PHA 260 OBSTETRICS/GYNECOLOGY CLERKSHIP

PHA 260 OBSTETRICS/GYNECOLOGY CLERKSHIP 3 s.h.

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

DESCRIPTION

During clinical experience 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 obstetricand gynecologic care, and to prepare them to manage the healthcare needs of women, throughout their life-span.

INSTRUCTIONAL OBJECTIVES AND LEARNER OUTCOMES

Instructional Objectives

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

Evaluation of the gynecologic patient by obtaining a thorough patient history, performing a physical exam, to include a breast examination and a pelvic examination and obtaining appropriate diagnostic and laboratory data

Assessment Tools Utilized

Competency for each instructional objective is measured by successful completion of assessment tools listed below: • Preceptor evaluation • Preceptor assessment and sign-off of competency on patient and procedure logs • EOR examination

Learner Outcomes

Upon successful completion of this clerkship, students will attain the following knowledge, interpersonal, clinical/technical skills, professional behaviors, clinical reasoning, and problemsolving abilities: • Elicit a detailed medical history, perform physical examination on a gynecologic patient, accurately record all data

Utilizing information obtained from the history, physical and diagnostic data to formulate differential diagnoses for obstetric and gynecologic patients • Preceptor evaluation • EOR examinations • Select and interpret appropriate diagnostic tests, lab studies or screening tools • Synthesize and analyze all clinical data correctly to aid in diagnosis

Knowledge of the different types of clinical patient encounters • Preceptor assessment and sign-off of competency on patient and procedure logs • EOR examination

Submission of clinical documentation • • Discern among acute, chronic, and emerging disease states

Develop evidence based, best • Preceptor evaluation • Utilize critical thinking and practice, patient-centered • EOR examinations problem-solving skills to management plans for obstetric identify and manage pediatric and gynecologic patients care

Accurately document pre-natal, obstetric, and gynecologic care • Locate, appraise, and apply evidence from scientific studies to enhance patient care • Preceptor evaluation • Accurately and adequately document medical information

Providing patient education, to • Preceptor evaluation • Use effective basic counseling include appropriate screening • EOR examinations and patient education skills recommendations, disease • Interesting patient case with patients and their prevention, family planning, assignment families to empower them to prenatal care, and menopause to participate in their care and obstetric and gynecologic enable shared decisionpatients and their families making

Completing technical skills competently • Preceptor evaluation • Competency is measured by meeting the number of exposures listed under “Exxat

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

Presenting patients to the preceptor or other designated clinician on team in a concise, organized way demonstrating thorough knowledge of patient • Preceptor evaluation • Effectively complete oral presentations

Communicating effectively and • Preceptor evaluation • Work collaboratively as a respectfully with obstetric and member of an interprofessional gynecologic patients and them healthcare team families and members of the • Exhibit reliability, interprofessional team 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

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 • Preceptor evaluation • Develop skills necessary for life-long learning

• Drug Cards • 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

Utilize the PAEA Core Tasks and Functions list found at https://paeaonline.org/assessment /core-tasks-and-objectives/ and apply to each of the pediatric conditions outlined at https://paeaonline.org/assessment/en d-of-rotation/content

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

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

ASSESSMENT/EVALUATION CRITERIA

The grade for this clerkship is based on the following components:

One Ob/Gyn History & Physical Note 15%

Three Ob/Gyn Drug Cards P/F

Preceptor Evaluation 50%

Clerkship Patient Encounter Requirement

Logs P/F

Procedure Logging Requirements P/F

End of Clerkship Examination 35%

Developmental Disabilities Curriculum

Requirements- if applicable P/F

Call Back Day Longitudinal Patient

Participation, Reflective Journal Entry & P/F

Quality Assurance/Performance

Improvement Assignment Medical

Documentation Submission -if applicable P/F *All assessment and evaluation tools are in the back of the handbook

SUBMISSION OF CLINICAL DOCUMENTATION

Each student will submit one history and physical note while on their ob/gyn clerkship using Microsoft to session required documents on Exxat.

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. • 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 note. All notes must be submitted to Exxat in session required documents prior to the start of 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, indications, contraindications, side effects, dosing, and cost of medication. The 45

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 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 ob/gyn 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 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 ob/gyn 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 encounters per week/60 per clerkship 15 encounters per clerkship 15 encounters 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 Ob/GYN encounters during the Ob/GYN 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 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 Adults- 18 y/o – 64 y/o Geriatrics- greater than 65 y/o 30 encounters during the clinical year 30 encounters during the clinical year 100 encounters during the clinical year 100 encounters during the clinical year

PROCEDURE LOGGING REQUIREMENTS

Students are required to perform and log a number of procedures. These procedures are tracked through the Exxat System. Please make sure to perform, rather than observe or assist as many procedures as possible, as credit is given only for those logged as “performed”. Students must print out their “procedure list” for each rotation and have preceptors sign off on the procedure list. Their signature not only confirms exposure but indicates that a student can competently perform the procedure. Once your log is signed, it needs to be uploaded onto Exxat in session required documents. 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 ob/gyn 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.

47

REQUIRED CLINICAL YEAR PROCEDURES/EXAMINATIONS

Procedure ABG Abscess I&D

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

*Center for Learning and Innovation (CLI)

END OF CLERKSHIP EXAMINATION

To assess comprehensive knowledge of the obstetrics/gynecology 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 through the following link: https://paeaonline.org/assessment/core-tasks-and-objectives/ and apply information to: https://paeaonline.org/assessment/end-of-rotation/content Student should also review the 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 Physician Assistant National Certifying Examination (PANCE) and are good preparation for successfully passing the PANCE.

To pass the examinations, a student must receive a grade of no less than 65%. Should a student fail the end-of-rotation exam, they will be given the opportunity to take a make-up PAEA 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.

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 49

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.