10. Supervised Clinical Practice Experiences - Year 2

USF MCOM PA Program

Clinical Year Schedule Class of 2019

Purpose

The Supervised Clinical Experience Practice Phase portion of the USF MCOM PA Program student handbook is designed to provide the student the policies, procedures, and pertinent information regarding the clinical year. It is important to remember that while students completing the clinical phase of the program are seldom on campus, they are still USF MCOM PA Program students and are expected to abide by the policies set forth in the USF MCOM PA Program Student Handbook as well as this manual at all times.

It is the student’s responsibility to read this manual. All students must sign a declaration of understanding prior to beginning the clinical year stating they have read, understand, and agree to abide by the contents of this manual.

Although not specifically stated after each section, failure to comply and/or conform to the guidelines, academic requirements, rules and regulations of this manual could result in disciplinary action, up to and including referral to the USF MCOM PA Program Academic Progress and Professionalism Review Committee (APPC) and dismissal from the program.

The USF MCOM PA Program reserves the right to alter, change, add to, or delete any of the policies or procedures in the manual. Students will be notified in writing and in a timely fashion of any changes in the clinical manual should they occur.

If there are questions regarding the manual, please direct them to the USF MCOM PA Program Clinical Director for clarification.

Overview of the Supervised Clinical Practice Experience (SCPE) Phase

The didactic year of education provides a broad base of knowledge, which will be further refined, challenged, and solidified through hands on clinical training during the clinical phase. The clinical phase is a 12 month period where students engage in well over 2100 hours of supervised clinical practice experiences. Students participate in eight core clinical clerkships Internal Medicine, Family Medicine, Pediatrics, Women’s Health, Surgery, Emergency Medicine, Behavioral Health and two elective clerkship (all clerkships are five weeks long). There are multiple subspecialties that are available for the elective supervised clinical practice. The USF MCOM PA Program has developed strategic partnerships with leading hospitals in the Tampa Bay area such as Tampa General Hospital, the James A. Haley Veteran's Administration Hospital. Students will also rotate through USF Health’s outpatient medical centers, the Carol and Frank Morsani Center for Advanced Healthcare and the South Tampa Center for Advanced Healthcare. These environments offer in-patient and out-patient experiences encompassing chronic, acute and health maintenance clinical encounters across the life span. Each clinical setting is unique, serving communities of diverse cultural and economic backgrounds. These facilities integrate the latest information technology, including electronic health records, and offer students the opportunity to create a true partnership with patients in an interdisciplinary learning environment. At the end of each supervised clinical practice experience the students return to the main campus for two days. End of rotation activities include an end of rotation examination, focused NCCPA board review with case discussions, and round table discussions on topics regarding Physician Assistant practice.

Course Descriptions

PAS 6100 Internal Medicine Clerkship

 This five week clinical course introduces the student to the Internal Medicine setting where the student is exposed to common diseases treated by Internal Medicine practitioners[2] in conjunction with other members of the health care team.  Physician assistant student becomes a part of an internal medicine practice caring for adult and geriatric patients. Students perform patient history and physical examinations, obtain diagnostic testing and present data to their precepting physician with a proposed differential diagnosis and treatment plan. Students participate in hospital rounds where diagnostic and therapeutic plans for acutely ill patients are discussed, performing and observing various clinical procedures, and preparing written and oral communication about patients. Where possible, students participate in grand rounds, noon conferences and other clinically relevant didactic presentations.

PAS 6125 Behavioral Health Clerkship

This five week clinical course introduces the student to Behavioral Health Medicine This clinical rotation allows the student the opportunity to develop skills in the evaluation and treatment of patient's suffering from behavioral and/or psychiatric medical conditions in the confines of a behavioral medicine hospital or outpatient clinic. The students will become involved in the care of persons experiencing a spectrum of emotional, behavioral, and psychiatric problems. Emphasis is placed on refining the student’s skills in performing history and physical exams, ordering and interpreting laboratory/diagnostic tests, synthesizing information in establishing diagnosis, formulating and implementing a treatment plan.

PAS 6200 General Surgery Clerkship

This five week clinical course introduces the student to the General Surgery setting where the student is exposed to common diseases treated by General Surgery practitioners[3] in conjunction with other members of the health care team. Emphasis is placed on refining the student’s skills in performing history and physical exams, ordering and interpreting laboratory/diagnostic tests, synthesizing information in establishing diagnosis, formulating and implementing a treatment plan. They will be exposed to routine and emergency surgical problems. Student will assess patients for common postoperative complications and wound healing. There will also be non-operating room surgical procedure exposure.

