Clinical Year Handbook CO 2017

CLINICAL YEAR HANDBOOK September 2016

TABLE OF CONTENTS Department Contact Information 2016-2017 Clinical Year Schedule Introduction

4 5 6

Making the Transition to Clinical Practice Structure of the Clinical Year Preparation for Clerkships Clerkship Assignment Policy Cultural Issues Registration for Clinical Courses

7 7 9 9 9

Policies Regarding Clinical Rotations Security and Personal Safety 10 Blackboard 10 Clinical Clerkship Contact and Information Packet 10 Clerkship Work Schedule 10 Clerkship Attendance 11 University Policy Related to Absences for Religious Observances 11 Student & Preceptor Review of Clinical Objectives 12 Preceptor Review and Countersignature 12 Clinical Year Stamps 12 Elective Surgical Rotations 12 Dress Requirements 13 Sexual Misconduct 13 Clinical Year Examination Policy 14 Examination Review Policy 14 End-of-Rotation Examination Failure 14 On-Site Evaluation 14 Call Back Day 15 Clerkship Grades 15 Clinical Clerkship Failure 16 Clinical Year Patient Encounter Requirements 16 Clinical Year Procedure Logging Requirements 17 Required Clinical Year Procedures/Examinations 17 Student Evaluations of Clinical Clerkships 18 Mid-Clerkship Evaluation 18 Submitting Call Back Day Materials 18

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Developmental Disabilities Curriculum Home Visit and Interview Community Agency Visit Reflective Journaling Clinical Encounters

19 19 19 20

Clinical Year Syllabi PHA 250 Family Medicine PHA 255 Internal Medicine PHA 260 Obstetrics/Gynecology PHA 265 Surgery PHA 270 Emergency Medicine PHA 280 Pediatric PHA 285 Psychiatry PHA 290 Elective

22 31 40 49 58 67 76 85

Clinical Year Forms Interesting Case Evaluation Form Elective Interesting Case Presentation Evaluation Mid-Clerkship Evaluation Form Student Evaluation of Program Rotations Form Student/Preceptor Review of Clinical Objectives Blood Borne Pathogen Exposure Form 2016-2017 Clinical Handbook Agreement Form Clerkship Work Schedule Form Family Medicine: Health Promotion Project Health Promotion Project Grading Form End-of-Rotation Grade Form Clinical Year Documentation Grading Form Evaluating a Peer-Reviewed Scientific Article Community Agency Experience Form Home Visit Form Preceptor Evaluation Form

94 95 96 97 98 99 100 101 102 104 105 107 108 109 111 113

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DEPARTMENT CONTACT INFORMATION The main PA Program office is located in Monroe Lecture Center, room 113. Chair and Program Director / Assistant Professor Carina Loscalzo, MS, PA-C (516) 463-4412 Carina.Loscalzo@hofstra.edu Monroe Lecture Center, room 218 Associate Director / Assistant Professor Mark L’Eplattenier, MPAS, PA-C (516) 463-1353 Mark.S.Leplattenier@hofstra.edu Monroe Lecture Center, room 112 Clinical Coordinator / Assistant Professor Shannan Ricoy, MS, PA-C (516) 463-4233 (516) 509-6470 (Program cellular phone) Shannan.Ricoy@hofstra.edu Gallon Wing, room 236 Academic Coordinator / Assistant Professor Kelly Porta, MS, PA-C (516) 463-4381 Kelly.R.Porta@hofstra.edu Monroe Lecture Center, room 106 Advisement Coordinator Gia Raponi (516) 463-4043 Gia.R.Raponi@hofstra.edu Monroe Lecture Center, room 110 Clinical Secretary – Part Time Karen Forman (516) 463-4074 Karen.S.Forman@hofstra.edu Monroe Lecture Center, room 113

Medical Director Samuel Sandowski, MD (516) 463-4074 ssandowski@snch.org Monroe Lecture Center, room 113 Research Coordinator / Assistant Professor Christina Ventura-DiPersia, MPH (516) 463-4042 Christina.M.VenturaDiPersia@hofstra.edu Gallon Wing, room 138 Clinical Coordinator / Assistant Professor Christine Zammit, MS, PA-C (516) 463-4380 Christine.Zammit@hofstra.edu Gallon Wing, room 237 Academic Coordinator / Assistant Professor Mary Banahan, MS, PA-C (516) 463-4161 Mary.K.Banahan@hofstra.edu Monroe Lecture Center, room 108 Secretary – Part Time Sharon Poulson (516) 463-4074 Sharon.Poulson@hofstra.edu Monroe Lecture Center, room 113 Senior Assistant-Full Time Marie Sorrentino (516) 463-3271 Marie.Sorrentino@hofstra.edu Monroe Lecture Center, room 113

Department Main Office Department office number: (516) 463-4074 Department fax number: (516) 463-5177

Department Mailing Address: Hofstra University Physician Assistant Studies 113 Monroe Lecture Center Hempstead, New York 11549-1270

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2016-2017 Clinical Year Schedule Rotation # 1:

9/6/2016 – 10/13/2016

CBD: 10/14/2016

Rotation # 2:

10/17/2016 – 11/22/2016

CBD: 11/23/2016

Rotation # 3 Part 1:

11/28/16 – 12/23/2016 VACATION 12/24/2016-1/1/2017

Rotation # 3 Part 2:

1/2/2016– 1/12/2017

CBD: 1/13/2017

Rotation # 4:

1/16/2017 – 2/23/2017

CBD: 2/24/2017

Rotation # 5

2/27/2016 – 4/6/2017

CBD: 4/7/2017

VACATION 4/8/2017 – 4/16/2017 Rotation # 6

4/17/2017 – 5/25/2017

CBD: 5/26/2017

Rotation # 7

5/30/2017 – 7/6/2017

CBD: 7/7/2017

Rotation # 8

7/10/2017 – 8/17/2017

CBD: 8/18/2017

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Introduction Congratulations on progressing to the clinical year! It is an accomplishment to complete the didactic phase of training and to advance to the clinical portion of the curriculum. The goal of the clinical year is to provide the skills necessary for graduation and ultimately for practice as a physician assistant. This manual is designed to provide the information necessary to complete the requirements for each clerkship. The Clinical Handbook will be useful throughout the clinical year; keep it in an accessible place. It is also posted on the program website. The clinical coordinators will be the key people with whom you will interact this year. Yet, the entire faculty and staff are available to support and guide you through this year. Please feel free to contact any of us with questions or concerns.

Making the Transition to Clinical Practice The clinical year varies from the academic year in many ways. A chief difference is that the security found in the company of fellow students will be absent in many cases. The familiar routine of the classroom will similarly be absent. Self-reliance and self-motivation will play a more important role in succeeding in the clinical year than it had in the didactic phase of the program. A key feature of the experience this year will be the ability to integrate and apply core knowledge with practical experience. This does not occur automatically and will depend on the ability to continue to study physiology, pharmacology, and clinical medicine in the evenings and when not on-site. While each clerkship will provide the opportunity to meet each objective, with some effort you will find additional opportunities that will yield added enrichment. Take advantage of these opportunities. Making the most of the clinical year depends on the amount of effort, work and dedication you are willing to expend. Some clerkships will be more enjoyable than others. While some clerkships may not meet all your expectations, remember that learning to navigate the clinical world in all circumstances is important to success in the clinical year. Learning to find the resources and individuals to help meet the objectives will optimize your clinical experiences.

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Structure of the Clinical Year The clinical year is made up of seven required clerkships and one elective clerkship. The required clerkships include: family medicine, internal medicine, surgery, psychiatry, obstetrics/gynecology, emergency medicine, and pediatrics. Each clerkship is six weeks in duration, concluding with a daylong ‘call back’ session on campus. The elective clerkship provides an experience to work within a subdiscipline of medicine, or the chance to repeat a rotation of personal interest in another setting. The objectives for each rotation are found in the back of this handbook. Students are responsible for the objectives regardless of the types of patient care experiences they encounter.

Preparation for Clerkships There are several factors to consider before beginning each clerkship. They include: •

Identification of Gaps in Knowledge: The ability to identify areas of weakness and finding ways to address them is a lifelong process that begins in the clinical year. Before presenting to the clinical site for the first time, review the learning objectives for that discipline (found at the end of the Handbook). Some areas of weakness will be apparent before beginning the clerkship; others may present during the course of the rotation. Early identification allows for timely remediation.

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Communication with Preceptor: Meet with the preceptor on the first day of each rotation and discuss the objectives with him/her. Reviewing the objectives with the preceptor will help plan how best to use the weeks allotted for the clerkship. Afterward, the preceptor must sign the “Student-Preceptor Review of Clinical Objectives” form.

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Personal Preparation: Students are required to be at the site at all times designated by the preceptor. In some cases that will require staying at the site late into the evening or overnight, arriving very early in the morning or working on weekends. Anticipate long, irregular hours and prepare by engaging baby-sitters, dog-walkers or helpers in the care for others who rely on you. Students may not be excused from any scheduled hours without contacting the program and obtaining permission from the clinical coordinator (see clinical year attendance).

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Transportation: A car in good working order is required to travel to most rotation sites. Many rotations will require a drive of many miles. It is not acceptable to miss time from a rotation because of car trouble. A back-up plan must be developed for reaching a clinical site without a car. While it is possible to complete the clinical year without a car, this will increase travelling time and require familiarity with the public transportation system. For rotations at sites that are far away or inaccessible via public transport, it may be necessary to find short-term living accommodations. As outlined in the list of tuition and fees upon entrance to the PA Program, students are responsible for all expenses related to the clinical rotations. These include, but are not limited to, parking, tolls, gasoline and car maintenance.

•

Smart phones or IPads: Owners of IPads or smart phones should download pertinent information such as textbooks, PDRs, EKG and radiology references. In addition to its use as a reference, these devices can be used to take notes, keep study lists or to log patients. Should the purchase of a device not be possible, determine how to quickly access information, to keep track 7

of patients, and take notes. It is not appropriate to be talking or texting on your phone in patient care areas while on clinical rotations. •

Oral Presentations: Clinical rotations require students to present patient cases to preceptors, fellow students, and other health care team members. Practice of the presentation beforehand will aid in the appearance of confidence and being well informed. Discomfort with public speaking can be remedied with practice in front of a mirror, to friends, and to classmates.

•

Emotions: When beginning the clinical year, many students feel inadequate when considering the responsibility associated with patient care. Acknowledgment of this feeling may prevent becoming crippled by it. Most preceptors and staff are sympathetic to student nervousness, and do not expect a students to know everything. It is important to ask questions, listen, and learn. Reading and preparing throughout the clerkship may help in feeling confident.

•

Getting Help: Students may experience personal problems during the clinical year or interpersonal conflicts may arise on a clinical site. The clinical coordinator and program director are available for advice and support. Call them as soon as a problem arises. Do not wait until the situation spirals out of control.

•

Involvement in Clinical Training: The amount of learning in and enjoyment of the clerkship is directly proportional to the effort extended. Reading about disease states encountered each day is essential. Students are expected to volunteer for presentations and to spend as much time as possible at the site. Many find that the best teaching is “after hours.” Others find that helping with “scut” work may make the preceptor more inclined to teach and mentor.

•

First Impressions Count: Preceptors often form opinions of students early in the rotation. It is important, therefore, to be punctual, maintain good physical appearance, and demonstrate initiative from the first day of the clerkship. Learning the layout of the facility, important phone numbers, and procedures for ordering labs, diagnostic studies, and consults early will aid in making a good first impression.

•

Interpersonal Communication: One key to a successful clerkship experience is the ability to get along with patients, preceptors and other medical staff at the site. Being respectful and courteous includes self-awareness of tone of voice, body language and attitude. Yet, the clerkship experience is not designed for any student to be taken advantage of or excluded from important learning experiences. It may be necessary to be assertive at times. Striking a balance between being courteous and a responsible learner may prove challenging. Program faculty can help negotiate this balance, and should be called upon if needed.

•

Seek Out Teachers: In addition to the preceptor, other members of the health care team such as social workers and nurses may be willing to teach. It is especially important to attend all teaching rounds that are offered at the site. If medical students rotate at the site, seek an invitation to participate in their teaching rounds. Being polite and respectful may result in opportunities that might otherwise be missed.

