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CLINICAL YEAR HANDBOOK

September 2021

TABLE OF CONTENTS Department Contact Information .................................................................................................................1 2021-2022 Clinical Year Schedule ..............................................................................................................2 Introduction ..................................................................................................................................................3 Making the Transition to Clinical Practice .............................................................................................3 Structure of the Clinical Year ......................................................................................................................4 Preparation for Clerkships ...........................................................................................................................4 Clerkship Assignment Policy .......................................................................................................................6 Cultural Competence ...................................................................................................................................6 Registration for Clinical Courses .................................................................................................................6 Policies Regarding Clinical Rotations ......................................................................................................7 Security and Personal Safety........................................................................................................................7 Exxat ............................................................................................................................................................7 Exxat Profile ................................................................................................................................................7 Clerkship Time Sheets .................................................................................................................................8 Clinical Attendance ......................................................................................................................................9 Remote Learning ........................................................................................................................................10 University Policy Related to absences for Religious Observances ............................................................10 Student & Preceptor Review of Clinical Objectives ..................................................................................11 Preceptor Review and Countersignature ....................................................................................................11 Clinical Year Stamps .................................................................................................................................11 Elective Surgical Rotations ........................................................................................................................12 Blood Borne Pathogen Exposure Control Plan Policy ..............................................................................12 Dress Requirements ...................................................................................................................................13 Sexual Misconduct & Other Unlawful Harassment ...................................................................................14 Clinical Year Examination Policy .............................................................................................................14 Clinical Year Remote Examination Policy ................................................................................................15 Test Taking Guide for Remote Examinations ...........................................................................................16 PAEA Examination Grade & Review Policy ............................................................................................16 End-of-Rotation Examination Failure ........................................................................................................17 Clinical Site Evaluation .............................................................................................................................17 Clerkship Grades ........................................................................................................................................17 Clinical Clerkship Failure ..........................................................................................................................17 Mid-Clerkship Evaluation ..........................................................................................................................18 Student Evaluation of Clinical Clerkships .................................................................................................18 Submitting Call Back Day Materials .........................................................................................................19 Clinical Year Syllabi ................................................................................................................................20 PHA 250 Family Medicine ........................................................................................................................21 PHA 255 Internal Medicine .......................................................................................................................30 PHA 260 Obstetrics/Gynecology ...............................................................................................................39 PHA 265 Surgery .......................................................................................................................................48 PHA 270 Emergency Medicine .................................................................................................................57 PHA 280 Pediatric .....................................................................................................................................66

PHA 285 Psychiatry ...................................................................................................................................75 PHA 290 Elective ......................................................................................................................................85 Clinical Year Forms .................................................................................................................................93 Interesting Case Evaluation Form ..............................................................................................................94 Elective Interesting Case Presentation Evaluation.....................................................................................95 Mid-Clerkship Evaluation Form ................................................................................................................96 Student Clinical Site & Preceptor Evaluation ............................................................................................97 Student/Preceptor Review of Clinical Objectives ......................................................................................99 Exposure Incident Investigation Form .....................................................................................................100 Post-Exposure Evaluation and Follow-up Checklist ...............................................................................101 2021-2022 Clinical Handbook Agreement Form ....................................................................................102 Family Medicine: Health Promotion Project ...........................................................................................103 Health Promotion Project Grading Form .................................................................................................105 End-of Rotation Grade Form ...................................................................................................................106 Clinical Year Documentation Grading Form ...........................................................................................108 Evaluating a Peer-Reviewed Scientific Article ........................................................................................109 Preceptor Evaluation Form ......................................................................................................................110

FACULTY AND STAFF CONTACT INFORMATION Chair and Program Director / Assistant Professor Carina Loscalzo, MS, PA-C (516) 463-4412 Carina.Loscalzo@hofstra.edu Gallon Wing, room 243B Associate Director / Assistant Professor Mark L’Eplattenier, MPAS, PA-C (516) 463-1353 Mark.S.Leplattenier@hofstra.edu Gallon Wing, room 243C Academic Coordinator / Assistant Professor Amy Roberts, MS, PA-C (516) 463-7728 Amy.Roberts@hofstra.edu Gallon Wing, room 130 Dual-Degree Coordinator / Assistant Professor Mary Banahan, MS, PA-C (516) 463-4161 Mary.K.Banahan@hofstra.edu Gallon Wing, room 244 Clinical Coordinator / Assistant Professor Thomas Gallo, JD, PA-C 516-463-4382 Thomas.Gallo@hofstra.edu Gallon Wing, room 231 Research Coordinator / Assistant Professor Christina M.Ventura, DrPH (516) 463-4042 Christina.M.Ventura@hofstra.edu Gallon Wing, room 138 Academic Faculty/Assistant Professor Gina Pontrelli, DHSc, PA-C (516) 463-4381 Gina.L.Pontrelli@hofstra.edu Gallon Wing, room 131 Assessment and Evaluation Analyst and Academic Support Debra Triolo, MS, RHIA 516-463-8543 Debra.Triolo@hofstra.edu Gallon Wing, room 140 Academic Support Specialist Katelyn Morgenstern, MBA 516-463-6479 Katelyn.Morgenstern@hofstra.edu Gallon Wing, room 132A

Medical Director Samuel Sandowski, MD (516) 463-4074 ssandowski@snch.org Gallon Wing, room 132 Academic Faculty/ Assistant Professor William Heuser, Pharm D, MS, EMT-P (516) 463-7008 William.Heuser@hofstra.edu Gallon Wing, room 139 Academic Coordinator / Assistant Professor Christine Zammit, MS, PA-C (516) 463-4380 Christine.Zammit@hofstra.edu Gallon Wing, room 137 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 Clinical Coordinator / Assistant Professor Jennifer Duperval, MS, PA-C 516-463-6841 Jennifer.P.Duperval@hofstra.edu Gallon Wing, room 237 Senior Assistant-Full Time Marie Sorrentino (516) 463-4074 Marie.Sorrentino@hofstra.edu Gallon Wing, room 132 Clinical Secretary/Secretary - Part Time Karen Forman/Sharon Poulson (516) 463-4074 Karen.S.Forman@hofstra.edu Sharon.Poulson@hofstra.edu Gallon Wing, room 132 Academic Administrator/Advisement Coordinator Gia Raponi (516) 463-4043 Gia.R.Raponi@hofstra.edu Gallon Wing, room 245

Department main office number: (516) 463-4074 Department fax number: (516) 463-5177 Department Mailing Address: Hofstra University Physician Assistant Studies Gallon Wing, room 132 Hempstead, New York 11549-1270

2021-2022 Clinical Year Schedule Rotation 1 Fall Semester

Rotation Fall Semester Rotation 3, Part #1 Fall Semester

8/30/2021 – 10/7/2021 Students off 9/6/2021

Call Back Day 10/8/2021

EM Simulation Date: 9/2/2021 10/11/2021 – 11/18/2021

Call Back Day 11/19/2021

EM Simulation Date: 11/1/2021 11/22/2021 - 12/17/2021 EM Simulation Date: 12/6/2021 Students off 11/25/2021 - 11/28/2021

Call Back Day 1/7/2022

Winter Break- 12/20/2021 – 12/26/2021 Rotation 3, Part #2 Fall Semester

12/27/2021 - 1/6/2022

Rotation 4 Spring Semester

1/10/2022 – 2/17/2022

Call Back Day 2/18/2022

EM Simulation Date: 1/31/2022 2/22/2022 – 3/31/2022 Students off 2/21/2022

Call Back Day 4/1/2022

Rotation 5 Spring Semester

EM Simulation Date: 3/7/2022 Spring Break- 4/2/2022 – 4/10/2022 Rotation 6 Spring Semester

4/11/2022 – 5/19/2022

Call Back Day 5/20/2022

EM Simulation Date: 5/2/2022 Rotation 7 Summer I

5/23/2022 – 6/30/2022 Students off 5/30/2022

Call Back Day 7/1/2022

Rotation 8 Summer II

EM Simulation Date: 6/13/2022 7/5/2022 – 8/11/2022 Students off 7/4/2022

Call Back Day 8/12/2022

EM Simulation Date: 7/25/2022 •

EM (Emergency Medicine)

Introduction Congratulations on progressing to the clinical year! It is an accomplishment to complete the didactic phase of training and to advance to the clinical portion of the curriculum. The goal of the clinical year is to provide the skills necessary for graduation and ultimately for practice as a physician assistant. This handbook is designed to provide the information necessary to complete the requirements for each clerkship (also referred to as a “rotation”). The Clinical Handbook will be useful throughout the clinical year; keep it in an accessible place. It is also posted on the program website and Exxat in the student packet section. The clinical coordinators will be the primary faculty you will interact with this year. Yet, the entire faculty and staff are available to support and guide you through this year. Please feel free to contact any faculty or staff member with questions or concerns.

Making the Transition to Clinical Practice The clinical year differs from the academic year in many ways. A chief difference is that the security found in the company of fellow students will be absent in many cases. The familiar routine of the classroom will similarly be absent. Self-reliance and self-motivation will play a more important role in succeeding in the clinical year. A key feature of the experience this year will be the ability to integrate and apply core knowledge with practical experience. This does not occur automatically and will depend on the ability to continue to study physiology, pharmacology, and clinical medicine when not on-site. While each clerkship will provide the opportunity to meet each objective, with some effort you will find additional opportunities that will yield added enrichment. Take advantage of these opportunities. Making the most of the clinical year depends on the amount of effort, work, and dedication you are willing to expend. Some clerkships will be more enjoyable than others. While some clerkships may not meet all your expectations, remember that learning to navigate the clinical world in all circumstances is important to success in the clinical year. Learning to find the resources and individuals to help meet the objectives will optimize your clinical experiences.

Structure of the Clinical Year The clinical year is made up of seven core clerkships and one elective clerkship, totaling approximately 2,000 hours of clinical training. The core clerkships include family medicine, internal medicine, surgery, psychiatry, obstetrics/gynecology, emergency medicine, and pediatrics. The elective clerkship provides an experience to work within a sub-specialty of medicine or surgery, or the chance to repeat a rotation of personal interest in another setting. At the conclusion of each clerkship, students are required to participate in ‘call back’ session(s) on campus or at the Center for Learning and Innovation (CLI). The objectives for each clerkship are found in the back of this handbook. Students are responsible for the objectives regardless of the types of patient care experiences they encounter. All students are responsible to contact the site for their upcoming clinical rotations according to the site’s requirements and timeline. Some sites require completion of an orientation session, online modules, and the submission of time-sensitive, site specific documents prior to attending the rotation. All students will have access to the clinical year software program, Exxat. Exxat contains all the information for the clinical year. Failure to check Exxat for clinical site related information may result in the student losing a rotation and not graduating on time.

Preparation for Clerkships There are several factors to consider before beginning each clerkship. They include: •

Identification of Gaps in Knowledge: The ability to identify areas of weakness and finding ways to address them is a lifelong process that begins in the clinical year. Before presenting to the clinical site for the first time, review the learning objectives for that discipline (found at the end of the Handbook). Some areas of weakness will be apparent before beginning the clerkship; others may present during the rotation. Early identification allows for timely remediation.

•

Communication with Preceptor: Meet with the preceptor on the first day of each rotation and discuss the objectives with him/her. Reviewing the objectives with the preceptor will help plan how best to use the weeks allotted for the clerkship. Afterward, the preceptor must sign the “Student-Preceptor Review of Clinical Objectives” form.

•

Personal Preparation: Students are required to be at the site at all times designated by the preceptor. In some cases, this will require staying at the site late into the evening or overnight, arriving very early in the morning, or working on weekends. Anticipate long, irregular hours and prepare by engaging baby-sitters, family, dog-walkers, or helpers in the care for others who rely on you. Students may not be excused from any scheduled hours without contacting the program and obtaining permission from the clinical coordinator (see Clinical Attendance).

•

Transportation: A car in good working order is required to travel to most rotation sites. Many rotations will require a drive of many miles. It is not acceptable to miss time from a rotation because of car trouble. A back-up plan must be developed for reaching a clinical site without a car. While it is possible to complete the clinical year without a car, this will increase travelling time and require familiarity with the public transportation system. For rotations at sites that are far away or inaccessible via public transport, it may be necessary to find short-term living accommodations. As outlined in the list of tuition and fees upon entrance to the PA Program, students are responsible for all expenses related to the clinical rotations. These include, but are not limited to, parking, tolls, gasoline, and car maintenance. 4

•

Smart phones or iPads: Owners of iPads or smart phones should download pertinent information such as textbooks, PDRs, EKG, and radiology references. In addition to its use as a reference, these devices can be used to take notes, keep study lists or to log patients. Should the purchase of a device not be possible, determine how to quickly access information, to keep track of patients, and take notes. It is not appropriate to be talking, texting, or taking pictures with your electronic device cell phone in patient care areas while on clinical rotations.

•

Oral Presentations: Clinical rotations require students to present patient cases to preceptors, fellow students, and other health care team members. Practice of the presentation beforehand will aid in the appearance of confidence and being well informed. Discomfort with public speaking can be remedied with practice in front of a mirror, to friends, and to classmates.

