Midwestern University College of Health Sciences Clinical Handbook

Transcription

Midwestern University
College of Health Sciences
Physician Assistant Program
Clinical Handbook
2011 - 2012
This Handbook is published for the convenience of students enrolled in Midwestern University’s Physician
Assistant Program, Downers Grove campus. It is intended to be effective as of June 1, 2011. The
Midwestern University Physician Assistant Program reserves the right to make changes in any or all
specifications contained herein.
Midwestern University provides equality of opportunity in its educational programs for all persons,
maintains nondiscriminatory admission policies, and considers for all admission all qualified students
regardless of race, color, sex, sexual orientation, religion, national or ethnic origin, citizenship status,
disability, status as a veteran, age, or marital status.
Midwestern University is not responsible for loss or damage to a student’s personal property on premises
owned or operated by the University, regardless of cause.
May 2011
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Mission Statement - Midwestern University
Midwestern University’s historical and sustaining philosophy dedicates the institution and its resources to
the highest standards of academic excellence to meet the educational needs of the health care
community.
Mission Statement - College of Health Sciences
The College of Health Sciences is dedicated to the highest standards of excellence in the education of
professionals who will meet the health care and service needs of the community in a wide range of
academic and practice settings. This mission is expressed in the education, scholarship, and service
objectives of the programs of the College of Health Sciences.
Mission Statement - Physician Assistant Program
The mission of the Midwestern University Physician Assistant (PA) Program is to:
Provide an educational environment that enables individuals to become competent and compassionate
physician assistants who possess the clinical skills to make meaningful contributions to the evolving
health care needs of the patients they will serve and to stimulate involvement in the physician assistant
profession by encouraging participation and leadership in local, state, and national organizations.
The goals of the PA Program are to:
1) provide a rigorous academic and clinical curriculum and achieve first-time PANCE percentage
pass rates and mean Program scores above the national average,
2) cultivate an environment of professionalism to encourage the development of competent and
compassionate providers,
3) prepare students to serve diverse populations in both primary care and specialty settings, and
4) demonstrate the application of evidence-based medicine and foster a continuous commitment to
life-long learning and community involvement as a health care provider.
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Dear Midwestern University Physician Assistant Students and Preceptors:
Progression to the clinical training phase of the Midwestern University Physician Assistant (PA) Program
is an important milestone for our students. It is the culmination of hours of preparation in lectures, small
group activities, and practical examinations, along with mastery of great quantities of didactic material in
written examinations throughout the didactic year.
Clinical rotations endeavor to build upon the academic knowledge gained in the first year through direct
patient care in a variety of settings. Our ultimate collective goal is to prepare each of our PA students for
excellence in professional practice.
This Midwestern University PA Program Clinical Handbook is an adjunct to the first year PA Program
Academic Policies, the Midwestern University Student Handbook, and the Midwestern University Catalog.
The Clinical Handbook is intended to guide PA students and Preceptors through the objectives of training,
and contains specific policies and procedures pertinent to the clinical portion of our Program.
The Handbook is organized into four major sections:
1)
2)
3)
4)
General information
Policies and procedures
Rotation-specific syllabi and objectives
Forms
Throughout the document you will find designations which demonstrate compliance with the Accreditation
th
Standards for Physician Assistant Education 4 Edition of the Accreditation Review Commission on
Education for the Physician Assistant (ARC-PA). These designations are noted in italics and parentheses,
just prior to the relevant section or policy.
We require both students and Preceptors to familiarize themselves with the content of the Clinical
Handbook before the start of clinical rotations, and hope this Handbook serves as a useful resource
during core and elective rotations.
The PA Program faculty and staff enthusiastically support our Preceptors and students throughout the
clinical phase of training and are dedicated to the development of exceptional clinical rotation
experiences. Please feel free to contact the Clinical Coordinators or other members of the PA Program
faculty or staff if you have any questions regarding the material in this Handbook or if you need
assistance during clinical rotations.
Sincerely,
A. Smith
Alyson L. Smith, MS, PA-C
Program Director & Associate Professor
Midwestern University PA Program
Downers Grove Campus
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Midwestern University College of Health Science
Faculty/Staff Contact List
Program Phone: (630) 515-6034
Program Fax: (630) 971-6402
Clinical Team email: [email protected]
Clinical Team
David A. Luce, MMS, PA-C
Clinical Coordinator
& Assistant Professor
[email protected]
Soonja L. Sawyer, MS, PA-C
Clinical Coordinator
& Instructor
[email protected]
Barbara Mullin, BS
Clinical Data Coordinator
Susan Laurenzana
Administrative Assistant
[email protected]
[email protected]
Program Faculty and Staff
Program Director
& Associate Professor
[email protected]
Kara N. Roman, MMS, PA-C
Associate Program Director
[email protected]
Lendell Richardson, MD
Medical Director
[email protected]
Sandhya Noronha, MD
Assistant Professor
[email protected]
James F. Gunn, MMS, PA-C
Instructor
[email protected]
Susan Blanchard
Senior Administrative Assistant
[email protected]
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Code of Ethics of the Physician Assistant Profession
The American Academy of Physician Assistants recognizes its responsibility to aid the profession in
maintaining high standards in the provision of quality and accessible health care services. The following
principles delineate the standards governing the conduct of physician assistants in their professional
interactions with patients, colleagues, other health professionals and the general public. Realizing that no code
can encompass all ethical responsibilities of the physician assistant, this enumeration of obligations in the Code
of Ethics is not comprehensive and does not constitute a denial of the existence of other obligations, equally
imperative, though not specifically mentioned.
Physician Assistants shall be committed to providing competent medical care, assuming as their primary
responsibility the health, safety, welfare, and dignity of all humans.
Physician Assistants shall extend to each patient the full measure of their ability as dedicated, empathetic
health care providers and shall assume all responsibility for the skillful and proficient transactions of their
professional duties.
Physician Assistants shall deliver necessary health care services to health consumers without regard to sex,
age, race, creed, socio-economic or political status.
Physician Assistants shall adhere to all state and federal laws governing informed consent concerning the
patient’s health care.
Physician Assistants shall seek consultation with their supervising physician, other health care providers, or
qualified professionals having special skills, knowledge or experience whenever the welfare of the patient will
be safeguarded or advanced by such consultation. Supervision should include ongoing communication
between the physician and the physician assistant regarding the care of all patients.
Physician Assistants shall take personal responsibility for being familiar with and adhering to all federal and
state laws applicable to the practice of their profession.
Physician Assistants shall provide only those services for which they are qualified via education and/or
experiences and by pertinent legal regulatory process.
Physician Assistants shall not represent in any manner, either directly or indirectly, their skills, training,
professional credentials, identity or services.
Physician Assistants shall uphold the doctrine of confidentiality regarding privileged patient information,
unless required to release such information by law or such information becomes necessary to protect the
welfare of the patient or the community.
Physician Assistants shall strive to maintain and increase the quality of individual health care service through
individual study and continuing education.
Physician Assistants shall have the duty to respect the law, to uphold the dignity of the physician assistant
profession, and to accept its ethical principles. The physician assistant shall not participate in or conceal any
activity that will bring discredit or dishonor to the physician assistant profession and shall expose, without fear
or favor, any illegal or unethical conduct in the medical profession.
Physician Assistants, ever cognizant of the needs of the community, shall use the knowledge and experience
acquired as professionals to contribute to an improved community.
Physician Assistants shall place service before material gain and must carefully guard against conflicts of
professional interest.
Physician Assistants shall strive to maintain a spirit of cooperation with their professional organizations and
the general public.
