PHA 250 FAMILY MEDICINE CLERKSHIP

PHA 250 FAMILY MEDICINE CLERKSHIP 3 s.h.

Course Coordinator: Jennifer Duperval, MS, PA-C; Email: Jennifer.P.Duperval@hofstra.edu Office: 516-463-6841

COURSE DESCRIPTION:

This is an 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.

INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES: Instructional Objectives

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

Assessment Tools Utilized

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

Learner Outcomes

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

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

• Use effective interviewing skills to elicit a detailed history • Determine the normal and abnormal in anatomy, physiology, laboratory findings and other diagnostic data and apply the information to recognize normal and abnormal health states • Preceptor evaluation • Select and interpret appropriate diagnostic tests or lab studies

commonly seen in the office setting

Management of acute and chronic illnesses that are commonly seen in the office setting • Submission of clinical documentation • EOR examinations • Virtual patient case assignment • Preceptor evaluation • Submission of clinical documentation • EOR examinations • Virtual patient case assignment • 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 • Discern among acute, chronic, and emerging disease states

Accurately document the medical care rendered for patients in primary care • Preceptor evaluation • Health Promotion Project

• Adequately document medical information in history & physical notes and progress notes Develop evidence-based • Preceptor evaluation • Use effective basic counseling recommendations regarding • EOR examinations and patient education skills health promotion and disease • Submission of with patients and their prevention for the well-patient, medical families to empower them to and patient centered best practices documentation participate in their care and plans for a wide variety of acute • Virtual patient case enable shared decisionand chronic conditions assignment making • Locate, appraise, and apply evidence from scientific studies to enhance patient care

Develop and promote measures to prevent occurrence, progression, and disabling effects of acute and chronic illnesses • Health Promotion Project • Understand the principles of preventative medicine and how they apply to clinical practice.

Completing technical skills competently • Preceptor evaluation • Performs procedures safely and • Competency is measured by meeting the number of procedures listed under “Exxat Procedure

Logging” in conjunction with the preceptor’s signature, indicating the procedure was done competently at an appropriate skill level • Identifies the indications and contraindications of technical procedures

Presenting patients to the family medicine preceptor in a concise and organized way • Preceptor evaluation • Effectively complete oral presentations

Identify the members of the • Preceptor evaluation • Develop relationships interprofessional team and the and effectively roles that they play in the communicate with delivery of healthcare. patients, families, physicians, and other members of the care team • Exhibit reliability, accountability, and dependability • Exhibit an understanding of the physician assistant profession and the role of a PA • Demonstrate empathetic and respectful behaviors • Demonstrates and identifies appropriate ethical behavior and attitudes • Provide appropriate referrals

Application of clinical reasoning and problem-solving to solve a virtual patient case • Virtual patient case assignment

Describe the indications, contraindications, mechanism of action, adverse effects and drug interactions of medications commonly used in primary care • Drug Cards • Develop skills necessary for lifelong learning • Synthesize and analyze clinical data correctly • Identify pharmacologic agents and other relevant treatment modalities as they relate to various medical conditions to include understanding the indications, contraindications, side effects, interactions, and adverse reactions

Utilize the PAEA Core Tasks and Functions list found at: https://paeaonline.org/assessment/ core-tasks-and-objectives/ and apply to each of the conditions outlined in the family medicine link found at: https://paeaonline.org/assessment/en d-of-rotation/content • EOR examination • 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

Demonstrate care that is appropriate in all patient encounters • Preceptor evaluation • Demonstrate care that is effective, safe, equitable and high quality

Appreciate the utility of improving the quality of medical care • Quality assurance / performance improvement assignment • Identify the value of quality improvement initiatives

Know ways to prevent disease and utilize in patient encounters to improve patient outcomes • Preceptor evaluation • Understand the principles of preventative medicine and how they apply to clinical practice

ASSESSMENT/EVALUATION CRITERIA

The grade for the family medicine clerkship is based on the following components:

Health Promotion Project Three Family Medicine Drug Cards 15% P/F

Virtual Patient Case Assignment

P/F Preceptor Evaluation 50% Clerkship Patient Encounter Requirement Logs P/F

Procedure Logging Requirements End of Clerkship Examination Developmental Disabilities Requirements-if applicable Call Back Day Longitudinal Patient Participation, Reflective Journal Entry & Medical Documentation Submission -if applicable Quality Assurance/Performance Improvement Assignment P/F 35% P/F

P/F

P/F

*All assessment and evaluation tools are 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 required to complete 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 on

Exxat will result in a grade of zero for this portion of the clerkship grade.

