clinical coordinator will either ask the student to fax a clinical note to the PA program office every day of the following clerkship, or the student will be asked for additional notes to be submitted on the succeeding call back day. DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their surgery clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects and cost of medication. The student is required to present these cards on the day of a site visit, and be prepared to answer questions regarding the drugs selected. Students who do not have a site visit should bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day will receive a grade of zero for this portion of the clerkship grade.

PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of their general medical background, knowledge and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, propose a management plan, present cases, and demonstrate the ability to collaboratively work in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and is posted on blackboard. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” The program fax number is 516-463-5177. In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. A failing preceptor evaluation at any point during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies. CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Clerkship logs are designed to help the Program track student clinical experiences and is completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum surgical requirements for the clinical year are presented in the table below. Please do not stop logging once the minimum requirement is completed, as clinical encounters will increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their surgical rotation, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Surgery Pre-op Intra-op Post-op

10 per week/60 per surgical rotation 10 per surgical rotation 10 per surgical rotation 10 per surgical rotation

CLINICAL YEAR PATEINT ENCOUNTER REQUIREMENTS Although students must log specific surgical encounters during the surgical clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the surgical clerkships. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation.

Preventative Acute Chronic

Types of Clinical Encounters 20 during clinical year 20 during clinical year 20 during clinical year 65

Emergent Developmental Disabilities Preventative Acute

20 during clinical year 15 during clinical year 20 during clinical year 20 during clinical year

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 during the clinical year Children- 1 y/o – 11 y/o 30 during the clinical year Adolescents- 12 y/o – 17 y/o 30 during the clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year Geriatrics- greater than 65 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. During your surgical clerkship, it is recommended that you focus on procedures such as ABG’s, I&D’s, Foley catheter placement, NG tube placement, suturing, operating room assist, rectal examinations and wound care/debridement. It is the student’s responsibility to find opportunities to meet the procedure requirements, however, not all the requirements listed below need to be completed during the student’s surgical clerkship. Difficulty in meeting these requirements should be brought to the attention of the clinical coordinator and a plan for meeting competencies will be formulated. The clinical coordinator reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 5 5 5 66

Rectal Examinations

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the surgical discipline, a 120-question multiple-choice examination is given at the end of the clerkship. This end of rotation examination is offered by the Physician Assistant Education Association (PAEA) and is developed by PA educators for use during the clinical year. It is a peer-reviewed exam that incorporates current, relevant test items that follow the NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following Core tasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to the following topic list of conditions. http://www.endofrotation.org/wp-content/uploads/2017/07/General-Surgery-TopicList-2017.pdf Student should also review the breakdown of the exam which can be found through the following link http://www.endofrotation.org/wp-content/uploads/2017/07/General-SurgeryBlueprint.pdf These end-of- examinations have the same format as the PANCE exam, and are good preparation for successfully passing the Physician Assistant National Certifying Examination (PANCE). In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she will be given the opportunity to take a make-up exam in exam master. A grade of 65 % or better must be achieved on the make-up exam in order to pass the clerkship. A grade of 65 % will be entered for this portion of the final grade, regardless of the passing grade earned for the make-up exam. Only one make up examination will be offered in any clerkship. A failure of the make-up examination will result in failure of the clerkship DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, reflect on your experiences and write them in a journal. Entries should focus on self-critique of the interaction, communication with individuals 67

and their families and personal reactions to situations. Commenting on internal struggles or feelings, comfort-ability with providing care to individuals with developmental disabilities and their families/caregivers and ways of improving care are also encouraged. Please journal on an electronic device. Title each journal entry adhering to the following format: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box on call back day at the end of the 3rd clerkship, 6th clerkship and then finally, the 8th clerkship. To encourage deep-rooted, self-analysis, journal entries will only be reviewed to assure assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. Please be sure you click on the “developmental disability” box to capture your patients in the system. In addition, you must write about each clinical encounter in your reflective journal. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) on the last day of their clerkship for a day of activities. Call back day activities can include lectures, case presentations, clinical skills workshops and simulated patient encounters. All callback day activities are mandatory. Activities will vary throughout the year, however every student, except those on their elective rotations will take a Physician Assistant Education Association (PAEA) end of rotation exam. Should an absence be unavoidable, the clinical coordinator must be contacted PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a five (5) point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a ten (10) point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully. Call back days at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. All patients are professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience. After each encounter, students will complete a SOAP note documenting the encounter on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she will receive two (2) points off their final rotation grade for each assignment not completed. Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. 68

CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not set textbook or resource that will address the specific needs of the learner or the clerkship experience. Course textbooks and resources should be tailored to student needs. Didactic textbooks can be utilized for the clinical year, however, faculty encourage students to utilize more advanced resources during their clinical year such as those found through your access medicine and Up-to-Date accounts. DISABILITY POLICY If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University. Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate. Please note that accommodations may require early planning and are not retroactive; please contact SAS as soon as possible. All students are responsible for providing accommodation letters to each instructor and for discussing with him or her the specific accommodations needed and how they can be best implemented in each course. For more information on services provided by the university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075.

PHA 270 EMERGENCY MEDICINE CLERKSHIP

4 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This is a six-week clerkship that will provide the student with opportunities to see a variety of patients with urgent or emergent conditions under the supervision of the site preceptor. Students will learn how to establish priorities while diagnosing and treating critically ill patients. COURSE GOAL The goal of this clerkship is to teach the student how to quickly recognize and manage life threatening conditions. Students will learn to manage multiple patients in a busy emergency room. In addition, this clerkship will provide the opportunity for the student to increase and refine their procedural skills. INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

Assessment Tools Utilized

By the conclusion of the emergency medicine clerkship, students will be competent in the following:

Competency for each instructional objective is measured by successful completion of assessment tools listed below:

Timely evaluation of the patient in the emergency room by obtaining a problem-focused history, and performing an appropriate physical examination

• •

• Applicable, cost-effective use of laboratory tests and other diagnostic data to aid in the diagnosis of patients in the emergency room

• •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation EOR examination

•

Select and interpret appropriate diagnostic tests, lab studies or screening tools

Recognize patients who require emergency medical intervention (including but not limited to trauma, chest pain, sepsis, CVA, shock, respiratory failure, surgical abdomen),

Utilize information obtained from the H&P, laboratory and diagnostic studies to determine differential diagnoses and prioritize most likely diagnosis for patients who present with acute problems Develop evidence based, best practice management plans for patient’s seen in the emergency department

Comprehensive and thorough documentation of H&P’s and progress notes in the emergency department Providing patient education, to include follow-up care, to patients in the emergency department and their families

• •

• • • • • • • • • • • • • • • •

Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient

• •

•

Preceptor evaluation • Preceptor assessment and sign-off of competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation • Submission of clinical documentation EOR examinations Interesting patient case assignment

