PHA 270 Emergency Medicine

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 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 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 severalprocedures. 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.

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 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.

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, 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 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

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.

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 PRIORtothedatetodiscussthelegitimacyofthe 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 270 EMERGENCY MEDICINE CLERKSHIP

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.

3 s.h.

INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

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

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-ofrotation (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 • 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),

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

Providing patient education, to include follow-up care, to patients in the emergency department and their families • Preceptor evaluation • EOR examination • Select and interpret appropriate screening and diagnostic studies

• 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

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

• Preceptor evaluation • EOR examinations • Interesting patient case assignment

• Preceptor evaluation • Interesting patient case assignment

• Preceptor evaluation • Interesting patient case assignment • Emergency Medicine

Simulation Activity • 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

• 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 • 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

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

Demonstrate clinical reasoning and problem-solving ability when managing a patient • Preceptor evaluation • Emergency Medicine Simulation Activity • Effectively complete oral presentations

• Preceptor evaluation • Emergency Medicine Simulation Exercise

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

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

Understand issues related to quality in a healthcare setting • Interesting patient case • Develop skills necessary for life-long learning

• Drug Cards • Interesting patient case • Emergency Medicine

Simulation Activity

• 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

Demonstrate care that is appropriate in all patient encounters • EOR examination • 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

• 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