VIRTUAL PATIENT CASE ASSIGNMENT FOR EDUCATING STUDENTS

Virtual Patient Case Assignments are internet-based virtual patient programs addressing the core clerkship learning objectives. Each student will be assigned two (2) cases within the first two weeks of the clerkship. Both assigned cases need to be completed by the designated due date and proof of completion uploaded to the session required documents. Failure to complete the assigned Virtual Patient Case Assignments will result in an incomplete grade for this clerkship.

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, indications, contraindications, side effects, dosing, and cost of medication. The student is required to present these cards on the day of a site visit and be prepared to answer questions regarding the drugs selected. Students will not be able to read from their cards. Students who do not have a site visit should upload them onto Exxat under “Session Required Documents” prior to the start of call back day. Student name, date and rotation number must be listed on each drug card. Drug cards may be typed and submitted in word format. Should a student fail to

produce these cards on a site visit or not upload onto Exxat prior to the start of call back day, they will receive an incomplete for this clerkship. PRECEPTOR EVALUATION

Students will be evaluated by each Clinical Preceptor based on their general medical background, knowledge, and ability to obtain a medical history and perform an appropriate physical exam. Included in the evaluation will be the student’s ability to organize a differential, order and interpret diagnostics, propose a management plan, present cases, and demonstrate the ability to work collaboratively in an interprofessional team. Dependability, reliability, attitude toward learning, and professionalism are also part of the evaluation. A copy of this evaluation can be found at the back of your clinical handbook and is posted on Exxat in the “Student Packet” section under “Generalized Documents.”

The preceptor evaluation will be sent to the preceptor via email from Exxat towards the end of each clerkship. Students are encouraged to discuss the evaluation with their preceptor. Students are responsible for ensuring that an evaluation is completed for each clinical clerkship. Students must make every reasonable effort to follow-up with the site to ensure that the evaluation is completed in a timely fashion. If a preceptor evaluation is not received within 60 calendar days of the end of the clerkship, the clerkship grade will be recorded as an “F.” In some instances a resident or another attending physician may complete a preceptor evaluation form in addition to the Clinical Preceptor of record. In those cases, additional evaluations may be submitted and averaged. A grade less than 60 on the preceptor evaluation constitutes a failure. A failing preceptor evaluation at any point

during the clerkship will result in clerkship failure. Please see the clinical handbook for additional policies.

CLERKSHIP SPECIFIC PATIENT ENCOUNTER REQUIREMENTS

Clerkship logs are designed to help the Program track student clinical experiences and is completed utilizing the Exxat system. Filling out logs thoroughly and accurately will help the program to ensure students are receiving a quality clinical education. Students are required to log information regarding each patient seen daily. All submissions are reviewed by the program each Monday at 9am. Weekly logs during the final week of the clerkship must be logged by 9am of the call back day. Students must log their patient experiences prior to this time. Students are contacted if the weekly review shows inadequate patient care experiences. The clinical coordinators will discuss ways to maximize clinical opportunities for the remaining time in the clerkship.

The minimum 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. Students should print out a copy of their patient encounter log in “graph” format and have their preceptor sign off on the following specific patient encounters. Their signature not only confirms exposure, but competence in these areas of care. Once signed, your log should be uploaded onto session required documents on Exxat. Should a student not meet these competencies during their 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 encounters per week/90 per clerkship

More than one failure to log minimum weekly patient encounters on time will result in a three (3) point deduction from the OVERALL ROTATION GRADE. Each additional failure to log will result in a one (1) point deduction from the overall rotation grade.

CLINICAL YEAR PATIENT ENCOUNTER REQUIREMENTS

Although students must log specific 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.

Preventative Acute Chronic Emergent Developmental Disabilities

Types of Clinical Encounters

20 encounters during clinical year 20 encounters during clinical year 20 encounters during clinical year 20 encounters during clinical year 15 encounters during clinical year

Medical Care Across the Life Span Encounters

Infants- less than 1 years of age 15 encounters during the clinical year Children- 1 y/o – 11 y/o Adolescents- 12 y/o – 17 y/o 30 encounters during the clinical year 30 encounters during the clinical year

Adults- 18 y/o – 64 y/o Geriatrics- greater than 65 y/o 100 encounters during the clinical year 100 encounters during the clinical year

PROCEDURE LOGGING REQUIREMENTS

Students are required to perform and log a number of procedures. These procedures are tracked through the Exxat System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “performed”. Students must print out their “procedure list” for each rotation and have preceptors sign off on the procedure list. Their signature not only confirms exposure, but also indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. During your 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 coordinators reviews procedure logs every three months. As all procedure requirements must be completed by graduation, students receive reports every three months regarding which procedure requirements are missing. A student will not be able to graduate until

competency is achieved in the items listed below.

REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS

Procedure ABG Abscess I&D

Required Number 4 2 Blood Cultures 2 Cardiopulmonary Resuscitation 1-assisted is acceptable or at CLI* Foley Catheter Placement 4 IM/SC/ID-injections 10 IV Placement 10 NG Tube Placement 2 Splinting 5 Suturing 5 Venipuncture 10 Assist in Operating Room 5 Wound Care/Debridement 5 Breast Examinations 5 Pelvic Examinations 5 Rectal Examinations 5

*Center for Learning and Innovation (CLI)

END OF CLERKSHIP EXAMINATION

To assess comprehensive knowledge of the family medicine 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 https://paeaonline.org/assessment/core-tasks-andobjectives/ and apply information to the following topic list of conditions: https://paeaonline.org/assessment/end-of-rotation/content. Student should also review the 28

breakdown of the exam, which can be found through the following link: https://paeaonline.org/assessment/end-of-rotation/content These end-of-rotation examinations have the same format as the PANCE exam and are good preparation for successfully passing the Physician Assistant National Certifying Examination (PANCE). To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they will be given the opportunity to take a PAEA make-up exam. A grade of 65 % or better must be achieved on the make-up exam to pass the clerkship. A grade of 65 % will be entered for this portion of the final grade, regardless of the passing grade earned for the make-up exam. Only one make up examination will be offered in any clerkship. A failure of the make-up examination will result in failure of the clerkship.

QUALITY ASSURANCE/PERFORMANCE IMPROVEMENT ASSIGNMENT

The Quality Assurance/ Performance Improvement educational project is designed to help students understand issues related to quality in a healthcare setting. It is designed to increase the awareness of quality issues and help students learn how to best manage such situations. This will take place in the form of a discussion board where students and faculty will interact. Failure of students to participate satisfactorily in this project by the end of the last clinical rotation will result in an "Incomplete" for the final clinical rotation.

As part of the clinical clerkship training, students are required to participate in a group discussion board on Blackboard. It can be found as a discussion board in the Medicine III course in blackboard. This material is from the Patient Safety Institute. Students are required to post at least twice as is indicated in the instructions. One original post and one reply to another student or professor’s post is the minimum requirement. Student posts should be thoughtful and substantial but need not be overly long. There are several short videos in the course documents section. Students must view these also. This assignment is not designed to take up a tremendous amount of time, but to simply enhance student learning in quality assurance. This is pass/fail. Students are required to participate accordingly. This assignment is required for graduation. This assignment may be completed between the start of the first clerkship and prior to the completion of the eighth clinical clerkship.

Summary:

1. Go to blackboard 2. Go to course PHA 227 3. Click on “discussion board” on left side 4. Click on “Patient Safety Institute CO 2023” 5. Click on course documents on left side and review “IHI Videos” at the bottom of page 6. Follow instructions for discussion board 7. See Professor Gallo with questions

CLINICAL ENCOUNTERS

Throughout the clinical year, 15 patients with a history of developmental disabilities must be logged in the Exxat system. Clinical encounters should focus on improving clinical management, knowledge, history and physical examination skills and communication/interpersonal skills. Please be sure you click on the “developmental disability” box to capture your patients in the system. Failure to demonstrate the required number of clinical encounters will affect the

student’s ability to graduate.

REFLECTIVE JOURNALING

Chose five clinical encounters with a patient with developmental disabilities, reflect on your experiences and write them in a journal. Entries should focus on self-critique of the interaction, communication with individuals and their families and personal reactions to situations. Commenting on internal struggles or feelings, comfortability with providing care to individuals with developmental disabilities and their families/caregivers and ways of improving care are also encouraged. Please journal on an electronic device. Title each journal entry adhering to the following format: “Clinical Encounter”. Date each entry as well. This journal will be submitted

via Exxat on call back day at the end of the 3rd clerkship, 6th clerkship and then finally, the

8th clerkship. To encourage deep-rooted, self-analysis, journal entries will only be reviewed to assure assignment completion rather than focus on a formal grade. All students will be required to submit a minimum of five reflective journal entry by call back day eight (8). Journal entries should be 1 page in length. Students can submit their reflective journal on Exxat. From the dashboard • placements • by session • to do list • session required documents • developmental disability reflective journaling. Failure to submit your reflective journaling will result in an incomplete

grade for thisclerkship.