Synthesize and analyze all clinical data correctly to aid in prompt diagnosis

Preceptor evaluation • Submission of clinical documentation EOR examinations Interesting patient case • assignment Preceptor evaluation • Submission of clinical documentation

Utilize critical thinking and problem solving skills to manage care of psychiatric patients Locate, appraise and apply evidence from scientific studies Accurately and adequately document medical information

Preceptor evaluation EOR examinations Submission of medical documentation Interesting patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

Elicit a detailed medical history, perform patient appropriate physical examination, utilize appropriate diagnostic tests and accurately record all data

•

Use effective basic counseling and patient education skills

•

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

Maintain respectful and • appropriate communications with patients, families and members of the interprofessional team in a potentially complex and stressful environment, such as the emergency department

Preceptor evaluation

• • • • •

Search for relevant information, • utilizing appropriate data sources, and critically appraise to make evidence-based decisions in patient care Describe the indications, • contraindications, mechanism of • action, adverse effects and drug interactions of medications commonly used in the emergency department

Interesting patient case •

Utilize the PAEA Core Tasks and • Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the psychiatric conditions outlined at http://www.endofrotation.org/wp content/uploads/2017/07/Emerge ncy-Medicine-Topic-List2017.pdf

EOR examination

Drug Cards • Interesting patient case

• • •

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment One Emergency Medicine SOAP Note Three Emergency Medicine Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements Computer Operated Adult/Child Simulators

25% 15% 25% P/F P/F P/F 72

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability Exhibit an understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

Identify pharmacologic agents and other relevant treatment modalities as they relate to patients with mental illnesses to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for acute and emergent conditions Identify signs and symptoms of acute and emergent conditions Utilize critical thinking and problem solving skills to manage patients with acute conditions

End of Clerkship Examination 35% Developmental Disabilities Curriculum P/F Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the emergency medicine clerkship. The interesting case will either be presented on a site visit or handed in on call back day. All interesting patient case assignments should include a focused H&P, a written summary of the pathophysiology of the disease state as well as one related journal article review utilizing the “Evaluating a Peer Reviewed Scientific Article” form. Journal article should be related to the chosen interesting case, current, less than 5 years old, and come from an academic, peer-reviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one SOAP note while on his or her emergency medicine clerkship. Please note: • SOAP notes are not the same as progress notes. Progress notes will not meet this requirement. • SOAP notes are to be a maximum of one (1) page in length. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • SOAP notes are not acceptable on hospital forms. • No identifying information may appear on any notes, as this is violates HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that particular note. All notes must be submitted to the clinical coordinator on call back day (see submitting call back day materials). A five (5) point deduction from the note grade will result for each day it is tardy. If a passing grade is not achieved, the clinical coordinator will either ask the student to fax a clinical note to the PA program office every day of the following clerkship, or the student will be asked for additional notes to be submitted on the succeeding call back day. DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their emergency medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects and cost of medication. The student is required to present these cards on the day of a site visit, and be prepared to answer questions regarding the drugs selected. Students who do not have a site visit should bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day, they will receive a grade of zero for this 73

portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of their general medical background, knowledge and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, propose a management plan, present cases, and demonstrate the ability to collaboratively work in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and is posted on blackboard. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” The program fax number is 516-463-5177. In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. A failing preceptor evaluation at any point during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies. CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Clerkship logs are designed to help the Program track student clinical experiences and are completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum emergency medicine requirements for the clinical year are presented in the table below. Please do not stop logging once the minimum requirement is completed, as clinical encounters should increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their psychiatry clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Emergency Medicine

15 per week/90 per clerkship

CLINICAL YEAR PATIENT ENCOUNTER REQUIREMENTS Although students must log specific psychiatric encounters during the emergency medicine clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the emergency medicine clerkship. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation.

Preventative Acute Chronic Emergent Developmental Disabilities Preventative Acute

Types of Clinical Encounters 20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during clinical year 20 during clinical year 20 during clinical year

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 during the clinical year Children- 1 y/o – 11 y/o 30 during the clinical year Adolescents- 12 y/o – 17 y/o 30 during the clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year Geriatrics- greater than 65 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS: Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. During your emergency medicine clerkship, it is recommended that you focus on procedures such as ABG’s, I&D’s, CPR, blood cultures, IV placement, splinting and NG tube placements. It is the student’s responsibility to find opportunities to meet the procedure requirements, however, not all the requirements listed below need to be completed during the student’s emergency medicine clerkship. Difficulty in meeting these requirements should be brought to the attention of the clinical coordinator and a plan for meeting competencies will be formulated. The clinical coordinator reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 75

Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

10 5 5 5 5 5

*Center for Learning and Innovation (CLI) COMPUTER-OPERATED ADULT/CHILD SIMULATORS SimMan are computer-operated adult and child simulators that are used to create a variety of clinical education scenarios based on the core clerkship learning objectives. Students will attend a simulation session at the Center for Learning and Innovation (CLI) while on their emergency medicine clerkship. Failure to attend and participate in the clinical scenarios at the patient safety institute will result in an incomplete grade for this clerkship. END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the discipline of the discipline of emergency medicine, a 120question multiple-choice examination is given at the end of the clerkship. This end of rotation examination is offered by the Physician Assistant Education Association (PAEA) and is developed by PA educators for use during the clinical year. It is a peer-reviewed exam that incorporates current, relevant test items that follow the NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following Core Tasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to http://www.endofrotation.org/wp-content/uploads/2017/07/Emergency-Medicine-Topic-List-2017.pdf Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2017/07/Emergency-Medicine-Blueprint.pdf These end-ofrotation examinations have the same format as the Physician Assistant National Certifying Examination (PANCE), and are good preparation for successfully passing the PANCE. In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she will be given the opportunity to take a make-up exam in exam master. A grade of 65 % or better must be achieved on the make-up exam in order to pass the clerkship. A grade of 65 % will be entered for this portion of the final grade, regardless of the passing grade earned for the make-up exam. Only one make up examination will be offered in any clerkship. A failure of the make-up examination will result in failure of the clerkship. DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a five (5) point deduction from your overall rotation grade. 76

COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, reflect on your experiences and write them in a journal. Entries should focus on self-critique of the interaction, communication with individuals and their families and personal reactions to situations. Commenting on internal struggles or feelings, comfort-ability with providing care to individuals with developmental disabilities and their families/caregivers and ways of improving care are also encouraged. Please journal on an electronic device. Title each journal entry adhering to the following format: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box on call back day at the end of the 3rd clerkship, 6th clerkship and then finally, the 8th clerkship. To encourage deep-rooted, self-analysis, journal entries will only be reviewed to assure assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. Please be sure you click on the “developmental disability” box to capture your patients in the system. In addition, you must write about each clinical encounter in your reflective journal. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) on the last day of their clerkship for a day of activities. Call back day activities can include lectures, case presentations, clinical skills workshops and simulated patient encounters. All callback day activities are mandatory. Activities will vary throughout the year, however every student, except those on their elective rotations will take a Physician Assistant Education Association (PAEA) end of rotation exam. Should an absence be unavoidable, the clinical coordinator must be contacted PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a 5-point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a 10-point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully. 77

