Preceptor Evaluation Form

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:

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 sureto 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 patientdue for?

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.

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.

Research Article _________(45%)

• Research article current (<5 years) • Research article is appropriate for topic • Paper summarizes article • Opinions regarding the article arediscussed • 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 (10%)

Final Score: (100%)

Faculty:

END OF ROTATION GRADE FORM

Name:

Site:

Final Grade:

Rotation: 1 2 3 4 5 6 7 8 Rotation Type: FM MED OB/GYN SURG EM 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 Notes

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

The components of the elective clerkship are the following:

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: Submitted Notes

DATE:

Medical Interview

•Conveys understanding and empathy for patient •Obtains all pertinentinformation •Follows an organizedformat •Obtains history in a reasonable time period

Physical Examination

•Explains procedure to patient beforeexam •Performs examination in an orderlysequence •Demonstrates respect forpatient •Performs appropriate and accurateexam

Oral Case Presentation

•Clear, organized, concisepresentation •Includes all major activecomplaints/problems

Patient Record

• Written materials are neat, legible, andappropriate • Accurately and adequately documents patientencounters •Electronic record, when utilized, is accurate andorganized

Utilization & Interpretation of Diagnostic Tests

•Demonstrates sound knowledge oftests •Orders appropriate test(s) for working differential diagnosis •Uses appropriate discretion inordering • Demonstrates the ability to interpret diagnostictests • Demonstrate care that is effective, safe, equitable, and high quality

Technical Skills/Clinical Procedures

•Performs procedures safely and at appropriate skilllevel • Understands indication(s) forprocedure(s) •Explains and attains consent of patient before starting procedure

Problem Solving/Clinical Thinking

•Synthesizes and analyzes clinical datacorrectly • Determines major active problem accurately and in a timely fashion •Determines abnormal fromnormal •Utilizes and evidence-based approach tomedicine

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 differentialdiagnoses • Determine the etiologies, risk factors, and epidemiology for medicalconditions •Identify the signs and symptoms of medicalconditions

Ability to Formulate and Implement a Followup and Management Plan

•Designs an effective and appropriate careplan • Selects appropriate consultations and referrals •Demonstrates an appropriate understanding of pharmacologic plan •Implements plan consistently andappropriately • Arranges for patientfollow-up • Performs patient education at appropriatelevel •Uses counseling and patient education skillseffectively

Relating to Colleagues

• Ability to work collaboratively in inter-professionalteams

Relating to Patients

•Communicates effectively and appropriately withpatients •Demonstrates respect and empathy forpatients

Understanding of PA Role

•Demonstrates understanding for medicalconditions and situations that require an attending physician or consultation • Understands the PA profession and the role of the PA as a teammember

Reliability and Dependability

• Assumes appropriate level ofresponsibility •Completes tasks thoroughly and in a timelyfashion

Self-Confidence

•Demonstrates confidence in clinical competence to patient, peers, andpreceptor

Attitude Toward Learning

•Demonstrates independent learning effort; undertakes supplemental readings; is inquisitive, insightful,and enthusiastic; attends conferences and lectures; and demonstrates knowledge of assignedreadings

Professionalism

•Exhibits culturalawareness • 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 andconfidentiality •Demonstrates a positive response to constructivecriticism •Dresses appropriately for professionalrole •Maintains clean and kemptappearance

Student Preparedness for Clinical Clerkship