ORIENTATION & COMMUNICATING STUDENT EXPECTATIONS

Exxat

Exxat is a software program that helps optimize clinical education during the clinical year. Exxat contains preceptor and site contact information, orientation information, clinical forms, site required documents, clinical site forms, patient and procedure logging, clinical year evaluations and any other materials needed by students during the clinical year. All students are required to be familiar with the information in Exxat. As this information is continuously in flux, the student is responsible for the most current information. Each student is responsible for checking Exxat daily for important announcements and site updates. Students can log in to Exxat at: https://apps.exxat.com.

Exxat PROFILE

All students will have an Exxat portfolio set-up before the start of the clinical year which contains their student profile. Student profiles will be sent to all clinical sites and preceptors via an Exxat email with the clinical year schedule. To see each student Exxat profile, please click the blue link at the bottom of your schedule that says, “click here to view student bio data, documents and other information for the students that will rotate through your department.” Then click on the orange tab “view profile” to the right of each student to review their Exxat profile. Once you are in the student’s Exxat profile please review all the “uploaded documents” on the left side of the page in green. It is this section that will house the students’ personal demographics, various certifications, background checks (if applicable), health documents, and completed ilearn modules/orientation materials.

PRECEPTOR CONTACT

Students are required to contact preceptors at least one week prior to the start of the clerkship unless the preceptor has advised otherwise. All students will contact their preceptor and site with an introductory email. Within this email is a link to see the students Exxat profile; students will also attach completed site required paperwork to this email for your review. Additionally, this email allows students an opportunity to communicate with the site and preceptors about student expectations, logistical information, and site requirements. For this process to go smoothly it is highly recommended that preceptors provide the clinical coordinators with updated and preferred contact and site information.

Orientation of the student to the clerkship site serves several purposes. Orientation facilitates a quicker transition in allowing the student to become a member of the medical team. It also establishes a feeling of enthusiasm and belonging to the team as well as helping students develop the functional capability to work more efficiently.

On the first day of the clerkship (or when possible, prior to the clerkship), the student should address any administrative needs, including obtaining a name badge/security clearance and computer password, completing any necessary paperwork, EMR training, and additional site-specific training/orientation, if needed. Hofstra does initiate access and provide training on Touch works and Sunrise (Northwell clinical sites ONLY). Early in the clinical clerkship, it is recommended that the preceptor and student formulate mutual goals with regards to what they hope to achieve during the clerkship. The preceptor should also communicate his or her expectations of the student during the clerkship. Expectations can include: • Hours • Interactions with office and professional staff • General attendance

• Call schedules • Overnight/weekend schedules • Participation during rounds and conferences • Expectations for clinical care, patient interaction, and procedures • Oral presentations • Written documentation • Assignments • Write-ups • Anything additional that the preceptor feels is necessary

Students are expected to communicate with preceptors any special scheduling needs they may have during the clerkship — in particular, when they may be out of the clinical setting for either personal reasons or programrequired educational activities. If students anticipate missing clinical time due to personal reasons, it needs to be discussed and approved on Exxat by the clinical team well in advance of the clinical absence.

Many sites find it helpful to create their own written orientation manual, which is given to the student prior to the first day of the clerkship. This helps the students quickly become more efficient. Creating such a sitespecific orientation/policy manual can be delegated to the students you host, with each “subsequent” student adding to a document that you as the preceptor maintain and edit.

PREPARING STAFF

The staff of an office or clinic has a key role in ensuring that each student has a successful clerkship. By helping the student learn about office, clinic, or ward routines and the location of critical resources, they help a student become functional and confident. Students, like their preceptors, depend on staff for patient scheduling and assistance during a patient’s visit. Students should communicate with the staff about procedures for making appointments, retrieving medical records, bringing patients into examination rooms, ordering tests, retrieving test results, and charting.

Preceptors should not assume that receptionists, schedulers, and nursing staff automatically know what role the student will have in a practice. The preceptor should inform the staff about how the student will interact with them and with patients. Consider having a meeting or creating a memo with/for staff in advance of the student’s arrival to discuss: 1. Student’s name 2. Student’s schedule (when they will be in the office) 3. Student’s expected role in patient care 4. Expected effect of the student on office operation: Will fewer patients be scheduled? Will the preceptor be busier? 5. How patients will be scheduled for the student

SUPERVISION OF THE PA STUDENT

During a student’s time at the clinic or hospital, the preceptor must be available for supervision, consultation, and teaching, or designate an alternate preceptor. Although the supervising preceptor may not be with a student during every shift, it is important to clearly assign students to another PA, Physician, or NP who will serve as the student’s preceptor for any given time interval. Having more than one clinical preceptor has the potential to disrupt continuity for the student but also offers the advantage of sharing preceptorship duties and exposes students to valuable variations in practice style, which can help learners develop the professional personality that best fits them. In the case where supervision is not available, students may be given an assignment or may 18

spend time with ancillary staff (x-ray, lab, physical therapy, etc.), as these experiences can be very valuable. The preceptor should be always aware of the student’s assigned activities.

