CLINICAL YEAR HANDBOOK September 2015 Revised November 2015
TABLE OF CONTENTS Department Contact Information 2015-2016 Clinical Year Schedule Introduction Making the Transition to Clinical Practice Structure of the Clinical Year Preparation for Clerkships Clerkship Assignment Policy Cultural Issues Registration for Clinical Courses Policies Regarding Clinical Rotations Health Insurance Health Clearance Identification Patient Rights and Confidentiality Universal Precautions Exposure Policy and Incident Reporting Security and Personal Safety Blackboard Clinical Clerkship Contact and Information Packet Social Media Policy Work Policy Clerkship Work Schedule Clinical Year Attendance Absence from Clinical Rotations Tardiness Student & Preceptor Review of Clinical Objectives Preceptor Review and Countersignature Clinical Year Stamps Elective Surgical Rotations Tenets of Professional Conduct Dress Requirements Sexual Misconduct Examination Policy Examination Review Policy End-of-Rotation Examination Failure On-Site Evaluation Call Back Day Clerkship Grades Clinical Clerkship Failure Clinical Year Patient Encounter Requirements Clinical Year Procedure Logging Requirements Required Clinical Year Procedures/Examinations Student Evaluations of Clinical Clerkships Mid-Clerkship Evaluation Submitting Call Back Day Materials
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Developmental Disabilities Curriculum Home Visits and Interviews Community Agency Visits Case Presentations Group Discussions Reflective Journaling Pre/Post Impact Survey Clinical Encounters 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 Partners in Health Education for People with Disabilities (PHEPD) Syllabi Clinical Year Forms On-Site/Interesting Case Evaluation Form Mid-Clerkship Evaluation Form Student Evaluation of Program Rotations Form Student/Preceptor Review of Clinical Objectives Blood Borne Pathogen Exposure Form Clinical Handbook Agreement Form Clerkship Work Schedule Form Patient Education Project Grading Form Elective Clerkship Pre and Post Essay Grade Form Family Medicine: Health Promotion Project Health Promotion Project Grading Form End-of-Rotation Grade Form Clinical Documentation Grading Form Evaluating a Peer-Reviewed Scientific Article Case Presentation Grade Form – PHEPD Community Agency Experience Form - PHEPD Home Visit Interview Form – PHEPD Preceptor Evaluation Form
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DEPARTMENT FACULTY AND STAFF CONTACT INFORMATION Program faculty offices are located on the first floor of Monroe Lecture Hall. The main office is located in room 113. Program Director/Assistant Professor Carina Loscalzo, M.S, PA-C (516) 463-4412 Carina.Loscalzo@hofstra.edu Associate Director/Assistant Professor Mark L’Eplattenier, M.S., PA-C (516) 463-1353 Mark.S.Leplattenier@hofstra.edu Research Coordinator/Assistant Professor Christina Ventura-DiPersia, MPH (516) 463-4042 Christine.M.VernturaDiPersia@hofstra.edu Academic Coordinator/Assistant Professor Mary Banahan, MS, PA-C (516)463-4161 Mary.K.Banahan@hofstra.edu Advisement Coordinator Gia Raponi (516) 463-4074 Gia.R.Raponi@hofstra.edu Secretary – Part Time Sharon Poulson (516) 463-4074 Sharon.Poulson@hofstra.edu
Medical Director Samuel Sandowski, MD (516) 463-4074 Samuel.Sandowski@snch.org Academic Coordinator/Assistant professor Kelly Porta, M.S., PA-C (516) 463-4381 Kelly.R.Porta@hofstra.edu Clinical Coordinator/Assistant Professor Shannan Ricoy, M.S, PA-C (516) 463-4233 (516) 509-6470 (Program cellular phone) Shannan.Ricoy@hofstra.edu Clinical Coordinator/Assistant Professor Christine Zammit, M.S., PA-C (516) 463-4380 Christine.Zammit@hofstra.edu Clinical Secretary – Part Time Karen Forman (516) 463-4074 Karen.S.Forman@hofstra.edu Program Main Office Program office number: (516) 463-4074 Program fax number: (516) 463-5177
Program Mailing Address: Hofstra University Department of Physician Assistant Studies 113 Monroe Lecture Center Hempstead, New York 11549-1270 4
Program in Physician Assistant Studies 2015-2016 Clinical Year Calendar
Rotation # 1:
9/8/2015 – 10/15/2015
CBD: 10/16/2015
Rotation # 2:
10/19/2015 – 11/24/2015
CBD: 11/25/2015
(Students off on 11/26/15 & 11/27/15 for Thanksgiving) Rotation # 3 Part 1:
11/30/15 – 12/18/15 (VACATION 12/21/15 – 12/25/15)
Rotation # 3 Part 2:
12/28/2015 – 1/14/2016
CBD: 1/15/2016
Rotation # 4:
1/19/2016 – 2/25/2016
CBD: 2/26/2016
Rotation # 5
2/29/2015 – 4/7/2016
CBD: 4/8/2016
(VACATION 4/11/2016 – 4/15/2016) Rotation # 6
4/18/2016 – 5/26/2016
CBD: 5/27/2016
Rotation # 7
5/31/2016 – 7/7/2016
CBD: 7/8/2016
Rotation # 8
7/11/2016 – 8/18/2016
CBD: 8/19/2016
*CBD= Call back day/last day of rotation
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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.
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 6
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. •
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.