•

Emotions: When beginning the clinical year, many students feel inadequate when considering the responsibility associated with patient care. Acknowledgment of this feeling may prevent becoming crippled by it. Most preceptors and staff are sympathetic to student nervousness, and do not expect a student to know everything. It is important to ask questions, listen, and learn. Reading and preparing throughout the clerkship may help in feeling confident.

•

Getting Help: Students may experience personal problems during the clinical year or interpersonal conflicts may arise on a clinical site. The clinical coordinators and program director are available for advice and support. Call them as soon as a problem arises. Do not wait until the situation spirals.

•

Involvement in Clinical Training: The amount of learning in and enjoyment of the clerkship is directly proportional to the effort extended. Reading about disease states encountered each day is essential. Students are expected to volunteer for presentations and to spend as much time as possible at the site. Many find that the best teaching is “after hours.” Others find that helping with “scut” work may make the preceptor more inclined to teach and mentor.

•

First Impressions Count: Preceptors often form opinions of students early in the rotation. It is important, therefore, to be punctual, maintain good physical appearance, and demonstrate initiative from the first day of the clerkship. Learning the layout of the facility, important phone numbers, and procedures for ordering labs, diagnostic studies, and consults early will aid in making a good first impression.

•

Interpersonal Communication: One key to a successful clerkship experience is the ability to get along with patients, preceptors and other medical staff at the site. Being respectful and courteous includes selfawareness of tone of voice, body language and attitude. Yet, the clerkship experience is not designed for any student to be taken advantage of or excluded from important learning experiences. It may be necessary to be assertive at times. Striking a balance between being courteous and a responsible learner may prove challenging. Program faculty can help negotiate this balance and should be called upon if needed.

•

Seek Out Teachers: In addition to the preceptor, other members of the health care team such as social workers and nurses may be willing to teach. It is especially important to attend all teaching rounds that are offered at the site. If medical students rotate at the site, seek an invitation to participate in their teaching rounds. Being polite and respectful may result in opportunities that might otherwise be missed.

•

Be Assertive: Some sites will have many students rotating at the same time, either from other PA programs or from other schools. All these students will compete for the attention of preceptors, for the opportunity to perform procedures, or for the privilege to present cases on rounds. This will necessitate the ability to assert 5

oneself to gain access to important learning opportunities. While this may be difficult, it is essential to maximize the clerkship experience.

• Expect Frustrations: As with other phases of PA education, there are aspects of the clinical year that are frustrating. Remaining flexible will help in minimizing the negative aspects of a clerkship experience. It is also important to keep in mind that patients can be the source of frustration. Patients can be angry, fearful, manipulative, or duplicitous. This may be due to any number of factors, some not directly related to the student. A discussion with the preceptor may help determine if there are factors that can be modified in the provider-patient interaction.

Clerkship Assignment Policy Students are assigned to clerkship sites by the clinical coordinators. Clerkship site assignments are not negotiable. The clinical schedule may change due to situations beyond the program’s control. It is necessary that students remain flexible when these situations arise. While personal considerations are respected, when possible, the primary focus of clerkship assignments is to give each student a well-rounded clinical experience. Therefore, students are required to rotate to each clerkship site as assigned. To ensure the best possible clinical year experience, students will be assigned clerkships that will require travel. As outlined in the tuition and fees list upon acceptance into the PA Program, the cost of possible temporary housing, meals and transportation is the responsibility of the student. All clerkship schedule decisions rest with the clinical coordinators.

Cultural Competence The range of clinical experiences will include working with patients of varied racial, ethnic, economic, geographic, and cultural backgrounds. Students will be assigned to sites in various geographical areas or work with patient populations with which they may be unfamiliar. Providing care to all populations is a central part of the mission of the PA profession. Students are expected to rotate to all sites to which they are assigned, regardless of geography or patient population.

Registration for Clinical Courses Students must register each semester for their clinical rotations. Since the clinical year does not follow the academic calendar, students must take responsibility for registering each semester. Students must register using the following schedule: Fall Semester Spring Semester: Summer I Summer II

Rotations 1-3 Rotations 4-6 Rotation 7 Rotation 8

Clerkships are considered courses. The codes for the clerkships are: Family Medicine Internal Medicine Ob/Gyn Surgery Emergency Med Pediatrics

PHA 250 PHA 255 PHA 260 PHA 265 PHA 270 PHA 280 6

Psychiatry Elective

PHA 285 PHA 290

Register for each clerkship in the order in which it is taken. The designation “R” before the course number refers to the sequence of the clerkship. For example, each student will register for the first rotation under “R-1”; the second “R-2” etc. Grades cannot be entered unless the correct clerkships appear in Banner in the proper semester and in the proper order. It is the responsibility of the student to update their registrations should a change occur in their clinical year schedule.

Course Coordinators A clinical coordinator has been assigned to each course. The course coordinator is responsible for all aspects of the course. All questions relating to a specific course should be directed to the respective course coordinator listed below, however, please carbon copy (cc) the rest of the clinical team on your email. Discipline Family Medicine Internal Medicine Ob/Gyn Surgery Emergency Medicine Pediatrics Psychiatry Elective

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

Course Coordinator Professor Duperval Professor Gallo Professor Duperval Professor Ricoy Professor Ricoy Professor Gallo Professor Ricoy Professor Duperval

Policies Regarding Clinical Rotations Security and Personal Safety Clinical year clerkship sites are evaluated by the clinical coordinators and deemed secure and safe for all students. If at any point a clinical year student feels that their personal safety is being compromised, the student should contact the on-site security department, the program, and alert their preceptor. If the site does not have a security department, the student is unable to reach a faculty member at the program, and the preceptor is unavailable, the student is to call 911. If a clinical year student has questions or concerns regarding site security or safety, they may contact the program main office at 516-463-4074 or call the emergency clinical coordinator program mobile at 516-509-6470 after office hours. All students are required to complete the ilearn module “Promoting a Culture of Workplace Safety” before the start of the clinical year. Once complete, upload your certificate to Exxat under required documents.

Exxat Exxat is a software program that helps optimize clinical education during the clinical year. Exxat will contain preceptor and site contact information, orientation information, clinical forms, site required documents, clinical site forms, patient and procedure logging, clinical year evaluations and any other materials needed by students during the clinical year. All students are required to be familiar with the information in Exxat. As this information is continuously in flux, the student is responsible for the most current information. Each student is responsible for checking Exxat daily for important site updates. Students can log in to Exxat at: https://apps.exxat.com. 7

Exxat Profile All students will have an Exxat portfolio set-up before the start of the clinical year which will contain your student profile. This student profile will be sent to all clinical sites and preceptors. Each student profile will house personal demographics, various certifications, health documents, and all completed site-specific documents. Exxat currently does not have the capability to send emails directly to sites and preceptors. Students will need to send their profile link through their own Hofstra email account via the following pathway: Dashboard → My profile → Send Profile Link → Enter your Hofstra email address into the recipient box and hit send to obtain your Exxat profile link (Link will appear in your Hofstra inbox) The student will need to copy and paste this link into the body of the email going to the clinical site. Only one email is necessary. This email must be sent to all required site contacts and/or preceptors as indicated in the site requirements. To prevent any discrepancies, the clinical team recommends using the copy and paste feature when entering the recipients email addresses. Attach all completed site required forms to your initial email unless otherwise specified on Exxat. The email being sent to your clinical site should state the following: Subject: Hofstra PA Student, (Include rotation number and discipline), Rotation Dates: XX to XX Dear Contact Person/Clinical PreceptorMy name is ____________________. I am a Hofstra University PA student and scheduled to rotate through your ____________ department from _________ to __________. Below is a link to my personal profile. My profile houses ilearn modules, health documents, various certifications and completed site specific documents. Please let me know via email about first day logistics and if you should need anything further. Thank you. Copy and Paste Profile Link Here Thank you, Student Name, PA-S

Clerkship Time Sheets All students are required to complete a weekly time sheet on Exxat for their clerkship. Time sheets can be completed week by week or once for the entire rotation. Students are required to submit their time sheet no later than Friday of the first week, and every Monday thereafter if submitting weekly (when submitting timesheets students must click “submit” not “save”), it is strongly recommended that students strive to be at their clinical site for a minimum of forty hours per week to get the best possible clinical experience. Time sheets can be found on the Exxat dashboard under- placements → by session → time sheet. Time sheets will be utilized in determining when to schedule a site visit or place a call to a student. It will also provide an assurance to the student and the program that the clinical site will average sufficient hours per week of clinical experience. 8

Your time sheet must be updated if your schedule changes for any reason. Any planned absence or lateness requests (including clinical year activity or required orientation for an upcoming clerkship) must be submitted via Exxat a minimum of 1 week prior and approved by the clinical coordinators. Your request is not approved until the clinical coordinators have reviewed your submission and sent you an approval via Exxat. It is the student’s responsibility to check Exxat regarding your submission status. To submit or review your absence or lateness request via Exxat, students must locate the “my leave” section. The “my leave” section can be found on the Exxat dashboard under- placements → by session → my leave. The time used to make up absences must be similarly documented on Exxat in the “my leave” section. Failure to submit a clerkship time sheet for the entire six weeks of your clerkship or my leave request will result in a grade of “incomplete” until your submission is received.

Clinical 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 at 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. If a student is unable to get to their clerkship due to adverse weather conditions, or told by the site to not come in, all students must still report the absence as outlined below. 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, they will be considered absent. It is not acceptable to go to the library to study or to be away from the team without the preceptor’s knowledge and permission. If an absence due to an illness occurs the day before, the day after a holiday or for longer than 2 days, the student must provide the clinical coordinators with a note from a medical provider verifying the student was seen and uploaded onto Exxat under the “my leave” section. As mentioned above, any absence not related to a clinical year activity or required orientation for an upcoming clerkship, must be made up at the site. There are no “personal days.” If a student is unexpectedly unable to report to or will be late to a clinical activity for any reason, they are required to: 1. Call and e-mail the course coordinator and cc the clinical team before the start of your activity or shift. 2. Call and e-mail the clinical preceptor before the start of your scheduled shift. 3. Log your lateness or absence on Exxat in “my leave.”

If a student is feeling ill, they should NOT report to their clerkship and should email their preceptor immediately. Students must call and e-mail clinical coordinators to report any absence. Students are also required to submit a “my leave” request on Exxat. 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 as outlined in the Student Handbook provided to students last year.

It is unacceptable to leave a message with the program administrative assistant. It is unacceptable for a student to call or email on behalf of another student. Additional information regarding attendance is found under “Clinical Year Examination Policy” and “Site Evaluation.”

Remote Learning There may be times where synchronous and asynchronous online learning may occur. Below are policies related to online learning Video/Audio Faculty and staff commonly use Zoom and Collaborate. Please install Zoom on all personal devices. Should additional software need to be downloaded, faculty and staff will provide instruction. Faculty strive to increase interaction with students regardless of the setting. Further, faculty feel strongly that it is important students are present and engaged during instructional sessions. As part of that initiative, faculty requires that video cameras remain on during online platform sessions, such as Zoom or Collaborate. If you are uncomfortable having others visualize what is behind you while participating, you may select a virtual background, set up the computer in front of a blank wall, or hang a drape. When you enter an online session, please ensure that your microphone is muted. If technical difficulties installing products or any other issue is encountered, please call the University Help Desk at 516-463-7777. Should you encounter technical difficulties during an instructional session, please email the Clinical team and then call the Help Desk. If technical difficulties arise on your main device which prevents you from being on the lecture, please log onto Zoom with an alternative device (e.g., cell phone, tablet, ipad). Netiquette While remote clinical activities may seem "relaxed", it is important to be cognizant of the comments you post in the chat, name displayed on your account and the background included in your video. Remote learning and platforms give you the option of using a virtual background if needed. Your attire should be professional, and your background should be respectful (do not lay down in your bed, drive around in your car, travel, etc.). This information and advice are especially important when participating in activities delivered by outside adjuncts and content experts, as these professionals may end up being your preceptor or be present in a future job interview. It is very easy for someone to misinterpret your communication and behavior during these remote activities. We are all part of the Hofstra Northwell family and need to ensure that we are representing the physician assistant profession and our program in a professional manner. Copyright Infringement All students should be aware that unauthorized distribution of copyrighted material, including unauthorized peer-to-peer file sharing, may subject them to civil and criminal liability. Copyright infringement is the act of exercising, without permission or legal authority, one or more of the exclusive rights granted to the copyright owner under section 106 of the Copyright Act (Title 17 of the United States Code). These rights include the right to reproduce or distribute a copyrighted work. In the file-sharing context, downloading or uploading substantial parts of a copyrighted work without authority constitutes an infringement. Penalties for copyright infringement include civil and criminal penalties. In general, anyone found liable for civil copyright infringement may be ordered to pay either actual damages or "statutory" damages affixed at not less than $750 and not more than $30,000 per work infringed. For "willful" infringement, a court may award up to $150,000 per work infringed. A court can, in its discretion, also assess costs and attorneys' fees. For details, see Title 17, United States Code, Sections 504, 505. Willful copyright infringement can also result in criminal penalties, including imprisonment of up to five years and fines of up to $250,000 per offense. 10

For more information, please see the website of the U.S. Copyright Office at www.copyright.gov, especially the FAQ at www.copyright.gov/help/faq. Students who engage in illegal downloading or unauthorized distribution of copyrighted material may also be charged with failure to comply with the Acceptable Use Guidelines in accordance with the procedures outlined in the Code of Community Standards and may be subject to loss of Hofstra University computing privileges, disconnection from the Hofstra network, and additional University sanctions as outlined in the Code of Community Standards.