Call back days at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. All patients are professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience. After each encounter, students will complete a SOAP note documenting the encounter on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she will receive two (2) points off their final rotation grade for each assignment not completed. Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not set textbook or resource that will address the specific needs of the learner or the clerkship experience. Course textbooks and resources should be tailored to student needs. Didactic textbooks can be utilized for the clinical year, however, faculty encourage students to utilize more advanced resources during their clinical year such as those found through your access medicine and Up-to-Date accounts. DISABILITY POLICY If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University. Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate. Please note that accommodations may require early planning and are not retroactive; please contact SAS as soon as possible. All students are responsible for providing accommodation letters to each instructor and for discussing with him or her the specific accommodations needed and how they can be best implemented in each course. For more information on services provided by the university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075.

PHA 280 PEDIATRIC CLERKSHIP

3 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This course is a six-week clinical experience where students work with pediatric preceptors to gain proficiency in the care of pediatric patients. Students will focus on recognizing and managing common childhood illnesses, well child care, management of chronic conditions, assessment of growth and development, and the practice of preventive health care in this specific population. COURSE GOAL The goal is to provide students with general knowledge of the principles of pediatric medicine and to allow students the opportunity to participate in the care of pediatric patients, from birth through adolescence. INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

Assessment Tools Utilized

By the conclusion of the pediatric clerkship, students will be competent in the following:

Competency for each instructional objective is measured by successful completion of assessment tools listed below:

Evaluation of the pediatric patient by obtaining an accurate patient history, performing an age-appropriate physical exam, obtaining and interpreting laboratory and diagnostic studies while recognizing normal age appropriate variations Recognize normal and abnormal patterns of pediatric growth and development and milestone achievement. Identify patients who require early intervention

• •

• • •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning and problem solving abilities: • Use effective interviewing skills to elicit a detailed history • Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data as applied to the pediatric population • Elicit a detailed medical history, perform ageappropriate physical examination, utilize appropriate

and initiate proper referral

Formulate differential diagnoses for common complaints and presentations in the pediatric population

Develop evidence based, best practice, patient-centered management plans for pediatric patients

Accurately document pediatric care in patient H&P and SOAP notes Providing patient education, to include health promotion and disease and injury prevention (including immunizations) to pediatric patients and their families Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient Communicating effectively and respectfully with pediatric patients and their families and members of the interprofessional team

•

Submission of clinical documentation EOR examination Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Interesting patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Preceptor evaluation

• • • • • • • • • • • • • • • • •

developmental screening tools and accurately record all data • • •

• • • •

• •

Use effective basic counseling and patient education skills

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

•

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability Exhibit an understanding of the physician assistant profession

• •

• • Search for relevant information, • utilizing appropriate data sources, and critically appraise to make evidence-based decisions in patient care Describe the indications, • contraindications, mechanism of action, adverse effects, drug interactions and correct dosing parameters of medications commonly used in pediatric patients

Interesting patient case •

Drug Cards

•

EOR examination

• • •

Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

Identify pharmacologic agents and other relevant treatment modalities as they relate to pediatric patients to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for pediatric conditions Identify signs and symptoms of common pediatric conditions Utilize critical thinking and problem solving skills to manage pediatric patients

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment 25% One Pediatric SOAP Note in Practice Fusion 15% Three Pediatric Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% Developmental Disabilities Curriculum P/F Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook

INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the pediatric clerkship. The interesting case will either be presented on a site visit or handed in on call back day. All interesting patient case assignments should include a focused H&P, a written summary of the pathophysiology of the disease state as well as one related journal article review utilizing the “Evaluating a Peer Reviewed Scientific Article” form. Journal article should be related to the chosen interesting case, current, less than 5 years old, and come from an academic, peer-reviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one SOAP note, using PRACTICE FUSION while on their pediatric clerkship. The note should be written legibly, accurately and adequately. Please note: • SOAP notes are not the same as progress notes. Progress notes will not meet this requirement. • SOAP notes are to be a maximum of one (1) page in length. • SOAP notes must contain pertinent patient history, physical examination findings, assessment and management plan. They should also include health care maintenance and patient education. • No identifying information may appear on any notes, as this is violates HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that particular note. All notes must be submitted to the clinical coordinator on call back day (see submitting call back day materials). A five (5) point deduction from the note grade will result for each day it is tardy.

If a passing grade is not achieved, the clinical coordinator will either ask the student to fax a clinical note to the PA program office every day of the following clerkship, or the student will be asked for additional notes to be submitted on the succeeding call back day. DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their pediatric clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects and cost of medication. The student is required to present these cards on the day of a site visit, and be prepared to answer questions regarding the drugs selected. Students who do not have a site visit should bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day, they will receive a grade of zero for this portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of their general medical background, knowledge and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, 82

propose a management plan, present cases, and demonstrate the ability to collaboratively work in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and is posted on blackboard. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” The program fax number is 516-463-5177. In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. A failing preceptor evaluation at any point during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies. CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Clerkship logs are designed to help the Program track student clinical experiences and are completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum pediatric requirements for the clinical year are presented in the table below. Please do not stop logging once the minimum requirement is completed, as clinical encounters should increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their pediatric clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Pediatrics

15 per week/90 per clerkship

CLINICAL YEAR PATIENT ENCOUNTER REQUIREMENTS Although students must log specific pediatric encounters during the pediatric clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the pediatric clerkship. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation.

Preventative Acute Chronic Emergent Developmental Disabilities Preventative Acute

Types of Clinical Encounters 20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during clinical year 20 during clinical year 20 during clinical year