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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 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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 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, 8
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 Surgery PHA 265 Emergency Med PHA 270 Pediatrics PHA 280 Psychiatry PHA 285 Elective PHA 290 Register for each clerkships 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 Health Insurance Health insurance is mandatory for the clinical year, as it is for the didactic year. Students must show proof of medical insurance before beginning the clinical year. The insurance policy must cover students in the event of illness or injury that may result from patient care. 9
Health Clearance All students must provide the Program with evidence of physical fitness by a health care provider that they can perform the duties of a physician assistant student. This verification must be provided at the beginning of the didactic and clinical year. Physical fitness includes proof of immunization in accordance with the recommendations for health care professionals of the Centers for Disease Control (CDC). In addition, students may need to be medically cleared by an individual clinical clerkship. The clinical coordinators will advise students of individual site requirements before the beginning of the rotation. Student health records are confidential and must not be accessible to program faculty or staff with the exception of immunization and tuberculosis screening results which are maintained and released with written permission of the student. Therefore, students are required to keep their own medical information and present it at the beginning of each clinical clerkship.
Identification Students must display their Hofstra University photo identification on their person in a clearly visible location while on clinical rotations. All students must identify themselves as a “physician assistant student” to patients and medical staff. Under no circumstance should a student encourage or fail to correct the misconception that he/she is a physician or a medical student. Students answering pages or phone calls must use their title when answering.
Patient Rights and Confidentiality All information regarding a patient’s health is privileged information. All students must strictly adhere to each institution’s policy governing patient rights and confidentiality and to all federal, state and local regulations. Students must not discuss any information regarding a patient in a manner or location that might reveal the identification of the patient to individuals not directly involved in that patient’s care. For this reason, all students must complete HIPAA training and provide proof of completion before entrance to the PA Program. Patient charts, inclusive of progress notes or lab reports, must not be removed from the clinical site by the physician assistant student. If photocopies of a patient’s record are needed for site evaluation, all information that might identify the patient must be removed, omitted or deleted to protect patient confidentiality.
Universal Precautions All PA students must complete a training session for healthcare professionals in infection control/universal precautions approved by the New York State Department of Health before entering the hospital setting. A certificate of completion must be kept by the student and provided to any clinical site requesting a copy. For additional information on universal precautions, please refer to www.cdc.gov. The principle of universal precautions has been adopted to protect clinicians from exposure to infectious disease because any patient may harbor microorganisms that could cause infection if transmitted. Although blood-borne pathogens are of particular concern, all bodily fluids, secretions, and excretions are included in universal precautions. Since infected patients may be asymptomatic, it becomes necessary to use basic precautions with every patient. Observance of universal precautions will help to provide better protection for every staff member. Students should also familiarize themselves with the 10
hospital/clinical sites specific policies regarding universal precautions. The material below reviews guidelines and preventative techniques. Universal Precautions Guidelines and Prevention Methods: 1. Avoid direct contact with: blood, body fluids, secretions, excretions, mucous membranes, nonintact skin, and lesions. 2. Avoid injuries from all sharp objects such as needles or scalpels. 3. Avoid direct contact with items, objects, and surfaces contaminated with blood, body fluids, secretions, and excretions. 4. Dispose of all sharp objects promptly in special puncture resistant containers. 5. Dispose of all contaminated articles and materials in a safe manner prescribed by law. In practice, using Universal Precautions also requires: 1. Wash hands frequently and thoroughly, especially if they become contaminated with blood, body fluids, secretions, and excretions. 2. Depending on job duties and risk of exposure, use appropriate barriers, which can include: gloves, gowns, aprons, caps, shoe covers, leggings, masks, goggles, face shields, and resuscitation devices. These barriers are to be used to protect: a. Skin, especially non-intact skin (where there are cuts, chapping, abrasions, or any other break in the skin). b. Mucous membranes, especially eyes, nose and mouth. NOTE: The items of protective apparel, including gloves, are to be removed after each use and are to be PROPERLY disposed of. Gloves, etc. are NOT to be worn from one patient or activity to another.
Exposure Policy and Incident Reporting Should a student be exposed to the body fluid of a patient, he/she will immediately report the incident to the clinical preceptor. The student will follow the institutional infectious and environmental hazard policy, including completing all necessary documentation as required. Students should be aware that an infectious or environmental hazard exposure can adversely affect their overall health as well as performance in the Program. Additionally, the student must contact the clinical coordinator or program director within 24 hours of the incident. The student is required to complete an incident form (see appendix) and submit it to the clinical coordinator, program director and university within 24 hours of the incident. Health information of any kind concerning students, patients, or staff should not be included when filling out the exposure form. Following an exposure, the student must follow-up with his/her medical provider or the Hofstra Wellness Center for further evaluation and/or treatment. Should any expense be incurred as a result of an exposure, the student is responsible for all costs related to the incident.
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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.
Social Media Policy Maintaining professionalism is of utmost importance when using social media. It is recommended that you assume all postings are visible to program faculty, future employers, and patients. It is strictly prohibited to discuss patient related matters, take photographs of patients and cadavers, including in the operating room, even if the patient is not identified. Similarly the posting of diagnostic images or any form of patient data on any social media platform such as YouTube, Facebook, iTunes, LinkedIn, Twitter, and blogs is strictly prohibited. Posting on Facebook or any other form of social media regarding program personnel, including faculty and fellow students is strictly prohibited. Requesting to connect with preceptors, faculty, staff, and supervisors while currently a student is unacceptable. Violation of this policy will result in being called before the Academic Standing Committee and possible dismissal from the program. Witnessing any violation of this policy should be immediately reported to the program director.
Work Policy The program strongly discourages any type of outside employment during the course of studies in the program. Program responsibilities are not negotiable, and will not be altered due to student work obligations. Furthermore, working has been the chief cause for academic difficulty in past years. Students who choose to volunteer or be paid employees during the course of their physician assistant training cannot use their affiliation with the program in any aspect of that employment. Any activity undertaken by the student, independent of the program, is not covered by the liability insurance offered 12
for clinical work associated with physician assistant training. Furthermore, students may not be required to perform clerical or administrative work for the Program. Students may not substitute for regular clinical or administrative staff during the clinical year. Should such a request be made of a student, it should be reported to the program director immediately.
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.