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 must notify faculty members and their current Preceptor in advance. Likewise, faculty members who anticipate missing class for religious observance will notify students in their classes with as much notice as possible. As per Faculty Policy Series 12 (B): “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 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 they may have missed because of that absence on any particular day or days.

Student & Preceptor Review of Clinical Objectives At the beginning of each clerkship, students are required to review the clinical objectives with their preceptor. Clinical objectives are in each syllabus. Once reviewed, the student and preceptor review of clinical objectives form must be uploaded onto Exxat by the Friday of the first week of each clerkship. This form can be found on the Exxat dashboard under- placements → by session → to do list → session required documents. Failure to submit this form will result in a three (3) point deduction from the rotation grade (see appendix).

Preceptor Review and Countersignature Students must ensure that each patient seen is evaluated by the supervising preceptor. The supervising preceptor must review and countersign all notes written by the student in a clinical setting. The student must sign each note with “PA-student” and not “PA-S” to prevent confusion. The supervising preceptor must countersign the note immediately. 11

The student is not authorized to initiate any orders for a patient without the consultation and the signature of the supervising preceptor. Students are not permitted to sign prescriptions or create e-prescriptions. Failure to adhere to these policies will result in a disciplinary hearing before the Academic Standing Committee.

Clinical Year Stamps All students will be required to purchase a self-inking stamp to be used underneath your signature on all clinical documents during the clinical year. Stamps should include the following information: Student’s Name PA Student Hofstra University

Elective Surgical Rotations Students who chose surgical electives may work with preceptors who practice in specialty areas. These preceptors may have operating room privileges in hospitals or other facilities such as surgi-centers which are not affiliated with the Program. These students will not be able to accompany the preceptor into the operating room in these circumstances. In some cases, the preceptor does operate in an affiliated hospital, however, additional paperwork or scrub class may need to be submitted before accompanying the preceptor in surgery. The clinical coordinators will assist you through this process. Students should consider the limits to operating room access before beginning a surgical elective rotation.

Blood Borne Pathogen Exposure Control Plan Policy An exposure incident is defined as a specific eye, mouth, other mucous membrane, or non-intact skin contact with any potentially infectious material. Students should be aware that an infectious or environmental hazard exposure can adversely affect their overall health as well as performance in the Program. 1. Immediately wash exposed skin area with soap and water. If eyes are exposed, immediately flush with water. For mouth or other mucous membrane exposures, rinse with large amounts of water. 2. If the exposure occurs on a clinical clerkship, the student shall IMMEDIATELY REPORT the incident to the Preceptor or clinician student is working with. The student will follow the institutional infectious and environmental hazard policy, including completing all necessary documentation as required and proceed to step 5. The student is required to report the incident via telephone and email to one of the clinical coordinators as soon as possible but no later than 24 hours following the incident. 3. If exposure occurs on the Hofstra University campus, the student shall IMMEDIATELY REPORT the incident to the course instructor. The course instructor should call Public Safety to report the incident. The number to call from a cell phone is: 516-463-6606 / Campus landline phone: x36606. If the source individual is another student or faculty member, they will be instructed to call Student Health Services at 516-463-6745 prior before reporting to Wellness and Campus Living Center for determination of infectious disease status and proceed to step 6. 4. If exposure occurs at the Northwell Bioskills lab, the student shall IMMEDIATELY REPORT the incident to the course instructor. The course instructor will ensure the student irrigates and cleans the affected area. The course instructor will notify Northwell staff. The course instructor will ask Northwell staff for a copy of the Anatomy Gifts Registry specimen data sheet. The student must call Student Health Services at 516463-6745 before reporting to Wellness and Campus Living Center and proceed to step 6. 12

5. The student must go to the nearest Hospital Emergency Department immediately after the incident to receive counseling, a physical examination, blood testing, and post-exposure prophylaxis if deemed appropriate by the health care provider. If possible, arrangements should be made to determine infectious disease state of the source person. This is generally done through established institutional protocols that are initiated by health care provider evaluating student post exposure. Although this is recommended, this is not a requirement and should not delay post exposure management. In the absence of known source person status, risk assessment of the severity of exposure and HIV status of the source person should be completed by healthcare provider to determine post exposure management. 6. The Exposure Incident Investigation Form should first be filled out by the student as much as possible, ensuring details are included as well as recommendations for avoiding repetition, and then reviewed and signed by an Academic Coordinator if the incident occurred on campus or at the Northwell Bioskills lab, or a Clinical Coordinator if occurred on a clinical clerkship. This form must be completed and signed in person or virtually by the appropriate faculty member within 24-48 hours of exposure. The form is available in all program handbooks, including electronically on Exxat and at http://www.hofstra.edu/academics/colleges/nursing-physician-assistant/physician-assistant/physicianassistant-handbooks.html. 7. A copy of the Exposure Incident Investigation Form, Post-Exposure Evaluation and Follow-up Checklist, and Emergency Department Discharge Papers (if applicable) should be brought to Hofstra University Student Health Services Center within 24-48 hours of exposure. In response to precautionary changes on campus associated with COVID-19, Student Health Services has implemented a phone triage system and requires all students to call first at 516-463-6745. When appropriate, clinicians may recommend an inperson evaluation. Hofstra University Student Health Services Center will complete the Post-Exposure Evaluation and Follow-Up Checklist. Follow-up is confidential. The Student Health Services Center hours of operation, services, and personnel information can be found at: http://www.hofstra.edu/StudentAffairs/StudentServices/welctr/index.html 8. The Academic Coordinator or Clinical Coordinator will review all pertinent documents and place a copy of the Exposure Incident Investigation Form into the student’s file and provide a copy to the PA Program Director as soon as possible.

Dress Requirements Dress requirements as outlined below, and each clinical sites policies and procedures must be strictly adhered to during 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. Students should wear business attire while on clinical clerkships and at related facilities. Button-down shirts with ties, dress slacks, professional tops or blouses, appropriate length skirts and dresses should be worn. Closed-toed shoes with socks or stockings as well as a short white uniform jacket must always be worn. 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. ID badges must be worn daily and should be easily visible.

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 the designated scrub policy for each hospital or facility. Hair must be pulled back away from the face if it is longer than shoulder length. Fingernails must be less than ¼ inch 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 sensitive to fragrances, particularly 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. Consider removing body piercings.

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 coordinators and/or to the University’s Equal Rights and Opportunity Officer (see 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.

Clinical Year Examination Policy Almost all multiple-choice examinations are administered utilizing an online format in a computer lab or with a laptop. At the end of each clerkship, except for the elective clerkship, students will be required to take a PAEA End of Rotation exam. If a student arrives late, no additional time will be granted to take the exam. Arriving more than fifteen minutes late for an exam will result in a five (5) point deduction in the exam grade. Should an unexcused absence occur for an exam, the student will need to meet with the 14

Academic Standing Committee. If the opportunity to take the exam at a later time is granted by the ASC, the highest possible grade the student would receive would be a 65%, regardless of the score. Any student with an excused absence on the day of the examination may result in a five (5) point deduction from the examination grade. No student is permitted to take the day off before an end of rotation examination to study or complete assignments. If this type of unexcused absence occurs, the student will receive ten points off final grade for the clerkship and must meet with the Academic Standing Committee.

Clinical Year Remote Examination Policy Since most exams in PA school are meant to simulate the PANCE, students must follow the procedures below: •

• • • • • • •

• • • • • • • •

All PAEA exams must be accessed via MonitorEDU, which will take you to ExamDriver. Should a student bypass MonitorEDU and access the exam directly through ExamDriver, the exam is automatically void, resulting in a score of zero and the student will be called before the Academic Standing Committee. Students should log into ExamDriver via MonitorEDU 15 minutes prior to scheduled exam time and be prepared to begin the exam at the posted time. If a student is having trouble logging in, they MUST contact MonitorEDU support via live video chat or private chat function IMMEDIATELY. Exam space should be quiet, well lit, and clear of everything. This includes all electronic devices, beverages, snacks, chewing gum, coats, and brimmed hats. No student will be permitted to wear a coat/jacket, zip-up shirt/sweatshirt, brimmed hat, hood, electronic device, or watch. All browsers on your laptop or computer must be closed. Cellphone should be fully charged and/or plugged into its charger, connected to WIFI, and on the Do Not Disturb setting during the test. There is NO scrap paper permitted during remote online examinations. Students must show their blank dry erase board and marker to the camera prior to the start of their PAEA exam. Prior to submitting the exam and logging off, student must erase board and hold it up to the camera to show that all content has been erased. Failing to follow these instructions will result in a meeting with the Academic Standing Committee. If a student needs to wear earplugs, they must be either standard foam or wax earplugs. Electronic earplugs are not permitted. Earplugs must remain in place for the entirety of the exam. Students may not ask questions during the exam. No student should get up from their seat or leave their seat to use the restroom until they have completed and submitted their exam. Students are not permitted to talk to others during the examination. Students are not permitted to take pictures or screenshots of examinations. Students are not permitted to write down any exam content during or after the examination. If an emergency should occur during your exam, notify your MonitorEDU proctor immediately. MonitorEDU will contact the program. Cellphone camera via MonitorEDU will be used throughout the entirety of the exam to monitor for suspicious activity, including cheating or other forms of academic dishonesty. If a student is flagged by MonitorEDU for engaging in suspicious activity, faculty will investigate the incident, and the student may be called before the Academic Standing Committee. Further action will be determined by the ASC.

Test-Taking Guide for Remote Examinations All remote PAEA examinations are administered utilizing an online format on a desktop or laptop. MonitorEDU proctors all examinations live. On the day of your remote exam, please follow the steps listed below: 1. Using your desktop computer or laptop, click on https://takemytest.live 2. Once on the MonitorEDU website, please click on “Take your test now live- select your school/organization” on the right side of the page. 3. Scroll down and click on Hofstra University 4. You will have to enter your name, phone number, and exam. Type in the name of the end of rotation exam you are taking (i.e., PAEA Emergency Medicine End of Rotation Exam). 5. Once you have entered the required information, it will take you to a private chatroom with your proctor. In this chatroom, your proctor will greet you and send you a link for your phone to begin a live video chat with your assigned proctor. 6. Enter the provided link into the browser on your phone to connect to your live video chat with your proctor by clicking on “Click to Start Video Chat”. 7. Once you have initiated your video chat, you will be able to speak to your proctor through your cellphone. This will be your primary form of communication with your proctor. If there are any difficulties before or during the exam, you will turn to your cellphone camera and discuss the issue with your proctor. 8. The proctor will instruct you to show a valid photo ID (i.e., Hofstra ID or Driver’s License) to verify students’ identity, testing area, room, and blank dry erase board. 9. You will proceed to set up your mobile camera so the proctor can see you and your desktop or laptop. You will NOT be using your webcam or laptop camera as an additional view. The proctor will ask you to make any necessary adjustments to ensure they have the best view. 10. Once the camera is setup and testing area is deemed appropriate by the proctor, you will be instructed to log onto ExamDriver on your computer. 11. Once logged into ExamDriver, your proctor will authorize and release your exam. 12. Before submitting your completed exam, you must erase all content on your dry erase board and hold it up to the camera for proctor verification. 13. Please review the following links before call back day: https://monitoredu.com/faq https://www.youtube.com/watch?v=PZyZPFkxiv0&feature=youtu.be If a student logs in late, no additional time will be granted to take the exam. Logging in more than fifteen minutes late for an exam will result in a five (5)-point deduction from the exam grade. Should an unexcused absence occur for an exam, the student will meet with the Academic Standing Committee. If the opportunity to take the exam at a later time is granted by the ASC, the highest possible grade the student would receive would be a 65%, regardless of the score. Any student with an excused absence on the day of the exam may result in a five (5)-point deduction from the exam grade.

PAEA Examination Grade & Review Policy Within 24-hours of submitting the exam, each student will receive an email from PAEA containing the raw score and feedback on incorrectly answered exam questions. This feedback should be saved and used for remediation and studying for the PANCE. Within 72-hours after receiving your PAEA raw score the clinical coordinators will convert your raw score to a numerical grade and post on Exxat. Your grade can be found from the Exxat dashboard under- my current placement → evaluations → PAEA End of Rotation Examination Grade. 16

End-of-Rotation Examination Failure A passing grade for end-of-rotation examinations is 65%. Should a student fail the end-of-rotation exam, the student 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 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. A failure of the make-up examination will result in failure of the clerkship. Students are permitted to take no more than two (2) make-up exams for the entire clinical year. Any student who fails two end-of-rotation exams will be called before the Academic Standing Committee and placed on academic probation. Failing a third end-of-rotation exam will result in appearance before the Academic Standing Committee and probable dismissal from the Program.

