PHA 265 Surgery

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 shouldfocusonself-critiqueoftheinteraction,communicationwithindividuals 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 entrieswillonlybereviewedtoassureassignmentcompletionratherthanfocusonaformal 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 thisclerkship.

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

Studentsreturntocampus, CenterforLearningandInnovation(CLI)or remotely via zoom onthelast 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 StudentCenter,516-463-7075.

PHA 265 SURGERY CLERKSHIP

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.

3 s.h.

INSTRUCTIONAL OBJECTIVES AND LEARNING OUTCOMES

Instructional Objectives

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

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

Assessment Tools Utilized

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-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. • 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

Provide intraoperative care of surgical patient.

Formulate assessment plans for surgical patients • Preceptor evaluation • Preceptor assessment and sign-off of competency on patient and procedure logs • EOR examinations • Preceptor evaluation • Submission of clinical documentation • EOR examinations

Develop management plans for surgical patients • Preceptor evaluation • Submission of clinical documentation • EOR examinations

Accurately documenting surgical care in patient charts

Providing patient education and counseling for surgical patients • 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

Demonstrate clinical reasoning and problem-solving ability when managing the surgical patient • 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 • Performs procedures safely and at an appropriate skill level • Identifies the indications and contraindications of technical procedures

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

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

Understand issues related to quality in a healthcare setting • Drug Cards

• 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 • 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

• 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 surgical SOAP Note Three surgical Drug Cards Preceptor Evaluation 15%

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 Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission - if applicable P/F Quality Assurance/Performance Improvement Assignment P/F *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 patienteducation. • 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