Clinical Year Attendance Attendance is mandatory for all clinical year call back days. 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.
Absence from Clinical Rotations If a student is unable to report to the clinical site for any reason, he/she is required to 1. Call and e-mail the clinical preceptor. 2. Call and e-mail the clinical coordinators at (516) 463-4233 or (516) 463-4380 by 9 AM that day. 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. Any absence, for any reason, must be made up at the site. There are no personal days. Failure to report an absence and obtain approval from the clinical coordinators will result in an unexcused absence. Any unexcused absence will result in a hearing before the Academic Standing Committee.
Tardiness Students are expected to arrive at the clinical site on time. If delayed, the clinical coordinators and site preceptor must be informed by phone. For in-patient rotations, it is especially important to arrive early each day to visit patients and to prepare for rounds. Physician assistant students can be questioned about features of the disease state and the course of care during rounds. Anticipate being put on the spot and to be prepared for any questions that may arise. 13
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
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 examined 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, 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, yet 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.
Tenets of Professional Conduct Students must adhere to standards of professional behavior at all times. These standards are the ethical foundation of medical practice and of our integrity as physician assistants. Breeches in professionalism may result in appearing before the Academic Standing Committee.
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Professional behavior is expressed through respect for instructors and fellow students. In the clinical setting, it is expressed through respect for patients and colleagues. Professional behavior is evaluated throughout the course of study and is also formally evaluated during advisement sessions. Examples of unprofessional behavior include but are not limited to: • poor attendance or tardiness; • unexcused absences or not following program protocol for notifying program personnel of an absence; • not following program protocol for reporting lateness or leaving early; • lack of preparation; • lack of involvement; • plagiarism; • falsifying documents; • falsifying Typhon procedure or patient encounters; • inability to accept constructive criticism; • lack of respect for the rights of patients to competent, confidential service; • failure to follow protocol, or directions of supervising physician, physician assistant or program faculty; • performing unauthorized procedures or administering services not permitted by the supervisor, the facility, or the program; • endangering the health and welfare of any patient; • violation of the Health Insurance Portability and Accountability Act (HIPAA); • failure to perform all or part of assigned tasks and responsibilities; • leaving the clinical setting without permission of supervising physician or physician assistant; • performing any activity which is beyond the scope of the role of a student; • failure to identify as a physician assistant student; • failure to report all observed unethical conduct by other members of the health profession, including other students; • engaging in conversation with others during a class or lecture; • leaving the classroom during lectures; • using personal e-mail, Facebook, or other social media while in class; • posting inappropriate content on social media platforms or otherwise violating the social medial policy; • Connecting on social media with faculty, preceptors or supervisors while a student in this program; • exhibiting un-truthful behavior; • lying to preceptor, faculty, or staff; • failure to submit program evaluations in a timely fashion; • neglecting to turn off cell phones, texting or talking on a cell phone during class, examinations, meetings, on the clinical site, or during any other professional functions; • unacceptable dress; • Failure to submit an incident report both to the program and the clinical site.
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 15
physician assistant profession and Hofstra University. Therefore, students must look professional while interacting with patients and health professionals at clinical sites. Both men and women should wear business attire while on clinical rotations. 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 rotations. Students should avoid wearing insignia, buttons or decals of a political nature while on clinical rotation. 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 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.
Examination Policy
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At the end of each clerkship, with the exception of the elective clerkship, student will be required to take and End of Rotation exam. Students should arrive at least fifteen minutes before each exam, logon to the computer at www. examdriver.com, and be prepared to start the exam at the posted time. Bathroom and eating needs should have been attended to, all electrical equipment turned off, and notes put away once arriving to the exam room. 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. All unexcused absences on the day of any examination will result in an examination grade of zero. No student is permitted to take the day off before call back day 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.
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 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 (see Course Failure). 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 on-site 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. Students are responsible for the following on site visits: 1) One H&P or SOAP note as designated by the clerkship syllabi. 17
2) Presentation of three (3) pharmaceutical presentations (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 on the last day of their clerkship for a day of activities. Activities will vary during the clinical year, however every student, except those on their elective rotations will take an end of rotation exam. Other activities may include lectures, case presentations, discussion groups, case studies and clinical skills sessions. All call back day activities are mandatory. Should an absence be unavoidable, the clinical coordinator must be contacted prior to the date to discuss the nature and 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 rotation grade. Students are required to fill out a Call Back Day Lecturer Evaluation on Typhon within one week of the call back day. Failure to do so will result in a three-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.
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:
18
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
20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during 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
Required Number 19
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
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 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
20
All materials must be submitted to the clinical coordinator prior to the 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) Patient Education 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) 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.
Developmental Disabilities Curriculum Requirements Home Visits and Interviews The home visits and interviews are 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. Home visits and interviews will be completed in pairs twice during the clinical year. Each interaction will be with a different participant. Whenever possible, visits 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 Visits Community agency visits are designed to improve understanding of system-based practice. Community agency visits may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. Community Agency Visits and interviews will be completed in pairs twice during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. Whenever possible, students will accompany the same patients 21
assigned for the home visits to community agency visits. 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.
Case Presentations Once during the clinical year, each student will present a patient seen at a Home Visit, Community Agency Visit or in the clinical setting. The presentation will briefly talk about the patient and describe their patient’s medical profile associated with their developmental disability and their patient’s personal and community life. The presentation will focus on the student’s personal experiences with the patient; obstacles encountered by families in their interactions with health care systems; and mechanisms of providing a comprehensive approach to patient’s medical and non-medical problems. The importance of increasing physician assistant awareness and sensitivity of persons with disabilities will be emphasized. Presentations should be no more than 10 minutes in length, unique formats for presentations are encouraged, and all materials must be submitted to the proctor at the time of the presentation. A copy of written material must be given to the proctor at the time of the case presentation. You must receive a 70% on this case presentation to pass. The presentation will be remediated until the student successfully completes the assignment. 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.