Clinical Site Evaluation Each student will have one (1) site evaluation during the clinical year. The student will be visited in person by one of the clinical coordinators at their clinical site, or remotely via zoom, within the last two weeks of the clerkship. The site evaluation assesses student command of clinical knowledge of the discipline practiced at the site. Notification for a visit can vary from five weeks to 24 hours beforehand. In the unlikely event that a student is unable to be present for the site visit, the clinical coordinators must be notified at least 24 hours prior to the visit. If a student is scheduled for a remote site visit, a member of the clinical team will send you a zoom link with the date and time of your visit. Students are responsible to have the below documentation uploaded onto Exxat in the session required documents designated for that rotation prior to their remote or site visit: 1) Depending upon the clerkship syllabus, one H&P or SOAP note, if applicable. 2) Presentation of three (3) pharmaceutical agents (called “drug cards”). 3) Depending upon the clerkship syllabus, if applicable, presentation of one of the following: • Interesting Patient Case Assignment • Health Promotion Project An unexcused absence will result in a failure of this component of the clerkship grade. If the student is not prepared for the clinical coordinator at the time of the site visit, the student will receive a zero for any missing component of the site visit grade.

Clerkship Grades Each clinical clerkship must be passed to graduate from the program. A course grade below 70% will result in failure.

Clinical Clerkship Failure A student will fail a clinical clerkship if: 1. A failing grade at any point in the clerkship is submitted by a preceptor on the Preceptor Evaluation Form. 2. A failing grade is earned on the end-of-rotation examination. Failure is defined as less than 65% on both the initial and the make-up exam. 3. The total clerkship grade is less than 70%. 17

Should a student fail a clerkship, the rotation will be repeated at the end of the research semester, thereby extending the length of the curriculum. Graduation will be delayed. The student will be responsible for all associated costs of repeating the failed clerkship. A failed rotation will result in the student appearing before the Academic Standing Committee and placement of the student on academic probation for the duration of study in the Hofstra University Program in Physician Assistant Studies. Two failed clerkships will result in reappearance before the Academic Standing Committee. All extenuating circumstances will be considered. Dismissal from the program will be considered at that time.

Mid-Clerkship Evaluation The mid-clerkship evaluation forms are completed and submitted on Exxat by the end of the third week of each clerkship (See appendix). Once the deadline has passed the evaluation will be locked on Exxat. This evaluation instrument is designed for students to determine their strengths and weaknesses early, so that the opportunity to correct deficiencies is possible. 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. If the mid-clerkship evaluation is not submitted on time, three (3) points will be deducted from the final grade for the rotation. Additionally, students who miss the deadline must email the clinical secretary to unlock the evaluation. The procedure for submitting the mid-clerkship evaluation form on Exxat is as follows: • Start from dashboard • Then go to my current placement • Click on the rotation number • Click “Evaluation Summary” under the “To Do” list • Select mid-clerkship evaluation form • Fill out the evaluation by clicking the green pencil icon • Submit evaluation

Student Clinical Site & Preceptor Evaluation The Student Clinical Site & Preceptor Evaluation form is to be completed and submitted on Exxat (see appendix). Student feedback and comments are vital to the growth and continued improvement of the program. Students must submit their evaluation of each clerkship on Exxat prior to the start of call back day. Once the deadline has passed the evaluation will be locked on Exxat. Three (3) points will be deducted from the FINAL GRADE for the course if the student evaluation is submitted late. Additionally, students who miss the deadline must email the clinical secretary to unlock the evaluation. The procedure for submitting the student clinical site & preceptor evaluation form on Exxat is as follows: • Start from dashboard • Then go to my current placement • Click on the rotation number • Click “Evaluation Summary” under the “To Do” list • Select student clinical site & preceptor evaluation form • Fill out the evaluation by clicking on the green pencil icon • Submit evaluation 18

Submitting Call Back Day Materials All materials must be completed and uploaded on Exxat prior to the start of call back day. Students should upload all call back materials to the “session required documents” section in the “to do list” on your Exxat dashboard. Once the deadline has passed, this section will be locked on Exxat. Failure to do this will result in a three (3) point deduction from the final rotation grade. The following materials must be uploaded or completed on Exxat: • • • • • • • • •

Clinical Documentation (H&P or SOAP if designated by syllabus) Preceptor End of Rotation Evaluation Student Clinical Site & Preceptor Evaluation Signed and stamped Exxat log specific to your rotation Interesting Patient Case Assignment (if applicable) Health Promotion Project (if applicable) Peer reviewed journal article relating to your interesting patient case assignment (if applicable). Elective Interesting Case Presentation (if applicable). Please note that if your presentation is too large to upload to Exxat, please email the PowerPoint to the clinical team prior to your presentation. Three (3) Pharmaceutical “Drug Cards (drug cards may be typed)”

Clerkship Grades The grading for each rotation takes five – six weeks from the previous call back day. Students can find their grades in the evaluation summary section on Exxat. From the dashboard → My placements or To Do List → Evaluation Summary.

Clinical Year Syllabi

PHA 250 FAMILY MEDICINE CLERKSHIP

3 s.h.

Course Coordinator: Jennifer Duperval, MS, PA-C; Email: Jennifer.P.Duperval@hofstra.edu Office: 516-463-6841 COURSE DESCRIPTION: This is an 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. 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

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

•

Use effective interviewing skills to elicit a detailed history Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data and apply the information to recognize normal and abnormal health states Select and interpret appropriate diagnostic tests or lab studies

commonly seen in the office setting

• • •

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

• • • •

Submission of clinical documentation EOR examinations Virtual patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations Virtual patient case assignment

•

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 Discern among acute, chronic, and emerging disease states Adequately document medical information in history & physical notes and progress notes Use effective basic counseling and patient education skills with patients and their families to empower them to participate in their care and enable shared decisionmaking Locate, appraise, and apply evidence from scientific studies to enhance patient care Understand the principles of preventative medicine and how they apply to clinical practice.

•

Accurately document the medical care rendered for patients in primary care

• •

Preceptor evaluation Health Promotion Project

•

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

• • •

Preceptor evaluation EOR examinations Submission of medical documentation Virtual patient case assignment

•

Develop and promote measures to prevent occurrence, progression, and disabling effects of acute and chronic illnesses

•

Health Promotion Project

•

Completing technical skills competently

• •

Preceptor evaluation Competency is measured by meeting the number of procedures listed under “Exxat Procedure Logging” in conjunction with the preceptor’s signature, indicating the procedure was done competently

•

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

Presenting patients to the family medicine preceptor in a concise and organized way Identify the members of the interprofessional team and the roles that they play in the delivery of healthcare.

•

Preceptor evaluation

•

Effectively complete oral presentations

•

Preceptor evaluation

•

Develop relationships and effectively communicate with patients, families, physicians, and other members of the care team Exhibit reliability, accountability, and dependability Exhibit an understanding of the physician assistant profession and the role of a PA Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Provide appropriate referrals Develop skills necessary for lifelong learning Synthesize and analyze clinical data correctly Identify pharmacologic agents and other relevant treatment modalities as they 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

• •

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

Virtual patient case assignment

• •

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 https://paeaonline.org/assessment/ core-tasks-and-objectives/ and apply to each of the conditions outlined at https://paeaonline.org/wpcontent/uploads/2020/03/eorfamilymed-topiclist-20200309.pdf

•

EOR examination

• • •

Demonstrate care that is appropriate • in all patient encounters

Preceptor evaluation

•

Demonstrate care that is effective, safe, equitable and high quality

Appreciate the utility of improving the quality of medical care

•

Quality assurance / • performance improvement assignment

Identify the value of quality improvement initiatives

Know ways to prevent disease and utilize in patient encounters to improve patient outcomes

•

Preceptor evaluation

•

Understand the principles of preventative medicine and how they apply to clinical practice

ASSESSMENT/EVALUATION CRITERIA The grade for the family medicine clerkship is based on the following components: Health Promotion Project & Three Drug Cards Virtual Patient Case Assignment Preceptor Evaluation Clerkship Patient Encounter Requirement Logs

15% P/F 50% P/F

Procedure Logging Requirements End of Clerkship Examination Developmental Disabilities Requirements- if applicable Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission - if applicable Quality Assurance/Performance Improvement Assignment

P/F 35% P/F P/F

P/F

*All assessment and evaluation tools are 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 required to complete 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.

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 on Exxat will result in a grade of zero for this portion of the clerkship grade. VIRTUAL PATIENT CASE ASSIGNMENT FOR EDUCATING STUDENTS Virtual Patient Case Assignments are internet-based virtual patient programs addressing the core clerkship learning objectives. Each student will be assigned two (2) cases within the first two weeks of the clerkship. Both assigned cases need to be completed by the designated due date and uploaded to the session required documents. Failure to complete the assigned Virtual Patient Case Assignments will result in an incomplete grade for this clerkship.

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, dosing, 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 upload them onto Exxat under session required documents prior to the start of call back day. Student name, date and number must be listed on each drug card. Drug cards may be typed and submitted in word format. Should a student fail to produce these cards on a site visit or not upload onto Exxat prior to the start of call back day, they will receive a grade of zero for this portion of the clerkship grade.

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 Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9am of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship. 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. Students should print out a copy of their patient encounter log in “graph” format and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. 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 encounters per week/90 per clerkship

Preventative Acute Chronic Emergent Developmental Disabilities

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

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 encounters during the clinical year Children- 1 y/o – 11 y/o 30 encounters during the clinical year 26

Adolescents- 12 y/o – 17 y/o Adults- 18 y/o – 64 y/o Geriatrics- greater than 65 y/o

30 encounters during the clinical year 100 encounters during the clinical year 100 encounters during the clinical year

PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Exxat 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 “performed”. Students must print out their “procedure list” for each rotation and have preceptors sign off on the procedure list. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. 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 coordinators 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 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 27

blueprints and topic lists. To assist with preparation for the examination, students must use the following Core Tasks and Objectives https://paeaonline.org/assessment/core-tasks-andobjectives/ and apply information to the following topic list of conditions: https://paeaonline.org/wp-content/uploads/2020/03/eor-familymed-topiclist-20200309.pdf Student should also review the breakdown of the exam, which can be found through the following link: https://paeaonline.org/wp-content/uploads/2018/06/family-medicine-blueprint20180524.pdf These end-of-rotation examinations have the same format as the PANCE exam and are good preparation for successfully passing the Physician Assistant National Certifying Examination (PANCE). To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they 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 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. QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation. As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship. Summary: 1. Go to blackboard 2. Go to course PHA 227 3. Click on “discussion board” on left side 4. Click on “Patient Safety Institute CO 2021” 5. Click on course documents on left side and review “IHI Videos” at the bottom of page 6. Follow instructions for discussion board 7. See Professor Gallo with questions REFLECTIVE JOURNALING After each clinical encounter with a patient with developmental disabilities, 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. 28

Commenting on internal struggles or feelings, comfortability 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: “Clinical Encounter”. Date each entry as well. This journal will be submitted via Exxat 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 five reflective journal entry by call back day eight (8). Journal entries should be 1 page in length. Students can submit their reflective journal on Exxat. From the dashboard → placements → by session → to do list → session required documents → developmental disability reflective journaling. 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 Exxat 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 (as described above). Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus, Center for Learning and Innovation (CLI) or remotely via zoom 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 an on-site or remote 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 involving the Center for Learning and Innovation will include a longitudinal patient care experience on-site or remotely via zoom. 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. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal 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. Students can submit their longitudinal patient reflection on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video selfreflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient encounter or does not complete either the SOAP notes or video self-reflection, they will receive two (2) points off their final rotation grade for each assignment not completed. 29

Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard → placements → by session → to do list → eval summary → call back day lecturer evaluation. 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 no 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 255 INTERNAL MEDICINE CLERKSHIP

3 s.h.