- American Academy of Physician Assistants
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TABLE OF CONTENTS
Mission and Goal Statements ..................................... 3
Program Director Letter ............................................... 5
Faculty/Staff Contact List............................................. 7
Code of Ethics ............................................................. 8
Calendar .................................................................... 11
Abbreviations ............................................................. 12
Policies and Procedures
Advanced Clinical Medicine Courses ........................ 13
Attendance ................................................................ 13
Boundaries ................................................................ 14
Clinical Assessment Days ......................................... 14
Clinical Rotation Grades ............................................ 14
Clinical Site Affiliation Agreement .............................. 15
Clinical Site Evaluations ............................................ 15
Communication with the PA Program ........................ 15
Core Rotations ........................................................... 15
Criminal History Background Checks ........................ 16
Dress Code ................................................................ 16
Elective Rotations ...................................................... 16
End-of-Rotation Exams ............................................. 17
Graduation Requirements ......................................... 17
Health Insurance ....................................................... 17
Health Insurance Portability and Accountability Act .. 18
Hours ......................................................................... 18
Immunization Requirements ...................................... 18
Independent Study in Capstone Project I -IV ............ 18
Leave of Absence ...................................................... 19
Legal .......................................................................... 19
Mid-Rotation Student Self-Evaluation........................ 19
Mid-Year Evaluation .................................................. 19
Needle Stick or Injury on Rotations ........................... 19
Patient Encounter Logs ............................................ 20
Physician Assistant Resources ................................. 21
Preceptor Evaluation ................................................. 21
Preceptor Resources ................................................. 21
Prescriptive Activities and Charting ........................... 21
Professional Curriculum in the First Year .................. 22
Professional Curriculum in the Second/Third Year .... 22
Professionalism ......................................................... 22
Professional Liability Insurance ................................. 23
Rotation Change Requests ....................................... 23
Rotation Prerequisites ............................................... 23
Safety ........................................................................ 23
Site Development ...................................................... 23
Student Performance Evaluation ............................... 23
Summative Exams ..................................................... 24
Supervision ................................................................ 24
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General Information
General Learning Objectives ..................................... 25
Competencies for the Physician Assistant ............... 27
Required and Recommended Textbooks .................. 31
Elective I and Elective II Rotation Syllabi .................. 33
Rotation Syllabi and Objectives
Behavioral Medicine .................................................. 37
Emergency Medicine ................................................. 41
Family Medicine ......................................................... 49
Geriatric Medicine ...................................................... 59
Internal Medicine ...................................................... 65
Pediatrics ................................................................... 73
General Surgery ........................................................ 81
Women’s Health ........................................................ 87
Forms
Request for Rotation Absence .................................. 93
Mid-Rotation Student Self-Evaluation Form .............. 95
Student Performance Evaluation Form ..................... 99
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CLINICAL YEAR CALENDAR 2011 - 2012
ACTIVITY
DATE
*Advanced Clinical Medicine I
6/6/11 - 6/17/11
Rotation #1
6/20/11 -7/31/11
*CAD #1
Friday, 7/29/11
Rotation #2
8/1/11 - 9/11/11
*CAD #2
Friday, 9/09/11
Rotation #3
9/12/11-10/23/11
*CAD #3
Friday, 10/21/11
Rotation #4
10/24/11-12/4/11
*CAD #4
*Advanced Clinical Medicine II
*Mid-Year Evaluation (MYE)
Winter Break
Rotation #5
*CAD #5
Rotation #6
Friday, 12/2/11
12/5/11 – 12/16/11
12/15/11 – 12/16/11
12/17/11 – 1/1/12
1/2/12 - 2/12/12
Friday, 2/10/12
2/13/12 - 3/25/12
*CAD #6
Friday, 3/23/12
Rotation #7
3/26/12 - 5/6/12
*CAD #7
Friday, 5/4/12
Rotation #8
5/7/12- 6/17/12
*CAD #8
Friday, 6/15/12
*Advanced Clinical Medicine III –
PANCE Review
6/18/12 – 6/22/12
*End-of-Year Evaluation (EYE)
6/21/12 – 6/22/12
Elective I
6/25/12 – 7/22/12
Elective II
7/23/12 – 8/19/12
*Advanced Clinical Medicine III –
Completion Week
8/20/12 – 8/24/12
*PA III Completion Date
8/24/12
*on campus
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ABBREVIATIONS
AAPA………………………………..……………. American Academy of Physician Assistants
ARC-PA…Accreditation Review Commission on Education for the Physician Assistant, Inc.
CAD……………………………………………..……………………....Clinical Assessment Day
CDC………………………………………..….…..Centers for Disease Control and Prevention
CHS……………………………………………..…...……………..…College of Health Sciences
CPT………………………………………..……………………Current Procedural Terminology
CSP…………………………………………..………………………………Clinical Skills Portion
EOR…………………………….…………….…...……………….………………End-of-Rotation
EYE…………………………….………………….………….…………..End-of-Year Evaluation
HIPAA……………………………….……Health Insurance Portability and Accountability Act
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ICD-9…………………………………….. International Classification of Diseases, 9 edition
LOA……………………………………….…………………………………….Leave of Absence
MCQ…………….…………………………………………………..….Multiple Choice Question
MWU……………………………….…………………………..…………..Midwestern University
MYE……………………………….…………………………..…………..…Mid-Year Evaluation
NCCPA……………………National Commission on Certification of the Physician Assistant
OSCE……………………….………………………Objective Structured Clinical Examination
PA..........................................................................................................Physician Assistant
PA-ARC………….………………………..Physician Assistant Academic Review Committee
PAEA………………………………….……………Physician Assistant Education Association
PANCE……………………………….…Physician Assistant National Certifying Examination
RMS......................................................................................Rotation Management System
Typhon………………………...Typhon Group Physician Assistant Student Tracking System
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Advanced Clinical Medicine Courses
Advanced Clinical Medicine I (ACM I): 6/6/11 – 6/17/11
This course is designed to build upon the student’s foundation of clinical medicine knowledge and to
prepare him or her for clinical rotations. Lectures will provide advanced information and instruction
covering a range of medical topics including interpretation of electrocardiograms, basic life support for
health care providers and advance cardiovascular life support, and other topics that will facilitate the
student’s continuing development of knowledge and therapeutic skills in patient assessment, medical
decision-making, and clinical management. Instructions for using the Typhon Group Physician Assistant
Tracking System (Typhon) will also be provided.
Advanced Clinical Medicine II (ACM II): 12/5/11 – 12/16/11
This course is designed to build upon the student’s foundation of clinical medicine knowledge and to
continue to develop critical thinking and medical decision making skills. Lectures will provide advanced
information and instruction covering a range of medical topics, and students will build upon their physical
examination skills in small group practical and discussion sessions.
Advanced Clinical Medicine III (ACM III): 6/18/12 – 6/22/12 and 8/20/12 – 8/24/12
This course is designed to build upon the student’s foundation of clinical medicine knowledge. Guest
lecturers with clinical expertise in a variety of fields will provide advanced information and instruction. In
addition, students will receive updates on clinical practice issues. During the course, students will receive
an intensive week of lecture topics to help them prepare for the Physician Assistant National Certifying
Examination (PANCE). Students will also focus on professional issues in preparation for graduation and
clinical practice. During this time students will also be engaged in presenting and evaluating final
Capstone Projects.
Attendance
(ARC-PA: A3.17) During the clinical portion of the Physician Assistant (PA) Program, students must
attend all scheduled courses, exams, and rotation activities. If a rotation requires that a student
participate in supervised call time, the student is expected to do so. The PA Program generally does not
permit absences for any reason other than personal illness or a family emergency. Students are not
permitted time off to study for exams or to seek employment, except as noted later in this section.
An unexcused absence is grounds for failure of a rotation or didactic clinical phase course. Any
unexcused absence will be reviewed by the PA Clinical Coordinators and the matter may be referred to
the PA Academic Review Committee (PA-ARC) for further action. Habitual tardiness is also considered
disruptive and unprofessional and may result in action by the Clinical Coordinators and referral to the PAARC.
For Clinical Rotation absences due to:
1. Personal illness or family emergency: The student MUST call the PA Program AND the
rotation site on the day the absence occurs. These calls must occur by 9:00 AM or the start of the
assigned clinic time, whichever is earlier. The Clinical Coordinators will work with the Preceptor to
determine how the missed time will be made up. Final approval for the make-up of missed time
will be at the discretion of the Clinical Coordinators. Extended absence, even if excused, may
require a Leave of Absence (LOA) from the Program, which will alter the student’s anticipated
date of graduation. For additional information, please refer to the College of Health Science
section of the Midwestern University (MWU) Catalog.
2. Conferences and Events: A University policy has been established for students to request an
excused absence from classes/laboratories/rotations to attend approved off-campus functions,
including medical conferences. Physician Assistant students must first complete a Request for
Rotation Absence form in this Handbook, and the request must be approved by the Clinical
Coordinators. For additional information, please refer to the Policies section of the MWU Student
Handbook.
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3. Personal Day - One (1): Students who have no unexcused absences during core rotations may
request a single personal day for use during elective rotations. A personal day may not be
requested for either the first or last working day of a rotation. Students should complete the
Request for Rotation Absence form and submit it to the Clinical Coordinators via email
[email protected] no later than 48 hours prior to the requested day off.
Outside of unforeseen personal illness or family emergency, the student may not plan any absence
unless the PA Clinical Coordinators grant approval in advance. The student should not, under any
circumstances, directly ask a Preceptor for permission for an absence for any reason.
Boundaries
Patients, providers, and staff must be treated with all due respect and courtesy. The PA Program
expressly forbids dating patients or becoming “involved” with patients, Preceptors, or other staff. Good
judgment and appropriate boundaries when dealing with patients and clinic/hospital personnel are
imperative. Any student breach in the Physician Assistant Code of Ethics on patient-professional
relationships will be referred to the PA-ARC as described in the MWU Student Handbook.
(ARC PA: A3.11, A3.17) Midwestern University believes in the dignity and worth of its students, faculty,
staff, interns and residents, and will not tolerate unacceptable conduct or behavior that has the effect of
substantially interfering with the individual’s performance or creates an intimidating, hostile, or offensive
learning/working environment. Members of the MWU community have a right to be free from sexual
harassment. If an MWU student feels he or she is being subjected to sexual harassment, he or she
should refer to the MWU Student Handbook for detailed policies and procedures and immediately contact
the PA Program Director and/or the Dean of Student Services.
Clinical Assessment Days
Clinical Assessment Days (CAD) are designed to help the student integrate medical knowledge and
clinical skills acquired during the didactic and clinical phase of training. Components of the CAD include
an end-of-rotation exam, advanced clinical lectures, clinical learning and assessment activities using
standardized patients, and a PA Program meeting. Students must satisfactorily participate in ALL
components of each CAD.