Group Discussions Group discussions will occur in groups of 4-5 students throughout the year and are designed to facilitate an informal peer-to-peer exchange. Topics for discussion should include: sharing home and community agency visit experiences, obstacles encountered by families in interactions with health care systems, specific ideas on how to improve interpersonal and communication skills, the impact of disabilities on a person or family/caregiver’s finances, work, school, home and relationships within the community and ideas for improving physician assistant comfort levels when communicating with individuals with disabilities and their families/caregivers. The group discussion will be proctored by a faculty member. Failure to participate in this discussion will result in an incomplete grade for this clerkship.
Reflective Journaling After each home visit, community visit and 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 #1”, “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. Failure to submit your reflective journaling will result in an incomplete grade for this clerkship.
Complete a Pre/Post Program Impact Survey 22
Before any part of the above curriculum is implemented, a pre-program survey will be given to all students to access baseline knowledge and affective attitudes. At the very end of the curriculum, a postprogram survey will be given. This is to assess if objectives and competencies have been reached. There is no passing grade, but the program goal is to objectively evaluate for improvement from baseline. Post lecture knowledge quizzes are also required after lectures and impact surveys after experiential activities. Failure to submit your surveys 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.
23
Clinical Year Syllabi
24
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 clinical experience where students work with family medicine preceptors to evaluate patients in all age groups 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 across a wide variety of acute and chronic presentations. 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
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 25
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 initial assessment in acute and chronic patients commonly seen in the office setting
•
•
Preceptor evaluation 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
•
•
•
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
• •
•
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
•
• 26
Select and interpret appropriate diagnostic tests or lab studies Synthesize and analyze clinical data correctly
providing care to primary care patients
•
• • 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
FMCases 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 25% Family Medicine Computer Assisted P/F Simulation Experience (FMCASE) One complete H&P in Practice Fusion 15% Three Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement Logs P/F Procedure Logging Requirements P/F End of Clerkship Examination 35% *All assessment ad 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 27
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 PracticeFusion. 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, 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. 28
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 516-4635177. 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 internal 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 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. 29
Preventative Acute Chronic Emergent Developmental Disabilities
20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during 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 Breast Examinations Pelvic Examinations Rectal Examinations
Required Number 4 2 2 1-assisted is acceptable or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5
*Center for Learning and Innovation (CLI
30
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 CoreTasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to the following topic list of conditions http://www.endofrotation.org/wpcontent/uploads/2015/07/Family-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/Family-Medicine-Blueprint.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. 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. FACULTY SYLLABI STATEMENT 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
31
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
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) 32
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
Formulation of assessment plans for patients on the internal medicine service
• •
• • Development of management plans for patients on the internal medicine service
• •
• • 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
• • •
• 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
examination Preceptor evaluation 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
Preceptor evaluation 33
• •
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 acute and chronic conditions
•
Adequately document medical information in history & physical notes and progress notes 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
•
roles that they play in the delivery of healthcare.
• •
• • 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
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
•
•
• •
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 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: Simulated Internal Medicine Patient Learning P/F Experience (SIMPLE) One Internal Medicine History & Physical 15% Note Three Drug Cards Interesting Case Assignment 25% Preceptor Evaluation 25% Clerkship Patient Encounter Requirement Logs P/F Procedure Logging Requirements P/F End of Clerkship Examination 35% *All assessment ad evaluation tools are located in the back of the handbook
34
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 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. 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, peerreviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. 35
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. 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 516-4635177. 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
36
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. Preventative Acute Chronic Emergent Developmental Disabilities
20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during 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 Wound Care/Debridement
Required Number 4 2 2 1-assisted is acceptable on or at CLI* 4 10 10 2 5 5 10 5 5 37
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 internal 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 CoreTasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to the following topic list of conditions http://www.endofrotation.org/wpcontent/uploads/2015/07/Internal-Medicine-Topic-List-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 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 FACULTY SYLLABI STATEMENT
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 38
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 life-span. 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 pre• natal history, performing an appropriate physical exam, to include a pelvic examination, and obtaining gestation or condition • specific laboratory and diagnostic studies
Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination 40
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
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 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
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
•
Elicit a detailed medical history, perform physical examination on a gynecologic 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
• •
• • • • • • • • • • • • • • • • • •
41
•
•
• •
respectfully with obstetric and gynecologic patients and their families and members of the interprofessional team
• • • •
Search for relevant information, • utilizing appropriate data sources, and critically appraise to make evidence-based decisions in patient care 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
•
•
•
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 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
ASSESSMENT/EVALUATION CRITERIA: The grade for this clerkship is based on the following components: Interesting Patient Case 25% One obstetrics/gynecology SOAP Note Three 15% obstetrics/gynecology Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement Logs P/F Procedure Logging Requirements P/F End of Clerkship Examination 35% *All assessment/evaluation tools are located at the end of the handbook
42
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, peerreviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required 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 516-4635177. 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. 44
Preventative Acute Chronic Emergent Developmental Disabilities
20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during 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 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 CoreTasks 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-List2015.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-HealthBlueprint.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 CLERKSHIP BIBLIOGRAPHY: During the clinical year and in clinical practice there is no set textbook list 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 FACULTY SYLLABI STATEMENT 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 46
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 post-op 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
• •
•
Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination 47
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
diagnosis and management plan Assessment of the pre-surgical and post-surgical patient.
• •
• • 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
• •
•
Preceptor evaluation 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
•
48
•
•
• • •
•
Elicit a detailed medical history, perform appropriate 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
on service 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
• •
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
ASSESSMENT/EVALUATION CRITERIA: The grade for this clerkship is based on the following components: Continuing Medical Education Project 25% One Surgical SOAP Note 15% Three Surgical Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% *All assessment/evaluation tools are located at the end of the handbook 49
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.