Students are not employees of the hospitals or clinics and, therefore, work entirely under the preceptor’s supervision. Students are not to substitute for paid clinicians, clerical staff, or other workers at the clinical sites. On each clerkship, it is the student’s responsibility to ensure that the supervising physician or preceptor also sees all the student’s patients. The preceptor can provide direct supervision of technical skills with gradually increased autonomy in accordance with the PA student’s demonstrated level of expertise. However, every patient must be seen, and every procedure evaluated prior to patient discharge. The preceptor must document the involvement of the PA student in the care of the patient in all aspects of the visit. The preceptor must also specifically document that the student was supervised during the entirety of the patient visit. The PA student will not be allowed to see, treat, or discharge a patient without evaluation by the preceptor.

INFORMED PATIENT CONSENT REGARDING STUDENT INVOLVMENT IN PATIENT CARE & HIPAA

The patients are essential partners in this educational endeavor as well. All efforts will be made to observe strict confidentiality, respect patient privacy and dignity, and honor their preferences regarding treatment. All students complete HIPAA training prior to their clinical year. However, patients must be informed that a physician assistant student will participate in their care, and the patient’s consent must be obtained. This may be done through standardized forms at admission or on a person-by-person basis. The students should be clearly identified as PA student and must also verbally identify themselves as such. If the patient requests a physician and refuses the PA student’s services, the request must be honored. Patients must know that they will see their regular provider, and they should have an explicit opportunity to decline student involvement.

SOCIAL MEDIA POLICY FOR STUDENTS

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 or 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, Instagram, 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. Other than LinkedIn or program and course related activities, requesting connections 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.

PATIENT RIGHTS AND CONFIDENTIALITY

All students have been HIPAA certified prior to entrance into clinical clerkships. All information regarding a patient’s health is privileged information. All students must strictly adhere to each institutional policy governing patient rights and confidentiality and to all federal, state, and local governances. 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.

DOCUMENTATION

If allowed by the preceptor and/or facility, PA students may enter information in the medical record. Preceptors should clearly understand how different payers view student notes as related to documentation of services provided for reimbursement purposes. Any questions regarding this issue should be directed to the clinical coordinator. Students are reminded that the medical record is a legal document. All medical entries must be identified as “student” and must include the PA student’s signature with the designation PA-Student. The preceptor cannot bill for the services of a student. Preceptors are required to document the services they provide as well as review and edit all student documentation. Although student documentation may be limited for reimbursement purposes, students’ notes are legal and are contributory to the medical record. Moreover, writing a succinct note that communicates effectively is a critical skill that PA students should develop. The utilization of EMR systems (electronic medical records) presents obstacles for students if they lack a password or are not fully trained in the use of one institution’s EMR system. In these cases, students are encouraged to hand-write notes, if simply for the student’s own edification, which should be reviewed by preceptors whenever possible for feedback.

PRECEPTOR REVIEW, COUNTERSIGNATURE AND PRESCRIPTION WRITING

Preceptors must evaluate all patients seen by students. It is the responsibility of each student to ensure that the supervising preceptor evaluates each patient seen by the student. The supervising preceptor must review, critique, and countersign all notes written by the student. The student will 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 may transmit prescribing information for the preceptor, but the preceptor must sign all prescriptions. More specifically, the student’s name is not to appear on the prescription. For clinical clerkship sites that use electronic prescriptions, the preceptor MUST log into the system under his/her own password and personally sign and send the electronic prescription. These guidelines must not be violated by the student or the preceptor. However, students are encouraged to practice writing unofficial orders and prescriptions and present them to preceptors for review. Similarly, if hospital policy does not allow students to write clinical notes in a patient chart, unofficial notes should be reviewed by the preceptor.

EXPECTED PROGRESSION OF PA STUDENT

PA students are trained to take detailed histories, perform physical examinations, give oral presentations of findings, and develop differential diagnoses. As the year continues, they should be able to come up with an assessment and plan more effectively, though this will involve discussion with the preceptor. If the preceptor deems it necessary, students initially may observe patient encounters. However, by the end of the first week, students should actively participate in evaluating patients. As the preceptor feels more comfortable with the student’s skills and abilities, the student should be allowed progressively increasing supervised autonomy.