•

Be Assertive: Some sites will have many students rotating at the same time, either from other PA programs or from other medical disciplines. All of these students will compete for the attention of preceptors, for the opportunity to perform procedures, or for the privilege to present cases on rounds. This will necessitate the ability to assert oneself to gain access to important 8

learning opportunities. While this may be difficult, it is essential in order to maximize the clerkship experience.

• Expect Frustrations: As with other phases of PA education, there are aspects of the clinical

year that are frustrating. Remaining flexible will help in minimizing the negative aspects of a clerkship experience. It is also important to keep in mind that patients can be the source of frustration. Patients can be angry, fearful, seductive or duplicitous. This may be due to any number of factors, some not directly related to the student. A discussion with the preceptor may help determine if there are factors that can be modified in the provider-patient interaction.

Clerkship Assignment Policy Students are assigned to clerkship sites by the clinical coordinators. Assignment sites are not negotiable. The clinical schedule may change due to situations beyond the program’s control. It is necessary that students remain flexible when these situations arise. While personal considerations are respected when possible, the primary focus of clerkship assignments is to give each student a well-rounded clinical experience. Therefore, students are required to rotate to each clerkship site to which they are assigned. To ensure the best possible clinical year experience, students will be assigned clerkships that will require travel. As outlined in the tuition and fees list upon acceptance into the PA Program, the cost of possible temporary housing, meals and transportation is the responsibility of the student. All clerkship schedule decisions rest with the clinical coordinators. Once the final clerkship schedule is completed, student requests for changes will not be considered.

Cultural Issues The range of clinical experiences will include working with patients of varied racial, ethnic, economic, geographic, and cultural backgrounds. Students will be assigned to sites in various geographical areas or work with patient populations with which they may be unfamiliar. Providing care to all populations is a central part of the mission of our profession. Students are expected to rotate to all sites to which they are assigned, regardless of their geography or patient population.

Registration for Clinical Courses Students must register each semester for their clinical rotations. Since the clinical year does not follow the academic calendar, students must take responsibility for registering each semester. Students must register using the following schedule: Fall Semester Spring Semester: Summer I Summer II

Rotations 1-3 Rotations 4-6 Rotation 7 Rotation 8

Clerkships are considered courses. The codes for the clerkships are: Family Medicine PHA 250 Internal Medicine PHA 255 Ob/Gyn PHA 260 9

Surgery Emergency Med Pediatrics Psychiatry Elective

PHA 265 PHA 270 PHA 280 PHA 285 PHA 290

Register for each clerkship in the order in which it is taken. The designation “R” before the course number refers to the sequence of the clerkship. For example, each student will register for the first rotation under “R-1”; the second “R-2” etc. Grades cannot be entered unless the correct clerkships appear in Banner in the proper semester and in the proper order. It is the responsibility of the student to update their registrations should a change occur in their clinical year schedule.

Policies Regarding Clinical Rotations Security and Personal Safety Clinical year clerkship sites are evaluated by the clinical coordinators and deemed secure and safe for all students. If at any point a clinical year student feels that their personal safety is being compromised, the student should contact the on-site security department, the program and alert their preceptor. If the site does not have a security department, the student is unable to reach a faculty member at the program and the preceptor is unavailable, the student is to call 911. If a clinical year student has questions or concerns regarding site security or safety he/she may contact the program main office at 516-463-4233 or call Professor Ricoy on the program mobile at 516-509-6470 after office hours.

Blackboard All students will have access to a clinical year blackboard shell. The clinical year blackboard shell contains all the information, forms and documents you will need during the clinical year. Each student is responsible for checking this shell daily for important announcements and site updates.

Clinical Clerkship Contact & Information Packet Prior to the clinical year, each student will have access to a clinical clerkship contact and information packet on the clinical year blackboard shell. This packet includes the preceptor contact information, site requirements, orientation information, and any other materials needed to begin each clerkship. All students are required to be familiar with the information in this packet. As this information is continuously in flux, the student is responsible for the most current information.

Clerkship Work Schedule All students are required to fax or email a “Clerkship Work Schedule” form (See appendix) to the program clinical secretary by Friday of the first week of each clinical rotation (Fax: 516-463-5177). A new clerkship schedule must be sent if the schedule changes for any reason. Absences must be documented on the bottom of the clerkship work schedule. The time used to make up absences must be similarly documented. The form must be signed by the designated preceptor. All students must contact the clinical secretary via email within 24 hours to confirm receipt of their work schedule. Failure to submit a clerkship work schedule will result in a grade of “incomplete” until all forms are received. 10

Clerkship Attendance Clinical year students are required to follow the schedule set by their preceptor. Students should arrive at the facility before their scheduled shift and remain on the site until excused. Students are expected to take call as designated by the preceptor. Students are expected to work weekends, holidays and overnight. University holidays do not pertain to the clinical year. Snow days do not pertain to the clinical year. Students may not take vacations apart from those designated by the clinical year schedule. Should a student be physically present on a site but away from the team, he/she will be considered absent. It is not acceptable to go to the library to study or to be away from the team without the preceptor’s knowledge and permission If an absence due to an illness occurs the day before or the day after a holiday, the student must provide the clinical coordinators with a note from a medical provider documenting their illness. Any absence, for any reason, must be made up at the site. There are no personal days. If a student is unable to report to or will be late to the clinical site for any reason, he/she is required to 1. Call and e-mail the clinical preceptor before the start of your shift. 2. Call and e-mail the clinical coordinators at (516) 463-4233 or (516) 463-4380 before the start of your shift. Failure to report an absence and obtain approval from the clinical coordinators will result in an unexcused absence. An unexcused absence, a pattern of multiple excused absences, extended absences, or chronic lateness are subject to disciplinary action including appearance before the Academic Standing Committee. It is unacceptable to leave a message with the program administrative assistant. It is unacceptable for a student to call on behalf of another student.

University Policy Related to Absences for Religious Observance For the purpose of the clinical year, class time as detailed below is equated to clinical clerkships and all related clinical year activities. Students should report absences as described under the clinical year attendance policy. Hofstra University recognizes that students and/or faculty may from time to time miss class due to religious observances. Students who anticipate missing class for this reason should notify faculty members in advance. Likewise, faculty members who anticipate missing class for religious observance should notify students in their classes. As per Faculty Policy Series 12 (B): “No student shall be expelled or refused admission to Hofstra University because he or she is unable to participate in any examination, study or work requirement because of his or her religious obligations and practices. However, all students are expected to complete all assignments and examinations. It is understood that no adverse or prejudicial effects shall result to any student who avails him or herself of religious observances. The University, faculty, and student shall work together to achieve a reasonable accommodation concerning any conflicts between educational and religious obligations.� 11

Faculty will publish notice of this policy in their syllabi and announce it during the first week of each semester, and will further make reasonable efforts to avoid scheduling exams and/or due dates of assignments that would otherwise interfere with religious observances of students. Additionally, in accordance with New York State Law, each student who is absent from school because of his or her religious beliefs will be given an equivalent opportunity to register for classes or make up any examination, study or work requirements which he or she may have missed because of that absence on any particular day or days.

Student & Preceptor Review of Clinical Objectives At the beginning of each clerkship, students are required to review the clinical objectives with their preceptors. Once reviewed, the Review of Clinical Objectives form must be emailed or faxed to the program office (516-463-5177) by the Friday of the first week of each clinical rotation. Failure to submit this form will result in a three (3) point deduction in the rotation grade (See appendix).

Preceptor Review and Countersignature Students must insure that each patient seen is evaluated by the supervising preceptor. The supervising preceptor must review and countersign all notes written by the student. The student must sign each note with “PA-student” and not “PA-S” to prevent confusion. The supervising preceptor must countersign the note immediately. The student is not authorized to initiate any orders for a patient without the consultation and the signature of the supervising preceptor. Students are not permitted to sign any prescriptions. Failure to adhere to these policies will result in a disciplinary hearing before the Academic Standing Committee.

Clinical Year Stamps All students will be required to purchase a self-inking stamp to be used underneath your signature on all clinical documents during the clinical year. Stamps should include the following information: Student’s Name, PA-S Physician Assistant Student Hofstra University

Elective Surgical Rotations Students who chose surgical electives may work with preceptors who practice in specialty areas. These preceptors may have operating room privileges in hospitals which are not affiliated with the Program. These students will not be able to accompany the preceptor into the operating room in these circumstances. In some cases, the preceptor does operate in an affiliated hospital, however, additional paperwork or scrub class may need to be submitted before accompanying the preceptor in surgery. The clinical coordinators will assist you through this process. Students should consider the limits to operating room access before beginning a surgical elective rotation.

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Dress Requirements Dress requirements must be strictly adhered to in the clinical year. One reason is safety – dress can increase or decrease the potential for injury. The second is that clinical year students represent both the physician assistant profession and Hofstra University. Therefore, students must look professional while interacting with patients and health professionals at clinical sites and related facilities. Both men and women should wear business attire while on clinical clerkships and at related facilities. Men should wear a dress shirt with tie. Closed toed shoes with socks or stockings as well as a short white uniform jacket must be worn by men and women, at all times. Each student should wear a watch with a second hand. Bracelets are not permitted on clinical clerkships or at program related facilities. Students should avoid wearing insignia, buttons or decals of a political nature while on clinical clerkships or at program related facilities. Unacceptable clothing includes: • • • • • • • •

Low cut, revealing blouses for women Sandals Short skirts Stirrup pants or leggings T-shirts, sweatshirts or sweatpants Any clothing made of denim Clothing that exposes the mid-abdomen Clothing that is soiled, in poor repair, or not well maintained

Students may wear scrubs only while in the operating room, emergency room or in the delivery room. Students may wear sneakers only while wearing scrubs as listed above. Students may not wear scrubs while outside the hospital, or while traveling to or from the hospital. All students are required to follow each facilities designated scrub policy. Hair must be pulled back away from the face if it is longer than shoulder length. Fingernails must be less than ¼“long. Nail polish should not be worn while on rotations that requires the student to scrub. No artificial nails, wraps, multi-colored or designer nail polish or nail paintings are permitted. Some patients may be particularly sensitive to fragrances when ill. Students should be sensitive to the needs of patients and avoid wearing fragrances while in the health care setting. Only post earrings are permitted. All tattoos should be concealed. Other body piercings should not be worn during rotations.

Sexual Misconduct Sexual relations between a PA student and a patient are unethical, regardless of who initiated the relationship. Reasonable proof of a sexual relationship between a student and patient will result in dismissal from the program. Sexual relations between a PA student and clinical staff at a site are similarly unacceptable. Sexual harassment of a physician assistant student by a preceptor or other rotation site employee is a serious matter and must be reported to the clinical coordinator immediately. All good faith reports of inappropriate behavior will be supported. Students should not attempt to handle this problem alone, as 13

sexual harassment involves issues of unequal power. Should a student feel he/she has been sexually harassed; assistance from the program faculty should be sought immediately.

Clinical Year Examination Policy Almost all multiple-choice examinations are administered utilizing an on-line format in a computer lab or with a laptop. At the end of each clerkship, with the exception of the elective clerkship, students will be required to take and End of Rotation exam. If a student arrives late, no additional time will be granted to take the exam. Arriving more than fifteen minutes late for an exam will result in a five (5) point deduction in the exam grade. Should an unexcused absence occur for an exam, the student will need to meet with the Academic Standing Committee. If the opportunity to take the exam at a later time is granted by the ASC, the highest possible grade the student would receive would be a 70%, regardless of the score. Any student with an excused absence on the day of the examination may result in a five (5) points deduction from the examination grade. No student is permitted to take the day off before an end of rotation examination in order to study or complete assignments. If the clinical coordinator is informed that such an unexcused absence occurred, the student will receive ten points off final grade for the clerkship, and must meet with the Academic Standing Committee.

Examination Review Policy Within 24-hours of submitting the exam, each student will receive an email from PAEA containing the raw score and feedback on incorrectly answered exam questions. This feedback should be saved and used for remediation and studying for the PANCE.