PAS 6300 Pediatric Medicine Clerkship

This five week pediatric medicine clinical course will introduce students to childhood illnesses and normal variations of growth and development. Emphasis is placed on refining the student’s skills in performing history and physical exams, ordering and interpreting laboratory/diagnostic tests, synthesizing information in establishing diagnosis, formulating and implementing a treatment plan in the pediatric and adolescent patient.

PAS 6400 Family Medicine Clerkship

This five week clinical course introduces the student to the Family Medicine setting where the student is exposed to common diseases treated by Family Medicine practitioners in conjunction with other members of the health care team. Emphasis is placed on refining the student’s skills in performing history and physical exams, ordering and interpreting laboratory/diagnostic tests, synthesizing information in establishing diagnosis, formulating and implementing a treatment plan. The student will begin to appreciate the long term impact of health care on patients‟ lives, and becomes more skilled in preventive health care and the long term management of chronic medical conditions

PAS 6500 Women’s Health Clerkship

This five week clinical course introduces the student to the Women’s Health. The purpose of this rotation is to provide the physician assistant student with a solid foundation in the diagnosis and management of common obstetric and gynecologic conditions as well as health care maintenance and disease prevention for women.  The rotation focuses on the health care of women during the reproductive and post-reproductive years. The course emphasizes care of the pregnant female, normal labor and delivery, common obstetrical and gynecologic problems, preventive care, screening for gynecologic malignancies, and family planning and sexuality. Emphasis is placed on refining the student’s skills in performing history and physical exams, ordering and interpreting laboratory/diagnostic tests, synthesizing information in establishing diagnosis, formulating and implementing a treatment plan.

PAS 6600 Emergency Medicine Clerkship

 This five week clinical course introduces the student to the Emergency Medicine setting. This allows the student to develop skills in managing patients in the emergency department setting These skills include those necessary for appropriate triage, stabilization, and initial management of patients with traumatic injuries and illnesses, the management of the less life threatening problems which present to the emergency room, working with the pre-hospital emergency medical service team, and making appropriate secondary referrals. Emphasis is placed on refining the student’s skills in performing history and physical exams, ordering and interpreting laboratory/diagnostic tests, synthesizing information in establishing diagnosis, formulating and implementing a treatment plan.

PAS 6940 Elective Clerkship

This ten week clinical course provides the student practical clinical exposure and knowledge, whether in an area of primary care or specialty medicine. Emphasis is placed on refining the student’s skills in performing history and physical exams, ordering and interpreting laboratory/diagnostic tests, synthesizing information in establishing diagnosis, formulating and implementing a treatment plan within a subspecialty or primary care.

Clinical Site Affiliation Agreements

The USF MCOM PA Program is committed to the continuous development of clinical sites. The evaluation, selection and eventual approval of a clinical site is a rigorous process, this is to ensure that the site provides the clinical experience requisite to Physician Assistant education. The USF MCOM PA Program requires current, formal, finalized and fully executed affiliation agreements between all clinical sites and USF MCOM. These agreements are legal documents that delineate academic, physical, clinical, and liability issues. This process is solely the responsibility of the USF MCOM PA Program. Students are not allowed to negotiate an affiliation with a clinical site.

If a student knows of a potential clinical site, the name, business address, email address, contact phone and fax numbers of the potential site are to be forwarded to the USF MCOM PA Clinical Director. The Clinical Director will then start that evaluation process to determine if the site is suitable. All potential clinical sites must be willing to precept other USF MCOM PA Program students in the future.

Students will not be assigned to nor will be allowed to attend any clinical site unless a current and fully executed affiliation agreement is in place. A violation of this policy by any student will result in an immediate referral to the USF MCOM PA Program Academic Progress and Professionalism Review Committee (APPC) or disciplinary action.

Students with questions or concerns about the above issues should immediately consult the USF MCOM PA Program Clinical Director.

Student Identification[5]

USF MCOM identification badges as well as a short white lab coat with the USF MCOM PA Program Seal Patch on the left sleeve and the student’s name embroidered on the left chest, above the pocket, must be worn at all times while on campus and during clinical experiences.

Students may be required to wear a separate security I.D. badge at clinical sites. The clinical site(s) will make arrangements for you during orientation prior to beginning the rotation.

PA students must always and only identify themselves as “physician assistant students” to faculty, patients, clinical site staff, and never present themselves as physicians, residents, medical students, or graduate physician assistants. While in the USF MCOM PA program, students may not use previously earned titles (i.e. RN, MD, DO, EMT, Ph.D., Dr. etc.) for identification purposes.

Academic Guidelines[6]

• Grading and Evaluation

• Throughout the clinical phase of the program, students will be evaluated and expected to meet the highest standards of achievement in the program defined learning outcomes based on the six areas of Competencies for the Physician Assistant Profession: Medical Knowledge, Interpersonal and Communication Skills, Patient Care, Professionalism, Practice Based Learning and Implementation and System-Based Practice.