CADs are held at the completion of each core clinical rotation. Each day will typically begin at 8:00 AM
and conclude by 5:30 PM. Attendance at the CAD is a requirement for each core rotation and is a
prerequisite for graduation. CAD schedules and lectures will be posted on Blackboard at least 48 hours
prior to the CAD. Once posted, individual student schedules for CAD activities cannot be changed.
Clinical Rotation Grades
(ARC-PA: A3.17) For each core rotation, students are required to achieve a passing score in each of the
following components:
1. End-of-rotation (EOR) exam – must attain a minimum score of 60%
2. Student Performance Evaluation - completed by the Preceptor(s)
3. CAD learning and assessment activities
For each elective rotation, students must receive a passing grade, based upon the Student Performance
Evaluation completed by rotation Preceptor(s) and satisfactory completion of all other rotation
requirements.
The Clinical Coordinators have the final determination as to whether a student has met all rotation
requirements and will confer the final grade for each rotation.
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Marginal or failing performance in any rotation will be reviewed by the PA Clinical Coordinators and
typically referred to the PA-ARC for action. This committee has the right to adjust the final rotation grade.
Failure of more than one rotation or didactic course during the clinical phase of training constitutes a
significant problem and may result in dismissal from the Program. The following describes the usual
course of action in the event of marginal or failing performance of a required rotation component:
A. A student receiving an unsatisfactory score from a Preceptor will be referred directly to the PAARC.
B. A student failing an EOR examination (score less than 60%) may be allowed a single re-test of
that examination. If the re-test score is equal to or greater than 60%, the student will receive a
passing score for the EOR exam. If the re-test score is less than 60%, the student will be referred
to the PA-ARC.
- For an EOR failure during a CAD, the re-test examination will be administered the next
business day at 7:30 AM in the PA Program office.
- For an EOR failure during ACM-II, the re-test examination will be administered within a
similar time frame.
C. Any student failing more than two EOR exams on the first attempt will be referred to the PA-ARC.
Clinical Site Affiliation Agreement
(ARC-PA: A1.02, A3.03) A formal affiliation agreement or memoranda of understanding between the
sponsoring institution and clinical sites is a required accreditation standard of the Accreditation Review
Commission on Education for the Physician Assistant (ARC-PA). The PA Program ensures that clinical
sites are capable of providing clinical instruction and experiences requisite to PA education, and final site
approval rests solely with the PA Program.
Clinical Site Evaluation
(ARC-PA: C4.01) The Program engages in ongoing evaluations of all sites and Preceptors to ensure
program-defined expectations for learning outcomes and performance evaluation measures are met.
Midwestern University faculty perform site visits routinely throughout the clinical training period. In
addition, site visits may be used to assess a student’s progress and to provide support to the Clinical
Preceptor. These visits may be scheduled or unannounced.
Communication with the PA Program
(ARC-PA: A3.10) Clinical phase students should feel free to contact any member of the PA Program
faculty for help, counsel, or advice related to professional training as often as necessary. Any student
experiencing significant personal stress during his or her training is encouraged to seek counseling and/or
support by directly contacting the MWU Wellness Center Director of Counseling for a free and confidential
appointment (630-515-7142). Midwestern University e-mail is the primary contact method used by the PA
Program during the clinical phase of training. The Program will not respond to email sent from personal
accounts. Students are required to check their MWU e-mail account daily for clinical phase information
which may include rotation changes, immunization notifications, or other important correspondence.
Core Rotations
(ARC-PA: B3.03, B3.04) The clinical phase of the program has eight 6-week core rotations. Core
rotations include Behavioral Medicine, Emergency Medicine, Family Medicine, Geriatrics, Internal
Medicine, Pediatrics, Surgery, and Women’s Health. The majority of core rotation sites are located within
the greater Chicago area. There is limited availability for core rotations at select MWU clinical sites
outside of the greater Chicago area and students are regularly assigned to these distant sites. Housing is
provided for out-of-state core clinical rotations only. Students are expected to secure their own housing
for local and elective rotations, and must provide their own transportation to all core and elective clinical
rotations regardless of location.
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(ARC-PA: A3.03) Students are never required to provide or solicit clinical sites or Preceptors.
The Program maintains responsibility for the coordination of clinical sites and Preceptors for all rotations.
The PA Program reserves the right to schedule student rotations based on, but not limited to, availability,
location, and previous healthcare experience. The student’s academic performance may be used as a
factor in assigning or changing clinical rotations. In addition, there are occasionally circumstances beyond
the Program’s control which may require amendment to a student’s clinical rotation schedule.
Criminal History Background Checks
All students are required to submit to a criminal background check at matriculation and immediately prior
to participation in the clinical training phase of the program. In addition, students who remain enrolled
must submit to a criminal background check as needed to remain eligible for continued participation.
Refer to the Policies section of the MWU Student Handbook for further information.
Dress Code
(ARC-PA: A1.03f, B3.01) During all rotations, and when returning to campus for scheduled didactic
courses, evaluations, and CADs, students are expected to maintain a professional appearance. On
rotations, students are required to wear a short white coat (not a long coat) with a Program-issued
nametag and a PA Program patch (left arm). There may be some rotations where site policies dictate that
white coats are not worn, but a nametag indicating physician assistant student status must be visible at
all times. Failure to wear proper identification is a violation of state statutes for medical practice and may
result in failure of the rotation and referral to the PA-ARC.
As representatives of the PA Program, students must be well-groomed, clean, neat, and dressed to avoid
extremes of hair and clothing styles. Students should be dressed modestly at all times during all seasons.
For example, shorts, sandals, halters, sheer or revealing clothing, and open-toed shoes are never
appropriate. Students are asked not to chew gum. Long fingernails, artificial nails, and colored fingernail
polish are unacceptable for health providers caring for patients. If you have additional questions or desire
clarification about appropriate professional attire or decorum, refer to the MWU Student Handbook or
please feel free to contact the Clinical Coordinators for guidance.
Elective Rotations
(ARC-PA: A3.03) Students must complete two 4-week elective rotations as part of their clinical training.
When submitting preferences for elective clinical rotations, students are required to enter a lottery for
existing MWU elective sites or may submit appropriate documentation to suggest a new elective site.
Core rotation sites cannot be used for elective rotations, and students are not permitted to contact any
existing MWU clinical site in an attempt to arrange their own electives.
For a new elective site to be considered, the student must complete the following tasks: 1) initiate contact
with the site/Preceptor and any hospital contacts and 2) complete the on-line Elective Rotation
Preference Sheet with appropriate Preceptor/site contact information. In order for a new site to be
considered, a current written affiliation agreement with MWU must already be in place, or the site must be
willing to accept MWU’s standard affiliation agreement.
A timeframe for submitting the above information will be announced to students during a regularlyscheduled Program meeting on a CAD. Student suggested sites, Preceptors, and affiliation agreements
will be reviewed by the Program for educational suitability. Final approval for all elective sites rests with
the PA Clinical Coordinators. In addition, there are occasionally circumstances beyond the Program’s
control which may require changes in a student’s elective clinical rotation schedule.
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End-of-Rotation Exams
An End-of-Rotation (EOR) exam must be successfully completed (score of 60% or higher) at the end of
each core rotation during the CAD as scheduled. Questions on EOR exams are based upon the General
Learning Objectives and the specific rotation objectives for each rotation as outlined in this Handbook.
End-of-Rotation scores will be securely posted to the Midwestern University on-line system
(https://online.midwestern.edu) by 5:00 PM on each CAD. In the event of an EOR exam failure, refer to
the Clinical Rotation Grades section in this Handbook for details on the typical course of action.
In order to be permitted to sit for the required EOR exam, each student must:
- successfully complete the required rotation as scheduled;
- complete all patient encounter logs by 12:00 PM on the day preceding the CAD; and
- complete the on-line Preceptor evaluation by 12:00 PM on the day preceding the CAD.
Graduation Requirements
(ARC-PA: A3.17) In order to be considered by the PA-ARC and the College of Health Sciences (CHS)
Promotion and Graduation Committee for timely graduation, each student must satisfactorily meet all the
following PA Program criteria for the clinical phase of training:
Eight 6-week core rotations and two 4-week elective rotations;
All components of each CAD;
Advanced Clinical Medicine I, II & III;
Independent Study in Capstone Project I-IV;
Mid-Year Evaluation;
End-of-Year Evaluation;
Cumulative Grade Point Average (GPA) ≥ 2.75 ;
Demonstrate professionalism throughout clinical training; and
CHS Graduation Clearance Form (online).
Health Insurance
The University requires that all full-time and part-time students enrolled in any University program be
covered under a health insurance plan acceptable to the University. Midwestern University has made a
Student Medical Health Care Plan available to students. Students may choose health care insurance
through Midwestern University or may choose their own comparable plan.
Evidence of acceptable non-University health insurance coverage must be provided prior to program
matriculation and prior to registration for the fall quarter each succeeding year thereafter by completing an
On-line Waiver Form that can be accessed through the on-line Midwestern web site
(https://online.midwestern.edu). Non-University insurance plans must provide coverage comparable to
that offered by the University. Short-term or catastrophic coverage is not deemed comparable and cannot
be an acceptable health insurance plan.
A student’s health insurance coverage may be randomly verified. Failure to maintain health insurance
may result in immediate dismissal from the University. Details of benefit plan coverage and related
premium costs are available by calling the MWU Department of Student Services at (630) 515-6470.