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 during the clinical year Children- 1 y/o – 11 y/o 30 during the clinical year Adolescents- 12 y/o – 17 y/o 30 during the clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year Geriatrics- greater than 65 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. During your pediatric clerkship, it is recommended that you focus on procedures such as blood cultures, IM/SC/ID injections, and venipuncture. It is the student’s responsibility to find opportunities to meet the procedure requirements, however, not all the requirements listed below need to be completed during the student’s pediatric clerkship. Difficulty in meeting these requirements should be brought to the attention of the clinical coordinator and a plan for meeting competencies will be formulated. The clinical coordinator reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the pediatric discipline, a 120-question multiple-choice 84

examination is given at the end of the clerkship. This end of rotation examination is offered by the Physician Assistant Education Association (PAEA) and is developed by PA educators for use during the clinical year. It is a peer-reviewed exam that incorporates current, relevant test items that follow the NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following Core Tasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to. http://www.endofrotation.org/wp-content/uploads/2017/07/Pediatrics-Topic-List-2017.pdf . Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2017/07/Pediatrics-Blueprint.pdf . These end-ofrotation examinations have the same format as the Physician Assistant National Certifying Examination (PANCE), and are good preparation for successfully passing the PANCE. In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she will be given the opportunity to take a make-up exam in exam master. A grade of 65 % or better must be achieved on the make-up exam in order to pass the clerkship. A grade of 65 % will be entered for this portion of the final grade, regardless of the passing grade earned for the make-up exam. Only one make up examination will be offered in any clerkship. A failure of the make-up examination will result in failure of the clerkship. DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, reflect on your experiences and write them in a journal. Entries should focus on self-critique of the interaction, communication with individuals and their families and personal reactions to situations. Commenting on internal struggles or feelings, comfort-ability with providing care to individuals with developmental disabilities and their families/caregivers and ways of improving care are also encouraged. Please journal on an electronic device. Title each journal entry adhering to the following format: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box on call back day 85

at the end of the 3rd clerkship, 6th clerkship and then finally, the 8th clerkship. To encourage deep-rooted, self-analysis, journal entries will only be reviewed to assure assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. Please be sure you click on the “developmental disability” box to capture your patients in the system. In addition, you must write about each clinical encounter in your reflective journal. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) on the last day of their clerkship for a day of activities. Call back day activities can include lectures, case presentations, clinical skills workshops and simulated patient encounters. All callback day activities are mandatory. Activities will vary throughout the year, however every student, except those on their elective rotations will take a Physician Assistant Education Association (PAEA) end of rotation exam. Should an absence be unavoidable, the clinical coordinator must be contacted PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a 5-point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a 10-point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully. Call back days at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. All patients are professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience. After each encounter, students will complete a SOAP note documenting the encounter on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she will receive two (2) points off their final rotation grade for each assignment not completed. Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade.

tailored to student needs. Didactic textbooks can be utilized for the clinical year, however, faculty encourage students to utilize more advanced resources during their clinical year such as those found through your access medicine and Up-to-Date accounts. DISABILITY POLICY If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University. Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate. Please note that accommodations may require early planning and are not retroactive; please contact SAS as soon as possible. All students are responsible for providing accommodation letters to each instructor and for discussing with him or her the specific accommodations needed and how they can be best implemented in each course. For more information on services provided by the university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075.

PHA 285 PSYCHIATRY CLERKSHIP

3 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This is a six-week clinical clerkship experience where students will work with psychiatrists, psychologists and other members of the interprofessional healthcare team to evaluate and manage patients with behavioral and psychiatric illnesses. COURSE GOAL The goal of this clerkship is to enhance the students’ knowledge of the general principles of psychiatry and to expose them to patients with a variety of mental illnesses. Students will develop proficiency in taking a psychiatric history and performing mental status examinations and learn appropriate use of psychoactive pharmaceuticals. INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

Assessment Tools Utilized

By the conclusion of the psychiatry clerkship, students will be competent in the following:

Competency for each instructional objective is measured by successful completion of assessment tools listed below:

Comprehensive evaluation of the psychiatric patient by obtaining an accurate medical history, family and social history, a thorough psychiatric history and performance of a physical examination to include a full mental status examination. Appropriate use of laboratory tests and other diagnostic data to aid in the diagnosis of patients with mental illnesses

• •

• • •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation EOR examination

•

Select and interpret appropriate diagnostic tests, lab studies or screening tools

Recognize normal and abnormal patterns of behavior. Identify patients who require admission versus those who can be treated as an outpatient and those who require specialty referral.

Utilize information obtained from the H&P, laboratory and diagnostic studies to determine psychiatric differential diagnoses according to DSM-V criteria Develop evidence based, best practice, patient-centered management plans for patients with mental illness

Comprehensive and thorough documentation of psychiatric H&P’s and progress notes Providing patient education, to include disease management skills to patients with mental illness and their families

• •

•

Elicit a detailed medical history, perform patient appropriate physical examination, utilize appropriate screening tools and accurately record all data

•

Synthesize and analyze all clinical data correctly to aid in diagnosis

•

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Interesting patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Effectively complete oral presentations

•

Preceptor evaluation

•

Work collaboratively as a member of an interprofessional healthcare team

• • • • • • • • • • • • • • • •

Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient Communicating appropriately and respectfully with psychiatric patients and their families and

• •

• • •

Use effective basic counseling and patient education skills

•

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

members of the interprofessional team

• • •

Search for relevant information, utilizing appropriate data sources, and critically appraise to make evidence-based decisions in patient care Describe the indications, contraindications, mechanism of action, adverse effects and drug interactions of medications commonly used in psychiatry (including but not limited to antidepressants, anxiolytics, antipsychotics, sedatives) Utilize the PAEA Core Tasks and Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the psychiatric conditions outlined at http://www.endofrotation.org/wp content/uploads/2017/07/Psychiat ry-Topic-List-2017.pdf

•

Interesting patient case •

• •

Drug Cards • Interesting patient case

•

EOR examination

• • •

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment One Complete Psychiatric H & P Three Psychiatry Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements

25% 15%

End of Clerkship Examination Developmental Disabilities Curriculum Requirements- if applicable Call Back Day Longitudinal Patient Participation, Reflective Journal Entry &

35% P/F

25% P/F P/F

P/F 90

Exhibit reliability and dependability Exhibit an understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

Identify pharmacologic agents and other relevant treatment modalities as they relate to patients with mental illnesses to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for psychiatric conditions Identify signs and symptoms of psychiatric conditions Utilize critical thinking and problem solving skills to manage psychiatric patients

Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the psychiatry clerkship. The interesting case will either be presented on a site visit or handed in on call back day. All interesting patient case assignments should include a focused H&P, a written summary of the pathophysiology of the disease state as well as one related journal article review utilizing the “Evaluating a Peer Reviewed Scientific Article” form. Journal article should be related to the chosen interesting case, current, less than 5 years old, and come from an academic, peer-reviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one Psychiatric H&P while on their psychiatry clerkship. The note should be written legibly, accurately and adequately. Please note: • The psychiatry H&P does not need a full physical exam included within the note unless pertinent. Students must make sure to include the mental status exam and appropriate psychiatric, medical and social assessment within the note. • H&P notes are to be a maximum of five (5) pages in length. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • H&P notes are not acceptable on hospital forms. • H&P notes cannot duplicate the interesting case patient. • No identifying information may appear on any notes, as this is violates HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that particular note. All notes must be submitted to the clinical coordinator on call back day (see submitting call back day materials). A five (5) point deduction from the note grade will result for each day it is tardy. If a passing grade is not achieved, the clinical coordinator will either ask the student to fax a clinical note to the PA program office every day of the following clerkship, or the student will be asked for additional notes to be submitted on the succeeding call back day.

DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their psychiatry clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects and cost of medication. The student is required to present these cards on the day of a site visit, and be prepared to answer questions regarding the drugs selected. Students who do not have a site visit should bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day, they will receive a grade of zero for this portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of their general medical background, knowledge and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, propose a management plan, present cases, and demonstrate the ability to collaboratively work in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and is posted on blackboard. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” The program fax number is 516-463-5177. In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. A failing preceptor evaluation at any point during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies. CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Clerkship logs are designed to help the Program track student clinical experiences and are completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum psychiatry requirements for the clinical year are presented in the table below. Please do not stop logging once the minimum requirement is completed, as clinical encounters should increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their psychiatry clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Psychiatry

10 per week/60 per clerkship

CLINICAL YEAR PATIENT ENCOUNTER REQUIREMENTS Although students must log specific psychiatric encounters during the psychiatry clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the psychiatry clerkship. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation.

Preventative Acute Chronic Emergent Developmental Disabilities Preventative Acute

Types of Clinical Encounters 20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during clinical year 20 during clinical year 20 during clinical year

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 during the clinical year Children- 1 y/o – 11 y/o 30 during the clinical year Adolescents- 12 y/o – 17 y/o 30 during the clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year Geriatrics- greater than 65 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. Typically psychiatry clerkships do not provide abundant opportunities to complete procedural competencies; however they may be some opportunity to perform procedures such as venipunctures, IM/SC/ID injections and IV placement. It is the student’s responsibility to find opportunities to meet the procedure requirements, however, not all the requirements listed below need to be completed during the student’s psychiatry clerkship. Difficulty in meeting these requirements should be brought to the attention of the clinical coordinator and a plan for meeting competencies will be formulated. The clinical coordinator reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation

Required Number 4 2 2 1-assisted is acceptable 93

Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

on or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the discipline of psychiatry, a 120-question multiple-choice examination is given at the end of the clerkship. This end of rotation examination is offered by the Physician Assistant Education Association (PAEA) and is developed by PA educators for use during the clinical year. It is a peer-reviewed exam that incorporates current, relevant test items that follow the NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following Core Tasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to http://www.endofrotation.org/wp-content/uploads/2017/07/Psychiatry-Topic-List-2017.pdf Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2017/07/Psychiatry-Blueprint.pdf These end-ofrotation examinations have the same format as the Physician Assistant National Certifying Examination (PANCE), and are good preparation for successfully passing the PANCE. In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she will be given the opportunity to take a make-up exam in exam master. A grade of 65% or better must be achieved on the make-up exam in order to pass the clerkship. A grade of 65% will be entered for this portion of the final grade, regardless of the passing grade earned for the make-up exam. Only one make up examination will be offered in any clerkship. A failure of the make-up examination will result in failure of the clerkship DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT 94

The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, reflect on your experiences and write them in a journal. Entries should focus on self-critique of the interaction, communication with individuals and their families and personal reactions to situations. Commenting on internal struggles or feelings, comfort-ability with providing care to individuals with developmental disabilities and their families/caregivers and ways of improving care are also encouraged. Please journal on an electronic device. Title each journal entry adhering to the following format: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box on call back day at the end of the 3rd clerkship, 6th clerkship and then finally, the 8th clerkship. To encourage deep-rooted, self-analysis, journal entries will only be reviewed to assure assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. Please be sure you click on the “developmental disability” box to capture your patients in the system. In addition, you must write about each clinical encounter in your reflective journal. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) on the last day of their clerkship for a day of activities. Call back day activities can include lectures, case presentations, clinical skills workshops and simulated patient encounters. All callback day activities are mandatory. Activities will vary throughout the year, however every student, except those on their elective rotations will take a Physician Assistant Education Association (PAEA) end of rotation exam. Should an absence be unavoidable, the clinical coordinator must be contacted PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a 5-point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a 10-point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully. Call back days at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. All patients are 95

professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience. After each encounter, students will complete a SOAP note documenting the encounter on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she will receive two (2) points off their final rotation grade for each assignment not completed. Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three-point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not set textbook or resource that will address the specific needs of the learner or the clerkship experience. Course textbooks and resources should be tailored to student needs. Didactic textbooks can be utilized for the clinical year, however, faculty encourage students to utilize more advanced resources during their clinical year such as those found through your access medicine and Up-to-Date accounts. DISABILITY POLICY If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University. Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate. Please note that accommodations may require early planning and are not retroactive; please contact SAS as soon as possible. All students are responsible for providing accommodation letters to each instructor and for discussing with him or her the specific accommodations needed and how they can be best implemented in each course. For more information on services provided by the university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075.

PHA 290 ELECTIVE CLERKSHIP s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This is a six-week clinical experience that provides students with the opportunity to either explore a medical sub-specialty, surgical sub-specialty or to gain further experience in one of the core disciplines of medicine. COURSE GOAL For students to learn to provide high quality and comprehensive medical care to the patients seen on their elective clerkship. INSTRUCTIONAL OBJECTIVES AND LEARNING OUTCOMES

Instructional Objectives Assessment Tools Utilized By the conclusion of the elective clerkship, students will be competent in the following:

•

Use effective interviewing skills to elicit a detailed history Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data Determine the etiologies, risk factors and epidemiology for

• •

Formulate an assessment for patients in the elective discipline

•

Preceptor evaluation

• •

Development of management plans for patients in the elective discipline

•

Preceptor evaluation

•

Accurately document the medical care rendered for patients in the elective discipline

•

Preceptor evaluation

•

Providing patient education and counseling for a wide variety of medical conditions seen on the elective discipline Completing technical skills competently

• •

Preceptor evaluation Interesting Patient Presentation

•

• •

Preceptor evaluation • Competency is measured by meeting the number of • exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation •

Presenting patients to the preceptor • or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patients seen on the elective discipline

various medical and surgical conditions Identify signs and symptoms of various medical and surgical conditions Utilize critical thinking and problem solving skills to identify and manage various medical and surgical conditions Select and interpret appropriate diagnostic tests or lab studies Synthesize and analyze clinical data correctly Utilize critical thinking and problem solving skills to identify and manage a wide variety of medical conditions seen on the elective discipline Adequately document medical information in history & physical notes and progress notes Use effective basic counseling and patient education skills

Performs procedures safely and at an appropriate skill level for the elective discipline Identifies the indications and contraindications of technical procedures

Effectively complete oral presentations

Identify the members of the interprofessional team and the roles that they play in the delivery of healthcare in the elective discipline

•

Preceptor evaluation

• • • • •

Identify clinical strengths and weaknesses, and set personal goals for future clinical practice

•

Pre & Post Elective Essay

•

ASSESSMENT/EVALUATION CRITERIA Interesting Case Assignment Presentation Pre & Post Essay Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements

50% 25% 25% P/F P/F

Developmental Disabilities Curriculum P/F Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook ELECTIVE INTERESTING PATIENT CASE PRESENTATION The interesting patient case presentation is a requirement during the elective clerkship. The interesting case will be presented on call back day. All interesting patient case presentations should be in a PowerPoint format and include a focused H&P, a summary of the pathophysiology of the disease state. In addition to this, students must create a unique plan to educate their patients on this topic. Examples include a poster, pamphlet or lesson plan. Students should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This presentation can be no longer than fifteen minutes in length. All topics are to be submitted to the clinical coordinators a minimum of two weeks prior to call back day for approval. When presenting students may utilize an outline or notes for guidance, however reading verbatim 99

off their PowerPoint slides is not permitted. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. PRE AND POST ESSAY As the elective clerkship gives the student a chance to explore a special interest, the “pre and post essay” evaluates how that choice was made and the level of success of the clerkship experience. The “pre” portion of the essay will outline the reasons for choosing the elective, the expectations for skills gained, the types of patients seen and the personal goals and objectives for the clerkship experience (See appendix). The “post” portion of this essay will discuss what was enjoyed and disliked about the specialty, and if the discipline may become a career choice. It will also discuss the degree to which goals and objectives were met and how adjustments were made to optimize learning. This portion must be completed near the end of the clerkship. This exercise is not an evaluation of the site. Therefore, all comments must be specific to the specialty, not the clerkship location. The final essay should be from 1.5 – 2 pages in length, typed, and double-spaced. As a professional document, all issues should be presented in a respectful manner. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of their general medical background, knowledge and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, propose a management plan, present cases, and demonstrate the ability to collaboratively work in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and is posted on blackboard. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” The program fax number is 516-463-5177. In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. A failing preceptor evaluation at any point during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies. CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS Clerkship logs are designed to help the Program track student clinical experiences and is completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the 100

program to ensure students are receiving a quality clinical education. The minimum elective requirements for the clinical year are presented in the table below. Please do not stop logging once the minimum requirement is completed, as clinical encounters will increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their internal medicine clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Elective

5 per week/30 per clerkship

CLINICAL YEAR PATIENT ENCOUNTER REQUIREMENTS Although students must log specific internal medicine encounters during the internal medicine clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the elective clerkship. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation. Types of Clinical Encounters Preventative 20 during clinical year Acute 20 during clinical year Chronic 20 during clinical year Emergent 20 during clinical year Developmental Disabilities 15 during clinical year Preventative 20 during clinical year Acute 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 during the clinical year Children- 1 y/o – 11 y/o 30 during the clinical year Adolescents- 12 y/o – 17 y/o 30 during the clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year Geriatrics- greater than 65 y/o 100 during the clinical year

completed during the student’s elective clerkship. Difficulty in meeting these requirements should be brought to the attention of the clinical coordinator and a plan for meeting competencies will be formulated. The clinical coordinator reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until competency is achieved in the items listed below. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

Required Number 4 2 2 1-assisted is acceptable or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT 102

clerkship grade. Any unexcused absence from call back day will result in a ten (10) point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully. Call back days at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. All patients are professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience. After each encounter, students will complete a SOAP note documenting the encounter on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she will receive two (2) points off their final rotation grade for each assignment not completed. Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not set textbook or resource that will address the specific needs of the learner or the clerkship experience. Course textbooks and resources should be tailored to student needs. Didactic textbooks can be utilized for the clinical year, however, faculty encourage students to utilize more advanced resources during their clinical year such as those found through your access medicine and Up-to-Date accounts. DISABILITY POLICY If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University. Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate.

104

105

Clinical Year Forms

106

EMAIL OR FAX THIS FORM Shannan Ricoy, M.S., PA-C

PROGRAM IN PHYSICIAN ASSISTANT STUDIES PRECEPTOR EVALUATION FORM

Clinical Coordinator, Program in

Studies

Email: Shannan.Ricoy@hofstra.edu 516-463-5177 516-463-4233 OR:

Christine Zammit, MS, PA-C Clinical Coordinator, Program in

Student Name _________________________________________________

Studies

Email: 516-463-5177 516-463-4380 OR Monroe Hall, Hofstra University Hempstead, New York 11549-1270

Rotation Type and Site_____________________________________________ Preceptor Name _______________________________________________ Rotation Dates __________________________________________________

Preceptors: Please use the Likert scale below to evaluate student overall performance on clinical clerkship.

Comments

(1 = poor, 2 = below average, 3 = average, 4 = good, 5 = excellent; total possible points = 100) Medical Interview

N/A

Physical Examination

N/A

Oral Case Presentation

N/A

Patient Record

N/A

Utilization of Diagnostic Tests

N/A

Interpretation of Diagnostic Tests

N/A

Technical Skills/Clinical Procedures

N/A

Problem Solving/Critical Thinking

N/A

Fund of Knowledge and Application of Concepts

N/A

Assessment/Differential Diagnoses

N/A

Ability to Formulate a Follow-up and Management Plan

N/A

Ability to Implement a Follow-up and Management Plan

N/A

Ability to Work Collaboratively in Interprofessional Teams

N/A

Relating to Patients and Colleagues

N/A

Understanding of PA Role

N/A

Reliability and Dependability

N/A

Self-Confidence

N/A

Attitude Toward Learning

N/A

Professionalism

N/A

Student Preparedness for Clinical Clerkship

N/A

**For components that received an N/A, please add 5 points when calculating the total points.** Total Points =

USE LEGEND BELOW TO CALCULATE OVERALL LETTER GRADE AND CIRCLE. Letter Grade

Overall Letter Grade =

Row Score

A-

B+

B-

C+

100-91

90-87

86-83

82-77

76-73

72-69

68-60

59 or below

Overall Competency:

Preceptorâ&#x20AC;&#x2122;s Signature: ____________________________________________________ Date:______________________ Student StudentSignatuDate: Signature:

107

DESCRIPTIONS OF EVALUATION CATEGORIES Ability to Formulate and Implement a Follow-up and Management Plan • Designs an effective and appropriate care plan • Selects appropriate consultations and referrals • Demonstrates an appropriate understanding of pharmacologic plan • Implements plan consistently and appropriately • Arranges for patient follow-up • Performs patient education at appropriate level • Uses counseling and patient education skills effectively

Medical Interview • Conveys understanding and empathy for patient • Obtains all pertinent information • Follows an organized format • Obtains history in a reasonable time period Physical Examination • Explains procedure to patient before exam • Performs examination in an orderly sequence • Demonstrates respect for patient • Performs appropriate and accurate exam

Relating to Colleagues • Ability to work collaboratively in inter-professional teams

Oral Case Presentation • Clear, organized, concise presentation • Includes all major active complaints/problems

Relating to Patients • Communicates effectively and appropriately with patients • Demonstrates respect and empathy for patients

Patient Record • Written materials are neat, legible and appropriate • Accurately and adequately documents patient encounters • Electronic record, when utilized, is accurate and organized