• End of rotation examination
  • Will be administered at 8:00AM on End of Rotation Day 1
  • Is comprised of 120 PANCE style, multiple choice questions based on the learning objectives of the clerkship completed.
  • Must be completed in 60 minutes.
  • Will follow the PANCE topic and task blueprints
  • Exam results will be available on the morning of End of Rotation Day 2
  • There will be no EOR exam for the students during their elective clerkships. Students during this rotation will be required to submit a brief written summary of case seen during their rotation. Student will present that case during the call back days.

• Preceptor evaluation of the student
  • End of rotation evaluation
    • This evaluation MUST be submitted via E*value by the clinical preceptor no later than 7 days after completion of the clerkship.
  • Clinical procedure log on E*value
    • This log MUST be submitted via E*value by the student no later than 7 days after the completion of the clerkship

• Patient profile log on E*value
  • This log MUST be submitted via E*value by the student no later than 7 days after the completion of the clerkship

• Student site evaluation
  • This evaluation MUST be submitted via E*value by the student no later than 7 days after the completion of the clerkship

• Student Self Evaluation

• This evaluation MUST be submitted via E*value by the student on the last day of the clerkship

All assessments become a part of the student’s permanent record.

• Final Grade Calculation

• The student MUST achieve a grade of 77% in all of the following clerkship performance assessments in order to pass the clerkship: End of rotation examination
  • Preceptor evaluation (average between mid-rotation and the end of rotation evaluations)

Failure to achieve a passing grade (77%) in any of the following assessments: End of rotation examination and Preceptor evaluations will result in the failure of the clerkship, regardless of the final composite grade.

Program Responsibilities[7]

The USF MCOM PA Program is committed to:

• The continuous development of clinical sites that provide clinical experiences requisite for Physician Assistant education
• Providing sufficient clinical sites for the USF MCOM PA Program’s required clinical practice experiences
• Monitoring and updating affiliation agreements, clinical preceptor licenses, certifications, resumes and any other documentation related to the clinical phase
• Providing clinical preceptors and sites a thorough orientation on Physician Assistant education, clearly delineating what are the USF MCOM PA Program’s goals and expectations.
• Providing students a thorough orientation to the clinical phase of the program, clearly delineating the USF MCOM PA Program’s goals and expectations.
• Providing students and clinical preceptor’s clerkship specific syllabi with clear learning objectives and goals.
• Being available to students and clinical preceptors to answer any question regarding policy and procedure or intervene should any problem arise
• Monitoring and assessing the student’s progress and achievement of the goals and objectives at the mid-point and the end of each clerkship.
• Monitoring and assessing that each clinical preceptor provides a high quality clinical experience
• Provide remediation and support for those students who are not achieving the goals and objectives of the clinical clerkship
• Abide by the policies and procedures set forth in this manual.

Preceptor’s Responsibilities

Preceptor responsibilities include, but are not limited to, the following:

• Orient students at the onset of the rotation with the practice/site policies and procedures and review the expectations and objectives for the rotation
• Provide ongoing and timely feedback regarding clinical performance, knowledge base, and critical thinking skills. This can be done with the student informally each week or at a designated time and can be formally reported to the clinical coordinator by submitting mid-rotation and end-of-rotation evaluations
• Supervise, demonstrate, teach, and observe clinical activities in order to aid in the development of clinical skills and ensure proper patient care
• Delegate to the student increasing levels of responsibility for clinical assessment and management as appropriate to the student’s experience and expertise
• Participate in the evaluation of clinical skills and medical knowledge base through the following mechanisms:
  • Direct supervision, observation, and teaching in the clinical setting
  • Direct evaluation of presentations (including both oral and written)
  • Assignment of outside readings and research to promote further learning
  • Dialogue with faculty during site visits to evaluate student progress and assist the learning process
  • Audit and co-sign charts in order to evaluate the student’s ability to write appropriate and complete progress notes, histories, physical examinations, assessments, and treatment plans
  • Complete the student’s electronic Clinical Performance Evaluation via E*value no later than the last day of the clerkship
  • Promptly notify the USF MCOM PA Program of any circumstances that might interfere with the accomplishment of the above goals or diminish the overall training experience
  • Maintain an ethical approach to the care of patients by serving as a role model for the student
  • Demonstrate cultural competency through interactions with patients
  • Spend a few minutes each week in a candid summary discussion with the student as to whether each is meeting the other’s needs and expectations, and what changes need to be made in the roles and relationship
  • Provide timely feedback to the student and the program regarding student performance