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Health Insurance Portability and Accountability Act
(ARC-PA: B2.16) All MWU PA students are required to abide by the standards and policies of the Health
Insurance Portability and Accountability Act (HIPAA). Violation of patient privacy is a serious offense and
is grounds for dismissal from the Program.
In addition to maintaining HIPPA standards within the clinical setting, students are expressly prohibited
from taking photographs or video of patients without proper Preceptor and patient consent. Distribution of
photographs, video, or discussion of patient encounters (even without patient identifying information) via
email or on social websites is considered a significant violation of both HIPPA standards and Program
policies and is grounds for referral to the PA-ARC and dismissal from the Program. Any student with
questions regarding appropriate implementation of HIPAA standards or other matters of patient
confidentiality must immediately contact the PA Clinical Coordinators for guidance.
Hours
(ARC-PA: A3.17) It is PA Program policy that students are expected to actively participate in a minimum
of 40 hours of supervised clinical practice experiences weekly. This time may include daytime business
hours, evening hours, weekend hours and supervised call time.
If a Preceptor unexpectedly needs to be away from the practice site for any period of time outside of his
or her normal schedule, the student must immediately notify the PA Program so alternate arrangements
for that student may be made. When a PA student is participating in a clinical rotation he or she must be
adequately supervised at all times. A licensed and board-certified medical provider (MD, DO, or PA) must
be on site and evaluate every patient seen by the student. See the Supervision section of this Handbook
for additional information.
Immunizations, Titers, Tuberculosis, and Other Related Requirements
(ARC-PA: A3.07) In order to meet Program accreditation standards, health screening and immunization
of students must be in compliance with current Centers for Disease Control and Prevention (CDC)
recommendations for health professionals. Current recommendations may be found at
http://www.cdc.gov/vaccines/.
Students are responsible for maintaining and updating their immunization status and proof of titers while
on clinical rotations. The University is required by law to keep student immunization documentation on
file. Students who are non-compliant with their required immunizations and/or testing will be
suspended from their rotations immediately. Any student who misses a rotation because of
incomplete immunizations or titers will receive a failing grade for the rotation and, if immunizations are not
quickly obtained, is subject to dismissal from the Program. Immunizations must not be obtained at the
student’s clinical training site.
In accordance with University policy, documented laboratory proof of the absence of tuberculosis must
include the following: date of placement, date of reading, result listed as number of millimeters, signature
of an authorized medical professional, and contact information for the site where the testing was
completed. For further information refer to MWU Student Handbook.
Independent Study in Capstone Project I - IV
This course is designed to facilitate the completion of an independent medical research project
(“Capstone Project”) as the culmination of the master’s degree for the physician assistant student. The
project entails scholarly inquiry into a clinical medicine topic, application of evidence-based medicine
techniques, creation of effective patient and community education materials, and a final
presentation/dissemination of the materials collected. Specific details and deadlines for Project
components are available on the Blackboard website. Satisfactory completion of all components of the
Capstone Project is a requirement for graduation.
18
Leave of Absence
(ARC-PA: A3.17) If any circumstances require a student’s absence for more than two days during clinical
training, even if excused, a Leave of Absence (LOA) may be required. Requests for a LOA should be first
made to the PA Program Director who will make a recommendation to the Dean of the College of Health
Sciences. The Dean has the final authority to grant a LOA. Please refer to MWU Catalog for further
information.
Legal
If a student believes a situation arising during a clinical rotation may have legal implications, the student
must contact the PA Program Director, and/or the Dean of Student Services immediately.
Mid-Rotation Student Self-Evaluation
The Mid-Rotation Student Self-Evaluation is designed to allow a student to thoughtfully reflect upon his or
her performance at the mid-point of a clinical rotation, and to foster a conversation with his or her
Preceptor regarding progress in the rotation. After completing the Mid-Rotation Student Self-Evaluation,
the student must meet with the Preceptor to review and sign the form. Students are required to fax or
scan/email the completed Mid-Rotation Student Self-Evaluation to the PA Program at the end of the third
week of each core rotation.
Mid-Year Evaluation
(ARC-PA: A3.17) Successful completion of the Mid-Year Evaluation (MYE) is a prerequisite for continued
progression in the Program and for graduation. All students are required to complete all components of
the MYE as scheduled. The evaluation consists of:
- a written, Multiple Choice Question (MCQ) test;
- an Objective Structured Clinical Examination (OSCE); and
- a Clinical Skills Portion (CSP).
Mid-Year Evaluation failures will be referred to the PA-ARC. Failure of the MYE may require the Program
to alter the student’s rotation schedule and may result in extension of the student’s curriculum.
Needle Stick or Injury on Rotations
(ARC-PA: A3.08) Students are potentially exposed to blood/infectious body fluids via respiratory,
percutaneous, or mucocutaneous exposures in hospital, clinic and doctors’ office environments, and are
at risk to acquire infectious diseases during the course of clinical training. Prompt evaluation of accidental
exposures and appropriate treatment and follow-up may reduce infection and associated risks.
An exposure incident is defined by Midwestern University as specific eye, mouth, other mucous
membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that
result from performing an assigned rotational task as a student. The bodily fluids considered potentially
infectious for blood borne pathogen exposures include blood and blood products, any fluid contaminated
with blood, semen, saliva, cerebrospinal fluid, amniotic fluid, vaginal secretions, pleural fluid, peritoneal
fluid, pericardial fluid and synovial fluid.
Procedure for Exposure Incident
MWU students exposed to a patient via blood or potentially infectious body fluid should:
1. Seek immediate treatment and follow-up in accordance with appropriate medical standards;
2. Fill out injury and treatment forms following the protocol of the rotational facility or physician's
office where they are assigned;
3. Go immediately to an emergency department; and
19
4. Immediately notify the Preceptor and Clinical Coordinators of the occurrence.
5. Students who incur expenses related to treatment of an accidental needle stick should seek
reimbursement first through their health insurance company. Please note that expenses incurred
due to a needle stick or injuries while on clinical rotations are not covered through Worker's
Compensation. Any expenses that are not covered through a student's own health insurance
company thereafter should be referred to Dean McLean, Director of Risk Management, at (630)
515-7232.
Students shall within 5 days send a copy of the injury and treatment forms to their Preceptor and Clinical
Coordinators. When making out an injury report for an exposure incident, the student and/or Preceptor
must give the name of the source individual and medical record number, if known or feasible. If an
exposure occurs, the following information should be recorded in the student's confidential medical
record:
1. Date and time of exposure;
2. Job duty being performed by student;
3. Whether protective equipment (gowns, gloves, masks, protective eyewear) or engineering
controls were used (i.e., recapping device or a needle disposal device or mechanical pipette);
4. Details of exposure, including amount and type of fluid or material, and severity (i.e. depth of
percutaneous exposure and whether fluid was injected; extent and duration of skin or mucous
membrane contract;
5. Description of source material, including HIV, HBV, HCV status if known. In the event the source
individual is a dialysis patient, a current HBsAg report should be used.
(ARC-PA: A3.09, A3.21) The above exposure incident policies and procedures are those prescribed by
Midwestern University. Information in a student’s confidential medical record is never accessible to or
reviewed by PA Program faculty or staff except for routine immunization records, and tuberculosis and
drug screening results. The PA Program Director, Medical Director, and principal faculty do not participate
as health care providers for students in the Program at any time, nor are they able to provide medical
advice or treatment to any student following an exposure incident.
Patient Encounter Logs
Students are required to electronically log their patient encounters in all rotations, including elective
th
rotations, using Typhon and the International Classification of Diseases, 9 edition (ICD-9) codes and
Current Procedural Technology (CPT) codes.
For core rotations, students will not be allowed to take the End-of-Rotation (EOR) Exams if on-line
activity logs for that rotation are not complete. Failure to take any End-of-Rotation exam as scheduled
due to delinquent encounter logs is considered an unexcused absence and may result in a failing grade
for the rotation. Each rotation’s activity logs must be completed by 12:00 PM on the day prior to
each Clinical Assessment Day (CAD) and by 12:00 PM on the Friday before Advanced Clinical
Medicine IIIb in August.
Students must be timely, accurate, and complete when logging patient encounters in Typhon. Patient
encounter logs are used by many state regulatory bodies and hospital boards requiring documentation
after graduation of procedures, prescriptive experience, or exposure to patient populations. This
documentation is required before final authority to practice or privileges are granted. In addition, the
student builds a portfolio using Typhon to demonstrate his or her clinical experience to prospective
employers.
(ARC-PA: C1.01, C4.02) Timely, accurate, and complete logs are an expected component of
professionalism and also enable the Clinical Coordinators to ensure that each rotation is providing
high-quality clinical education that meets Program-defined expectations for clinical practice experiences.
20
Physician Assistant Resources
American Academy of Physician Assistants (AAPA)
www.aapa.org/
Physician Assistant Education Association (PAEA)
www.paeaonline.org/
National Commission on Certification of Physician Assistants (NCCPA)
www.nccpa.net/
Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)
www.arc-pa.org/
Preceptor Evaluation
(ARC-PA: C4.01, C4.02) In order to meet Accreditation Review Commission on Education for the
Physician Assistant (ARC-PA) Standards and to permit ongoing Program self-study of student
experiences at clinical training sites, the MWU PA Program requires each student to complete an
evaluation of the Preceptor(s) and training site at the end of each core and elective clinical rotation. The
PA program may share anonymous student evaluation scores and feedback in aggregate with
Preceptor(s). Each student must complete the Preceptor evaluation by 12:00 PM on the day preceding
each CAD or by 12:00 PM on the Friday before Advanced Clinical Medicine IIIb in August.
