PHA 255 Internal Medicine

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

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

Assessment Tools Utilized

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

Formulation of assessment plans for patients on the internal medicine service inclusive of geriatric patients • Preceptor evaluation • Submission of clinical documentation • EOR examinations • Virtual patient case assignment

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

Knowledge of the different types of clinical patient encounters

Development of management plans for patients 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

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

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

Completing technical skills competently • 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 • Discern among acute, chronic, and emerging disease states

• 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

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 • Effectively complete oral presentations

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

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

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

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 • 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

• Virtual patient case assignment

• Drug Cards

• 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 • EOR examination • 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 • 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 the internal medicine clerkship is based on the following components: Virtual Patient Case Assignment P/F One Internal Medicine History & Physical Note Three Drug Cards 15% Preceptor Evaluation 50% Clerkship Patient Encounter Requirement Logs P/F Procedure Logging Requirements P/F End of Clerkship Examination 35% Developmental Disabilities Curriculum 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 P/F *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.

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, theclerkship gradewillberecorded as an“F.”In someinstancesa residentoranother attendingphysicianmaycomplete 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

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 internal medicine encounters during the internal medicine clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the Internal Medicine clerkship. These requirements may be met on any of the eight clerkships. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Competency in these areas is required forgraduation

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

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 36

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

Required Number 4 2 Blood Cultures 2 Cardiopulmonary Resuscitation 1-assisted is acceptable on or at CLI* Foley Catheter Placement 4 IM/SC/ID-injections 10 IV Placement 10 NG Tube Placement 2 Splinting 5 Suturing 5 Venipuncture 10 Assist in Operating Room 5 Wound Care/Debridement 5 Breast Examinations 5 Pelvic Examinations 5

Rectal Examinations 5

*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