End-of-Rotation Examination Failure Passing grade for end-of-rotation examinations is 65%. Should a student fail the end-of-rotation exam, he/she 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 in order 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. A failure of the make-up examination will result in failure of the clerkship. Students are permitted to take no more than two (2) make-up exams for the entire clinical year. Any student who fails two end-of-rotation exams will be called before the Academic Standing Committee. Failing a third end-of-rotation exam will result in appearance before the Academic Standing Committee and probable dismissal from the Program.

On-Site Evaluation Each student will have one (1) onsite evaluation during the clinical year. The student will be visited by one of the clinical coordinators, at their clerkship site, within the last two weeks of the clerkship. The onsite evaluation assesses student command of clinical knowledge of the discipline practiced at the site. Notification for a visit can vary from one week to 24 hours beforehand. In the unlikely event that a student is unable to be present for the site visit, the clinical coordinator must be notified at least 24 hours prior to the visit. All unexcused absences will result in a failure of this component of the clerkship grade. If the student is not prepared for the clinical coordinator at the time of the on-site visit, the student will receive a zero for any missing component of the site visit grade. 14

Students are responsible for the following on site visits: 1) One H&P or SOAP note as designated by the clerkship syllabi. 2) Presentation of three (3) pharmaceutical agents (called “drug cards�). 3) Depending upon the clerkship syllabi, presentation of one of the following: a. Interesting Patient Case Assignment b. Continuing Medical Education Project c. Health Promotion Project

Call Back Day Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving 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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each 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 by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she 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 Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a two-point deduction from the overall rotation grade.

Clerkship Grades Each clinical clerkship must be passed in order to graduate from the program. A course grade below 70% will result in failure.

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Clinical Clerkship Failure A student will fail a clinical clerkship if: 1. A failing grade at any point in the clerkship is submitted by a preceptor on the Preceptor Evaluation Form. 2. A failing grade is earned on the end-of-rotation examination. Failure is defined as less than 65% on both the initial and the make-up exam. 3. The total clerkship grade is less than 70%. Should a student fail a clerkship, the rotation will be repeated at the end of the research semester, thereby extending the length of the curriculum. The student will be responsible for any and all associated costs of repeating the failed clerkship. A failed rotation will result in the student appearing before the Academic Standing Committee and placement of the student on academic probation for the duration of study in the Hofstra University Program in Physician Assistant Studies Two failed clerkships will result in reappearance before the Academic Standing Committee. All extenuating circumstances will be considered. Dismissal from the program will be considered at that time.

Clinical Year Patient Encounter Requirements Typhon Group Physician Assistant Tracking System is an electronic tracking system to log patient encounters and procedures. As each rotation progresses, your level of involvement in patient care and the complexity of patients seen should increase as well. 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 coordinator will discuss ways to maximize clinical opportunities for the remaining time in the 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 will result in a three (3) point deduction as well. A copy of the signed Typhon log “graphical� must be included in your call back day packet. Each student is to only submit a graphical log specific for that rotation. All patient logs must be signed, dated and stamped by the preceptor. Failure to have your log signed, dated and stamped by your preceptor will result in an incomplete for his/her rotation grade until received. The below clinical encounters are required to be completed by the end of the clinical year. These requirements may be met on any of the eight clerkships. In addition to these encounters, there are discipline specific patient encounter requirements, which can be found within each individual syllabus. Preceptors must sign off on 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 during the clinical year 20 during the clinical year 20 during the clinical year 20 during the clinical year 15 during the clinical year 16

Medical Care Across the Life Span Encounters Infants- less than 1 years of age 15 during the clinical year Children- 1 y/o – 11 y/o 30 during the clinical year Adolescents- 12 y/o – 17 y/o 30 during the clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year Geriatrics- greater than 65 y/o 100 during the clinical year

Clinical Year Procedure Logging Requirements Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. It is the student’s responsibility to find opportunities to meet the procedure requirements. Each clerkship syllabi will provide suggestions on procedures that may be found within that discipline; however the requirements may be met on any of the eight clerkships. 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 Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) 17

Student Evaluation of Clinical Clerkships Student evaluations of clinical rotations are entered into the Typhon System (See appendix). Student feedback and comments are vital to the growth and continued improvement of the program. Students must submit their evaluation of each clerkship on Typhon and a hard copy in call back packets by call back day. Three (3) points will be deducted from the final grade for the course if the student evaluation is submitted late. The procedure for submitting and printing student evaluation of clinical sites: • Enter the Typhon ESAI system • Click on Student Evaluation of Clerkship Site • Enter the name of the clinical site and the date • Fill out the evaluation • Click on “submit evaluation” • Click on “print my responses” and then click “print”.

Mid-Clerkship Evaluation Mid-clerkship evaluations are completed via the Typhon System by the end of the third week of each clerkship (See appendix). This evaluation instrument is designed for students to determine their strengths and weaknesses early, so that the opportunity to correct deficiencies is possible. This tool also provides the program with feedback regarding clerkship quality. Lastly, it allows the clinical coordinator to identify problems with a clinical site or with an individual student and provide early intervention. If the mid-clerkship evaluation is not submitted on time, three (3) points will be deducted from the final grade for the rotation.

Submitting Call Back Day Materials All materials must be submitted to the clinical coordinator prior to the PAEA end-of- rotation examination. Failure to do this will result in a three (3) point deduction from the final rotation grade. The following materials must be submitted to the clinical coordinator • • • • • • • • • • •

Clinical Documentation (H&P or SOAP as designated for specific rotation) Preceptor End of Rotation Evaluation (in sealed envelope with preceptor name and stamp across the seal) Print out of completed Student Evaluation of Program Clinical Site from Typhon EASI Signed and stamped Typhon “Graphical” Log specific to your rotation CME Project (if applicable) Interesting Patient Case Assignment (if applicable) Health Promotion Project (if applicable) Peer reviewed journal article relating to your interesting patient case assignment. Please make sure to staple the journal article to the assignment and to write your name on the article (if applicable). Elective Pre and Post Essay (if applicable) Elective Interesting Case Presentation (if applicable) Three (3) Pharmaceutical “Drug Cards.” (Please write your name on all of the “drug cards”).

All materials that are submitted on call back day or at site visits must be accompanied by the appropriate grade sheet (which can be found on BlackBoard). Forms must be filled out by student with their name and rotation specific information. Failure to provide appropriate grading forms will result in a 10 point deduction from the assignment grade. 18

Developmental Disabilities Curriculum Requirements Home Visit and Interview The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade.

Community Agency Visit The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade.

Reflective Journaling After the home visit, community visit and each clinical encounter, 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, comfort-ability 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: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship.

19

Clinical Encounters Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate.

20

Clinical Year Syllabi

PHA 250 FAMILY MEDICINE CLERKSHIP

4 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION: This is a six-week out-patient clinical experience where students work with family medicine preceptors to evaluate patients with a wide variety of illness in an office setting. Emphasis is placed on evaluation, management, health promotion, and preventive medicine. COURSE GOAL: The goal is to have students develop an approach to the evaluation and management of frequently occurring, complex, comorbid or ill-defined problems with a wide variety of acute and chronic presentations across the life span. INSTRUCTIONAL OBJECTIVES AND LEARNING OUTCOMES:

Instructional Objectives Assessment Tools Utilized By the conclusion of the family medicine clerkship, students will be competent in the following:

Evaluation of the acute, chronic and well patient by obtaining an accurate history, performing a physical exam, obtaining and interpreting appropriate laboratory and diagnostic studies and developing a differential diagnosis and/or management plan Determine the initial assessment in acute and chronic patients

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 • Preceptor evaluation

22

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning and problem solving abilities:

•

Use effective interviewing skills to elicit a detailed history Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data

•

Select and interpret appropriate diagnostic tests or lab studies

•

commonly seen in the office setting

•

Synthesize and analyze clinical data correctly

•

Utilize critical thinking and problem solving skills to identify and manage a wide variety of acute and chronic conditions

•

Adequately document medical information in history & physical notes and progress notes Use effective basic counseling and patient education skills Locate, appraise, and apply evidence from scientific studies

•

Submission of clinical documentation EOR examinations SIMPLE virtual patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations SIMPLE virtual patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation FM Cases virtual patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Preceptor evaluation

•

• • Management of acute and chronic illnesses that are commonly seen in the office setting

• •

• • Accurately document the medical care rendered for patients in primary care

• •

Develop evidence-based recommendations regarding health promotion and disease prevention for the well-patient, and patient centered best practices plans for a wide variety of acute and chronic conditions

• • •

Completing technical skills competently

• •

Presenting patients to the family medicine preceptor in a concise and organized way Understand the value and role of multiple members of the clinical care team (e.g. pharmacy, specialists, physical therapy, radiology, and allied health) when providing care to primary care patients

•

• •

•

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

•

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability

•

•

23

•

• • 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 primary care

Utilize the PAEA Core Tasks and Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the conditions outlined at http://www.endofrotation.org/wpcontent/uploads/2015/07/FamilyMedicine-Topic-List-2015.pdf

FM Cases virtual patient case assignment

•

•

Drug Cards

•

•

EOR examination

•

•

• •

Exhibit and understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning Synthesize and analyze clinical data correctly Identify pharmacologic agents and other relevant treatment modalities as the relate to various medical conditions to include understanding the indications, contraindications, side effects, interactions and adverse reactions 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

ASSESSMENT/EVALUATION CRITERIA The grade for the family medicine clerkship is based on the following components: Health Promotion Project Family Medicine Computer Assisted Simulation Experience (FMCASE) One complete H&P in Practice Fusion Three Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements End of Clerkship Examination Developmental Disabilities Requirements- if applicable Call Back Day Longitudinal Patient Participation, Reflective Journal Entry &

25% P/F 15% 25% P/F P/F 35% P/F P/F

24

Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook HEALTH PROMOTION PROJECT An important element of family medicine clerkship is to provide patient centered care by promoting healthy lifestyles, identifying risky behavior and preventing complications from chronic illness. Therefore, during the family medicine rotation, students will be assigned a health promotion project. The objective of this project is to explore ways to enable patients to increase control over risk factors, thereby improving health outcomes. This project provides a vehicle for students to counsel, teach and support patients about preventive measures for their disease states and to evaluate the effectiveness of their efforts. The student will choose a patient with chronic illness or lifestyle risk factors and provide counseling. Afterward, the student completes the questionnaire found in the appendix. Question number 4 requires that the student follow-up with the patient. This can be accomplished via a follow-up visit or by telephone conversation. Should a telephone conversation be chosen, permission must be obtained from the patient, and the site preceptor. Question 5 requires that the student read and submit an academic article, no more than five years old that discusses the health promotion issues related to the patient. A one-paged, typed, double-spaced paper summarizing the article and discussing how to implement the recommendations is submitted and/or presented during the site visit or on call back day should a site visit not occur. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. FAMILY MEDICINE COMPUTER ASSISTED SIMULATIONS FOR EDUCATING STUDENTS (FMCASES) FMCASES is an internet-based virtual patient program addressing the core clerkship learning objectives of a family medicine clerkship. Each student will be assigned TWO (2) family medicine cases within the first two weeks of the clerkship. Both cases need to be completed by the designated due date. Failure to complete the FMCASE’s 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 family medicine clerkship using Practice Fusion. The note should be written legibly, accurately and adequately. 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. • H&P notes cannot duplicate the interesting case patient. • 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 particular 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 family medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, 25

indications, contraindications, side effects 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 bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day will receive a grade of zero for this portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of 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 collaboratively work 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 blackboard. 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. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. 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.” The program fax number is 516-463-5177. 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 a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. 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 Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum family 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. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their family 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. Family Medicine

15 per week/90 per clerkship

CLINICAL YEAR PATEINT ENCOUNTER REQUIREMENTS Although students must log specific family medicine encounters during the family medicine clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the family 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 for graduation. 26

Types of Clinical Encounters Preventative 20 during clinical year Acute 20 during clinical year Chronic 20 during clinical year Emergent 20 during clinical year Developmental Disabilities 15 during clinical year Preventative 20 during clinical year Acute 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 2 years of age 50 during clinical year Children- 2 y/o – 12 y/o 50 during clinical year Adolescents- 13 y/o – 17 y/o 50 during clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year

PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. During your family medicine clerkship, it is recommended that you focus on procedures such as IM/SC/ID injections, wound care/debridement and breast examinations. 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 family 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 Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement

Required Number 4 2 2 1-assisted is acceptable or at CLI* 4 10 10 2 5 5 10 5 5 27

Breast Examinations Pelvic Examinations Rectal Examinations

5 5 5

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the family 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 http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to the following topic list of conditions http://www.endofrotation.org/wp-content/uploads/2015/07/Family-Medicine-TopicList-2015.pdf Student should also review the breakdown of the exam, which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2015/06/Family-MedicineBlueprint.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). In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she 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 in order 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. DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this 28

assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, 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, comfort-ability 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: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving 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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each 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 by 11:59pm. If a student 29

misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she 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 Typhon within one week of the call back day for any scheduled lecturers. 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 not 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

30

PHA 255 INTERNAL MEDICINE CLERKSHIP

4 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This is a six-week clerkship experience that 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 “in-house” 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 Assessment Tools Utilized By the conclusion of the internal medicine clerkship, students will be competent in the following:

Evaluation of the 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 Formulation of assessment plans for patients on the internal medicine service inclusive of geriatric patients

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 • Preceptor evaluation

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning and problem solving abilities:

•

Use effective interviewing skills to elicit a detailed history Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data

•

Select and interpret appropriate diagnostic tests or lab studies

•

•

• • Development of management plans for patients on the internal medicine service inclusive of geriatric patients

• •

• • 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

• • •

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

Submission of clinical documentation EOR examinations SIMPLE virtual patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations SIMPLE virtual patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation SIMPLE virtual patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Synthesize and analyze clinical data correctly

•

Utilize critical thinking and problem solving skills to identify and manage a wide variety of acute and chronic conditions

•

Adequately document medical information in history & physical notes and progress notes Use effective basic counseling and patient education skills

Preceptor evaluation

•

•

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

•

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability

•

• 32

•

• • 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 http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of conditions outlined at http://www.endofrotation.org/wpcontent/uploads/2015/07/InternalMedicine-Topic-List-2015.pdf

SIMPLE virtual patient case assignment

•

•

Drug Cards

•

•

EOR examination

•

•

• •

Exhibit and understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning Synthesize and analyze clinical data correctly Identify pharmacologic agents and other relevant treatment modalities as the relate to various medical conditions to include understanding the indications, contraindications, side effects, interactions and adverse reactions 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

ASSESSMENT/EVALUATION CRITERIA The grade for the internal medicine clerkship is based on the following components: Interesting Case Assignment 25% Simulated Internal Medicine Patient Learning P/F Experience (SIMPLE) One Internal Medicine History & Physical 15% Note Three Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% Developmental Disabilities Curriculum P/F Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & 33

Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the internal medicine clerkship. The interesting case will either be presented on a site visit or handed in on 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, peer-reviewed 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 SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SIMULATED INTERNAL MEDICINE PATIENT LEARNING EXPERIENCES (SIMPLE) SIMPLE is an internet-based virtual patient program addressing the core clerkship learning objectives of an internal medicine clerkship. Each student will be assigned TWO (2) internal medicine cases within the first two weeks of the clerkship. Both cases need to be completed by the designated due date. Failure to complete SIMPLE cases by the designated due date 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. The note should be written legibly, accurately and adequately. Please note: • H&P notes are to be a maximum of five (5) pages in length. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • H&P notes are not acceptable on hospital forms. • H&P notes cannot duplicate the interesting case patient. • 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 particular 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 internal medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects and cost of medication. The student is required to present 34

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 bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day will receive a grade of zero for this portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of 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 collaboratively work 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 blackboard. 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. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. 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.” The program fax number is 516-463-5177. 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 a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. 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 Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. 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. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. 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 per week/60 per clerkship

CLINICAL YEAR PATEINT 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 for graduation. 35

Types of Clinical Encounters Preventative 20 during clinical year Acute 20 during clinical year Chronic 20 during clinical year Emergent 20 during clinical year Developmental Disabilities 15 during clinical year Preventative 20 during clinical year Acute 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 2 years of age 50 during clinical year Children- 2 y/o – 12 y/o 50 during clinical year Adolescents- 13 y/o – 17 y/o 50 during clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. 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 Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 36

Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

5 5 5 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 http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to the following topic list of conditions http://www.endofrotation.org/wp-content/uploads/2015/07/Internal-Medicine-TopicList-2015.pdf Student should also review the breakdown of the exam, which can be found through the following link: http://www2.paeaonline.org/index.php?ht=a/GetDocumentAction/i/140861 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). In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she 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 in order 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 DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. 37

REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, 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, comfort-ability 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: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY: Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving 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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each 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 by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she will receive two (2) points off their final rotation grade for each assignment not completed. 38

Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not 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.

39

PHA 260 OBSTETRICS/GYNECOLOGY CLERKSHIP

3 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 DESCRIPTION This is a six-week clinical experience where students work with obstetric and gynecologic preceptors to evaluate women’s health, throughout the reproductive and post-menopausal years. Participation in common gynecological surgical procedures along with assisting in labor and delivery may be included in this clerkship. This clerkship may take place in a hospital, clinic or private practice setting. COURSE GOAL The goal of this clerkship is to provide students with general knowledge of the principles of obstetric and gynecologic care, and to prepare them to manage the healthcare needs of women, throughout their lifespan. INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

Assessment Tools Utilized

By the conclusion of the obstetrics/gynecology clerkship, students will be competent in the following:

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

Evaluation of the obstetric patient by obtaining an accurate prenatal history, performing an appropriate physical exam, to include a pelvic examination, and obtaining gestation or condition specific laboratory and diagnostic studies Evaluation of the gynecologic patient by obtaining a thorough patient history, performing a physical exam, to include a breast

• •

• • •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation Preceptor assessment and sign-off of

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning and problem solving abilities: • Use effective interviewing skills to elicit a detailed history • Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data as applied to the obstetric and post-partum population • Elicit a detailed medical history, perform physical examination on a gynecologic

examination and a pelvic examination and obtaining appropriate diagnostic and laboratory data Utilizing information obtained from the history, physical and diagnostic data to formulate differential diagnoses for obstetric and gynecologic patients Develop evidence based, best practice, patient-centered management plans for obstetric and gynecologic patients

Accurately document pre-natal, obstetric and gynecologic care in patient H&P and SOAP notes Providing patient education, to include appropriate screening recommendations, disease prevention, family planning, prenatal care, and menopause to obstetric and gynecologic patients and their families Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient Communicating effectively and respectfully with obstetric and gynecologic patients and their families and members of the interprofessional team

• • • • • • • • • • • •

competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Interesting patient case assignment

patient, accurately record all data

•

•

•

• •

Select and interpret appropriate diagnostic tests, lab studies or screening tools Synthesize and analyze all clinical data correctly to aid in diagnosis Utilize critical thinking and problem solving skills to identify and manage pediatric care Locate, appraise and apply evidence from scientific studies Accurately and adequately document medical information

•

Use effective basic counseling and patient education skills

• •

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Effectively complete oral presentations

•

Preceptor evaluation

•

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability

• • • • • •

• 41

• • • 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, drug interactions, and pregnancy risk category of medications commonly used in obstetric and gynecologic

Interesting patient case •

Drug Cards

•

Utilize the PAEA Core Tasks and • Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the pediatric conditions outlined at http://www.endofrotation.org/wp content/uploads/2015/07/Women s-Health-Topic-List-2015.pdf

EOR examination

•

•

•

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment One obstetrics/gynecology SOAP Note Three obstetrics/gynecology Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements End of Clerkship Examination Developmental Disabilities Curriculum Requirements- if applicable Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable

25% 15% 25% P/F P/F 35% P/F P/F

42

Exhibit an understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

Identify pharmacologic agents and other relevant treatment modalities as they relate to pediatric patients to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for obstetric and gynecologic conditions Identify signs and symptoms of common obstetric and gynecologic conditions Utilize critical thinking and problem solving skills to manage obstetric and gynecologic patients

*All assessment and evaluation tools are located in the back of the handbook INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the obstetrics and gynecology clerkship. The interesting case will either be presented on a site visit or handed in on 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, peer-reviewed 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 SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one SOAP note, using while on their obstetrics/gynecology clerkship. The note should be written legibly, accurately and adequately. Please note: • SOAP notes are not the same as progress notes. Progress notes will not meet this requirement. • SOAP notes are to be a maximum of one (1) page in length. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • SOAP 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 particular 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 obstetrics/gynecology clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects 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 bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day, they will receive a grade of zero for this portion of the clerkship grade.

43

PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of 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 collaboratively work 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 blackboard. 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. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. 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.” The program fax number is 516-463-5177. 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 a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. 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 are completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum obstetrics/gynecology 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 should increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their pediatric clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Ob/GYN Prenatal Care Gynecologic Care

10 per week/60 per clerkship 15 per clerkship 15 per clerkship

CLINICAL YEAR PATEINT ENCOUNTER REQUIREMENTS Although students must log specific pediatric encounters during the pediatric clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the obstetrics/gynecology 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.

Preventative Acute Chronic

Types of Clinical Encounters 20 during clinical year 20 during clinical year 20 during clinical year 44

Emergent Developmental Disabilities Preventative Acute

20 during clinical year 15 during clinical year 20 during clinical year 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 2 years of age 50 during clinical year Children- 2 y/o – 12 y/o 50 during clinical year Adolescents- 13 y/o – 17 y/o 50 during clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. During your obstetrics/gynecology clerkship, it is recommended that you focus on procedures such as IM/SC/ID injections, venipuncture, IV placement, Foley catheter placement, suturing, breast examinations and pelvic examinations. 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 Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) 45

END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the obstetrics/gynecology discipline, 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 http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to http://www.endofrotation.org/wp-content/uploads/2015/07/Womens-Health-Topic-List-2015.pdf. Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2015/06/Womens-Health-Blueprint.pdf. These endof- rotation examinations have the same format as the Physician Assistant National Certifying Examination (PANCE), and are good preparation for successfully passing the PANCE. In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she 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 in order 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. DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, 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, comfort-ability with providing care to individuals with developmental disabilities and their 46

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: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a five (5) point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a ten (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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each 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 by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she 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 Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade.

47

CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not 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.

48

PHA 265 SURGERY CLERKSHIP

3 s.h.

COURSE COORDINATORS Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This course is a six-week 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 postop 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. INSTRUCTIONAL OBJECTIVES AND LEARNING OUTCOMES

Instructional Objectives

Assessment Tools Utilized

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

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

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 of the pre-surgical and post-surgical patient.

• •

• •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning and problem solving abilities: • Use effective interviewing skills to elicit a detailed history • Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data

•

Elicit a detailed medical history, perform appropriate

•

• • Provide intraoperative care of surgical patient.

• •

Formulate assessment plans for surgical patients

• • •

Develop management plans for surgical patients

• • •

Accurately documenting surgical care in patient SOAP notes and progress notes. Providing patient education and counseling for surgical patients

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

• • • • • • • •

•

Preceptor assessment and sign-off of competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs EOR examinations Preceptor evaluation Submission of clinical documentation EOR examinations Preceptor evaluation Submission of clinical documentation EOR examinations Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

50

•

• •

• • •

•

physical examination and accurately record all data Identify and formulate an appropriate assessment and management plan

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures Select and interpret appropriate diagnostic tests or lab studies Synthesize and analyze clinical data correctly Utilize critical thinking and problem solving skills to identify and manage surgical conditions Accurately and adequately document medical information

•

Use effective basic counseling and patient education skills

• •

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

Communicating effectively and respectfully with members of the interprofessional team, patients, and their families

•

Preceptor evaluation

•

• •

• • Participate in a form of continuing medical education Describe the indications, contraindications, mechanism of action, adverse effects and drug interactions of medications commonly used in surgical patients

•

CME Project

•

•

Drug Cards

•

EOR examination

•

Utilize the PAEA Core Tasks and • Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of surgical conditions outlined at http://www.endofrotation.org/wp content/uploads/2015/07/General -Surgery-Topic-List-2015.pdf

• •

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Continuing Medical Education Project One surgical SOAP Note Three surgical Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements End of Clerkship Examination Developmental Disabilities Curriculum Requirements- if applicable

25% 15% 25% P/F P/F 35% P/F

51

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability Exhibit and understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning 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 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

Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook CONTINUTING MEDICAL EDUCATION PROJECT During the surgery rotation, students will be assigned a CME project focusing on a surgically related topic. The purpose of the project is for students to emphasize the need for life-long learning and introduce students to an item necessary to maintain certification. This project may be either web-based or found in a peer-reviewed journal article. Students must submit proof of completion of the CME project either during a site visit or on call back day if a visit has not occurred. A 100% will be awarded to students who complete the project and display a good understanding of the CME topic. If the student has a site visit, he/she should be prepared to present the CME project on the day of a site visit, and answer questions regarding the project. Students who do not have a site visit should bring the CME certification at call back day. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one SOAP note while on their surgery clerkship. The note should be written legibly, accurately and adequately. Please note: • SOAP notes are not the same as progress notes. Progress notes will not meet 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 patient education. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • SOAP 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 particular 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 clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects 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 bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at call back day will receive a grade of zero for this portion of the clerkship grade.