Understanding of PA Role • Demonstrates understanding for medical conditions and situations that require an attending physician or consultation • Understands the PA profession and the role of the PA as a team member

Utilization & Interpretation of Diagnostic Tests • Demonstrates sound knowledge of tests • Orders appropriate test(s) for working differential diagnosis • Uses appropriate discretion in ordering • Demonstrates the ability to interpret diagnostic tests

Reliability and Dependability • Assumes appropriate level of responsibility • Completes tasks thoroughly and in a timely fashion

Technical Skills/Clinical Procedures • Performs procedures safely and at appropriate skill level • Understands indication(s) for procedure(s) • Explains and attains consent of patient before starting procedure

Self-Confidence • Demonstrates confidence in clinical competence to patient, peers, and preceptor

Problem Solving/Critical Thinking • Synthesizes and analyzes clinical data correctly • Determines major active problem accurately and in a timely fashion • Determines abnormal from normal • Utilizes and evidence-based approach to medicine

Attitude Toward Learning • Demonstrates independent learning effort; undertakes supplemental readings; is inquisitive, insightful and enthusiastic; attends conferences and lectures; and demonstrates knowledge of assigned readings

Fund of Knowledge and Application of Concepts • Demonstrates application of basic and clinical sciences to patient care • Demonstrates evidence of outside reading and studies during rotation • Ability to apply knowledge of biomedical and psychosocial principles • Uses information technology to support the application of knowledge

Professionalism • Exhibits cultural awareness • Maintains professional relationship with patients, staff and preceptor • Demonstrates ethical behavior and attitude in accordance with AAPA’s Guidelines for Ethical Conduct for the Physician Assistant Profession • Respects patient privacy and confidentiality • Demonstrates a positive response to constructive criticism • Dresses appropriately for professional role • Maintains clean and kempt appearance

Assessment/Differential Diagnoses • Formulates and justifies differential diagnoses • Determine the etiologies, risk factors, and epidemiology for medical conditions • Identify the signs and symptoms of medical conditions

Student Preparedness for Clinical Clerkship • Student was well prepared to transition into clinical clerkship

61974:8/15

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Mid-Clerkship Evaluation Please complete this evaluation by the end of the second week of the clerkship. The mid-clerkship evaluation is designed to have students reflect on their strengths and weaknesses at the mid-point of their clerkship. This provides the opportunity for students to obtain the best possible clinical experience and correct deficiencies before the clerkship ends. This tool also provides the program with feedback regarding clerkship quality. This allows for identification of deficiency areas at clerkship sites and early intervention should it be necessary. CLERKSHIP: 1- FM 2- Med 3- Ob/Gyn 4- Surg 5- EM 6- Psych 7- Peds 8- Elective: CLERKSHIP NUMBER: 1 2 3 4 5 6 7 8 CLERKSHIP SITE: ___________________ Please rate the following learning experiences as appropriate to your clerkship 5= superior

4= very good

3= good

2= fair

1= poor

N/A = Not Applicable

Student Self-Assessment: How would you rate the following items? 1) 2) 3) 4) 5) 6) 7)

Your ability to acclimate and acculturate to the clinical team? _____ Your professional behavior and attendance? _____ Your ability to perform histories and administer physical examinations? Your ability to formulate a differential diagnosis? _____ Your ability to formulate and implement a management plan? _____ Your oral presentations? _____ Your ability to perform clinical procedures? _____

_____

Clerkship Site Analysis: How would you rate the following items? 1) 2) 3) 4) 5) 6)

Appropriateness of supervision (i.e. is the supervisor adequately supervising patient encounters)? Opportunity to perform history and physical examinations? _____ Opportunity to formulate differential diagnosis and management plans? _____ Opportunity to perform oral presentations? _____ Opportunity to perform clinical procedures? _____ Ability for this clerkship to meet the stated learning objectives? ____

COMMENTS:

109

_____

Student Evaluation of Program Rotations The Physician Assistant Program is always interested in improving. Therefore, your input is very important. Please complete this anonymous evaluation of your rotation and recommendations on how to improve it. (Your comments will not, in any manner, affect your final clerkship grade.) ROTATION: 1- FM 2- Med 3- Ob/Gyn 4- Surg 5- EM 6- Psych 7- Peds 8- Elective: ROTATION NUMBER: 1 2 3 4 5 6 7 8

ROTATION SITE: ____________________

Please rate the following learning experiences as appropriate to your rotation as 5= Strongly Agree 4= Agree 3= Neither Agree nor Disagree 2= Disagree 1= Strongly Disagree Applicable 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Provides opportunity to interview and examine patients _____ Provides opportunity to formulate assessments and create management plan _____ Provides the opportunity to present patients to preceptor or supervisor _____ Preceptor reviews student clinical documentation _____ Preceptor provides performance feedback to student _____ Provides adequate supervision of students _____ Provides opportunity to observe, learn, assist and/or perform clinical procedures ____ Students are integrated into medical team _____ Provides quality teaching _____ Clerkship, in conjunction with self-study, enables the student to achieve stated learning objectives _____

Please utilize this section for professionally written, constructive comments. COMMENTS:

110

N/A = Not

STUDENT/PRECEPTOR REVIEW OF CLINICAL OBJECTIVES FORM

Student_________________________________________ of Hofstra University Physician (NAME) Assistant Program has provided me the learning objectives for this clerkship. We discussed in detail the expectations involved in successfully completing this clerkship.

Preceptor__________________________________ Student____________________________________ Date______________________________________

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BLOOD BORNE PATHOGEN EXPOSURE FORM Name: _____________________________________

Date of Report: __________________

Date of Exposure: ___________________________

Time of Exposure: ________am/ pm

Clerkship Location of Exposure:____________________________________________ Brief Description of Exposure: (OMIT ANY PATIENT SPECIFIC INFORMATION)

(Signature at end of statement is mandatory) Yes

Submitted institutionâ&#x20AC;&#x2122;s exposure forms: .............. Followed institution protocol: .............................. FOR PHYSICIAN ASSISTANT PROGRAM STAFF ONLY: 112 Reviewed by: ______________________________

Date:

CLERKSHIP SCHEDULE FORM Complete the following schedule form and fax it to the Program by the Friday of the first week of the clerkship. Program fax number: 516-463-5177. Student Name:_________________________________________ Date:______________________ Preceptor Name:_______________________________________ Preceptor Telephone:________ Clerkship Specialty:_____________________________________ Clerkship Number:_________ Document the date and hours that you are assigned to work on the following table. Also document any hours that you are making up. Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Week 1 Dates: Week 2 Dates: Week 3 Dates: Week 4 Dates: Week 5 Dates: Any changes to this schedule must be submitted to the program immediately and prior to date/dates changed. All changes must be approved by the clinical coordinator and this form needs to be signed by your designated preceptor. Excused Absences (please list date of absence and make-up date) 1.____________________________________ 2.____________________________________ 3.____________________________________ Student Signature____________________________________________________Date __________ Preceptor Signature__________________________________________________ Date __________ 113

Evaluating a Peer-Reviewed Scientific Article In which journal was this article published (1 point)?

