PHA 290 Elective

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

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 • 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 • Interesting patient case • Develop skills necessary for life-long learning

• 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 psychiatry (including but not limited to antidepressants, anxiolytics, antipsychotics, sedatives) Understand issues related to quality in a healthcare setting

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 • Drug Cards • Interesting patient case

• Quality Assurance &

Quality Improvement

Project • 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

• EOR examination • 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

• 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:

Interesting Case Assignment & Three Psychiatry 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 Quality Assurance/Performance Improvement Assignment Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission - if applicable P/F

P/F

P/F

. *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

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 residentoranotherattendingphysicianmaycomplete 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. Weeklylogs 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

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

Types of Clinical Encounters

Preventative Acute Chronic

20 encounters during clinical year 20 encounters during clinical year 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. 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.

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 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-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 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 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 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 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 caseSOAP 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.