50
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 516-4635177. 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. 51
Preventative Acute Chronic Emergent Developmental Disabilities
20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during 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 52
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/wpcontent/uploads/2015/07/General-Surgery-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/General-Surgery-Blueprint.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 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. FACULTY SYLLABI STATEMENT 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
53
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
• •
Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation EOR examination 54
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
diagnostic data to aid in the diagnosis of patients in the emergency room 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
screening tools
• •
• • • • • • • • • • • • • • • •
Completing technical skills competently
Presenting patients to the preceptor or other designated
• •
•
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
55
Elicit a detailed medical history, perform patient appropriate physical examination, utilize appropriate diagnostic tests and accurately record all data
clinician on team in a concise, organized way demonstrating thorough knowledge of patient 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 Patient Case 25% One SOAP Note 15% Three Emergency Medicine Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs 56
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
Procedure Logging Requirements P/F Computer Operated Adult/Child Simulators P/F End of Clerkship Examination 35% *All assessment/evaluation tools are located at the end 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, peerreviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required 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 57
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 516-4635177. 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 58
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
20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during 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 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 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 59
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 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 CoreTasks 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-List2015.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-MedicineBlueprint.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 CLERKSHIP BIBLIOGRAPHY: During the clinical year and in clinical practice there is no set textbook list 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. FACULTY SYLLABI STATEMENT 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.
60
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
61
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
• •
•
Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination 62
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
appropriate variations Recognize normal and abnormal patterns of pediatric growth and development and milestone achievement. Identify patients 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
•
•
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
• •
• • • • • • • • • • • • • • • • • •
63
•
•
•
• •
•
population Elicit a detailed medical history, perform ageappropriate physical examination, utilize appropriate developmental screening tools and 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
•
Effectively complete oral presentations
•
Work collaboratively as a
•
respectfully with pediatric patients and their families and members of the interprofessional team
• • • •
Search for relevant information, • utilizing appropriate data sources, and critically appraise to make evidence-based decisions in patient care 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
•
• •
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 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 Patient Case 25% One Pediatric SOAP Note in Practice 15% Fusion Three Pediatric Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% *All assessment/evaluation tools are located at the end of the handbook 64
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, peerreviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required 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. 65
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 516-4635177. 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. Preventative Acute
20 during clinical year 20 during clinical year 66
Chronic Emergent Developmental Disabilities
20 during clinical year 20 during clinical year 15 during 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
67
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 NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following CoreTasks 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/PediatricsBlueprint.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. CLERKSHIP BIBLIOGRAPHY: During the clinical year and in clinical practice there is no set textbook list 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. FACULTY SYLLABI STATEMENT 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 68
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
• •
• • •
Preceptor evaluation Preceptor assessment and sign-off of competency on patient and procedure logs PAEA end-of-rotation (EOR) examination Preceptor evaluation EOR examination 69
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
aid in the diagnosis of patients with mental illnesses 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
screening tools • •
• • • • • • • • • • • • • • • •
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 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
70
•
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
• •
•
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 appropriately and respectfully with psychiatric patients and their families and members of the interprofessional team
•
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 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
•
• •
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 psychiatric conditions Identify signs and symptoms of psychiatric conditions Utilize critical thinking and problem solving skills to manage psychiatric patients
ASSESSMENT/EVALUATION CRITERIA: The grade for this clerkship is based on the following components: Interesting Patient Case 25% One Complete Psychiatric H&P 15% Three Psychiatry Drug Cards Preceptor Evaluation 25% Clerkship Patient Encounter Requirement P/F Logs Procedure Logging Requirements P/F End of Clerkship Examination 35% *All assessment/evaluation tools are located at the end of the handbook 71
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, peerreviewed medical publication. Students that present the interesting case on a site visit should be prepared to lead a discussion with their fellow classmates and the clinical coordinator. This discussion should include all the elements of a focused H&P, related pathophysiology and review of their chosen journal article. The interesting case assignment format can be submitted as either a word document or Power Point presentation in the same format as a focused H & P note. Students who are required to present their case may utilize an outline or notes for guidance, however reading verbatim is not permitted. The interesting case patient cannot duplicate patients used for the required 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. 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 72
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 516-4635177. 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
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 73
confirms exposure, but competence in these areas of care. Competency in these areas is required for graduation. Preventative Acute Chronic Emergent Developmental Disabilities
20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 15 during 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 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 74
END OF CLERKSHIP EXAMINATION: To assess comprehensive knowledge of the discipline of psychiatry, a 120-question multiplechoice examination is given at the end of the clerkship. This end of rotation examination is offered by the Physician Assistant Education Association (PAEA) and is developed by PA educators for use during the clinical year. It is a peer-reviewed exam that incorporates current, relevant test items that follow the NCCPA tasks and blueprints and corresponding PAEA blueprints and topic lists. To assist with preparation for the examination, students must use the following CoreTasks and Objectives http://www.endofrotation.org/exams/core-tasks-objectives/ and apply information to http://www.endofrotation.org/wp-content/uploads/2015/07/PsychiatryTopic-List-2015.pdf Student should also review the breakdown of the exam which can be found through the following link: http://www.endofrotation.org/wpcontent/uploads/2015/06/Psychiatry-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 CLERKSHIP BIBLIOGRAPHY: During the clinical year and in clinical practice there is no set textbook list 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. FACULTY SYLLABI STATEMENT 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 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: • •
•
• 76
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
•
Formulate an assessment for patients in the elective discipline
•
Preceptor evaluation
• •
various medical and surgical conditions 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 Patient Education Project
•
• •
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
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
•
• • 77
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
•
profession Demonstrate empathetic and respectful behaviors Demonstrates and identifies appropriate ethical behavior and attitudes Develop skills necessary for life-long learning
ASSESSMENT/EVALUATION CRITERIA: Pre & Post Essay Assignment 25% Patient Education Project 50% Preceptor Evaluation 25% Clerkship Patient Encounter Requirement Logs P/F Procedure Logging Requirements P/F *All assessment ad evaluation tools are located in the back of the handbook 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 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 double-spaced. 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. PATIENT EDUCATION PROJECT: During the elective clerkship, the student will select a patient education topic to research and present to the class during call back day via Power Point format. In addition to the Power Point presentation, the student will create a unique plan to educate patients on their topic. Examples include a poster board, pamphlet, or lesson plan. The purpose of this assignment to have each student educate their classmates on how to education patients about this topic. Presentations should be no longer than 10 minutes in length (See appendix). All topics are to be submitted to the clinical coordinator a minimum of two weeks prior to call back day for approval. Failure to submit this project or project topic will result in a grade of zero for this portion of the clerkship grade.