Course Coordinator: Thomas Gallo, PA-C, JD; Email: Thomas.Gallo@hofstra.edu Office: 516-463-4382 COURSE DESCRIPTION This clerkship experience 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 “inhouse” 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:

Formulation of assessment plans for patients on the internal medicine service inclusive of geriatric patients

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

Preceptor evaluation Submission of clinical documentation EOR examinations Virtual patient case assignment

•

Knowledge of the different types of clinical patient encounters

•

Discern among acute, chronic, and emerging disease states

Preceptor evaluation Submission of clinical documentation EOR examinations Virtual patient case assignment

•

Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Virtual patient case assignment

•

Utilize critical thinking and problem-solving skills to identify and manage a wide variety of acute and chronic conditions Discern among acute, chronic, and emerging disease states Adequately document medical information in history & physical notes and progress notes Use effective basic counseling and patient education skills with patients and their families to empower them to participate in their care and enable shared decision-making Provide appropriate referrals Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

• •

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

• • • •

Preceptor assessment and sign-off of competency on patient and procedure logs EOR examination Submission of clinical documentation

•

• 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 evaluation Competency is measured by meeting the number of exposures listed under “Exxat Procedure Logging” in conjunction with the preceptor’s signature, indicating the procedure was done competently

•

Preceptor evaluation

•

Effectively complete oral presentations

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

•

Preceptor evaluation

•

• •

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

•

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 https://paeaonline.org/assessment/c ore-tasks-and-objectives/ and apply to each of conditions outlined at https://paeaonline.org/wpcontent/uploads/2020/03/eorinternalmed-topiclist20200309.pdf

•

EOR examination

•

• •

Develop relationships and effectively communicate with patients, families, physicians, and other members of the care team Exhibit reliability accountability, and dependability Exhibit an understanding of the physician assistant profession and the role of a PA 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 they 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

Demonstrate care that is appropriate in all patient encounters

•

Preceptor evaluation

Appreciate the utility of improving the quality of medical care

•

Quality assurance / • performance improvement assignment

•

Demonstrate care that is effective, safe, equitable and high quality

Identify the value of quality improvement initiatives

ASSESSMENT/EVALUATION CRITERIA The grade for the internal medicine clerkship is based on the following components: Virtual Patient Case Assignment P/F 15% One Internal Medicine History & Physical Note Three Drug Cards Preceptor Evaluation 50% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% P/F Developmental Disabilities Curriculum Requirements- if applicable Quality Assurance/Performance P/F Improvement Assignment P/F Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission - if applicable *All assessment and evaluation tools are in the back of the handbook VIRTUAL PATIENT CASE ASSIGNMENT FOR EDUCATING STUDENTS Virtual Patient Case Assignments are internet-based virtual patient programs addressing the core clerkship learning objectives. Each student will be assigned two (2) cases within the first two weeks of the clerkship. Both assigned cases need to be completed by the designated due date and uploaded to the session required documents. Failure to complete the assigned Virtual Patient Case Assignments 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 using Microsoft to session required documents on Exxat. 34

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. • 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 note. All notes must be submitted to Exxat in session required documents prior to the start of 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, dosing, 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 upload them onto Exxat under session required documents prior to the start of call back day. Student name, date and number must be listed on each drug card. Drug cards may be typed and submitted in word format. Should a student fail to produce these cards on a site visit or not upload onto Exxat prior to the start of 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 based on 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 work collaboratively 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 Exxat under generalized documents for all students in your student packet. The preceptor evaluation will be sent to the preceptor via email from Exxat during the last week of each rotation. 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. 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.” 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, additional evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure. 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 Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information 35

regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9am of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship. 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. Students should print out a copy of their patient encounter log in “graph” format and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. 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 encounters per week/60 per clerkship

Preventative Acute Chronic Emergent Developmental Disabilities

list. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. 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 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

Rectal Examinations

*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 https://paeaonline.org/assessment/core-tasks-and-objectives/ and apply information to the following topic list of conditions https://paeaonline.org/wp-content/uploads/2020/03/eorinternalmed-topiclist-20200309.pdf Student should also review the breakdown of the exam, which can be found through the following link: https://paeaonline.org/wpcontent/uploads/2018/06/internal-medicine-blueprint-20180524.pdf These end-of-rotation 37

examinations have the same format as the PANCE exam and are good preparation for successfully passing the Physician Assistant National Certifying Examination (PANCE). To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they 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 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 QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation. As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship. Summary: 1. Go to blackboard 2. Go to course PHA 227 3. Click on “discussion board” on left side 4. Click on “Patient Safety Institute CO 2021” 5. Click on course documents on left side and review “IHI Videos” at the bottom of page 6. Follow instructions for discussion board 7. See Professor Gallo with questions. REFLECTIVE JOURNALING After each clinical encounter with a patient with developmental disabilities, 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, comfortability 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: “Clinical Encounter”. Date each entry as well. This journal will be submitted via Exxat 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 38

assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of five reflective journal entry by call back day eight (8). Journal entries should be 12 pages in length. Students can submit their reflective journal on Exxat. From the dashboard → placements → by session → to do list → session required documents → developmental disability reflective journaling. 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 Exxat 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 (as described above). Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus, Center for Learning and Innovation (CLI) or remotely via zoom 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 an on-site or remote 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 involving the Center for Learning and Innovation will include a longitudinal patient care experience on-site or remotely via zoom. 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. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal 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. Students can submit their longitudinal patient reflection on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video self-reflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient encounter or does not complete either the SOAP notes or video self-reflection, they 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 Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard → placements → by session → to do list → eval summary → call back day lecturer evaluation. Failure to do so will result in a three-point deduction from the overall rotation grade. 39

CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is no 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.

Course Coordinator: Jennifer Duperval, MS, PA-C; Email: Jennifer.P.Duperval@hofstra.edu Office: 516-463-6841 DESCRIPTION During clinical experience 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 life- span. 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:

Evaluation of the gynecologic patient by obtaining a thorough patient history, performing a physical exam, to include a breast examination and a pelvic examination and obtaining appropriate diagnostic and laboratory data

Elicit a detailed medical history, perform physical examination on a gynecologic patient, accurately record all data

Utilizing information obtained from the history, physical and diagnostic data to formulate differential diagnoses for obstetric and gynecologic patients Knowledge of the different types of clinical patient encounters

Develop evidence based, best practice, patient-centered management plans for obstetric and gynecologic patients

• • •

Preceptor evaluation EOR examinations

•

• Preceptor assessment and sign-off of competency on patient and procedure logs • EOR examination Submission of clinical documentation • •

•

Preceptor evaluation EOR examinations

• •

•

Accurately document pre-natal, obstetric and gynecologic care

•

Preceptor evaluation

Providing patient education, to include appropriate screening recommendations, disease prevention, family planning, prenatal care, and menopause to obstetric and gynecologic patients and their families

• • •

Preceptor evaluation • EOR examinations Interesting patient case assignment

Completing technical skills competently

• •

•

• • •

Utilize critical thinking and problem-solving skills to identify and manage pediatric care Locate, appraise, and apply evidence from scientific studies to enhance patient care Accurately and adequately document medical information Use effective basic counseling and patient education skills with patients and their families to empower them to participate in their care and enable shared decisionmaking Provide appropriate referrals Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

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 them families and members of the interprofessional team

•

Preceptor evaluation

•

Effectively complete oral presentations

•

Preceptor evaluation

•

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

• • • •

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

•

Preceptor evaluation

•

Drug Cards

•

Utilize the PAEA Core Tasks and Functions list found at https://paeaonline.org/assessment /core-tasks-and-objectives/ and apply to each of the pediatric conditions outlined at https://paeaonline.org/wpcontent/uploads/2020/03/eorwomenshealth-topiclist20200309.pdf

•

EOR examination

•

Demonstrate care that is appropriate in all patient encounters

• •

•

Preceptor evaluation

•

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 Demonstrate care that is effective, safe, equitable and high quality

Appreciate the utility of improving the quality of medical care

•

Quality assurance / performance improvement assignment

•

Identify the value of quality improvement initiatives

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: H & P & Three Drug Cards 15% Preceptor Evaluation 50% 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 & P/F Quality Assurance/Performance Improvement Assignment Medical Documentation Submission - if applicable *All assessment and evaluation tools are in the back of the handbook SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one history and physical note while on their ob/gyn clerkship using Microsoft to session required documents on Exxat. 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. • 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 note. All notes must be submitted to Exxat in session required documents prior to the start of 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 ob/gyn medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects, dosing, and cost of medication. The student is required to present these cards on the day of a site visit and be prepared to answer 44

questions regarding the drugs selected. Students who do not have a site visit should upload them onto Exxat under session required documents prior to the start of call back day. Student name, date and number must be listed on each drug card. Drug cards may be typed and submitted in word format. Should a student fail to produce these cards on a site visit or not upload onto Exxat prior to the start of 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 based on 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 work collaboratively 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 Exxat under generalized documents for all students in your student packet. The preceptor evaluation will be sent to the preceptor via email from Exxat during the last week of each rotation. 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. 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.” 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, additional evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure. 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 Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9am of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship. The minimum ob/gyn 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. Students should print out a copy of their patient encounter log and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. Should a student not meet these competencies during their ob/gyn 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 encounters per week/60 per clerkship 15 encounters per clerkship 15 encounters per clerkship

More than one failure to log minimum weekly patient encounters on time will result in a three (3) point deduction from the OVERALL ROTATION GRADE. Each additional failure to log will result in a one (1) point deduction from the overall rotation grade. CLINICAL YEAR PATIENT ENCOUNTER REQUIREMENTS Although students must log specific Ob/GYN encounters during the Ob/GYN 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 Types of Clinical Encounters Preventative 20 encounters during clinical year Acute 20 encounters during clinical year Chronic 20 encounters during clinical year Emergent 20 encounters during clinical year Developmental Disabilities 15 encounters during clinical year Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 encounters during the clinical year Children- 1 y/o – 11 y/o 30 encounters during the clinical year Adolescents- 12 y/o – 17 y/o 30 encounters during the clinical year Adults- 18 y/o – 64 y/o 100 encounters during the clinical year Geriatrics- greater than 65 y/o 100 encounters during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Exxat 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 “performed”. Students must print out their “procedure list” for each rotation and have preceptors sign off on the procedure list. Their signature not only confirms exposure but indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. 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 ob/gyn 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. 46

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 obstetrics/gynecology 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 https://paeaonline.org/assessment/core-tasks-and-objectives/ and apply information to. https://paeaonline.org/wp-content/uploads/2020/03/eor-womenshealth-topiclist-20200309.pdf Student should also review the breakdown of the exam which can be found through the following link: https://paeaonline.org/wp-content/uploads/2018/06/womens-health-blueprint20180524.pdf These end- of- rotation examinations have the same format as the Physician Assistant National Certifying Examination (PANCE) and are good preparation for successfully passing the PANCE. To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they 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 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.

QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation. As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship. Summary: 1. Go to blackboard 2. Go to course PHA 227 3. Click on “discussion board” on left side 4. Click on “Patient Safety Institute CO 2021” 5. Click on course documents on left side and review “IHI Videos” at the bottom of page 6. Follow instructions for discussion board 7. See Professor Gallo with questions. REFLECTIVE JOURNALING After 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, comfortability 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: “Clinical Encounter”. Date each entry as well. This journal will be submitted via Exxat on call back day at the end of the 3 rd 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 five reflective journal entry by call back day eight (8). Journal entries should be 1 page in length. Students can submit their reflective journal on Exxat. From the dashboard → placements → by session → to do list → session required documents → developmental disability reflective journaling. 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 Exxat system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. 48

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 (as described above). Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus, Center for Learning and Innovation (CLI) or remotely via zoom 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 an onsite or remote 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 involving the Center for Learning and Innovation will include a longitudinal patient care experience on-site or remotely via zoom. 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. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal 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. Students can submit their longitudinal patient reflection on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video self-reflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient encounter or does not complete either the SOAP notes or video self-reflection, they 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 Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard → placements → by session → to do list → eval summary → call back day lecturer evaluation. 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 no 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 49

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 Coordinator: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu Office: 516-463-4233 COURSE DESCRIPTION This course is a 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 post- op 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

• •

•

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

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning, and problemsolving abilities: • Use effective interviewing skills to elicit a detailed history • Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data and apply the information to recognize normal and abnormal health states

Knowledge of the different types of clinical patient encounters

•

• • Assessment of the pre-surgical and post-surgical patient.

• •

• • Provide intraoperative care of surgical patient.