Preceptor Resources
Precepting a student can be one of the most rewarding experiences of your career. As a Preceptor when
you share your knowledge and experience with today’s students you are molding tomorrow’s health care
providers. The Physician Assistant Education Association (PAEA) recognizes your efforts and offers the
following link as a tool to assist you. Physician Assistant Education Association (PAEA) Resources on
Precepting http://www.paeaonline.org/index.php?ht=d/sp/i/80183/pid/80183.
Prescriptive Activities and Charting
(ARC-PA: B3.02, C4.02) Students may not independently 1) prescribe legend or non-legend
medications, 2) authorize a prescription or refills, or 3) dispense medications. A student in violation of
these guidelines on prescription writing or dispensing of medications will be immediately removed from
the rotation and brought before the PA-ARC.
All charting and orders (written or electronic) completed by students must be reviewed and countersigned
by a supervising physician and/or physician assistant. Should a student or Preceptor have further
questions or need clarification regarding these policies before or during a clinical rotation, he or she
should call the PA Clinical Coordinators immediately for guidance.
21
Professional Curriculum in the First Year (June 2010-May 2011)
The didactic curriculum is taught by Midwestern University PA Program principal and instructional faculty
and is comprised of the following courses:
First Quarter:
Biopsychosocial Issues
Clinical Biochemistry/Nutrition
Clinical Medicine I
Human Anatomy I
Professional Seminar I
Second Quarter:
Clinical Medicine II
Healthcare Issues
Human Neurosciences
Human Physiology
Pharmacology I
Physical Diagnosis
Research Seminar I
Third Quarter:
Clinical Medicine III
Human Physiology II
Immunology
Pharmacology II
Psychiatric Principles
Research Seminar II
Fourth Quarter:
Clinical Medicine IV
Human Genetics
Infectious Diseases
Introduction to Capstone Project
Pharmacology III
Professional Seminar II
Professional Curriculum in the Second/Third Year (June 2011-August 2012)
The clinical curriculum is taught by the Midwestern University PA Program principal and instructional
faculty and is comprised of the following courses:
Advanced Clinical Medicine I
Advanced Clinical Medicine II
Advanced Clinical Medicine III
Independent Study in Capstone Project III & IV
The remaining clinical curriculum includes the 8 six-week core rotations listed below and 2 four-week
electives.
Behavioral Medicine
Family Medicine
Surgery
Internal Medicine
Electives (I/II) (four-weeks each)
Emergency Medicine
Pediatric Medicine
Geriatrics
Women’s Health
The MWU CHS Physician Assistant Program reserves the right to alter its curriculum as it deems
appropriate.
Professionalism
(ARC-PA: B2.04) Student conduct is expected to be exemplary and professional at all times. Failure to
exhibit professional demeanor jeopardizes a student’s continued participation in the PA Program. During
clinical experiences, students are interacting with other medical professionals and should make every
effort to establish and maintain professional working relationships.
Attitude is one of the most important aspects of student clinical rotations. While every rotation may have
challenges, a positive attitude can make a difference in how a student is perceived and accepted.
Preceptors often solicit staff input regarding interpersonal skills when filling out student evaluations.
Dependability, consistency, and professionalism are traits that patients, staff, and fellow providers
appreciate. Regardless of how the day is going, students should be patient, consistent, and professional
in their approach to all patients and professionals.
22
Professional Liability Insurance
(ARC-PA: A1.03g) Each student is insured for malpractice under the Midwestern University’s student
professional liability program. This insurance only covers students on Program-authorized and assigned
clinical rotations. This does not cover personal medical or hospitalization insurance. Furthermore, the
insurance does not cover the student during voluntary or paid clinical activities not assigned by the PA
Program. Any student choosing to pursue outside clinical activities may not represent him or herself as a
MWU PA student during these activities, and participates in these activities at his or her own legal risk.
Rotation Change Requests
In the event of unusual extenuating circumstances, it may be appropriate for a student to request a
change in rotation. To request a rotation change, the student must submit a request in writing that
identifies the rotation type, dates, and reason for the requested change. This request must be submitted
to the PA Clinical Coordinators a minimum of three months prior to the rotation start date. Final approval
or denial for any requested rotation change rests with the PA Clinical Coordinators. Students may not
request core or elective rotation assignment changes for matters of convenience or personal preference.
Rotation Prerequisites
(ARC-PA: A1.02) Certain clinical sites require students to complete paperwork or on-line training
applications prior to the rotation as part of the clinical affiliation agreement with the Program. Students are
required to comply with all rotation prerequisites. Some sites require drug testing, respiratory mask fit
testing, and/or fingerprinting. The Program will cover costs related to site-specific requirements for core
rotations. If testing is required for elective rotations, this expense may fall to the student for payment.
Safety
(ARC-PA: A1.03g) If a student finds himself or herself in any position that threatens his or her safety, he
or she must contact the appropriate authorities immediately. Additionally, he or she must contact the PA
Program Director, and/or the Dean of Students as soon as it is safe to do so.
Site Development
(ARC-PA: A3.03) Midwestern University PA students are never required to provide or solicit clinical sites
or Preceptors. Students wishing to suggest new clinical training sites or Preceptors should contact the PA
Clinical Coordinators. Final approval or denial of any clinical site or Preceptor rests with the PA Clinical
Coordinators. Students are not permitted to contact existing MWU clinical sites in an attempt to arrange a
new clinical rotation.
Students may not participate in rotations with persons who are or are about to become members of their
immediate or extended family, or with a person considered to be a “significant other”. If a student finds
him or herself in a position which may represent a conflict of interest relevant to this policy, he or she
must immediately contact the Clinical Coordinators for guidance.
Student Performance Evaluation
(ARC-PA: C4.02) The Student Performance Evaluation Form is completed by the Preceptor by the end of
a rotation. It can be faxed, scanned/emailed, or mailed to the PA Program in the self-addressed prepaid
envelope, or returned in person on the CAD. The Preceptor and the student must sign the completed
evaluation form before it is submitted to the Program.
23
Summative Evaluation
(ARC-PA: C3.04) Successful completion of the summative End-of-Year Evaluation (EYE) is a prerequisite
for continuation in the Program and for graduation. All students are required to complete and pass all
three components of the summative EYE as scheduled.
- a Multiple Choice Question (MCQ) test;
- an Objective Structured Clinical Examination (OSCE); and
- a Clinical Skills Portion (CSP).
The PA-ARC reviews all student scores following the EYE. Failure to pass the EYE may result in
extension of the student’s curriculum and/or dismissal from the PA Program.
Supervision
(ARC-PA: A2.16, A2.17) When a PA student is participating in a clinical rotation he or she must be
adequately supervised at all times. A licensed and board-certified medical provider (MD, DO, or PA) must
be on site and evaluate every patient seen by the student. Never, under any circumstances, should
the student be the only provider to see a patient. This is a violation of Midwestern University policy as
well as state statutes and regulations governing the practice of both physicians and physician assistants.
Students have a moral and legal responsibility to immediately notify the PA Clinical Coordinators of any
serious concerns they have about a clinical site or Preceptor, such as inadequate clinical supervision or
significant problems with patient care. Any student who does so will not be penalized. If a student is
removed from a clinical site due to problems with the setting, he or she will not be required to repeat the
missed clinical time.
24
GENERAL LEARNING OBJECTIVES
During the clinical year, PA students learn to provide exceptional patient care via two major activities:
1) the evaluation and treatment of patients under the direct supervision of a Preceptor, and 2) the study of
assigned medical diseases, disorders, and essential skills using required textbooks and other resources.
All PA students are required to complete readings and meet objectives for each core rotation as outlined
in this handbook. The listed disease and skill topics for core rotations are based upon those published in
the National Commission on Certification for the Physician Assistant (NCCPA) Content Blueprint.
Readings during elective rotations are self-directed and/or may be assigned by the Preceptor.
In addition to rotation-specific objectives, these general objectives apply for every core and elective
rotation:
Medical History
Takes and records focused histories on patients
Associates patients’ complaints with their presented history
Interprets history and formulates a differential diagnosis
Knows and understands individual risk factors for each disease and related condition
Recognizes and understands signs and symptoms associated with a specific diagnosis
Physical Examination
Knows and understands what constitutes an appropriate directed physical exam after eliciting a
patient history
Recognizes pertinent physical findings
Interprets particular physical findings in order to differentiate one disorder from another
Laboratory and Diagnostic Studies
Selects appropriate routine or initial laboratory or diagnostic studies to help establish a diagnosis
Interprets and applies results of diagnostic studies
Knows and understands appropriate follow-up studies
Knows and understands when diagnostic or laboratory studies are not indicated
Differential Diagnosis
Selects the most likely diagnosis; evaluates the differential diagnosis in light of history, physical
exam, diagnostic test findings
Understands the pathophysiology for the most likely diagnosis
Recognizes associated disease conditions and complications
Management
Evaluates severity of the patient’s condition
Prioritizes each patient’s conditions and makes appropriate referrals for further diagnostic
assessment.