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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 516-4635177. 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. Preventative Acute Chronic Emergent
20 during clinical year 20 during clinical year 20 during clinical year 20 during clinical year 79
Developmental Disabilities
15 during 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 Pelvic Examinations Rectal Examinations
Required Number 4 2 2 1-assisted is acceptable or at CLI* 4 10 10 2 5 5 10 5 5 5 5 5
*Center for Learning and Innovation (CLI 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.
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FACULTY SYLLABI STATEMENT 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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Partners in Health Education for People with Disabilities (PHEPD)Disabilities Curriculum Syllabi
INTRODUCTION The New York State Developmental Disabilities Planning Council (DDPC) is a federally funded state agency comprised of individuals with disabilities, their families and communities, university affiliated programs and other professionals. The council directly responds to the needs and ideas of its constituency by developing and funding new ways to improve the delivery of services to New Yorkers with developmental disabilities. Partners in Health Education for People with Disabilities (PHEPD) is a program based on a curriculum developed by the Illinois Council on Developmental Disabilities for medical residents in family care and pediatrics. The NYS Council on Developmental Disabilities (DDPC) demonstrated the benefits of PHEPD from 2005-2010 in 11 NYS Teaching Hospitals and 16 residency programs. In 2012 the DDPC provided funding to pilot the PHEPD curriculum to Nurse Practitioner and Physician Assistant training programs. Hofstra is one of the pilot project sites. Each program adapts the PHEPD curriculum to meet and align to their unique and specific instructional approach and coursework while maintaining a high level of fidelity to the common core curriculum goals. DESCRIPTION The PHEPD curriculum was designed and funded by the New York State Developmental Disabilities Planning Council (DDPC) to help health care professionals enhance their understanding of individuals with developmental disabilities and the impact on families and caregivers. The Hofstra PA Program has partnered with the DDPC and the Association for Children with Down Syndrome (ACDS) to integrate this curriculum into Hofstra’s PA Program.
The Hofstra University Program in Physician Assistant Studies is in a unique position to enhance our mission and goal to “inspire a desire among physician assistants toward service with underserved communities” by implementing a disabilities curriculum. This curriculum will be Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council. 82
introduced with a didactic lecture series focusing on communication skills, the use of developmental assessment tools and the legal aspects associated with patients with disabilities. Curricular activities will focus on developing patient interaction sensitivity to the unique needs of patients with developmental disabilities. GOAL The purpose of the PHEPD curriculum is to provide PA students with the skills necessary to become
more comfortable and more equipped to provide competent, compassionate care to patients with disabilities. OBJECTIVES Once the clinical year is complete, the physician assistant student will be able to: • • • • • • • • • • • • • •
Define developmental disabilities and gain an appreciation and acceptance of disability as an aspect of natural and normal diversity Describe common developmental disabilities Identify and utilize developmental assessment tools Evaluate patients with developmental disabilities Identify and discuss personal strengths and deficiencies in assessing individuals with developmental disabilities Identify and discuss barriers associated with caring for individuals with developmental disabilities Formulate methods for improving the care of individuals with developmental disabilities; both medical and non-medically related Outline ideas for improving student/health care provider comfort levels interacting with individuals with developmental disabilities and their families/caregivers Identify resources and services available to clinicians caring for individuals with development disabilities as well as those with developmental disabilities Describe the needs of, resources, and services available to families/caregivers of people with developmental disabilities Document potential internal struggles or feelings, comfort-ability with providing care to individuals with developmental disabilities Describe how the impact of disabilities may affect a person or a family’s home and community life, finances, and relationships Identify the communication skills necessary to formulate a productive, insightful doctor-patientfamily relationship Illustrate the legal aspects associated with caring for individuals with disabilities
Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council. 83
CORE COMPETENCY Many activities within the curricular component meet core competencies physician assistants should acquire. Physician Assistant Core Competencies
Hofstra University Partners in Health Education for People with Disabilities Curriculum Clinical Experiences Didactic Lectures Home Visits and Interviews Case Presentations Community Agency Visits Group Discussions Home Visits and Interviews Case Presentations Community Agency Visits Group Discussions Community Agency Visits
Medical Knowledge Interpersonal & Communication Skills
Professionalism
Systems-based practice
EVALUATION CRITERIA Throughout the clinical year student will be require to complete: 2 home visits, 2 community agency visits, a case presentation, evaluate 15 patients with developmental disabilities, 1 small group discussion, a pre/post program impact survey, post-lecture knowledge quizzes and activity impact surveys, and keep a reflective journal. Fostering the self-directed and lifelong learning that is necessary in the medical field, students are encouraged to actively supplement assigned readings with outside sources to enhance the learning experience.