52

PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of 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 collaboratively work 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 blackboard. 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. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. 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.” The program fax number is 516-463-5177. 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 a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. 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 Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum surgical 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. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their surgical rotation, 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 per week/60 per surgical rotation 10 per surgical rotation 10 per surgical rotation 10 per surgical rotation

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

Types of Clinical Encounters 20 during clinical year 20 during clinical year 20 during clinical year 53

Emergent 20 during clinical year Developmental Disabilities 15 during clinical year Preventative 20 during clinical year Acute 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 2 years of age 50 during clinical year Children- 2 y/o – 12 y/o 50 during clinical year Adolescents- 13 y/o – 17 y/o 50 during clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. 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 Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) 54

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 http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to the following topic list of conditions http://www.endofrotation.org/wp-content/uploads/2015/07/General-Surgery-TopicList-2015.pdf . Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2015/06/General-SurgeryBlueprint.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). In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she 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 in order 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 DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, 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, comfort-ability 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 55

device. Title each journal entry adhering to the following format: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a five (5) point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a ten (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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each 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 by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she 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 Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade.

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CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not 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.

57

PHA 270 EMERGENCY MEDICINE CLERKSHIP

4 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This is a six-week 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. INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

Assessment Tools Utilized

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

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

Timely evaluation of the patient in the emergency room by obtaining a problem-focused history, and performing an appropriate physical examination

• •

• Applicable, cost-effective use of laboratory tests and other diagnostic data to aid in the diagnosis of patients in the emergency room

• •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation 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 problem solving abilities: • Use effective interviewing skills to elicit a detailed history • Perform problem-focused physical examination

•

Select and interpret appropriate diagnostic tests, lab studies or screening tools

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, best practice management plans for patient’s seen in the emergency department

Comprehensive and thorough documentation of H&P’s and progress notes in the emergency department Providing patient education, to include follow-up care, to patients in the emergency department and their families

• •

• • • • • • • • • • • • • • • •

Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient

• •

•

Preceptor evaluation • Preceptor assessment and sign-off of competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation • Submission of clinical documentation EOR examinations Interesting patient case assignment

Synthesize and analyze all clinical data correctly to aid in prompt diagnosis

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

Utilize critical thinking and problem solving skills to manage care of psychiatric patients Locate, appraise and apply evidence from scientific studies Accurately and adequately document medical information

Preceptor evaluation EOR examinations Submission of medical documentation Interesting patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Use effective basic counseling and patient education skills

• •

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

59

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

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

Preceptor evaluation

•

• • • •

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

Interesting patient case •

Utilize the PAEA Core Tasks and • Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the psychiatric conditions outlined at http://www.endofrotation.org/wp content/uploads/2015/07/Emerge ncy-Medicine-Topic-List2015.pdf

EOR examination

Drug Cards • Interesting patient case

•

• •

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment One Emergency Medicine SOAP Note Three Emergency Medicine Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements Computer Operated Adult/Child Simulators

25% 15% 25% P/F P/F P/F 60

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability Exhibit an understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

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 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

End of Clerkship Examination 35% Developmental Disabilities Curriculum P/F Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the emergency medicine clerkship. The interesting case will either be presented on a site visit or handed in on 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, peer-reviewed 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 SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one SOAP note while on his or her emergency medicine clerkship. Please note: • SOAP notes are not the same as progress notes. Progress notes will not meet this requirement. • SOAP notes are to be a maximum of one (1) page in length. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • SOAP 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 particular 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 emergency medicine clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects 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 bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site 61

visit or not hand in the drug cards at 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 on the basis of 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 collaboratively work 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 blackboard. 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. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. 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.” The program fax number is 516-463-5177. 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 a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. 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 are completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum emergency 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 should increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. 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. Emergency Medicine

15 per week/90 per clerkship

CLINICAL YEAR PATIENT ENCOUNTER REQUIREMENTS Although students must log specific psychiatric encounters during the emergency medicine clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the emergency 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 for graduation.

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Types of Clinical Encounters Preventative 20 during clinical year Acute 20 during clinical year Chronic 20 during clinical year Emergent 20 during clinical year Developmental Disabilities 15 during clinical year Preventative 20 during clinical year Acute 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 2 years of age 50 during clinical year Children- 2 y/o – 12 y/o 50 during clinical year Adolescents- 13 y/o – 17 y/o 50 during clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS: Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. During your emergency medicine clerkship, it is recommended that you focus on procedures such as ABG’s, I&D’s, CPR, blood cultures, IV placement, splinting and NG tube placements. 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 emergency 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 Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 63

Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

5 5 5 5 5

*Center for Learning and Innovation (CLI) COMPUTER-OPERATED ADULT/CHILD SIMULATORS SimMan are computer-operated adult and child simulators that are used to create a variety of clinical education scenarios based on the core clerkship learning objectives. Students will attend a simulation session at the Center for Learning and Innovation (CLI) while on their emergency medicine clerkship. Failure to attend and participate in the clinical scenarios at the patient safety institute will result in an incomplete grade for this clerkship. END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the discipline of the discipline of emergency medicine, a 120question 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 http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to http://www.endofrotation.org/wp-content/uploads/2015/07/Emergency-Medicine-Topic-List-2015.pdf Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2015/06/Emergency-Medicine-Blueprint.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. In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she 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 in order 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. DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a five (5) point deduction from your overall rotation grade.

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COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, 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, comfort-ability 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: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving 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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. 65

The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each 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 by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she 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 Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not 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.

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PHA 280 PEDIATRIC CLERKSHIP

3 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This course is a six-week clinical experience where students work with pediatric preceptors to gain proficiency in the care of pediatric patients. Students will focus on recognizing and managing common childhood illnesses, well child care, management of chronic conditions, assessment of growth and development, and the practice of preventive health care in this specific population. COURSE GOAL The goal is to provide students with general knowledge of the principles of pediatric medicine and to allow students the opportunity to participate in the care of pediatric patients, from birth through adolescence. INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

Assessment Tools Utilized

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

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

Evaluation of the pediatric patient by obtaining an accurate patient history, performing an age-appropriate physical exam, obtaining and interpreting laboratory and diagnostic studies while recognizing normal age appropriate variations Recognize normal and abnormal patterns of pediatric growth and development and milestone achievement. Identify patients

• •

• • •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning and problem solving abilities: • Use effective interviewing skills to elicit a detailed history • Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data as applied to the pediatric population • Elicit a detailed medical history, perform ageappropriate physical examination, utilize appropriate

who require early intervention and initiate proper referral Formulate differential diagnoses for common complaints and presentations in the pediatric population

Develop evidence based, best practice, patient-centered management plans for pediatric patients

Accurately document pediatric care in patient H&P and SOAP notes Providing patient education, to include health promotion and disease and injury prevention (including immunizations) to pediatric patients and their families Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient Communicating effectively and respectfully with pediatric patients and their families and members of the interprofessional team

•

Submission of clinical documentation EOR examination Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Interesting patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Preceptor evaluation

• • • • • • • • • • • • • • • • • •

developmental screening tools and accurately record all data •

•

•

• •

•

Use effective basic counseling and patient education skills

•

•

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

•

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability Exhibit an understanding of the physician assistant profession

•

• •

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Select and interpret appropriate diagnostic tests, lab studies or screening tools Synthesize and analyze all clinical data correctly to aid in diagnosis Utilize critical thinking and problem solving skills to identify and manage pediatric care Locate, appraise and apply evidence from scientific studies Accurately and adequately document medical information

• • 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, drug interactions and correct dosing parameters of medications commonly used in pediatric patients

Interesting patient case •

Drug Cards

•

Utilize the PAEA Core Tasks and • Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the pediatric conditions outlined at http://endofrotation.org/exams/bl ueprints-and-topiclists/pediatrics-topic-list.pdf

EOR examination

•

• •

Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

Identify pharmacologic agents and other relevant treatment modalities as they relate to pediatric patients to include understanding the indications, contraindications, side effects, interactions and adverse reactions Determine the etiologies, risk factors and epidemiology for pediatric conditions Identify signs and symptoms of common pediatric conditions Utilize critical thinking and problem solving skills to manage pediatric patients

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment 25% One Pediatric SOAP Note in Practice Fusion 15% Three Pediatric Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% Developmental Disabilities Curriculum P/F Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook

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INTERESTING PATIENT CASE ASSIGNMENTS The interesting patient case assignment is a requirement during the pediatric clerkship. The interesting case will either be presented on a site visit or handed in on 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, peer-reviewed 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 SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one SOAP note, using PRACTICE FUSION while on their pediatric clerkship. The note should be written legibly, accurately and adequately. Please note: • SOAP notes are not the same as progress notes. Progress notes will not meet 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 patient education. • 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 particular 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 pediatric clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects 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 bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at 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 on the basis of 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, 70

propose a management plan, present cases, and demonstrate the ability to collaboratively work 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 blackboard. 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. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. 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.” The program fax number is 516-463-5177. 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 a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. 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 are completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum pediatric 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 should increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Should a student not meet these competencies during their pediatric clerkship, students must formulate a plan with one of the clinical coordinators to meet these competencies. Competency in these areas is required for graduation. Pediatrics

15 per week/90 per clerkship

CLINICAL YEAR PATEINT ENCOUNTER REQUIREMENTS Although students must log specific pediatric encounters during the pediatric clerkship, the below clinical encounters are required to be completed by the end of the clinical year, not by the end of the pediatric 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 20 during clinical year Acute 20 during clinical year Chronic 20 during clinical year Emergent 20 during clinical year Developmental Disabilities 15 during clinical year Preventative 20 during clinical year Acute 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 2 years of age 50 during clinical year 71

Children- 2 y/o – 12 y/o Adolescents- 13 y/o – 17 y/o Adults- 18 y/o – 64 y/o

50 during clinical year 50 during clinical year 100 during the clinical year

PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. During your pediatric clerkship, it is recommended that you focus on procedures such as blood cultures, IM/SC/ID injections, and venipuncture. 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 pediatric 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 Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the pediatric 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 72

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 http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to http://www.endofrotation.org/wp-content/uploads/2015/07/Pediatrics-Topic-List-2015.pdf. Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2015/06/Pediatrics-Blueprint.pdf. These end-ofrotation examinations have the same format as the Physician Assistant National Certifying Examination (PANCE), and are good preparation for successfully passing the PANCE. In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she 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 in order 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. DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, 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, comfort-ability 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: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 73

a formal grade. All students will be required to submit a minimum of fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving 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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each 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 by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she 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 Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not 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. 74

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.