Formulate assessment plans for surgical patients

• •

• • • •

Develop management plans for surgical patients

• • •

Accurately documenting surgical • care in patient charts • Providing patient education and counseling for surgical patients

• • •

Preceptor assessment and sign-off of competency on patient encounters EOR examination Submission of clinical documentation Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs Submission of clinical documentation EOR examination

•

Discern among acute, chronic, and emerging disease states

•

Elicit a detailed medical history, perform appropriate physical examination and accurately record all data Identify and formulate an appropriate assessment and management plan

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

•

• •

• • •

•

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures Select and interpret appropriate screening and diagnostic studies Synthesize and analyze clinical data correctly Utilize critical thinking and problem-solving skills to identify and manage surgical conditions Provide appropriate referrals Accurately document medical information Use effective basic counseling and patient education skills with patients and their families to empower them to participate in their care and enable shared decisionmaking Provide appropriate referrals

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

• •

•

Effectively complete oral presentations

•

Preceptor evaluation

•

Develop relations and effectively communicate with patients, families, physicians, and other members of the care team Exhibit reliability, accountability, and dependability Exhibit an understanding of the physician assistant profession and the role of a PA Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Demonstrate care that is effective, safe, equitable, and high quality

•

• •

Demonstrate clinical reasoning and problem-solving ability when managing the surgical patient

•

Preceptor evaluation

•

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

Demonstrate clinical reasoning and problem-solving ability when managing the surgical patient

•

Preceptor evaluation

•

Demonstrate care that is effective, safe, equitable, and high quality

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

•

Drug Cards

•

Understand issues related to quality in a healthcare setting

•

Quality Assurance & Quality Improvement Project

•

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 Identify the value of quality improvement initiatives

Utilize the PAEA Core Tasks and Functions list found at https://paeaonline.org/assessment /core-tasks-and-objectives/ and apply to each of surgical conditions outlined at https://paeaonline.org/wpcontent/uploads/2020/03/eorgeneralsurgery-topiclist20200309.pdf Demonstrate care that is appropriate in all patient encounters

•

EOR examination

• • •

•

Preceptor evaluation

•

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 Demonstrate care that is effective, safe, equitable and high quality

Appreciate the utility of improving the quality of medical care

•

Quality assurance / • performance improvement assignment

Identify the value of quality improvement initiatives

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: 15% One surgical SOAP Note Three surgical Drug Cards Preceptor Evaluation 50% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% P/F Developmental Disabilities Curriculum Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission - if applicable P/F Quality Assurance/Performance Improvement Assignment *All assessment and evaluation tools are in the back of the handbook SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one typed SOAP note while on their surgery clerkship to session required documents on Exxat. The note should be written legibly, accurately, and adequately. Please note: • SOAP notes are not the same as progress notes. Progress notes will not fulfill 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. • Photocopies are not acceptable. • SOAP notes are not acceptable on hospital forms. • No identifying information may appear on any notes, as this violates HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that 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 medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects, dosing, 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 upload them onto Exxat under session required documents prior to the start of call back day. Student name, date and number must be listed on each drug card. Drug cards may be typed and submitted in word format. Should a student fail to produce these cards on a site visit or not upload onto Exxat prior to the start of 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 based on 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 work collaboratively 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 Exxat under generalized documents for all students in your student packet. The preceptor evaluation will be sent to the preceptor via email from Exxat during the last week of each rotation. 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. 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.” 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, additional evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure. 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 Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9am of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship. The minimum surgery 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 56

throughout the clinical phase of the program. Students should print out a copy of their patient encounter log in “graph” format and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. Should a student not meet these competencies during their surgery clerkship, 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 encounters per week/60 per surgical rotation 10 encounters per surgical rotation 10 encounters per surgical rotation 10 encounters per surgical rotation

More than one failure to log minimum weekly patient encounters on time will result in a three (3) point deduction from the overall rotation grade. Each additional failure to log will result in a one (1) point deduction from the overall rotation grade. 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 Emergent Developmental Disabilities

Medical Care Across the Life Span Encounters 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 encounters during the clinical year 30 encounters during the clinical year 30 encounters during the clinical year 100 encounters during the clinical year 100 encounters during the clinical year

PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log several procedures. These procedures are tracked through the Exxat 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 “performed”. Students must print out their “procedure list” for each rotation and have preceptors sign off on the procedure list. Their signature not only confirms exposure but indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. 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. 57

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 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 https://paeaonline.org/assessment/core-tasks-and-objectives/ and apply information to the following topic list of conditions. https://paeaonline.org/wp-content/uploads/2020/03/eor-generalsurgerytopiclist-20200309.pdf should also review the breakdown of the exam which can be found through the following link https://paeaonline.org/wp-content/uploads/2018/06/general-surgery-blueprint20180524.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). To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they 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 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.

QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation. As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship. Summary: 1. Go to blackboard 2. Go to course PHA 227 3. Click on “discussion board” on left side 4. Click on “Patient Safety Institute CO 2021” 5. Click on course documents on left side and review “IHI Videos” at the bottom of page 6. Follow instructions for discussion board 7. See Professor Gallo with questions. REFLECTIVE JOURNALING After each clinical encounter with a patient with developmental disabilities, 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, comfortability 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: “Clinical Encounter”. Date each entry as well. This journal will be submitted via Exxat 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 five reflective journal entry by call back day eight (8). Journal entries should be 1 page in length. Students can submit their reflective journal on Exxat. From the dashboard → placements → by session → to do list → session required documents → developmental disability reflective journaling. 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 Exxat system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. 59

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 (as described above). Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus, Center for Learning and Innovation (CLI) or remotely via zoom 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 an on-site or remote 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 involving the Center for Learning and Innovation will include a longitudinal patient care experience on-site or remotely via zoom. 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. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal 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. Students can submit their longitudinal patient reflection on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video self-reflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient encounter or does not complete either the SOAP notes or video self-reflection, they 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 Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard → placements → by session → to do list → eval summary → call back day lecturer evaluation. 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 no 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

3 s.h.

Course Coordinator: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu Office: 516-463-4233 COURSE DESCRIPTION This is a 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:

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

Use effective interviewing skills to elicit a detailed history Perform problem-focused physical examination

Applicable, cost-effective use of laboratory tests and other diagnostic data to aid in the diagnosis of patients in the emergency room Recognize patients who require emergency medical intervention (including but not limited to trauma, chest pain, sepsis, CVA, shock, respiratory failure, surgical abdomen),

• •

Preceptor evaluation EOR examination

• •

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

Synthesize and analyze all clinical data correctly to aid in prompt diagnosis Discern among acute, chronic, and emerging disease states

Preceptor evaluation • EOR examinations Interesting patient case assignment •

Utilize critical thinking and problem-solving skills to manage care of psychiatric patients Locate, appraise and apply evidence from scientific studies to enhance patient care Provide appropriate referrals Accurately document medical information

•

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 medicine/best practice management plans for patient’s seen in the emergency department

• • • •

• • •

•

• •

Comprehensive and thorough documentation in the emergency department

• •

Preceptor evaluation Interesting patient case assignment

Providing patient education, to include follow-up care, to patients in the emergency department and their families

• •

Preceptor evaluation • Interesting patient case assignment Emergency Medicine Simulation Activity

•

Select and interpret appropriate screening and diagnostic studies

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 with patients and their families to empower them to participate in their care and enable shared decisionmaking Provide appropriate referrals

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 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 Emergency Medicine Simulation Activity

•

Effectively complete oral presentations

• •

Preceptor evaluation Emergency Medicine Simulation Exercise

•

• • • •

Demonstrate clinical reasoning and problem-solving ability when managing a patient

•

Preceptor evaluation

•

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

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 •

Develop skills necessary for life-long learning

• • •

Drug Cards • Interesting patient case Emergency Medicine Simulation Activity

Understand issues related to quality in a healthcare setting

•

Quality Assurance & Quality Improvement Project

•

Identify pharmacologic agents and other relevant treatment modalities as they relate to patients with emergent conditions to include understanding the indications, contraindications, side effects, interactions and adverse reactions Identify the value of quality improvement initiatives

Utilize the PAEA Core Tasks and Functions list found at https://paeaonline.org/assessment /core-tasks-and-objectives/ and apply to each of the psychiatric conditions outlined at https://paeaonline.org/wpcontent/uploads/2020/03/eoremergencymed-topiclist20200309.pdf

•

EOR examination

•

Demonstrate care that is appropriate in all patient encounters

•

Preceptor evaluation

•

Demonstrate care that is effective, safe, equitable and high quality

Appreciate the utility of improving the quality of medical care

•

Quality assurance / performance improvement assignment

•

Identify the value of quality improvement initiatives

• •

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

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment & Three Drug 15% Cards Preceptor Evaluation 50% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F Computer Operated Adult/Child Simulators P/F End of Clerkship Examination 35% Developmental Disabilities Curriculum P/F Requirements- if applicable P/F Quality Assurance/Performance Improvement Assignment P/F Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission- if applicable *All assessment and evaluation tools are 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 uploaded onto Exxat prior to the start of 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. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. 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, dosing, 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 upload them onto Exxat under session required documents prior to the start of call back day. Student name, date and number must be listed on each drug card. Drug cards may be typed and submitted in word format. Should a student fail to produce these cards on a site visit or not upload onto Exxat prior to the start of 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 based on 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 work collaboratively 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 Exxat under generalized documents for all students in your student packet. The preceptor evaluation will be sent to the preceptor via email from Exxat during the last week of each rotation. 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. 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.” 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, additional evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure. 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 Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9am of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship. 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 will increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Students should print out a copy of their patient encounter log in “graph” format and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. Should a student not meet these competencies during their emergency 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. Emergency Medicine

15 encounters per week/90 per clerkship

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

Medical Care Across the Life Span Encounters 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 encounters during the clinical year 30 encounters during the clinical year 30 encounters during the clinical year 100 encounters during the clinical year 100 encounters during the clinical year

PROCEDURE LOGGING REQUIREMENTS: Students are required to perform and log a number of procedures. These procedures are tracked through the Exxat 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 “performed”. Students must print out their “procedure list” for each rotation and have preceptors sign off on the procedure list. Their signature not only confirms exposure but indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. 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 68

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. Students will receive an email from the clinical coordinators with the date and time of your simulation session within the first two weeks of the clerkship. If CLI should be closed for any reason, all efforts will be made to make-up simulation at a later date. Failure to attend and participate in the clinical scenarios at CLI 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 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 https://paeaonline.org/assessment/core-tasks-and-objectives/ and apply information to https://paeaonline.org/wp-content/uploads/2020/03/eor-emergencymedtopiclist-20200309.pdf Student should also review the breakdown of the exam which can be found through the following link: https://paeaonline.org/wp-content/uploads/2018/06/emergencymedicine-blueprint-20180524.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. To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they 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 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. QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation. As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. 69

This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship. Summary: 1. Go to blackboard 2. Go to course PHA 227 3. Click on “discussion board” on left side 4. Click on “Patient Safety Institute CO 2021” 5. Click on course documents on left side and review “IHI Videos” at the bottom of page 6. Follow instructions for discussion board 7. See Professor Gallo with questions. REFLECTIVE JOURNALING After each clinical encounter with a patient with developmental disabilities, 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, comfortability 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: “Clinical Encounter”. Date each entry as well. This journal will be submitted via Exxat 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 five reflective journal entry by call back day eight (8). Journal entries should be 1 page in length. Students can submit their reflective journal on Exxat. From the dashboard → placements → by session → to do list → session required documents → developmental disability reflective journaling. 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 Exxat 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 (as described above). Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus, Center for Learning and Innovation (CLI) or remotely via zoom 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 70

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 an on-site or remote 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 involving the Center for Learning and Innovation will include a longitudinal patient care experience on-site or remotely via zoom. 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. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal 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. Students can submit their longitudinal patient reflection on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video self-reflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient encounter or does not complete either the SOAP notes or video self-reflection, they 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 Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard → placements → by session → to do list → eval summary → call back day lecturer evaluation. 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 no 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 71

university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075.

PHA 280 PEDIATRIC CLERKSHIP

3 s.h.

Course Coordinator: Thomas Gallo, PA-C, JD Email: Thomas.Gallo@hofstra.edu Office: 516-463-4382 COURSE DESCRIPTION This course is a 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 childcare, 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 ageappropriate physical exam, obtaining and interpreting laboratory and diagnostic studies while recognizing normal ageappropriate variations Recognize normal and abnormal patterns of pediatric growth and development and milestone achievement. Identify patients

• •

• • •

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 problemsolving 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

who require early intervention and initiate proper referral •

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

• • • •

competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation Submission of clinical documentation EOR examinations

developmental screening tools and accurately record all data

• • •

Develop evidence-based medicine/best practice, patientcentered 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

• • •

Preceptor evaluation Submission of clinical documentation EOR examinations

•

Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation

•

• 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

• •

•

• •

•

Select and interpret appropriate diagnostic tests, lab studies or screening tools Synthesize and analyze all clinical data correctly to aid in diagnosis Discern among acute, chronic, and emerging disease states Utilize critical thinking and problem-solving skills to identify and manage pediatric care Locate, appraise, and apply evidence from scientific studies to enhance patient care Accurately and adequately document medical information Use effective basic counseling and patient education skills with patients and their families to empower them to participate in their care and enable shared decisionmaking Provide appropriate referrals 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 pediatric patients and their families and members of the interprofessional team

•

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, drug interactions and correct dosing parameters of medications commonly used in pediatric patients

•

Demonstrate care that is appropriate in all patient encounters

•

Submission of medical documentation Preceptor evaluation

Develop skills necessary for life-long learning

•

Drug Cards

•

EOR examination

•

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

• •

•

Preceptor evaluation

•

Demonstrate care that is effective, safe, equitable and high quality

Appreciate the utility of improving the quality of medical care

•

Quality assurance / • performance improvement assignment

Identify the value of quality improvement initiatives

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: One Pediatric SOAP Note & 15% Three Pediatric 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 Quality Assurance/Performance Improvement Assignment Participation, Reflective Journal Entry & Medical Documentation Submission - if applicable

50% P/F P/F 35% P/F P/F P/F P/F

*All assessment and evaluation tools are in the back of the handbook

SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit to Exxat one (1) SOAP note, using ONETOUCH EMR while on their pediatric clerkship in session required documents. 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 violating HIPAA regulations. Notes submitted with identifying information will earn a grade of zero for that 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. 76

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, dosing, 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 upload them onto Exxat under session required documents prior to the start of call back day. Student name, date and number must be listed on each drug card. Drug cards can be typed and submitted via word. Should a student fail to produce these cards on a site visit or not upload onto Exxat prior to the start of 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 based on 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 work collaboratively 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 Exxat under generalized documents for all students in your student packet. The preceptor evaluation will be sent to the preceptor via email from Exxat during the last week of each rotation. 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. 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.” 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, additional evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure. 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 Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9 a.m. of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship.