DESCRIPTION OF ASSIGNMENTS • Home Visits and Interviews: The home visits and interviews are 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. Home visits and interviews will be completed in pairs twice during the clinical year. Each interaction will be with a different participant. Whenever possible, visits 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. • Community Agency Visits: Community agency visits are designed to improve understanding of system-based practice. Community agency visits may include therapies, educational or school meetings, rehabilitation settings or any other community agency visit that serves individuals with disabilities. Community Agency Visits and interviews will be completed in pairs twice during the clinical year. Experiences will focus on identifying available resources, understanding the importance of interactions with society, and barriers to obtaining appropriate services. Whenever possible, students will accompany the same patients assigned for the home visits to community agency visits. After the experience, Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council. 84
• •
•
•
•
•
complete all information on the “Community Agency Form” and submit it via the blackboard drop box to within 48 hours of the visit. Case Presentation: Once during the clinical year, each student will present a patient seen at a Home Visit, Community Agency Visit or in the clinical setting. The presentation will briefly talk about the patient and describe their patient’s medical profile associated with their developmental disability and their patient’s personal and community life. The presentation will focus on the student’s personal experiences with the patient; obstacles encountered by families in their interactions with health care systems; and mechanisms of providing a comprehensive approach to patient’s medical and non-medical problems. The importance of increasing physician assistant awareness and sensitivity of persons with disabilities will be emphasized. Presentations should be no more than 10 minutes in length, unique formats for presentations are encouraged, and all materials must be submitted to the proctor at the time of the presentation. A copy of written material must be given to the proctor at the time of the case presentation. You must receive a 70% on this case presentation to pass. The presentation will be remediated until the student successfully completes the assignment. Group Discussion: Group discussions will occur in groups of 4-5 students throughout the year and are designed to facilitate an informal peer-to-peer exchange. Topics for discussion should include: sharing home and community agency visit experiences, obstacles encountered by families in interactions with health care systems, specific ideas on how to improve interpersonal and communication skills, the impact of disabilities on a person or family/caregiver’s finances, work, school, home and relationships within the community and ideas for improving physician assistant comfort levels when communicating with individuals with disabilities and their families/caregivers. The group discussion will be proctored by a faculty member. Reflective Journaling: After each home visit, community visit and 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 #1”, “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. Complete a Pre/Post Program Impact Survey: Before any part of the above curriculum is implemented, a pre-program survey will be given to all students to access baseline knowledge and affective attitudes. At the very end of the curriculum, a post-program survey will be given. This is to assess if objectives and competencies have been reached. There is no passing grade, but the program goal is to objectively evaluate for improvement from baseline. Post lecture knowledge quizzes are also required after lectures and impact surveys after experiential activities. 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
Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council.
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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. REQUIRED READINGS • Minihan, P.M., Robey, K.L, Lon-Bellil, L.M. et al. Desired Educational Outcomes of Disability-Related Training for the Generalist Physician: Knowledge, Attitudes, and Skills. Academic Medicine. 2011;86:1171-1178. • Minnes, P. and Steiner, K. Parent Views on Enhancing the Quality of Healthcare for their Children with Fragile X Syndrome, Autism or Down Syndrome. Child: care, health and development. 2009;35:250-256. • Sices, L., Egbert, L., and Mercer, M.B. Sugar-coaters and Straight Talkers: Communicating About Developmental Delays in Primary Care. Pediatrics. 2009;124:705-713. ADDITIONAL REQUIRED MEDIA FOR REVIEW • • • • •
About the New York State Developmental Disabilities Planning Council: http://www.nacdd.org/documents/New%20York%20State%20Jan%202011.pdf The basics: http://en.wikipedia.org/wiki/Developmental_disability http://ici.umn.edu/welcome/definition.html A day in the life: http://www.youtube.com/watch?v=OffSjqE8cZo&feature=plcp Communication skills: http://vkc.mc.vanderbilt.edu/etoolkit/generalissues/communicating-effectively/
MISSING CLINICAL CLERKSHIPS FOR PROGRAM RELATED ACTIVITES It will be necessary to miss clerkship time for activities related to the PHEPD curriculum. Every effort to make arrangements to make up the time should be made. If PHEPD activities end early, return to your clerkship site. Similarly, if PHEPD activities are scheduled for the afternoon, attend clerkship activities in the morning. Although preceptors have been made aware of the introduction of this component of the curriculum, please contact a clinical coordinator should an “excuse” form be required of your clinical site. Should a preceptor not fully understand the reasoning for missing clerkship time, contact a clinical coordinator immediately. ACDS CONTACT INFORMATION Address: 4 Fern Place Plainview, NY 11803 Phone: 516-933-4700 Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council.