75

PHA 285 PSYCHIATRY CLERKSHIP

3 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This is a six-week clinical clerkship experience where students will work with psychiatrists, psychologists and other members of the interprofessional healthcare team to evaluate and manage patients with behavioral and psychiatric illnesses. COURSE GOAL The goal of this clerkship is to enhance the students’ knowledge of the general principles of psychiatry and to expose them to patients with a variety of mental illnesses. Students will develop proficiency in taking a psychiatric history and performing mental status examinations and learn appropriate use of psychoactive pharmaceuticals. INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

Assessment Tools Utilized

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

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

Comprehensive evaluation of the psychiatric patient by obtaining an accurate medical history, family and social history, a thorough psychiatric history and performance of a physical examination to include a full mental status examination. Appropriate use of laboratory tests and other diagnostic data to aid in the diagnosis of patients with mental illnesses

• •

• • •

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation 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 problem solving abilities: • Use effective and compassionate interviewing skills to elicit a detailed history • Perform patient appropriate physical examination

•

Select and interpret appropriate diagnostic tests, lab studies or screening tools

Recognize normal and abnormal patterns of behavior. Identify patients who require admission versus those who can be treated as an outpatient and those who require specialty referral.

Utilize information obtained from the H&P, laboratory and diagnostic studies to determine psychiatric differential diagnoses according to DSM-V criteria Develop evidence based, best practice, patient-centered management plans for patients with mental illness

Comprehensive and thorough documentation of psychiatric H&P’s and progress notes Providing patient education, to include disease management skills to patients with mental illness and their families

•

Elicit a detailed medical history, perform patient appropriate physical examination, utilize appropriate screening tools and accurately record all data

•

Synthesize and analyze all clinical data correctly to aid in diagnosis

•

Utilize critical thinking and problem solving skills to manage care of psychiatric patients Locate, appraise and apply evidence from scientific studies Accurately and adequately document medical information

•

Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs Submission of clinical documentation EOR examination Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation EOR examinations Interesting patient case assignment Preceptor evaluation Submission of clinical documentation Preceptor evaluation EOR examinations Submission of medical documentation Interesting patient case assignment Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

Preceptor evaluation

• •

• • • • • • • • • • • • • • • •

Completing technical skills competently

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient Communicating appropriately and respectfully with psychiatric patients and their families and

• •

77

• •

•

Use effective basic counseling and patient education skills

• •

Performs procedures safely and at an appropriate skill level Identifies the indications and contraindications of technical procedures

•

Effectively complete oral presentations

•

Work collaboratively as a member of an interprofessional healthcare team

members of the interprofessional team

• • • •

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 psychiatry (including but not limited to antidepressants, anxiolytics, antipsychotics, sedatives) Utilize the PAEA Core Tasks and Functions list found at http://www.endofrotation.org/exa ms/core-tasks-objectives/ and apply to each of the psychiatric conditions outlined at http://www.endofrotation.org/wp content/uploads/2015/07/Psychiat ry-Topic-List-2015.pdf

•

Interesting patient case •

• •

Drug Cards • Interesting patient case

•

EOR examination

•

• •

ASSESSMENT/EVALUATION CRITERIA The grade for this clerkship is based on the following components: Interesting Case Assignment One Complete Psychiatric H & P Three Psychiatry Drug Cards Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements

25% 15%

End of Clerkship Examination Developmental Disabilities Curriculum Requirements- if applicable Call Back Day Longitudinal Patient Participation, Reflective Journal Entry &

35% P/F

25% P/F P/F

P/F 78

Exhibit reliability and dependability Exhibit an understanding of the physician assistant profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

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 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

Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located 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 handed in on 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, peer-reviewed 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 SOAP note. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. SUBMISSION OF CLINICAL DOCUMENTATION Each student will submit one Psychiatric H&P while on their psychiatry clerkship. The note should be written legibly, accurately and adequately. Please note: • The psychiatry H&P does not need a full physical exam included within the note unless pertinent. Students must make sure to include the mental status exam and appropriate psychiatric, medical and social assessment within the note. • H&P notes are to be a maximum of five (5) pages in length. • Notes cannot be typed and have to be in original handwriting. Photocopies are not acceptable. • H&P notes are not acceptable on hospital forms. • H&P notes cannot duplicate the interesting case patient. • 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 particular 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.

79

DRUG CARDS Students are required to research three (3) pharmaceutical agents used during their psychiatry clerkship and make flash cards demonstrating their knowledge of the class, mechanism of action, indications, contraindications, side effects 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 bring drug cards to each call back day. Student name, date and number must be listed on each drug card. Should a student fail to produce these cards on a site visit or not hand in the drug cards at 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 on the basis of 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 collaboratively work 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 blackboard. 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. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. 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.” The program fax number is 516-463-5177. 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 a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. 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 are completed utilizing the Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. 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 should increase in complexity and level of participation as student’s progress in each clerkship and throughout the clinical phase of the program. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. 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 per week/60 per clerkship

80

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 20 during clinical year Acute 20 during clinical year Chronic 20 during clinical year Emergent 20 during clinical year Developmental Disabilities 15 during clinical year Preventative 20 during clinical year Acute 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 2 years of age 50 during clinical year Children- 2 y/o – 12 y/o 50 during clinical year Adolescents- 13 y/o – 17 y/o 50 during clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but indicates that a student can competently perform the procedure. 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. REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS Procedure ABG Abscess I&D Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections

Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 81

IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations Pelvic Examinations Rectal Examinations

10 2 5 5 10 5 5 5 5 5

*Center for Learning and Innovation (CLI) END OF CLERKSHIP EXAMINATION To assess comprehensive knowledge of the discipline of psychiatry, 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 http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to http://www.endofrotation.org/wp-content/uploads/2015/07/Psychiatry-Topic-List-2015.pdf Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wp-content/uploads/2015/06/Psychiatry-Blueprint.pdf These end-ofrotation examinations have the same format as the Physician Assistant National Certifying Examination (PANCE), and are good preparation for successfully passing the PANCE. In order to pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, he/she 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 in order 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 DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits 82

and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, 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, comfort-ability 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: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving 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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback 83

day. In addition, after each 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 by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she 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 Typhon within one week of the call back day for any scheduled lecturers. 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 not 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.

84

PHA 290 ELECTIVE CLERKSHIP

3 s.h.

Clinical Coordinators: Shannan Ricoy, M.S., PA-C; Email: Shannan.Ricoy@hofstra.edu; Office: 516-463-4233 Christine Zammit, M.S., PA-C; Email: Christine.Zammit@hofstra.edu; Office: 516-463-4380 COURSE DESCRIPTION This is a six-week clinical experience that provides students with the opportunity to either explore a medical sub-specialty, surgical sub-specialty or to gain further experience in one of the core disciplines of medicine. COURSE GOAL For students to learn to provide high quality and comprehensive medical care to the patients seen on their elective clerkship. INSTRUCTIONAL OBJECTIVES AND LEARNING OUTCOMES

Instructional Objectives Assessment Tools Utilized By the conclusion of the elective clerkship, students will be competent in the following:

Evaluation of the 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

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

Learner Outcomes Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning and problem solving abilities: • •

•

•

Use effective interviewing skills to elicit a detailed history Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data Determine the etiologies, risk factors and epidemiology for various medical and surgical conditions Identify signs and symptoms of various medical and surgical conditions

Formulate an assessment for patients in the elective discipline

•

Preceptor evaluation

•

Utilize critical thinking and problem solving skills to identify and manage various medical and surgical conditions

•

Select and interpret appropriate diagnostic tests or lab studies Synthesize and analyze clinical data correctly Utilize critical thinking and problem solving skills to identify and manage a wide variety of medical conditions seen on the elective discipline Adequately document medical information in history & physical notes and progress notes Use effective basic counseling and patient education skills

• Development of management plans for patients in the elective discipline

•

Preceptor evaluation

•

Accurately document the medical care rendered for patients in the elective discipline

•

Preceptor evaluation

•

Providing patient education and counseling for a wide variety of medical conditions seen on the elective discipline Completing technical skills competently

• •

Preceptor evaluation Interesting Patient Presentation

•

• •

Preceptor evaluation Competency is measured by meeting the number of exposures listed under “Typhon Procedure Logging” in conjunction with the preceptors signature, indicating the procedure was done competently Preceptor evaluation

•

•

Effectively complete oral presentations

Preceptor evaluation

•

Work collaboratively as a member of an interprofessional healthcare team Exhibit reliability and dependability Exhibit and understanding of the physician assistant profession

Presenting patients to the preceptor • or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patients seen on the elective discipline Identify the members of the • interprofessional team and the roles that they play in the delivery of healthcare in the elective discipline

•

• •

86

Performs procedures safely and at an appropriate skill level for the elective discipline Identifies the indications and contraindications of technical procedures

• • Identify clinical strengths and weaknesses, and set personal goals for future clinical practice

•

Pre & Post Elective Essay

•

Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning

ASSESSMENT/EVALUATION CRITERIA Interesting Case Assignment Presentation Pre & Post Essay Preceptor Evaluation Clerkship Patient Encounter Requirement Logs Procedure Logging Requirements

50% 25% 25% P/F P/F

Developmental Disabilities Curriculum P/F Requirements- if applicable Call Back Day Longitudinal Patient P/F Participation, Reflective Journal Entry & Medical Documentation Submission via Practice Fusion- if applicable *All assessment and evaluation tools are located in the back of the handbook ELECTIVE INTERESTING PATIENT CASE PRESENTATION The interesting patient case presentation is a requirement during the elective clerkship. The interesting case will be presented on call back day. All interesting patient case presentations should be in a PowerPoint format and include a focused H&P, a summary of the pathophysiology of the disease state. In addition to this, students must create a unique plan to educate their patients on this topic. Examples include a poster, pamphlet or lesson plan. Students should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This presentation can be no longer than fifteen minutes in length. All topics are to be submitted to the clinical coordinators a minimum of two weeks prior to call back day for approval. When presenting students may utilize an outline or notes for guidance, however reading verbatim off their PowerPoint slides is not permitted. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. PRE AND POST ESSAY As the elective clerkship gives the student a chance to explore a special interest, the “pre and post essay” evaluates how that choice was made and the level of success of the clerkship experience. The “pre” portion of the essay will outline the reasons for choosing the elective, the expectations for skills gained, the types of patients seen and the personal goals and objectives for the clerkship experience (See appendix). The “post” portion of this essay will discuss what was enjoyed and disliked about the specialty, and if the discipline may become a career choice. It will also discuss the degree to which goals and objectives were 87

met and how adjustments were made to optimize learning. This portion must be completed near the end of the clerkship. This exercise is not an evaluation of the site. Therefore, all comments must be specific to the specialty, not the clerkship location. The final essay should be from 1.5 – 2 pages in length, typed, and doublespaced. As a professional document, all issues should be presented in a respectful manner. Failure to submit this project will result in a grade of zero for this portion of the clerkship grade. PRECEPTOR EVALUATION Students will be evaluated by each Clinical Preceptor on the basis of 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 collaboratively work 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 blackboard. 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. Some sites choose to mail or fax their evaluations to the Program. In this case students should check with one of the clinical coordinators to confirm the evaluation has been received. 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.” The program fax number is 516-463-5177. 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 a maximum of two evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure of the preceptor evaluation. 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 Typhon system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. The minimum elective 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. Preceptors must sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. 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. Elective

5 per week/30 per clerkship

CLINICAL YEAR PATEINT 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 elective 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. 88

Types of Clinical Encounters Preventative 20 during clinical year Acute 20 during clinical year Chronic 20 during clinical year Emergent 20 during clinical year Developmental Disabilities 15 during clinical year Preventative 20 during clinical year Acute 20 during clinical year Medical Care Across the Life Span Encounters Infants- less than 2 years of age 50 during clinical year Children- 2 y/o – 12 y/o 50 during clinical year Adolescents- 13 y/o – 17 y/o 50 during clinical year Adults- 18 y/o – 64 y/o 100 during the clinical year PROCEDURE LOGGING REQUIREMENTS Students are required to perform and log a number of procedures. These procedures are tracked through the Typhon 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 “done”. Preceptors must sign off on the procedure logs. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. During your elective clerkship, it is recommended that you focus on the procedures listed below, as well as procedures unique to the elective clerkship. 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 elective 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 Blood Cultures Cardiopulmonary Resuscitation Foley Catheter Placement IM/SC/ID-injections IV Placement NG Tube Placement Splinting Suturing Venipuncture Assist in Operating Room Wound Care/Debridement Breast Examinations

Required Number 4 2 2 1-assisted is acceptable or at CLI* 4 10 10 2 5 5 10 5 5 5 89