Recognizes factors in the history that affect the patient’s treatment plan or prognosis
Identifies and evaluates patients for whom a specific type of therapy is appropriate or
inappropriate
Health Maintenance and Disease Prevention
Knows and understands risk factors for conditions amenable to prevention or detection in an
asymptomatic individual
Appreciates pertinent incidence statistics among patient groups at risk, including incidence of
symptoms and identifiable disorders among various groups
Selects appropriate treatment, which may include preventive measures, education and
medication
25
Clinical Intervention
The student demonstrates knowledge and understands:
Priority in management, or medical intervention, specifically in emergency or acute cases
Indications for hospital admission
Appropriate discharge planning
Components of a rehabilitation program
Appropriate counseling of a patient or family regarding current and future problems, including risk
factors related to the present encounter
The importance of education for both the patient and family regarding self-care
The relevant roles of allied health personnel
Issues surrounding management of chronic pain, especially in terminally ill patients
Recognizes and addresses the patient’s expression of fear of injury or death
Clinical Therapeutics
Recognizes indications for use of medications
Knows and understands the appropriate follow-up schedule or monitoring approach regarding a
therapeutic regimen
Knows and understands the importance of patient compliance with a treatment regimen and
techniques to increase compliance or understanding, specifically patient and family education
Applies knowledge of drugs to the safe and effective selection and administration of drugs
Knows and understands the risks, signs and symptoms of drug interactions resulting from
polypharmacy in the therapeutic regimen
Knows and understands the actions to take in response to acute, specific drug toxicity
Modifies the therapeutic regimen within the context of continuing care
Legal/Ethical and Health Care Systems
Knows and understands informed consent
Recognizes the patient’s right to refuse treatment or testing (patient autonomy)
Knows and understands the guidelines for confidentiality of medical records
Is aware of cost containment issues
Recognizes practitioner error versus negligence
Knows and understands the Good Samaritan Law
Knows and understands the guidelines for reporting findings to proper authorities
Recognizes the need for third-party permission for treatment in medical emergencies
Assesses the degree of disclosure to terminally ill patients
Knows and understands the definitions of, and legal issues regarding, brain death and organ donation
26
Competencies for the Physician Assistant Profession
Preamble
In 2003, the National Commission on Certification of Physicians Assistants (NCCPA) initiated an effort to define
PA competencies in response to similar efforts being conducted within other health care professions and
growing demand for accountability and assessment in clinical practice. The following year, representatives from
three other national PA organizations, each bringing a unique perspective and valuable insights, joined NCCPA
in that effort. Those organizations were the Accreditation Review Commission for Education of the Physician
Assistant (ARC-PA), the body that accredits PA educational programs; the Association of Physician Assistant
Programs (APAP), the membership association for PA educators and program directors; and the American
Academy of Physician Assistants (AAPA), the only national membership association representing all PAs.
The resultant document, Competencies for the Physician Assistant Profession, is a foundation from which each
of those four organizations, other physician assistant organizations and individual physician assistants
themselves can chart a course for advancing the competencies of the PA profession.
Introduction
The purpose of this document is to communicate to the PA profession and the public a set of competencies
that all physician assistants regardless of specialty or setting are expected to acquire and maintain throughout
their careers. This document serves as a map for the individual PA, the physician-PA team and organizations
that are committed to promoting the development and maintenance of these professional competencies among
physician assistants.
The clinical role of PAs includes primary and specialty care in medical and surgical practice settings.
1
Professional competencies for physician assistants include the effective and appropriate application of medical
knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and
improvement, systems-based practice, as well as an unwavering commitment to continual learning,
professional growth and the physician-PA team, for the benefit of patients and the larger community being
served. These competencies are demonstrated within the scope of practice, whether medical or surgical, for
each individual physician assistant as that scope is defined by the supervising physician and appropriate to the
practice setting.
The PA profession defines the specific knowledge, skills, and attitudes required and provides educational
experiences as needed in order for physician assistants to acquire and demonstrate these competencies.
MEDICAL KNOWLEDGE
Medical knowledge includes an understanding of pathophysiology,
patient presentation, differential diagnosis, patient management, surgical principles, health promotion and
disease prevention. Physician assistants must demonstrate core knowledge about established and evolving
biomedical and clinical sciences and the application of this knowledge to patient care in their area of practice.
In addition, physician assistants are expected to demonstrate an investigatory and analytic thinking approach to
clinical situations. Physician assistants are expected to:
• understand etiologies, risk factors, underlying pathologic process, and epidemiology for medical
conditions
• identify signs and symptoms of medical conditions
• select and interpret appropriate diagnostic or lab studies
• manage general medical and surgical conditions to include understanding the indications,
contraindications, side effects, interactions and adverse reactions of pharmacologic agents and other
relevant treatment modalities
• identify the appropriate site of care for presenting conditions, including identifying emergent cases and
those requiring referral or admission
• identify appropriate interventions for prevention of conditions
27
• identify the appropriate methods to detect conditions in an asymptomatic individual
• differentiate between the normal and the abnormal in anatomic, physiological, laboratory findings and
other diagnostic data
• appropriately use history and physical findings and diagnostic studies to formulate a differential diagnosis
• provide appropriate care to patients with chronic conditions
INTERPERSONAL & COMMUNICATION SKILLS
Interpersonal and communication
skills encompass verbal, nonverbal and written exchange of information. Physician assistants must
demonstrate interpersonal and communication skills that result in effective information exchange with patients,
their patients’ families, physicians, professional associates, and the health care system. Physician assistants
are expected to:
• create and sustain a therapeutic and ethically sound relationship with patients
• use effective listening, nonverbal, explanatory, questioning, and writing skills to elicit and provide
information
• appropriately adapt communication style and messages to the context of the individual patient interaction
• work effectively with physicians and other health care professionals as a member or leader of a health
care team or other professional group
• apply an understanding of human behavior
• demonstrate emotional resilience and stability, adaptability, flexibility and tolerance of ambiguity and
anxiety
• accurately and adequately document and record information regarding the care process for medical,
legal, quality and financial purposes
PATIENT CARE
Patient care includes age-appropriate assessment, evaluation and management.
Physician assistants must demonstrate care that is effective, patient-centered, timely, efficient and equitable for
the treatment of health problems and the promotion of wellness. Physician assistants are expected to:
• work effectively with physicians and other health care professionals to provide patient-centered care
• demonstrate caring and respectful behaviors when interacting with patients and their families
• gather essential and accurate information about their patients
• make informed decisions about diagnostic and therapeutic interventions based on patient information and
preferences, up-to-date scientific evidence, and clinical judgment
• develop and carry out patient management plans
• counsel and educate patients and their families
• competently perform medical and surgical procedures considered essential in the area of practice
• provide health care services and education aimed at preventing health problems or maintaining health
28
PROFESSIONALISM
Professionalism is the expression of positive values and ideals as care is
delivered. Foremost, it involves prioritizing the interests of those being served above one’s own. Physician
assistants must know their professional and personal limitations. Professionalism also requires that PAs
practice without impairment from substance abuse, cognitive deficiency or mental illness. Physician assistants
must demonstrate a high level of responsibility, ethical practice, sensitivity to a diverse patient population and
adherence to legal and regulatory requirements. Physician assistants are expected to demonstrate:
• understanding of legal and regulatory requirements, as well as the appropriate role of the physician
assistant
• professional relationships with physician supervisors and other health care providers
• respect, compassion, and integrity
• responsiveness to the needs of patients and society
• accountability to patients, society, and the profession
• commitment to excellence and on-going professional development
• commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of
patient information, informed consent, and business practices
• sensitivity and responsiveness to patients’ culture, age, gender, and disabilities
• self-reflection, critical curiosity and initiative
PRACTICE-BASED LEARNING AND IMPROVEMENT Practice-based learning and
improvement includes the processes through which clinicians engage in critical analysis of their own
practice experience, medical literature and other information resources for the purpose of selfimprovement. Physician assistants must be able to assess, evaluate and improve their patient care
practices. Physician assistants are expected to:
• analyze practice experience and perform practice-based improvement activities using a systematic
methodology in concert with other members of the health care delivery team
• locate, appraise, and integrate evidence from scientific studies related to their patients’ health problems
• obtain and apply information about their own population of patients and the larger population from which
their patients are drawn
• apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other
information on diagnostic and therapeutic effectiveness
• apply information technology to manage information, access on-line medical information, and support
their own education
• facilitate the learning of students and/or other health care professionals
• recognize and appropriately address gender, cultural, cognitive, emotional and other biases; gaps in
medical knowledge; and physical limitations in themselves and others
29
SYSTEMS-BASED PRACTICE
Systems-based practice encompasses the societal,
organizational and economic environments in which health care is delivered. Physician assistants must
demonstrate an awareness of and responsiveness to the larger system of health care to provide patient care
that is of optimal value. PAs should work to improve the larger health care system of which their practices are a
part. Physician assistants are expected to:
• use information technology to support patient care decisions and patient education
• effectively interact with different types of medical practice and delivery systems
• understand the funding sources and payment systems that provide coverage for patient
care
• practice cost-effective health care and resource allocation that does not compromise quality of care
• advocate for quality patient care and assist patients in dealing with system complexities
• partner with supervising physicians, health care managers and other health care providers to assess,
coordinate, and improve the delivery of health care and patient outcomes
• accept responsibility for promoting a safe environment for patient care and recognizing and correcting
systems-based factors that negatively impact patient care
• apply medical information and clinical data systems to provide more effective, efficient patient care
• use the systems responsible for the appropriate payment of services
1
In 1999, the Accreditation Council for Graduation Medical Education (ACGME) endorsed a list of general competencies for medical
residents. NCCPA’s Eligibility Committee, with substantial input from representatives of AAPA, APAP and ARC-PA, has modified
the ACGME’s list for physician assistant practice, drawing from several other resources, including the work of Drs. Epstein and
Hundert; research conducted by AAPA’s EVP/CEO, Dr. Steve Crane; and NCCPA’s own examination content blueprint.