The minimum pediatrics 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. Students should print out a copy of their patient encounter log in “graph” format and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. 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 encounters per week/90 per clerkship

20 encounters during clinical year

Acute Chronic Emergent Developmental Disabilities

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

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 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 https://paeaonline.org/assessment/core-tasks-and-objectives/ and apply information to https://paeaonline.org/wp-content/uploads/2020/03/eor-pediatrics-topiclist-20200309.pdf Student should also review the breakdown of the exam which can be found through the following link: https://paeaonline.org/wp-content/uploads/2018/06/pediatrics-blueprint-20180608.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. To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they 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 to pass the clerkship. A grade of 65 % will be entered for this portion of the final grade, regardless of the passing grade 79

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. QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation. As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship. Summary: 1. Go to blackboard 2. Go to course PHA 227 3. Click on “discussion board” on left side 4. Click on “Patient Safety Institute CO 2021” 5. Click on course documents on left side and review “IHI Videos” at the bottom of page 6. Follow instructions for discussion board 7. See Professor Gallo with questions. REFLECTIVE JOURNALING After each clinical encounter with a patient with developmental disabilities, 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, comfortability 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: “Clinical Encounter”. Date each entry as well. This journal will be submitted via Exxat 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 five reflective journal entry by call back day eight (8). Journal entries should be 1page in length. Students can submit their reflective journal on Exxat. From the dashboard → placements → by session → to do list → session required documents → developmental disability reflective journaling. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. 80

CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Exxat 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 (as described above). Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus, Center for Learning and Innovation (CLI) or remotely via zoom 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 an on-site or remote 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 involving the Center for Learning and Innovation will include a longitudinal patient care experience on-site or remotely via zoom. 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. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal 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. Students can submit their longitudinal patient reflection on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video self-reflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient encounter or does not complete either the SOAP notes or video self-reflection, they 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 Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard → placements → by session → to do list → eval summary → call back day lecturer evaluation. 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 no 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. 81

PHA 285 PSYCHIATRY CLERKSHIP

3 s.h.

Course Coordinator: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu Office: 516-463-4233 COURSE DESCRIPTION This is a 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 screening and diagnostic studies

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.

• •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs Interesting patient case assignment EOR examination

•

• •

Utilize information obtained from the H&P, laboratory, and diagnostic studies to determine psychiatric differential diagnoses according to DSM-V criteria

• • •

Preceptor evaluation • EOR examinations Interesting patient case assignment

Develop evidence-based medicine/best practice, patient-centered management plans for patients with mental illness

• • •

Preceptor evaluation • EOR examinations Interesting patient case assignment •

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

•

Preceptor evaluation

• • •

Preceptor evaluation • EOR examinations Interesting patient case assignment

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

• •

•

• • •

•

Elicit a detailed medical history, perform patient appropriate physical examination, utilize appropriate screening tools, and accurately record all data Provide appropriate referral Discern among acute, chronic, and emerging disease states Synthesize and analyze all clinical data correctly to aid in diagnosis

Utilize critical thinking and problem-solving skills to manage care of psychiatric patients Locate, appraise, and apply evidence from scientific studies to enhance patient care Accurately document medical information Use effective basic counseling and patient education skills with patients and their families to empower them to participate in their care and enable shared decisionmaking Provide appropriate referrals Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

Effectively complete oral presentations

Communicating appropriately and respectfully with psychiatric patients and their families and members of the interprofessional team

•

Preceptor evaluation

• • • • •

Search for relevant information, utilizing appropriate data sources, and critically appraise to make evidence-based decisions in patient care Demonstrate clinical reasoning and problem-solving ability when managing the psychiatric patient

•

Interesting patient case •

•

Preceptor evaluation

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) Understand issues related to quality in a healthcare setting

• •

Drug Cards • Interesting patient case

•

Quality Assurance & Quality Improvement Project

•

EOR examination

•

Utilize the PAEA Core Tasks and • Functions list found at https://paeaonline.org/assessment /core-tasks-and-objectives/ and apply to each of the psychiatric conditions outlined at https://paeaonline.org/wpcontent/uploads/2020/03/eor-psychtopiclist-20200309.pdf Demonstrate care that is appropriate in all patient encounters

•

• •

Preceptor evaluation

•

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

Demonstrate care that is effective, safe, equitable, and high quality

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 Identify the value of quality improvement initiatives

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 Demonstrate care that is effective, safe, equitable and high quality

Appreciate the utility of improving the quality of medical care

•

Quality assurance / performance improvement assignment

•

Identify the value of quality improvement initiatives

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

15% 50% P/F P/F

End of Clerkship Examination 35% Developmental Disabilities Curriculum P/F Requirements- if applicable Quality Assurance/Performance Improvement P/F Assignment P/F Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission - if applicable *All assessment and evaluation tools are 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 uploaded onto Exxat prior to the start of 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, peerreviewed 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 H & P note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their psychiatry medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects, dosing, 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 upload them 86

onto Exxat under session required documents prior to the start of call back day. Student name, date and number must be listed on each drug card. Drug cards can be typed and submitted in word format. Should a student fail to produce these cards on a site visit or not upload onto Exxat prior to the start of call back day, they will a grade of zero for this portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor based on 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 work collaboratively 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 Exxat under generalized documents for all students in your student packet. The preceptor evaluation will be sent to the preceptor via email from Exxat during the last week beginning of each rotation. 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. 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.” 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, additional evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure. 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 Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9am of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship. 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 will increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Students should print out a copy of their patient encounter log in “graph” format and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. 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 encounters per week/60 per clerkship 87

Preventative Acute Chronic Emergent Developmental Disabilities

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 encounters during the clinical year Children- 1 y/o – 11 y/o 30 encounters during the clinical year Adolescents- 12 y/o – 17 y/o 30 encounters during the clinical year Adults- 18 y/o – 64 y/o 100 encounters during the clinical year Geriatrics- greater than 65 y/o 100 encounters during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Exxat 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 “performed”. Students must print out their “procedure list” for each rotation and have preceptors sign off on the procedure list. Their signature not only confirms exposure but indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. 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 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 discipline of psychiatry, 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 https://paeaonline.org/assessment/core-tasks-andobjectives/ and apply information to https://paeaonline.org/wp-content/uploads/2020/03/eorpsych-topiclist-20200309.pdf Student should also review the breakdown of the exam which can be found through the following link: https://paeaonline.org/wpcontent/uploads/2018/06/psychiatry-blueprint-20180608.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. To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they 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 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. QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation. 89

As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship. Summary: 1. Go to blackboard 2. Go to course PHA 227 3. Click on “discussion board” on left side 4. Click on “Patient Safety Institute CO 2021” 5. Click on course documents on left side and review “IHI Videos” at the bottom of page 6. Follow instructions for discussion board 7. See Professor Gallo with questions. REFLECTIVE JOURNALING After each clinical encounter with a patient with developmental disabilities, 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, comfortability 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: “Clinical Encounter”. Date each entry as well. This journal will be submitted via Exxat 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 five reflective journal entry by call back day eight (8). Journal entries should be 1page in length. Students can submit their reflective journal on Exxat. From the dashboard → placements → by session → to do list → session required documents → developmental disability reflective journaling. 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 Exxat 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 (as described above). Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus, Center for Learning and Innovation (CLI) or remotely via zoom on the last day of their clerkship for a day of activities. Call back day activities can include lectures, case 90

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 an on-site or remote 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 involving the Center for Learning and Innovation will include a longitudinal patient care experience on-site or remotely via zoom. 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. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal 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. Students can submit their longitudinal patient reflection on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video self-reflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient encounter or does not complete either the SOAP notes or video self-reflection, they 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 Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard → placements → by session → to do list → eval summary → call back day lecturer evaluation. 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 no 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

3 s.h.

Course Coordinator: Jennifer Duperval, MS, PA-C; Email: Jennifer.P.Duperval@hofstra.edu Office: 516-463-6841 COURSE DESCRIPTION This is a 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:

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

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

•

Use effective interviewing skills to elicit a detailed history Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data and apply the information to recognize normal and abnormal health states Determine the etiologies, risk factors and epidemiology for various medical and surgical conditions

• •

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

• •

Preceptor evaluation Interesting Patient Presentation

•

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 seen on the elective discipline

• •

•

Preceptor evaluation

• • •

•

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 Discern among acute, chronic, and emerging disease states 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 with patients and their families to empower them to participate in their care and enable shared decisionmaking Provide appropriate referrals 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

• • •

Demonstrate care that is appropriate in all patient encounters

•

Preceptor evaluation

Appreciate the utility of improving the quality of medical care

•

Quality assurance / • performance improvement assignment

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

50% 50% P/F P/F

Developmental Disabilities Curriculum P/F Requirements- if applicable P/F Quality Assurance/Performance Improvement Assignment P/F Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission - if applicable *All assessment and evaluation tools are in the back of the handbook

•

Identify the value of quality improvement initiatives

ELECTIVE INTERESTING PATIENT CASE PRESENTATION The elective 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 twenty minutes in length and submitted to Exxat in session required documents prior to the start of call back day. If your file is too large to submit on Exxat, please send to the clinical team via email. 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 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. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor based on 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 work collaboratively 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 Exxat under generalized documents for all students in your student packet. The preceptor evaluation will be sent to the preceptor via email from Exxat during the last week of each rotation. 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. 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.” 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, additional evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure. 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 Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9am of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship. 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 96

throughout the clinical phase of the program. Students should print out a copy of their patient encounter log in “graph” format and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. Should a student not meet these competencies during their elective 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 encounters per week/30 per clerkship

Preventative Acute Chronic Emergent Developmental Disabilities

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 encounters during the clinical year Children- 1 y/o – 11 y/o 30 encounters during the clinical year Adolescents- 12 y/o – 17 y/o 30 encounters during the clinical year Adults- 18 y/o – 64 y/o 100 encounters during the clinical year Geriatrics- greater than 65 y/o 100 encounters during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Exxat 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 “performed”. Students must print out their “procedure list” for each rotation and have preceptors sign off on the procedure list. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. During your elective clerkship, it is recommended that you focus on the procedures listed below, as well as procedures unique to the elective clerkship. 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 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. 97

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) QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation. As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship. Summary: 1. Go to blackboard 2. Go to course PHA 227 98

3. 4. 5. 6. 7.

Click on “discussion board” on left side Click on “Patient Safety Institute CO 2021” Click on course documents on left side and review “IHI Videos” at the bottom of page Follow instructions for discussion board See Professor Gallo with questions.

REFLECTIVE JOURNALING After each clinical encounter with a patient with developmental disabilities, 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, comfortability 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: “Clinical Encounter”. Date each entry as well. This journal will be submitted via Exxat 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 five reflective journal entry by call back day eight (8). Journal entries should be 1 page in length. Students can submit their reflective journal on Exxat. From the dashboard → placements → by session → to do list → session required documents → developmental disability reflective journaling. 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 Exxat 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 (as described above). Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus, Center for Learning and Innovation (CLI) or remotely via zoom 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 an on-site or remote 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 involving the Center for Learning and Innovation will include a longitudinal patient care experience on-site or remotely via zoom. 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. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard → placements → by session → to do list → session required documents 99

→ longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal 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. Students can submit their longitudinal patient reflection on Exxat. From the dashboard → placements → by session → to do list → session required documents → longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video self-reflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient encounter or does not complete either the SOAP notes or video self-reflection, they 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 Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard → placements → by session → to do list → eval summary → call back day lecturer evaluation. 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 no 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.