In what year was this article published (1 point)?

What hypothesis is being tested (2 points)?

Which groups are being compared (i.e. describe control group and experimental group) (2 points)?

What is the primary outcome being measured? How is it measured (2 points)?

What is the major finding of this study (2 points)? Is this finding significant (1 point)?

What is the clinical relevance of this studyâ&#x20AC;&#x2122;s findings (2 points)?

Describe any flaws in the study design (2 points). 114

FAMILY MEDICINE CLERKSHIP: HEALTH PROMOTION PROJECT Name: ____________________________

Date: __________________

The main goal of this health promotion project is to enable patients to increase control over and improve their own health. As healthcare providers, it is our responsibility to promote healthy lifestyles, along with identifying high risk patients who can develop complications from their various chronic illnesses or lifestyle risk factors. The objectives of this project are to inform patients about the prevention of a specific disease states and evaluate the effectiveness of their efforts. Ask the patient the following questions and record and reassess the results. Please attach a current article (<5 years old) that discusses health promotion issues that relates to one of your patientâ&#x20AC;&#x2122;s illness(es). 1. Identify and list this patientâ&#x20AC;&#x2122;s chronic illnesses and any lifestyle risk factors. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 2. What specific recommendations or actions did you take to enable patient self-management, disease prevention and health promotion? _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 3. Has your patient been receiving continuous health screening from visited facility? If so, when and what was done? _______________________________________________________________________________________ _______________________________________________________________________________________ 115

_______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 4. Reassess the patient and note if any changes were attempted or made after your initial discussions. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 5. Please read your article (<5 years) that discusses one health promotion issue that relates to your patientâ&#x20AC;&#x2122;s illness(es). Please attach a one-page, typed, double spaced paper summarizing the article and discussing opinions regarding the article.

116

CLINICAL YEAR – CLINICAL DOCUMENTATION GRADING FORM Student’s Name: ___________________ _____________________ Date: _________________ Faculty Evaluator: _______________________________________ Grade: ______________ SOAP/H&P: Item

Student Value

Maximum Point Value

1. 2. 3. 4.

Introduction History Components PE Assessment (Includes acute, chronic, HCM) 5. Plan (Patient Education, Follow Up, Preventive Care) 6. Signature 7. Overall Evaluation of Note _____________ (Organization, legibility, completeness, clarity, spelling, etc.)

(3) (20) (15) (20) (20) (2) (20)

Total Points: _______ X 10% = ________ Pharmaceutical Cards: Item 1. 2. 3. 4. 5. 6.

Class of medication Mechanism of Action Indications Contraindications Side Effects Cost of medication

Student Value

Maximum Point Value

_____________ _____________ _____________ _____________ _____________ _____________

(10) (20) (20) (20) (20) (10)

Total Points: _______ X 5%= ________ Total Clinical Documentation Grade: _________ + ________ /15 = _________ SOAP/H&P Points Pharm. Points

Final Grade

Faculty Signature: _________________________________________Date: __________

117

Elective Interesting Case Presentation Evaluation Form Student ______________________________________

Site Visitor____________________

Rotation Type __________________ Site __________________________ Visit Dates______ Rotation Dates _________________________

Preceptor Name _______________________

\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ SCORING: 0 = Not done, 1/5 = Poor, 5/5 = Excellent TOPIC: ____________________________________________ HISTORY: Descriptors included in HPI Clear & concise HPI HPI includes pertinent positive and negatives Includes all pertinent past medical history

0 0 0 0

PHYSICAL EXAM: Focused physical exam-including all components Includes pertinent positive & negative PE findings

1 1 1 1

2 2 2 2

COMMENTS

3 3 3 3

4 4 4 4

5 ________________________________ 5 ________________________________ 5 ________________________________ 5 ________________________________

0 1 0 1

2 3 2 3

4 4

5 ________________________________ 5 ________________________________

LABS/DIAGNOSTIC PROCEDURES: Utilization of appropriate diagnostic tests Presents pertinent findings

0 1 0 1

2 3 2 3

4 4

5 ________________________________ 5 ________________________________

DIAGNOSIS: Addresses both acute, chronic disease & HCM Ability to formulate & eliminate differential dx Describes pathophysiology of disease state

0 1 0 1 0 1

2 3 2 3 2 3

4 4 4

5 ________________________________ 5 ________________________________ 5 ________________________________

MANAGEMENT: Understands pharmacologic therapy Discusses appropriate non-pharmacologic therapy Addresses disease prevention/HCM Provides patient with follow-up instructions

0 0 0 0

6 3 6 3

8 4 8 4

10 ________________________________ 5 _________________________________ 10 ________________________________ 5 _________________________________

PATIENT EDUCATION: Development of patient education materials

0 2

4 6

10 _______________________________

PROFESSIONALISM:

0 1

2 3

5 _______________________________

2 4 1 2 2 4 1 2

TOTAL POINTS ________

Faculty Signature _________________________________________________ Date _________________

118

Interesting Case Presentation Evaluation Form Student ______________________________________

Site Visitor____________________

Rotation Type __________________ Site __________________________ Visit Dates______ Rotation Dates _________________________

Preceptor Name _______________________

0 0 0 0

PHYSICAL EXAM: Focused physical exam-including all components Includes pertinent positive & negative PE findings

1 1 1 1

2 2 2 2

COMMENTS

3 3 3 3

4 4 4 4

5 ________________________________ 5 ________________________________ 5 ________________________________ 5 ________________________________

0 1 0 1

2 3 2 3

4 4

5 ________________________________ 5 ________________________________

LABS/DIAGNOSTIC PROCEDURES: Utilization of appropriate diagnostic tests Presents pertinent findings

0 1 0 1

2 3 2 3

4 4

5 ________________________________ 5 ________________________________

DIAGNOSIS: Addresses both acute, chronic disease & HCM Ability to formulate & eliminate differential dx Describes pathophysiology of disease state

0 1 0 1 0 1

2 3 2 3 2 3

4 4 4

5 ________________________________ 5 ________________________________ 5 ________________________________

MANAGEMENT: Understands pharmacologic therapy Discusses appropriate non-pharmacologic therapy Addresses disease prevention/HCM Provides patient with follow-up instructions

0 0 0 0

6 3 6 3

8 4 8 4

10 ________________________________ 5 _________________________________ 10 ________________________________ 5 _________________________________

JOURNAL: Discusses or writes a summary of article Submits supporting journal article (< 5yrs old)

0 2

4 6

10 _______________________________

PROFESSIONALISM:

0 1

2 3

5 _______________________________

2 4 1 2 2 4 1 2

TOTAL POINTS ________ Faculty Signature __________________________________Date: __________________________________

119

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