Vers. 3.5 (3/22/05)
30
Required and Recommended Textbooks for Clinical Rotations: 2011-2012
ALL ROTATIONS
Required:
Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H.
Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition)
Antimicrobial Therapy. ISBN-10: 1930808526
Pagana KD, Pagana TJ.
rd
Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed.
Mosby; 2005. ISBN-10: 0323039030
Any pocket (or PDA) drug reference of your choosing.
BEHAVIORAL MEDICINE
Required:
Kaplan VA, Sadock, BJ.
Kaplan and Sadock's Synopsis of Psychiatry. 10th Ed.
Lippincott, Williams & Williams; 2008. ISBN-10: 078177327X
American Psychiatric Association
st
Desk Reference to the Diagnostic Criteria from DSM-IV-TR. 1 Ed.
American Psychiatric Publishing, Inc.; 2000 ISBN-10: 0890420270
EMERGENCY MEDICINE
Required:
Ma OJ, Cline DM, Tintinalli JE, Kelen GD, Stapczynski JS
th
Emergency Medicine Manual. 6 Ed.
McGraw-Hill Professional; 2003. ISBN-10: 0071410252
Recommended:
Buttarovoli, P
nd
Minor Emergencies-Splinters to Fractures. 2 Ed. Mosby Elsevier;
2010. ISBN-10 0323083463
Tintinalli J, Stapczynski J, John Ma O, Cline D, Cydulka R, Meckler G.
th
Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7 Ed.
McGraw-Hill Professional; 2010 ISBN-10: 0071484809
Garmel, G.M., Mahadevran, S.V.
nd
An Introduction to Clinical Emergency Medicine, 2 Ed. Cambridge
University Press. 2006. ISBN-10: 0521542596
FAMILY MEDICINE
Required:
McPhee, SJ, Papadakis, MA
th
Current Medical Diagnosis and Treatment 2010. 49 Ed.
McGraw-Hill Lange, 2009. ISBN-10: 9780071624442
Kliegman RM, Marcdante K, Jenson H. Behrman R.
th
Nelson Essentials of Pediatrics, 6 Ed.
Saunders; 2011. ISBN-10: 1437706436
DeCherney A, Nathan L, Goodwin TM, Laufer N.
th
Current Diagnosis and Treatment – Obstetrics/Gynecology. 10 Ed.
McGraw-Hill Lange; 2007. ISBN-10: 0071439005
31
Recommended:
Mengel, MB, Schwiebert, LP
th
Family Medicine Ambulatory Care and Prevention. 5 Ed.
Kahan, S, Ashar, BH.
nd
Medicine In a Page. 2 Ed.
Blackwell Publishing; 2009. ISBN-10: 9780781770354
GERIATRICS
Required:
Ham RJ, Sloane PD, Warshaw GA, Bernard MA, Flaherty E.
th
Primary Care Geriatrics, A Care-Based Approach. 5 Ed.
Mosby; 2006 ISBN-10: 323039308
Recommended:
Reuben DB et al.
th
Geriatrics at Your Fingertips, 12 Edition.
American Geriatrics Society; 2010. ISBN-10: 9781886775541
INTERNAL MEDICINE
Required:
Andreoli, TE, Carpenter, CCJ, Griggs, RC, Benjamin, IJ.
Cecil’s Essentials of Medicine. 8th Ed. W. B. Saunders; 2011
ISBN-10: 9781416061090
Recommended:
Fauci AS et al.
th
Harrison’s Principles of Internal Medicine. 17 Edition.
McGraw-Hill; 2008. ISBN-10: 0071466339
PEDIATRICS
Required:
Kliegman RM, Marcdante K, Jenson H, Behrman R.
th
Nelson Essentials of Pediatrics. 6 Ed.
Saunders; 2011. ISBN-10: 1437706436
SURGERY
Required:
Lawrence PF, Bell RM, Dayton MT.
Essentials of General Surgery. 4th Ed.
Lippincott, Williams and Wilkins; 2006. ISBN-10: 0781750032
Blackbourne, LH.
th
Surgical Recall. 5 Ed.
Recommended:
rd
Essentials of Surgical Subspecialties. 3 Edition.
WOMEN’S HEALTH
Required:
32
th
Current Diagnosis and Treatment - Obstetrics/Gynecology. 10 Ed.
McGraw-Hill; 2006. ISBN-10: 0071439005
PHYSICIAN ASSISTANT PROGRAM
COURSE SYLLABUS
Elective I and Elective II Rotation
PASS 0749, PASS 0750
Credit Hours 4.00 (each rotation)
Total Required Hours: 8.00
COURSE PURPOSE
The overall educational goal for Elective Rotation I and II is for students to explore areas of medical or
surgical interest in more depth and to further develop skills and knowledge toward the goal of professional
PA practice. Students remain responsible for following the General Learning Objectives of core rotations.
In addition, students and Preceptors are encouraged to work together to develop a unique list of
objectives based upon the elective specialty to focus the student’s learning efforts on the rotation. These
specialty-specific lists should emphasize conditions listed in the NCCPA content Blueprint and those
within the General Learning Objectives of the MWU Clinical Handbook. Students are also encouraged to
frame their experiences within the context of the Competencies for the Physician Assistant Profession as
they prepare for graduation and clinical practice.
COURSE COORDINATORS
Instructor and Clinical Coordinator
[email protected]
Clinical Coordinator and Assistant Professor
[email protected]
Affiliated clinical Preceptors will provide rotation experiences and will participate in student assessment.
Students should direct all questions regarding course administration to the PA Clinical Coordinators.
COURSE TIMES/LOCATION
Elective rotation II and Elective rotation II follow successful completion of all aspects of the second year of
training in the PA Program, including 8 six-week core rotations in Behavioral Medicine, Emergency
Medicine, Family Medicine, Geriatrics, Internal Medicine, Pediatrics, Surgery, and Women’s Health. All
students must complete 2 four-week elective rotations in sequence; the electives may occur at a single
clinical training site. This rotation will take place in hospital, clinic, or private practice settings in urban,
suburban, or rural communities. Students are required to take call, attend conferences, provide patient
presentations, and complete required readings, whether assigned by the Program or the Preceptor.
REQUIRED COURSE TEXTBOOKS
rd
Mosby; 2005. ISBN-10: 0323039030
Drug reference of the student’s choosing
33
COURSE REQUIREMENTS AND POLICIES
This is a 4-credit clinical rotation. To receive course credit, the student is required to attend all clinic
sessions and satisfactorily complete all learning activities in their entirety. Please see the Policies and
Procedures section of this handbook for specific details on all expectations regarding clinical rotations.
EVALUATION AND GRADING
The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for
this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the
evaluation of the student for each rotation. Please see the Policies and Procedures section of the
Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading for
elective rotations.
GENERAL KNOWLEDGE OBJECTIVES
During the clinical year, PA students learn to provide exceptional patient care via two major activities: 1)
the evaluation and treatment of patients under the direct supervision of a Preceptor, and 2) the study of
assigned medical diseases, disorders, and essential skills using required textbooks and other resources.
In addition to rotation-specific objectives, these general objectives apply for every core and elective
rotation. The Preceptor and PA student are asked to work together to create a list of specialty-specific
objectives relevant to those included on the Content Blueprint prepared by the National Commission on
Certification of Physician Assistants. In addition, Preceptors may assign specialty-specific reading and/or
provide additional training in skills, tasks, or procedures relevant to PA practice in that specialty.
Medical History
Takes and records focused histories on patients
Associates patients’ complaints with their presented history
Interprets history and formulates a differential diagnosis
Knows and understands individual risk factors for each disease and related condition
Recognizes and understands signs and symptoms associated with a specific diagnosis
Physical Examination
Knows and understands what constitutes an appropriate directed physical exam after eliciting a
patient history
Recognizes pertinent physical findings
Interprets particular physical findings in order to differentiate one disorder from another
Laboratory and Diagnostic Studies
Selects appropriate routine or initial laboratory or diagnostic studies to help establish a diagnosis
Interprets and applies results of diagnostic studies
Knows and understands appropriate follow-up studies
Knows and understands when diagnostic or laboratory studies are not indicated
Differential Diagnosis
Selects the most likely diagnosis; evaluates the differential diagnosis in light of history, physical
exam, diagnostic test findings
Understands the pathophysiology for the most likely diagnosis
Recognizes associated disease conditions and complications
Management
Evaluates severity of the patient’s condition
Prioritizes each patient’s conditions and makes appropriate referrals for further diagnostic
assessment.