Pelvic Examinations Rectal Examinations

5 5

*Center for Learning and Innovation (CLI) DEVELOPMENTAL DISABILITIES CURRICULUM REQUIREMENTS HOME VISIT AND INTERVIEW The home visit and interview is designed to improve student interpersonal and communication skills, describe how family, home life, society, health related interactions, work, school and economics may be affected by the impact of the disabilities of a patient, and recognize the possible additional demands that may be placed on those involved in the care of individuals with developmental disabilities. The home visit and interview will be completed in pairs once during the clinical year. Whenever possible, the visit will be completed in the participant’s home. After interviewing the patient and caregiver(s), all the information on the “Home Visit Interview Form” must be completed and submitted via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. COMMUNITY AGENCY VISIT The community agency visit is designed to improve understanding of system-based practice. The community agency visit may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. The community agency visits and interview will be completed in small groups once during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. After the experience, complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Failure to complete this assignment on the rotation in which it was assigned will result in a 5 point deduction from your overall rotation grade. REFLECTIVE JOURNALING After the home visit, community visit and each clinical encounter, 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, comfort-ability 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: “Home Visit”, “Clinical Encounter #2”. Date each entry as well. This journal will be submitted via the blackboard drop box 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 fifteen reflective journal entries. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship. CLINICAL ENCOUNTERS Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Typhon 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. Examples of writings may reflect on, but are not limited to, the general interaction, communication skills and methods of improvement, discussion or lack of discussion of services available, medical practices indicated. Please title each clinical interaction in the reflective journal as “Clinical Encounter #1”, #2, #3 until you have met 15 90

patients with developmental disabilities. Failure to demonstrate the required number of clinical encounters will affect the student’s ability to graduate. CALL BACK DAY Students return to campus or the Center for Learning and Innovation (CLI) 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 PRIOR to the date to discuss the legitimacy of the absence. A student leaving call back day early, without notifying the clinical coordinator will result in a five (5) point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a ten (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 at the Center for Learning and Innovation will involve a longitudinal patient care experience. This gives clinical year students the ability to see the same patient throughout the clinical year. The student will have five encounters with this patient throughout the clinical year. 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 on practice fusion. The SOAP note is due to the clinical year blackboard shell by 11:59pm of callback day. In addition, after each 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 by 11:59pm. If a student misses a patient encounter, or does not complete either the SOAP note or video self-reflection, he or she 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 Typhon within one week of the call back day for any scheduled lecturers. Failure to do so will result in a three (3) point deduction from the overall rotation grade. CLERKSHIP BIBLIOGRAPHY During the clinical year and in clinical practice there is not 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 91

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.

92

CLINICAL YEAR FORMS

93

Interesting Case Presentation Evaluation Form Student ______________________________________

Site Visitor____________________

Rotation Type __________________ Site __________________________ Visit Dates______ Rotation Dates_________________________

Preceptor Name _______________________

\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ SCORING: 0 = Not done, 1/5 = Poor, 5/5 = Excellent TOPIC: _____________________________________________ HISTORY: Descriptors included in HPI Clear & concise HPI HPI includes pertinent positive and negatives Includes all pertinent past medical history

0 0 0 0

PHYSICAL EXAM: Focused physical exam-including all components Includes pertinent positive & negative PE findings

1 1 1 1

2 2 2 2

COMMENTS

3 3 3 3

4 4 4 4

5 ________________________________ 5 ________________________________ 5 ________________________________ 5 ________________________________

0 1 0 1

2 3 2 3

4 4

5 ________________________________ 5 ________________________________

LABS/DIAGNOSTIC PROCEDURES: Utilization of appropriate diagnostic tests Presents pertinent findings

0 1 0 1

2 3 2 3

4 4

5 ________________________________ 5 ________________________________

DIAGNOSIS: Addresses both acute, chronic disease & HCM Ability to formulate & eliminate differential dx Describes pathophysiology of disease state

0 1 0 1 0 1

2 3 2 3 2 3

4 4 4

5 ________________________________ 5 ________________________________ 5 ________________________________

MANAGEMENT: Understands pharmacologic therapy Discusses appropriate non-pharmacologic therapy Addresses disease prevention/HCM Provides patient with follow-up instructions

0 0 0 0

6 3 6 3

8 4 8 4

10 ________________________________ 5 _________________________________ 10 ________________________________ 5 _________________________________

JOURNAL: Discusses or writes a summary of article Submits supporting journal article (< 5yrs old)

0 2

4 6

8

10 _______________________________

PROFESSIONALISM:

0 1

2 3

4

5 _______________________________

2 4 1 2 2 4 1 2

TOTAL POINTS ________ Faculty Signature: _________________________________________________________Date: __________

Elective Interesting Case Presentation Evaluation Form Student ______________________________________

Site Visitor____________________

Rotation Type __________________ Site __________________________ Visit Dates______ Rotation Dates_________________________

Preceptor Name _______________________

\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\ SCORING: 0 = Not done, 1/5 = Poor, 5/5 = Excellent TOPIC: _____________________________________________ HISTORY: Descriptors included in HPI Clear & concise HPI HPI includes pertinent positive and negatives Includes all pertinent past medical history

0 0 0 0

PHYSICAL EXAM: Focused physical exam-including all components Includes pertinent positive & negative PE findings

1 1 1 1

2 2 2 2

COMMENTS

3 3 3 3

4 4 4 4

5 ________________________________ 5 ________________________________ 5 ________________________________ 5 ________________________________

0 1 0 1

2 3 2 3

4 4

5 ________________________________ 5 ________________________________

LABS/DIAGNOSTIC PROCEDURES: Utilization of appropriate diagnostic tests Presents pertinent findings

0 1 0 1

2 3 2 3

4 4

5 ________________________________ 5 ________________________________

DIAGNOSIS: Addresses both acute, chronic disease & HCM Ability to formulate & eliminate differential dx Describes pathophysiology of disease state

0 1 0 1 0 1

2 3 2 3 2 3

4 4 4

5 ________________________________ 5 ________________________________ 5 ________________________________

MANAGEMENT: Understands pharmacologic therapy Discusses appropriate non-pharmacologic therapy Addresses disease prevention/HCM Provides patient with follow-up instructions

0 0 0 0

6 3 6 3

8 4 8 4

10 ________________________________ 5 _________________________________ 10 ________________________________ 5 _________________________________

PATIENT EDUCATION: Development of patient education materials

0 2

4 6

8

10 _______________________________

PROFESSIONALISM:

0 1

2 3

4

5 _______________________________

2 4 1 2 2 4 1 2

TOTAL POINTS ________ Faculty Signature: _________________________________________________________Date: __________

Mid-Clerkship Evaluation Please complete this evaluation by the end of the third week of the clerkship. The mid-clerkship evaluation is designed to have students reflect on their strengths and weaknesses at the mid-point of their clerkship. This provides the opportunity for students to obtain the best possible clinical experience and correct deficiencies before the clerkship ends. This tool also provides the program with feedback regarding clerkship quality. This allows for identification of deficiency areas at clerkship sites and early intervention should it be necessary. ROTATION: 1- FM 2- Med 3- Ob/Gyn 4- Surg 5- EM 6- Psych 7- Peds 8- Elective: ROTATION NUMBER: 1 2 3 4 5 6 7 8 ROTATION SITE: __________________ Please rate the following learning experiences as appropriate to your rotation 5= superior

4= very good

3= good

2= fair

1= poor

N/A = Not Applicable

Student Self-Assessment: How would you rate the following items: 1) 2) 3) 4) 5) 6) 7)

Your ability to acclimate and acculturate to the clinical team? _____ Your professional behavior and attendance? _____ Your ability to perform histories and administer physical examinations? Your ability to formulate a differential diagnosis? _____ Your ability to formulate and implement a management plan? _____ Your oral presentations? _____ Your ability to perform clinical procedures? _____

_____

Clerkship Site Analysis: How would you rate the following items: 1) Appropriateness of supervision (i.e. is the supervisor adequately supervising patient encounters)? _____ 2) Opportunity to perform history and physical examinations? _____ 3) Opportunity to formulate differential diagnosis and management plans? _____ 4) Opportunity to perform oral presentations? _____ 5) Opportunity to perform clinical procedures? _____ 6) Ability for this clerkship to meet the stated learning objectives? ____ COMMENTS:

Student Evaluation of Program Rotations The Physician Assistant Program is always interested in improving. Therefore, your input is very important. Please complete this anonymous evaluation of your rotation and recommendations on how to improve it. (Your comments will not, in any manner, affect your final clerkship grade.) ROTATION: 1- FM 2- Med 3- Ob/Gyn 4- Surg 5- EM 6- Psych 7- Peds 8- Elective: ROTATION NUMBER: 1

2

3

4 5

6

7

8

ROTATION SITE: ____________________

Please rate the following learning experiences as appropriate to your rotation as 5= Strongly Agree 4= Agree 3= Neither Agree nor Disagree N/A = Not Applicable 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

2= Disagree

1= Strongly Disagree

Provides opportunity to interview and examine patients _____ Provides opportunity to formulate assessments and create management plan _____ Provides the opportunity to present patients to preceptor or supervisor _____ Preceptor reviews student clinical documentation _____ Preceptor provides performance feedback to student _____ Provides adequate supervision of students _____ Provides opportunity to observe, learn, assist and/or perform clinical procedures ____ Students are integrated into medical team _____ Provides quality teaching _____ Clerkship, in conjunction with self-study, enables the student to achieve stated learning objectives _____

Please utilize this section for professionally written, constructive comments. COMMENTS:

STUDENT/PRECEPTOR REVIEW OF CLINICAL OBJECTIVES FORM Student_________________________________________ of Hofstra University Physician (NAME) Assistant Program has provided me the learning objectives for this rotation. We discussed in detail the expectations involved in successfully completing this rotation.

Preceptor__________________________________ Student____________________________________ Date______________________________________

BLOOD BORNE PATHOGEN EXPOSURE FORM Name: ____________________________________ Date of Report:______________________ Date of Exposure: ____________________ Time of Exposure: __________________ am/ pm Clerkship Location of Exposure:____________________________________________ Brief Description of Exposure: (OMIT ANY PATIENT SPECIFIC INFORMATION)

(Signature at end of statement is mandatory) Yes

No

Completed institution’s exposure forms: .............‫ٱ‬

‫ٱ‬

Submitted institution’s exposure forms: ..............‫ٱ‬

‫ٱ‬

FOR PHYSICIAN ASSISTANT PROGRAM STAFF ONLY: Reviewed by ______________________________ Date: _____________________________________

2016-2017 CLINICAL YEAR HANDBOOK AGREEMENT FORM

September 2016 Edition The 2016-2017 Physician Assistant Studies Program Student 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:

_____________________________________________

100

CLERKSHIP WORK SCHEDULE Complete the following schedule form and fax it to the Program by the Friday of the first week of the clerkship. Program fax number: 516-463-5177. Student Name: ________________________________________ Date: _______________________ Preceptor Name: ______________________________________ Preceptor Telephone: _________ Clerkship Specialty: ___________________________________ Clerkship Number: ___________ Document the date and hours that you are assigned to work on the following table. Also document any hours that you are making up. Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Week 1 Dates: Week 2 Dates: Week 3 Dates: Week 4 Dates: Week 5 Dates: Any changes to this schedule must be submitted to the program immediately and prior to date/dates changed. All changes must be approved by the clinical coordinator and this form needs to be signed by your designated preceptor. Excused Absences (please list date of absence and make-up date) 1.____________________________________ 2.____________________________________ 3.____________________________________ Student Signature____________________________________________________Date _________ Preceptor Signature__________________________________________________ Date __________

101

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 patientâ&#x20AC;&#x2122;s illness(es). 1. Identify and list this patientâ&#x20AC;&#x2122;s chronic illnesses and any lifestyle risk factors. __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 2. What specific recommendations or actions did you take to enable patient self-management, disease prevention and health promotion? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ _____________________ 3. Has your patient been receiving continuous health screening from visited facility? If so, when and what was done? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 102

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 patientâ&#x20AC;&#x2122;s illness(es). Please attach a one-page, typed, double spaced paper summarizing the article and discussing opinions regarding the article.