PRECETOR EVALUATION OF STUDENT

The preceptor evaluation comprises 50% of the grade for the clerkship. If a student fails a preceptor evaluation, the student fails the clerkship. The evaluation is designed to promote communication between preceptor and

student. Preceptors are encouraged to discuss strengths and weaknesses to encourage students about their strengths as well as provide opportunities to improve upon weaknesses. The evaluation should also reflect on student knowledge and skills as well as their improvement throughout the clerkship and assess progress in comparison to other students at the same level. The preceptor's evaluation of the student is tremendously important. On required clerkships (i.e., core clerkships required by the specific institution for all students prior to graduation), a passing evaluation from the preceptor is mandatory. If deemed “not passing,” the student will need to repeat the clerkship.

We encourage preceptors to review the preceptor evaluation with their students privately to get additional insight into the student’s performance, professionalism, and effectiveness as a team player. These comments are helpful contributions to student evaluations. Additionally, staff feedback may enhance the student experience from one clerkship to another and can help to improve efficiency and flow while also maximizing educational opportunities.

This evaluation will be sent to clinical preceptors electronically via our clinical year software program, Exxat, in the last week of the rotation. All preceptor evaluations must be submitted electronically on Exxat upon completion of the clerkship. When completing your preceptor evaluation, you have two options: “submit” or “save”. Preceptors may click “save” to go back to the evaluation and complete later. Once the evaluation is complete, preceptors must click “submit” for the program to receive the evaluation. Paper copies of the preceptor evaluation will no longer be accepted. Grades for the clerkship will not be posted until the evaluation form is received.

STUDENT FEEDBACK

While students may have only one formal evaluation during the clinical clerkship, it is imperative that they receive regular positive and constructive feedback daily from their preceptors to help improve their clinical performance. Preceptors are encouraged to provide students with feedback throughout clerkships as identification of strengths and weaknesses which is essential for student self-improvement. A planned meeting with the student midway through the clerkship may be helpful. Suggested areas of feedback include weaknesses in clinical knowledge, history taking, physical exam skills, formulation of differential diagnoses, and management/follow-up. The preceptor can provide helpful feedback on oral and written presentation skills as well as issues concerning professionalism. If a preceptor feels that a student is not meeting the expectations of the clerkship, they must notify the clinical coordinators by either phone or email prior to the end of the clerkship. It is also advised that the preceptor meet with the student directly to discuss any issues or deficiencies noted by the preceptor.

CLERKSHIP SCHEDULE

All students are required on Exxat to complete a weekly time sheet for the duration of their clerkship. Time sheets can be completed week by week or once for the entire rotation, if applicable. It is strongly recommended that students strive to be at their clinical site for a minimum of forty hours per week to get the best possible clinical experience.

A new time sheet must be submitted if a student’s schedule changes for any reason. Any planned absence or lateness requests must be submitted via Exxat a minimum of 1 week prior and approved by the clinical coordinators. The student’s request is not approved until the clinical coordinators have reviewed their submission and sent an approval via Exxat. It is the student’s responsibility to check Exxat regarding their submission status. The time used to make up absences must be similarly documented on Exxat in the “my leave” section.

Failure to submit a clerkship time sheet for the entire rotation or my leave request will result in a grade of “incomplete” until the student’s submission is received.

CME FOR PHYSICIAN ASSISTANT PRECEPTORS

The Hofstra University Department of Physician Assistant Studies can award Category 1 CME for clinical teaching. The credits are awarded by the American Academy of Physician Assistants (AAPA), made possible through collaboration with the Physician Assistant Education Association (PAEA). At this time, due to regulations from the AAPA and PAEA, this credit is limited to preceptors who are currently practicing PA’s.

The number of credits awarded is determined by the amount of time spent precepting students. Hofstra will award 2.00 AAPA Category I CME credit for each 2 weeks of clinical teaching. For the purposes of credit calculation, a week is defined as 40 hours of precepting. If a preceptor has more than one student at a time, that preceptor may be awarded an additional 2.00 CME credit for each additional student per 2 weeks of teaching. The previous limit of 20 AAPA Category 1 CME for preceptors is no longer in effect. Preceptors may now earn an unlimited number of AAPA Category 1 CME for their precepting efforts from programs accredited by AAPA to provide these CME credits. Preceptorship CME is still earned at a rate of 2 AAPA Category 1 CME credits per PA student per 40-hour week.

The preceptor must keep track of students assigned to them and the number of weeks spent clinically teaching. August 31st marks the culmination of the clinical year, at which time the preceptor is required to submit the selfevaluation form and attestation of number of weeks spent teaching. If there are multiple physician assistants precepting a single student, the PA should claim credit only for time spent actively teaching that student. If the clinical coordinator is not in receipt of these documents within one month of the end of the clinical year, credits will not be awarded.