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CLINICAL YEAR FORMS
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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 PQRST and chief complaint HPI includes pertinent positive and negatives in HPI
0 0 0 0
PHYSICAL EXAM: Focused physical exam-including all components Includes pertinent positive & negative PE findings
1 1 1 1
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: Presents pertinent findings Understands reason for ordering each test Draws appropriate conclusions from findings
0 1 0 1 0 1
2 3 2 3 2 3
4 4 4
5 ________________________________ 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 Addresses medications given & possible side effects Explains tests & procedures to patient Provides patient with follow-up instructions
0 0 0 0 0 0
2 2 2 2 2 2
3 3 3 3 3 3
4 4 4 4 4 4
5 ________________________________ 5 ________________________________ 5 ________________________________ 5 ________________________________ 5 ________________________________ 5 ________________________________
JOURNAL: Discusses or writes a summary of article Submits supporting journal article (< 5yrs old)
0 1
2 3
4
5 _______________________________
PROFESSIONALISM:
0 1
2 3
4
5 _______________________________
1 1 1 1 1 1
2 2 2 2
COMMENTS
TOTAL POINTS ________ Faculty Signature: _________________________________________________________Date: __________
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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:
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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
9
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:
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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______________________________________
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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: ______________________________ 92
Date: ________________________
2015-2016 CLINICAL YEAR HANDBOOK AGREEMENT FORM
September 2015 Edition The 2015-2016 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:
____________________________________________
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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 __________
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PATIENT EDUCATION PROJECT GRADING FORM Student Name: ____________________________
Date: ____________________
Rotation: Elective Clerkship
Rotation Number__________
Content • Addresses topic assigned to student • Demonstrates good research base • Educates classmates on how to teach patients about topic • Demonstrates effective method for communicating material to patients • Addresses how to identify those patients that require specific patient education • Is able to answer questions regarding topic _________ (40) Written and Other Material • Materials potentially able to be used as patient education materials in a clinical setting • May include but is not limited to poster, pamphlet, creating a lesson plan or small group discussion. • Is properly footnoted and referenced if needed • Material is presented in a creative fashion • Materials are meticulously completed and submitted professionally ___________ (30) Podium Skills • Interactive, cohesive delivery • Glances at written material but DOESN’T READ from written material • Rate, tone and pitch of speech • Organized with good transition • Good movement, use of available space ___________ (30) Final Score: Faculty: ______________________________________
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___________ (100%)
ELECTIVE CLERKSHIP PRE AND POST ESSAY GRADE FORM Student Name____________________________
Date: ____________________
Rotation Number_________________
Content Pre Essay ● Student defines a clear set of goals and objectives for clerkship experience ● Describes the single most important item they would like to experience, gain or have clarified ● Discusses expectations on types of patients anticipated ● Reason for choice _______ (45%)
Post Essay (Comment only on the discipline, not the particular clerkship site) ●Describes the most important issue/entity learned at clerkship site ●Student is able to critique their own learning and is able to compare pre & post learning ● Essay is unique and creative ● States what enjoyed/disliked about the discipline ● Discusses “tips” and information gained from the experience ● How goals and objectives were met ● Discusses student’s initiatives to maximize learning experience ● Comments on discipline not particular clerkship site ● Exercises proper composition skills
_______(45%)
Professionalism ● Submitted materials on time in a professional manner Final Score: Faculty: _________________________________________
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_______(10%) _______ (100%)
FAMILY MEDICINE CLERKSHIP: HEALTH PROMOTION PROJECT Name: ____________________________
Date: __________________
The main goal of this health promotion project is to enable patients to increase control over and improve their own health. As healthcare providers, it is our responsibility to promote healthy lifestyles, along with identifying high risk patients who can develop complications from their various chronic illnesses or lifestyle risk factors. The objectives of this project are to inform patients about the prevention of a specific disease states and evaluate the effectiveness of their efforts. Ask the patient the following questions and record and reassess the results. Please attach a current article (<5 years old) that discusses health promotion issues that relates to one of your patient’s illness(es). 1. Identify and list this patient’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? __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 97
__________________________________________________________________________________ __________________________________________________________________________________ 4. Reassess the patient and note if any changes were attempted or made after your initial discussions. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 5. Please read your article (<5 years) that discusses one health promotion issue that relates to your patient’s illness(es). Please attach a one-page, typed, double spaced paper summarizing the article and discussing opinions regarding the article.
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HEALTH PROMOTION PROJECT GRADE FORM Student Name ___________________________ Rotation Number ____________
Date _______________________
Content • Identified and listed patient’s chronic illnesses and lifestyle risk factors. • Describes specific recommendations or actions taken to enable patient 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: ___________________________________
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_________ (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
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
Final Grade
X 100%
Total Points
The components of the elective clerkship are calculated by the following: Percentage Preceptor Grade
X 25%
Patient Education Project Grade
X 50%
100
Total Points
Pre & Post Essay Grade
X 25%
Procedure Logging Requirements
P/F
Clerkship Patient Encounters Requirements
P/F
Final Grade
X 100%
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: _________
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CLINICAL YEAR – CLINICAL DOCUMENTATION GRADING FORM Student’s Name: ___________________ _____________________ Date: _______________ Faculty Evaluator: _______________________________________ Grade: ______________ SOAP/H&P: Item Student Value Maximum Point Value 1. 2. 3. 4.
Introduction (3) History Components (20) PE (15) 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.
Class of medication Mechanism of Action Indications Contraindications Side Effects Cost of medication
Student Value
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: __________
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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 study’s findings?
Describe any flaws in the study design.
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Case Presentation Grade Form Partners in Health Education for People with Disabilities Student Name: _________________________________
Date: ____________________
Podium Skills: • All group members are Interactive, provide cohesive delivery, and glances but DOESN’T READ from paper • All group members have good rate, tone and pitch of speech • All group members have good movement, use of available space • Group actively involves students within the group • Creates a non-threatening atmosphere for group discussion • Utilized a unique mechanism for delivery of material • Uses first person language ________ (25) Content • Briefly introduces the individual, setting, personal interactions and his/her medical condition. • Presents the experience encountered • Examines mechanisms of providing a more comprehensive approach to medical and non-medical issues • Present obstacles encountered by the individual • Presents one community resource, in detail, that is available to this particular patient population • Discusses one clear mechanism for increasing physician assistant/physician assistant student awareness of the developmentally disabled population _______(50) Professionalism • Addresses all topics required • Hard copies of all materials are submitted to the course coordinator • Presentation is submitted by due date • Presentation is free of grammatical and spelling errors • Doesn’t exceed 10 minutes in length _______(25) Final Score:
__________ (100%)
Faculty: ____________________________________________ Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council 104
Community Agency Experience Form Partners in Health Education for People with Disabilities 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 doesn’t apply, write doesn’t apply and the reasoning. After the meeting, complete and submit the form. Age of the individual with developmental disabilities: _______________ What is the person’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?
Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council. 105
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?
Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council. 106
Department of Physician Assistant Studies Home Visit Interview Form Partners in Health Education for People with Disabilities 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 doesn’t apply, write doesn’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?
Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council. 107
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?
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?
Partners in Health Education for People with Disabilities (PHEPD) is funded in part with a grant from the New York State Developmental Disabilities Planning Council. 108
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