103

HEALTH PROMOTION PROJECT GRADE FORM Student Name ___________________________

Date _______________________

Rotation Number ____________ Content • Identified and listed patient’s chronic illnesses and lifestyle risk factors. • Describes specific recommendations or actions taken to enable patient self-management, disease prevention and health promotion. • Discusses whether or not 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. _________ (45%) Research Article • • • • •

Research article current (<5 years) Research article is appropriate for topic Paper summarizes article Opinions regarding the article are discussed Exercises proper composition skills

Professionalism • Submitted materials on time in a professional manner Final Score: Faculty: ___________________________________

104

_________ (45%) _________ (10%) _________ (100%)

END OF ROTATION GRADE FORM Name: Rotation: 1 Rotation Type:

Site: 2

3 FM

4 MED

5

6 OB/GYN

7

Final Grade: ______ 8 SURG

EM

PSYCH

PEDS

ELECT: _________

Grades for Psychiatry, Pediatrics, Surgery and OB/GYN clerkships are based on the following components: Percentage Preceptor Grade

X 25%

Interesting Patient Case Grade or CME Assignment

X 25%

End- of- Rotation Examination Grade

X 35%

Clinical Documentation & 3 Pharm Cards Grade

X 15%

Procedure Logging Requirements

P/F

Clerkship Patient Encounters Requirements

P/F

Completion of Call Back Day Activities

P/F

Developmental Disabilities Curriculum Requirements

P/F

Final Grade

X 100%

Total Points

Grades for Family Medicine, Internal Medicine and Emergency Medicine clerkships are based on the following components: Percentage Preceptor Grade

X 25%

Interesting Patient Case Grade or Health Promotion Assignment

X25%

SimMan Clinical Experience or SIMPLE Cases or FM Cases

P/F

End- of- Rotation Examination Grade

X 35%

Clinical Documentation & 3 Pharm Cards Grade

X 15%

Procedure Logging Requirements

P/F

Clerkship Patient Encounters Requirements

P/F

Completion of Call Back Day Activities

P/F

Developmental Disabilities Curriculum Requirements

P/F

Final Grade

X 100%

105

Total Points

The components of the elective clerkship are calculated by the following: Percentage Preceptor Grade

X 25%

Elective Interesting Case Presentation Grade

X 50%

Pre & Post Essay Grade

X 25%

Procedure Logging Requirements

P/F

Clerkship Patient Encounters Requirements

P/F

Completion of Call Back Day Activities

P/F

Developmental Disabilities Curriculum Requirements

P/F

Final Grade

X 100%

Total Points

USE LEGEND BELOW TO CALCULATE OVERALL LETTER GRADE

Letter Grade

A

A-

B+

B

B-

C+

C

F

Raw Score

100 - 93

92 - 90

89 - 87

86 - 83

82 - 80

79 - 77

76 - 70

69 or below

OVERALL GRADE: _______________FACULTY SIGNATURE: _________________________________________________DATE: __________

106

CLINICAL YEAR – CLINICAL DOCUMENTATION GRADING FORM Student’s Name: _______________________________________ Date: _______________ Faculty Evaluator: _______________________________________ Grade: ______________ SOAP/H&P: Item Student Value Maximum Point Value 1. Introduction (3) 2. History Components (20) 3. PE (15) 4. Assessment (20) (Includes acute, chronic, HCM) 5. Plan (20) (Patient Education, Follow Up, Preventive Care) 6. Signature (2) 7. Overall Evaluation of Note _____________ (20) (Organization, legibility, completeness, clarity, spelling, etc.) Total Points: _______ X 10% = ________ Pharmaceutical Cards: Item

1. 2. 3. 4. 5. 6.

Student Value

Class of medication Mechanism of Action Indications Contraindications Side Effects Cost of medication

Maximum Point Value

_____________ _____________ _____________ _____________ _____________ _____________

(10) (20) (20) (20) (20) (10)

Total Points: _______ X 5%= ________ Total Clinical Documentation Grade: _________ + ________ /15 = _________ SOAP/H&P Points Pharm. Points Final Grade Faculty Signature: _________________________________________Date: __________

107

EVALUATING A PEER-REVIEWED SCIENTIFIC ARTICLE In which journal was this article published? What hypothesis is being tested?

Which groups are being compared (i.e. describe control group and experimental group)?

What is the primary outcome being measured? How is it measured?

What is the major finding of this study? Is this finding significant?

What is the clinical relevance of this studyâ&#x20AC;&#x2122;s findings?

Describe any flaws in the study design.

108

Community Agency Experience Form Please explain to the client and caregiver who you are, why this project was implemented and the goals of the visit today. By then end of the meeting, you must be able to answer all questions listed below. If an item doesnâ&#x20AC;&#x2122;t apply, write doesnâ&#x20AC;&#x2122;t apply and the reasoning. After the meeting, complete and submit the form. Age of the individual with developmental disabilities: _______________ What is the personâ&#x20AC;&#x2122;s identified Developmental Disability if known: _______________________ Community Agency Setting: _________________ Community Agency Visit Number: 1 or 2 Give a brief explanation of the community resource visited?

Who has access to these services? Who qualifies for this service?

Are there any similar resources available?

Can you think of additional resources an individual with developmental disabilities would benefit from?

109

Comments: Reflective Journaling: Please reflect on your thoughts regarding this experience and write them in your online journal. They do not have to be written on this document, but we have included some questions below to help you think about the experience. What are your general thoughts about this experience? How do you think this experience will improve your comfort-ability with different patient populations? How did this experience help you gain additional knowledge (could be medical, non-medical, awareness of resources etc.) about the people/patients with developmental disabilities and their caregivers?

110

Home Visit Form Please explain to the client and caregiver who you are, why this project was implemented and the goals of the visit today. By the end of the interview, you must be able to answer all questions listed below. If an item doesnâ&#x20AC;&#x2122;t apply, write doesnâ&#x20AC;&#x2122;t apply and the reasoning. After the meeting, complete and submit the faculty member via blackboard within 48 hours of the visit. Age of Individual with Developmental Disability: _______________ Faculty Member: ______________ Developmental Disability, if known: _______________________ Family/Friends/Counselor/Others Present: ___________________________________________ Home Visit Number: 1 or 2 What is a typical day like?

Types of services available? Comments on the resource?

Experiences with health care providers? Overall communication skills? Comfort-ability? Medical knowledge?

Methods for improving experiences with health care providers? What advice would you give to new or current health care providers as it relates to caring for individuals with disabilities? Barriers encountered to receiving services/health care?

111

Describe how life has been affected by caring for individuals with disabilities? Address any/all of the following: how family, home life, society, health-related interactions, work, school and economics.

Overall general comments:

Reflective Journaling: Please reflect on your thoughts regarding this experience and write them in your online journal. They do not have to be written on this document, but we have included some questions below to help you think about the experience. What are your general thoughts about this experience? How do you think this experience will improve your comfort-ability with different patient populations? How did this experience help you gain additional knowledge (could be medical, non-medical, awareness of resources etc.) about people with Developmental Disabilities and their families/caregivers?

112

EMAIL OR FAX THIS FORM Shannan Ricoy, M.S., PA-C

PROGRAM IN

Clinical Coordinator, Program in

Studies

Email: Shannan.Ricoy@hofstra.edu 516-463-5177 516-463-4233 OR:

EVALUATION FORM

Christine Zammit, MS, PA-C Clinical Coordinator, Program in

Studies

Email: 516-463-5177 516-463-4380 OR Monroe Hall, Hofstra University Hempstead, New York 11549-1270

Student Name _________________________________________________ Rotation Type and Site_____________________________________________ Preceptor Name _______________________________________________ Rotation Dates __________________________________________________

Preceptors: Please use the Likert scale below to evaluate student overall performance on clinical clerkship.

Comments

(1 = poor, 2 = below average, 3 = average, 4 = good, 5 = excellent; total possible points = 100) Medical Interview

N/A

1

2

3

4

5

Physical Examination

N/A

1

2

3

4

5

Oral Case Presentation

N/A

1

2

3

4

5

Patient Record

N/A

1

2

3

4

5

Utilization of Diagnostic Tests

N/A

1

2

3

4

5

Interpretation of Diagnostic Tests

N/A

1

2

3

4

5

Technical Skills/Clinical Procedures

N/A

1

2

3

4

5

Problem Solving/Critical Thinking

N/A

1

2

3

4

5

Fund of Knowledge and Application of Concepts

N/A

1

2

3

4

5

Assessment/Differential Diagnoses

N/A

1

2

3

4

5

Ability to Formulate a Follow-up and Management Plan

N/A

1

2

3

4

5

Ability to Implement a Follow-up and Management Plan

N/A

1

2

3

4

5

Ability to Work Collaboratively in Interprofessional Teams

N/A

1

2

3

4

5

Relating to Patients and Colleagues

N/A

1

2

3

4

5

Understanding of PA Role

N/A

1

2

3

4

5

Reliability and Dependability

N/A

1

2

3

4

5

Self-Confidence

N/A

1

2

3

4

5

Attitude Toward Learning

N/A

1

2

3

4

5

Professionalism

N/A

1

2

3

4

5

Student Preparedness for Clinical Clerkship

N/A

1

2

3

4

5

**For components that received an N/A, please add 5 points when calculating the total points.** Total Points =

USE LEGEND BELOW TO CALCULATE OVERALL LETTER GRADE AND CIRCLE. Letter Grade

Overall Letter Grade =

Score

100-91

90-87

86-83

82-77

76-73

72-69

68-60

or

Overall Competency:

Preceptorâ&#x20AC;&#x2122;s Signature: ____________________________________________________ Date:______________________ Student StudentSignature: Signature:

Date:

113

DESCRIPTIONS OF EVALUATION CATEGORIES Ability to Formulate and Implement a Followup and Management Plan • Designs an effective and appropriate care plan • Selects appropriate consultations and referrals • Demonstrates an appropriate understanding of pharmacologic plan • Implements plan consistently and appropriately • Arranges for patient follow-up • Performs patient education at appropriate level • Uses counseling and patient education skills effectively

Medical Interview • Conveys understanding and empathy for patient • Obtains all pertinent information • Follows an organized format • Obtains history in a reasonable time period Physical Examination • Explains procedure to patient before exam • Performs examination in an orderly sequence • Demonstrates respect for patient • Performs appropriate and accurate exam

Relating to Colleagues • Ability to work collaboratively in inter-professional teams

Oral Case Presentation • Clear, organized, concise presentation • Includes all major active complaints/problems

Relating to Patients • Communicates effectively and appropriately with patients • Demonstrates respect and empathy for patients

Patient Record • Written materials are neat, legible and appropriate • Accurately and adequately documents patient encounters • Electronic record, when utilized, is accurate and organized

Understanding of PA Role • Demonstrates understanding for medical conditions and situations that require an attending physician or consultation • Understands the PA profession and the role of the PA as a team member

Utilization & Interpretation of Diagnostic Tests • Demonstrates sound knowledge of tests • Orders appropriate test(s) for working differential diagnosis • Uses appropriate discretion in ordering • Demonstrates the ability to interpret diagnostic tests

Reliability and Dependability • Assumes appropriate level of responsibility • Completes tasks thoroughly and in a timely fashion

Technical Skills/Clinical Procedures • Performs procedures safely and at appropriate skill level • Understands indication(s) for procedure(s) • Explains and attains consent of patient before starting procedure

Self-Confidence • Demonstrates confidence in clinical competence to patient, peers, and preceptor

Problem Solving/Critical Thinking • Synthesizes and analyzes clinical data correctly • Determines major active problem accurately and in a timely fashion • Determines abnormal from normal • Utilizes and evidence-based approach to medicine

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

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

Professionalism • Exhibits cultural awareness • 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 • Respects patient privacy and confidentiality • Demonstrates a positive response to constructive criticism • Dresses appropriately for professional role • Maintains clean and kempt appearance

Assessment/Differential Diagnoses • Formulates and justifies differential diagnoses • Determine the etiologies, risk factors, and epidemiology for medical conditions • Identify the signs and symptoms of medical conditions

Student Preparedness for Clinical Clerkship • Student was well prepared to transition into clinical clerkship

61974:8/15

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