100

CLINICAL YEAR FORMS

101

Interesting Case Presentation Evaluation Form Student Rotation Type

Faculty Site

Rotation Dates

Date_________________ 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

COMMENTS 0 0 0 0

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

PHYSICAL EXAM: Focused physical exam-including all components 0 Includes pertinent positive & negative PE findings 0

1 1

2 3 4 2 3 4

5 5

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

0 0

1 1

2 3 4 2 3 4

5 5

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

0 0 0

1 1 1

2 3 4 2 3 4 2 3 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

2 1 2 1

4 2 4 2

8 4 8 4

10 5 10 5

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

4 6 8

PROFESSIONALISM:

2 3 4

6 3 6 3

TOTAL POINTS Faculty Signature:

Date:

102

Elective Interesting Case Presentation Evaluation Form Student Rotation Type

Faculty Site

Date

Rotation Dates

Preceptor Name

COMMENTS 0 0 0 0

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

PHYSICAL EXAM: Focused physical exam-including all components 0 Includes pertinent positive & negative PE findings 0

1 1

2 3 4 2 3 4

5 5

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

0 0

1 1

2 3 4 2 3 4

5 5

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

0 0 0

1 1 1

2 3 4 2 3 4 2 3 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

2 1 2 1

4 2 4 2

8 4 8 4

10 5 10 5

PATIENT EDUCATION: Development of patient education materials

4 6 8

PROFESSIONALISM:

2 3 4

6 3 6 3

TOTAL POINTS Faculty Signature:

Date:

103

Mid-Clerkship Evaluation Please complete this evaluation by the end of the third week of the clerkship. The midclerkship 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. ROTATION: 1- FM 2- Med 3- Ob/Gyn 4- Surg 5- EM 6- Psych 7- Peds 8- Elective: ROTATION NUMBER: 12 3 4 5 6 7 8

ROTATION SITE:

Please rate the following learning experiences as appropriate to your rotation 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) Appropriateness of supervision (i.e., is the supervisor adequately supervising patient encounters)? 2) Opportunity to perform history and physical examinations? 3) Opportunity to formulate differential diagnosis and management plans? 4) Opportunity to perform oral presentations? 5) Opportunity to perform clinical procedures? 6) Ability for this clerkship to meet the stated learning objectives? COMMENTS: 104

Student Clinical Site & Preceptor Evaluation Your feedback regarding your clinical experience is very important to the ongoing assessment and improvement process of the Hofstra Physician Assistant Studies Program. Please complete this confidential evaluation of your clinical site and preceptor on Exxat. We also ask that you provide detailed recommendations, using professional language, on how this experience may be improved. Your input is voluntary and appreciated. 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: 12 3 4 5 6 7 8

ROTATION SITES:

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 N/A = Not Applicable to this clinical rotation Clinical Rotation Site Evaluation 1. The clinical site provided students with an orientation to the setting 2. The clinical site provided students with the opportunity to collaborate with/become a part of the medical team 3. The clinical site made students feel comfortable approaching staff with questions 4. The clinical site provided students with opportunities to interview and examine patient 5. The clinical site provided students with the ability to observe, learn, assist and/or perform clinical procedures 6. The clinical rotation, in conjunction with self-study, enabled the students to achieve stated learning objectives Preceptor Evaluation 1. The preceptor provides students with the opportunity to formulate differential diagnoses and management plans 2. The preceptor provides students with the ability to observe, learn, assist and/or perform clinical procedures 3. The preceptor provides adequate supervision for the students 4. The preceptor provides students with the opportunity to present patients to them 5. The preceptor provides guidance regarding student’s clinical note writing 105

6. The preceptor gives the students feedback regarding their performance throughout

the clinical rotation 7. The preceptor encouraged the student to ask question and was approachable Site/Preceptor Evaluation 1. Would you recommend this site to other students? a. Yes b. No c. Unsure d. Why or why not (please be detailed and use professional language) 2. Would you recommend this preceptor to other students? a. Yes b. No c. Unsure d. Why or why not? (Please be detailed and use professional language)

106

STUDENT/PRECEPTOR REVIEW OF CLINICAL OBJECTIVES FORM

Student

at Hofstra University Physician (NAME)

Assistant Program has provided me the learning objectives for this rotation. We discussed in detail the expectations involved in successfully completing this rotation.

Preceptor Student Date

107

Hofstra University Physician Assistant Program Exposure Incident Investigation Form Date of Report: __________________________ Date of Incident _________________________

Time of Report: _____________ Time of Incident ____________

Name and Hofstra ID# of Student(s) involved in incident: Name of Preceptor/Instructor at time of incident: Location of potential exposure (classroom, Bioskills, or clinical clerkship): If clinical clerkship, include specific site, discipline, and rotation number (ex: Woodhull, IM, rotation #4) Exposure occurred as part of (check all that apply): ⃝ Supervised laboratory assignment ⃝ Patient care provided during clinical experience hours ⃝ Northwell Bioskills Lab ⃝ Other _______________________________________________________ Potentially Infectious Materials Involved: Type of body fluids, route, and source of exposure (ie. Needle stick, contact with open wound, etc) Circumstance (Task being performed, where, how, and severity of the exposure): How incident was caused? (Accident, equipment malfunction. if a device was being used include type and brand of device, whether or not it was a safety device, and when in the course of handling the device, the incident occurred): Personal protective equipment being used: (gloves, gown, etc.): Actions taken (decontamination, clean-up, immediate referral, reporting, etc.): Recommendations for avoiding repetition:

If at Northwell Bioskills Lab, a copy of the Anatomy Gifts Registry specimen data sheet is attached? YES NO Student has the Post-Exposure Evaluation and Follow-Up Checklist? circle one: YES NO Student Signature _____________________________________________________________________ Name and Title of Investigator (Academic Coordinator or Clinical Coordinator): Print and Sign _____________________________________________________________________

108

Hofstra University Department of Physician Assistant Studies Post-Exposure Evaluation and Follow-Up Checklist Date of Report: __________________________ Name and Hofstra ID# of Student(s) involved in incident: ____________________________ The following steps must be taken, and information transmitted, in the case of a student’s exposure to Bloodborne Pathogens: Activity Completion Date The Exposure Incident Investigation Form was completed If applicable, source individual’s blood tested, and result given to exposed student. Consent was not obtained (__________________________________) Exposed Student’s Signature

If applicable, exposed student’s blood collected and tested. If refused, student must sign below. (__________________________________) Exposed Student’s Signature

If refused to see health care professional, then exposed student must sign below (_________________________________) Exposed Student’s Signature

Name of Hofstra Student Health Services Provider – Print and Signature: __________________________________________________________ 109

Date: _____________

2021-2022 CLINICAL YEAR HANDBOOK AGREEMENT FORM

September 2021 Edition The 2021-2022 Physician Assistant Studies Program Clinical Handbook outlines school-wide and program-specific policies and regulations for Physician Assistant Program students in the clinical phase of the program. The clinical handbook is to be used in conjunction with the student handbook and does not supersede the student handbook. If the student is in doubt about the intent or content of any of the material in this handbook, it is his or her responsibility to initiate a discussion with their faculty advisor or the clinical coordinator. I have read and understand the policies, rules and regulations as outlined within the Hofstra University Physician Assistant Program Clinical Year Handbook and agree, without reluctance, to abide by them.

NAME (Signature): NAME (Print): DATE:

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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 patient’s illness(es). The assignment must be typed. 1. Identify and list this patient’s chronic illnesses and any lifestyle risk factors. Make sure to include the age, sex, and race of your patient.

2. What specific recommendations or actions did you take to enable patient selfmanagement, disease prevention and health promotion?

3. Has your patient been receiving continuous health screening from visited facility? If so, when and what was done? If no, what health care maintenance or health screening is this patient due for?

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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 patient’s illness(es). Please attach a one-page, typed, double spaced paper summarizing the article and discussing opinions regarding the article.

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HEALTH PROMOTION PROJECT GRADE FORM Student Name

Rotation Number

Date Content • Identified and listed patient’s chronic illnesses and lifestyle risk factors. • Describes specific recommendations or actions taken to enable patient selfmanagement, disease prevention and health promotion. • Discusses whether patient is receiving continuous health screening from visited facility. If so, elaborates. • Patient is reassessed. Discusses changes made or attempted • States, expands, and supports main points. • Exercises proper composition skills. _________(45%) Research Article • • • • •

Research article current (<5 years) Research article is appropriate for topic Paper summarizes article Opinions regarding the article are discussed Exercises proper composition skills (45%)

Professionalism • Submitted materials on time in a professional manner • Student was engaged his/her audience and had good command of topic Final Score: Faculty:

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(10%) (100%)

END OF ROTATION GRADE FORM Name: Rotation: 1 Rotation Type:

Site: 2 FM

5 MED

6 7 OB/GYN

Final Grade:

8 SURG

PSYCH

PEDS ELECT:

The components for Psychiatry, Pediatrics, Surgery and OB/GYN clerkships are the following: Submitted

Notes

Student Clinical Site & Preceptor Evaluation Preceptor Evaluation Clinical Documentation and 3 Pharm Cards Interesting Case Assignment Procedure Logging Requirements Clerkship Patient Encounters Requirements Completion of Call Back Day Activities Developmental Disabilities Curriculum Requirements Quality Assurance/Performance Improvement

The components for Family Medicine, Internal Medicine and Emergency Medicine clerkships are the following: Submitted Student Clinical Site & Preceptor Evaluation Preceptor Evaluation Clinical Documentation and 3 Pharm Cards Sim Man or Virtual Cases Interesting Case Assignment or Health Promotion Project Procedure Logging Requirements Clerkship Patient Encounters Requirements Completion of Call Back Day Activities Developmental Disabilities Curriculum Requirements

Quality Assurance/Performance Improvement

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Notes

The components of the elective clerkship are the following: Submitted

Notes

Student Clinical Site & Preceptor Evaluation Preceptor Evaluation Elective Interesting Case Presentation Procedure Logging Requirements Clerkship Patient Encounters Requirements Completion of Call Back Day Activities Developmental Disabilities Curriculum Requirements

Quality Assurance/Performance Improvement

OVERALL GRADE:

FACULTY SIGNATURE:

DATE:

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CLINICAL YEAR – CLINICAL DOCUMENTATION GRADING FORM Student’s Name: Faculty Evaluator: SOAP/H&P: Item

Date: Grade:

Student Value

Maximum Point Value

1. Introduction 2. History Components 3. PE 4. Assessment (Includes acute, chronic, HCM) 5. Plan

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

(Patient Education, Follow Up, Preventive Care) 6. Signature 7. Overall Evaluation of Note (Organization, legibility, completeness, clarity, spelling, etc.) Total Points:

(2) (20)

X 10% =

Pharmaceutical Cards: Item

Student Value 1. 2. 3. 4. 5. 6.

Maximum Value

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

Class of medication Mechanism of Action Indications Contraindications Side Effects Dosing & Cost of medication Total Points:

Total Clinical Documentation Grade:

SOAP/H&P Points

Faculty Signature:

X 5%= /15 =

Pharm. Points

Final Grade

Date: 116

PLEASE EMAIL OR FAX THIS FORM TO:

PROGRAM IN PHYSICIAN ASSISTANT STUDIES

Clinical Coordinator, Program in Physician Assistant Studies

PRECEPTOR EVALUATION FORM

Fax: 516-463-5177 • Phone: 516-463-4233

Student Name Clinical Coordinator, Program in Physician Assistant Studies

Rotation Type and Site

Fax: 516-463-5177 • Phone: 516-463-4382

Preceptor Name

Clinical Coordinator, Program in Physician Assistant Studies

Fax: 516-463-5177 • Phone: 516-463-6841

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

3 4

Physical Examination

N/A

3 4

Oral Case Presentation

N/A

3 4

Patient Record

N/A

3 4

Utilization of Diagnostic Tests

N/A

3 4

Interpretation of Diagnostic Tests

N/A

3 4

Technical Skills/Clinical Procedures

N/A

3 4

Problem Solving/Clinical Thinking

N/A

3 4

Fund of Knowledge and Application of Concepts

N/A

3 4

Assessment/Differential Diagnoses

N/A

3 4

Ability to Formulate a Follow-up and Management Plan

N/A

3 4

Ability to Implement a Follow-up and Management Plan

N/A

3 4

Ability to Work Collaboratively in Interprofessional Teams

N/A

3 4

Relating to Patients and Colleagues

N/A

3 4

Understanding of PA Role

N/A

3 4

Reliability and Dependability

N/A

3 4

Self-Confidence

N/A

3 4

Attitude Toward Learning

N/A

3 4

Professionalism

N/A

3 4

Student Preparedness for Clinical Clerkship

N/A

3 4

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

Letter Grade Row Score

A 100-91

A90-87

B+ 86-83

B 82-77

B76-73

C+ 72-69

Overall Competency: _______ Preceptor’s signature:

Date:

Student’s signature:

Date:

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C F 68-60 59 or below

DESCRIPTIONS OF EVALUATION CATEGORIES Medical Interview • Conveys understanding and empathy for patient • Obtains all pertinent information • Follows an organized format • Obtains history in a reasonable time period

Ability to Formulate and Implement a Followup and Management Plan • Designs an effective and appropriate care plan • Selects appropriate consultations and referrals • Demonstrates an appropriate

Physical Examination

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

• Explains procedure to patient before exam • Performs examination in an orderly sequence • Demonstrates respect for patient • Performs appropriate and accurate exam

Oral Case Presentation

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

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

Relating to Patients

Patient Record

• Communicates effectively and appropriately with patients • Demonstrates respect and empathy for patients

• 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

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 • Demonstrate care that is effective, safe, equitable, and high quality

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

Problem Solving/Clinical Thinking • Synthesizes and analyzes clinical data correctly • Determines major active problem accurately and in a timely

and situations that require an attending physician or consultation • Understands the PA profession and the role of the PA as a team member

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

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

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

fashion • Determines abnormal from normal • Utilizes and evidence-based approach to medicine

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

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

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 • Respect’s patient privacy and confidentiality • Demonstrates a positive response to constructive criticism • Dresses appropriately for professional role • Maintains clean and kempt appearance

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

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