CALL BACK DAY

Students will return to campus and/or the Center for Learning and Innovation (CLI) at the end of each clerkship for one or two days for clinical year activities. At times call back may involve a remote clinical year activity via zoom. This is up to the discretion of the clinical team and students will be notified in advance. Call back day dates and locations can be found at the beginning of the handbook and on Exxat in the “student packet” section. 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 on call back day. Should an absence be unavoidable, the clinical coordinator must be contacted PRIOR to the date to discuss the legitimacy of the absence.

A student leaving an on-site or remote call back day early, without notifying the clinical coordinator will result in a 5-point deduction from the overall clerkship grade. Any unexcused absence from call back day will result in a 10-point deduction from the overall clerkship grade and an incomplete will be submitted for the course until all assignments have been completed successfully.

CALL BACK DAY STRUCTURE

Call back day activities for rotations 1, 2, 3 and 6 will be one day in length and held on campus or remotely, if decided by the clinical team. All students on core rotations will take their PAEA end of rotation examination. Students on their elective rotation (rotation 6 only) will be required to present their interesting case to their assigned group. A guest lecture/workshop activity will also be scheduled.

Call back day activities for rotations 4, 5, 7 and 8 will be two days in length. Day one of call back day will be on campus or remote and require all students on core rotations to take their PAEA end of rotation examination. Students on their elective rotation will be required to present their interesting case to their assigned group. A guest lecture/workshop activity may also be scheduled.

Day two of call back day will be at CLI or remote and include a longitudinal patient care experience. All patients involved in the longitudinal patient care experience are professional standardized patients, hired and trained by CLI to provide our students with a superior patient care experience.

After each encounter, students will complete a SOAP note documenting the encounter. The SOAP note must be submitted on Exxat within 72 hours of call back day. Students can submit their SOAP note on Exxat. From the dashboard • placements • by session • to do list • session required documents • longitudinal patient case SOAP note. Please make sure to upload under the correct rotation. In addition, after each “on-site” longitudinal patient care experience, the student will be required to view their encounter remotely (on Hofstra or Northwell network) and complete a video self-reflection form assessing their performance. The video self-reflection is due 2 weeks after the callback day. Students can submit their longitudinal patient reflection on Exxat. From the dashboard • placements • by session • to do list • session required documents • longitudinal patient reflection. Please make sure to upload under your current rotation. There will be no video selfreflection if the longitudinal patient care experience occurs via zoom. If a student misses a patient

encounter or does not complete either the SOAP note or video self-reflection, they will receive an incomplete in the course.

Additionally, all students are required to fill out a Call Back Day Lecturer Evaluation on Exxat within one week of the call back day for any scheduled lecturers. This evaluation can be found from the dashboard • placements • by session • to do list • eval summary • call back day lecturer evaluation. Failure to do so will result in a three-point deduction from the overall

rotation grade.

CLERKSHIP BIBLIOGRAPHY

During the clinical year and in clinical practice there is no set textbook or resource that will address the specific needs of the learner or the clerkship experience. Course textbooks and resources should be tailored to student needs. Didactic textbooks can be utilized for the clinical year however, faculty encourage students to utilize more advanced resources during their clinical year such as those found through your access medicine and Up-to-Date accounts.

DISABILITY POLICY

If you believe you need accommodations for a disability, please contact Student Access Services (SAS). In accordance with Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990, qualified individuals with disabilities will not be discriminated against in any programs, or services available at Hofstra University.

Individuals with disabilities are entitled to accommodations designed to facilitate full access to all programs and services. SAS is responsible for coordinating disability-related accommodations and will provide students with documented disabilities accommodation letters, as appropriate. Please note that accommodations may require early planning and are not retroactive; please contact SAS as soon as possible. All students are responsible for providing accommodation letters to each instructor and for discussing with him or her the specific accommodations needed and how they can be best implemented in each course. For more information on services provided by the university and for submission of documentation, please contact Student Access Services, 107 Student Center, 516-463-7075.