Recognizes factors in the history that affect the patient’s treatment plan or prognosis
Identifies and evaluates patients for whom a specific type of therapy is appropriate or
inappropriate
34
Health Maintenance and Disease Prevention
Knows and understands risk factors for conditions amenable to prevention or detection in an
asymptomatic individual
Appreciates pertinent incidence statistics among patient groups at risk, including incidence of
symptoms and identifiable disorders among various groups
Selects appropriate treatment, which may include preventive measures, education and
medication
Clinical Intervention
The student demonstrates knowledge and understands:
Priority in management, or medical intervention, specifically in emergency or acute cases
Indications for hospital admission
Appropriate discharge planning
Components of a rehabilitation program
Appropriate counseling of a patient or family regarding current and future problems, including risk
factors related to the present encounter
The importance of education for both the patient and family regarding self-care
The relevant roles of allied health personnel
Issues surrounding management of chronic pain, especially in terminally ill patients
Recognizes and addresses the patient’s expression of fear of injury or death
35
36
COURSE SYLLABUS
Behavioral Medicine Rotation
PASS 0642
Credit Hours 6.00
COURSE PURPOSE
The overall educational goal for the Behavioral Medicine Rotation is to train Physician Assistant students
to become competent in both knowledge and skills while providing medical care to patients in a
supervised Behavioral Medicine clinical setting. Students are expected to master each of the topics
listed, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology,
symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management,
non-pharmacological treatment (including surgical options), complications, health maintenance,
prevention, patient education and counseling.
COURSE COORDINATOR
Assistant Professor and Clinical Coordinator
[email protected]
Sandhya Noronha, MD
Assistant Professor
[email protected]
Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student
assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day.
This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year.
Students are required to take call, attend conferences, provide patient presentations, and read required
textbooks. Students are responsible for assigned reading material even if those topics are not
experienced on the rotation.
Required for all clinical rotations:
rd
Mosby; 2005. ISBN-10: 0323039030
Required for Behavioral Health rotation:
Kaplan and Sadock's Synopsis of Psychiatry. 10th Ed.
Lippincott, Williams & Williams; 2008. ISBN-10: 078177327X
American Psychiatric Association
st
Desk Reference to the Diagnostic Criteria from DSM-IV-TR. 1 Ed.
American Psychiatric Publishing, Inc.; 2000 ISBN-10: 0890420270
37
sessions and satisfactorily complete all learning activities, including CAD days, in their entirety. Please
see the Policies and Procedures section of this handbook for expectations regarding clinical rotations.
Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading.
Upon completion of this rotation, the student will be able to:
1. Understand the pathophysiology, diagnosis and treatment of common psychiatric problems.
2. Develop a problem-based approach to the diagnosis and management of a wide spectrum of
common (and less common) psychiatric illnesses.
3. Obtain a medical history based on the patient’s chief complaint and clinical presentation.
4. Formulate a differential diagnosis based on chief complaint, history and physical exam.
5. Master each of the topics listed in the Diseases and Disorders section of the clinical
handbook, focusing on the following areas: etiology, epidemiology, prognosis,
physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing,
interpretation of findings, medical management, patient education and counseling.
6. Order, perform (or assist in the performance of), explain and interpret the labs and diagnostic
procedures outlined in the Skills Section of the clinical handbook.
7. Counsel patients and family members with regards to rehabilitation therapy and side effects
of psychotropic drugs as well as psychodynamic psychotherapy, psychoanalysis, supportive
psychotherapy, cognitive and behavioral therapies, group therapies, couples and family
therapy, psychoeducational interventions and electroconvulsive therapy.
Diseases and Disorders
The topics listed below are those included on the Content Blueprint prepared by the National Commission
on Certification of Physician Assistants and others pertinent to Behavioral Medicine.
Anxiety Disorders
Panic Disorder
Generalized Anxiety Disorder
Posttraumatic Stress Disorder
Phobias
Psychoses
Delusional Disorder
Schizophrenia
Schizoaffective Disorder
Medications
Somatoform Disorders
Substance Abuse Disorders
Alcohol Abuse/Dependence
Drug Abuse/Dependence
Tobacco Abuse
Mood Disorders
Adjustment Disorders
Depression
Dysthymia
Bipolar Disorder
Medications
Personality Disorders
Antisocial
Avoidant
Borderline
38
Eating Disorders
Anorexia Nervosa
Bulimia
Obesity
Other Behavioral and Emotional Disorders
Acute Reaction to Stress
Child/Elder Abuse
Domestic Violence
Dependent
Histrionic
Narcissistic
Obsessive-Compulsive
Paranoid
Schizoid
Schizotypal
Uncomplicated Bereavement
Disorders of Infancy, Childhood
& Adolescence
Mental Retardation
Autistic Spectrum Disorder
Asperger Disorder
Pervasive Developmental Disorder, NOS
Attention Deficit/Hyperactivity Disorder
Conduct Disorder
Oppositional Defiant Disorder
Tourette Disorder
Cognitive Disorders
Delirium
Dementia
Alzheimer’s
Amnesic Disorders
Miscellaneous
Psychiatry and the Law
Psychopharmacology
Continuity of Care
SKILLS
This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical
rotation. It is desirable that the PA student reach a performance level commensurate with his or her
peers.
Labs/Diagnostics
Perform and/or interpret the following:
Liver function tests
Renal function tests
Toxicology screen
Procedures
Order, perform and/or assist, and/or explain to patients the following procedures and tests:
Formulate DSM-IV diagnosis
Perform mental status examination
Screen for domestic violence, suicide, and depression with the appropriate tools
Chemical and/or physical restraints
Patient Education/Counseling
Provide patient education and counseling in the following areas:
Counsel patient and family members in regards to rehabilitation therapy
Work with family members to facilitate and coordinate treatment
Understand the common side effects, and drug interactions of each class of psychotropic
medications and demonstrate the ability to select and use these agents to treat mental disorders
State the characteristics and techniques of, and common indications and contraindications for,
psychodynamic psychotherapy, psychoanalysis, supportive psychotherapy, cognitive and
behavioral therapies, group therapies, couples and family therapy, psychoeducational
interventions, and electroconvulsive therapy
39
40
COURSE SYLLABUS
Emergency Medicine Rotation
PASS 0644
Credit Hours 6.00
COURSE PURPOSE
The overall educational goal for the Emergency Medicine Rotation is to train physician assistant students
in all aspects of care of the emergent patient. The rotation is designed to prepare the student for triaging
patients presenting for emergent care, for evaluating, managing, and stabilizing patients with acutely
presenting conditions, and for performing invasive and noninvasive procedures commonly performed in
the Emergency Department.
COURSE COORDINATION
[email protected]
Instructor
[email protected]
Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student
assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day.
This rotation will take place in an emergency department setting for 6 weeks in the clinical year. Students
are required to take call, attend conferences, provide patient presentations, and read required textbooks.
Students are responsible for assigned reading material even if those topics are not experienced on the
rotation.
rd
Mosby; 2005. ISBN-10: 0323039030
Required for Emergency Medicine Rotation
th
Emergency Medicine Manual. 6 Ed.
Ma OJ, Cline DM, Tintinalli JE, Kelen GD, Stapczynski JS.
McGraw-Hill Professional; 2003.
ISBN-10: 0071410252
41
Recommended for Emergency Medicine Rotation
nd
Minor Emergencies-Splinters to Fractures. 2 Ed.
Buttaravoli, P.
Mosby Elsevier; 2010. ISBN-10: 0323083463
nd
An Introduction to Clinical Emergency Medicine. 2 Ed.
Mahadevan SV, Garmel GM.
Cambridge University Press; 2006.
ISBN-10: 0521542596
th
Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7 Ed.
Tintinalli J, Stapczynski J, John Ma O, Cline D, Cydulka R, Meckler G.
McGraw-Hill Professional; 2010.
ISBN-10: 0071484809
The student will be evaluated in his or her medical knowledge, technical skills, and professionalism
for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the
1. Understand the pathophysiology, prevention, diagnosis and treatment of common clinical
conditions requiring emergent evaluation and treatment.
2. Perform a complete and focused history and physical exam as it relates to the presenting
condition.
3. Order the appropriate imaging and/or laboratory studies for clinical diseases and conditions
requiring emergent evaluation.
4. Appropriately interpret laboratory and imaging abnormalities that indicate the necessity for
emergent care and/or surgical intervention.
5. Demonstrate the skills and knowledge required for basic life support and advanced cardiac
life support.
6. Master each of the topics listed in the Diseases and Disorders Section of the clinical
handbook, focusing on the following areas: etiology, epidemiology, prognosis,
physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing,
interpretation of findings, medical management, non-pharmacological treatment (including
surgical options), complications, patient education and counseling.
7. Perform or assist in the performance of and interpret and explain the labs, diagnostic
procedures outlined in the Skills Section of the clinical handbook.
42
DISEASES AND DISORDERS
on Certification of Physician Assistants and others pertinent to Emergency Medicine.
The Eye, Ear, Nose & Throat
Eye Disorders
Acute-angle glaucoma
Blowout fracture
Chronic glaucoma
Conjunctivitis
Corneal Abrasion
Dacryoaedenitis
Diabetic Retinopathy
Hypertensive Retinopathy
Hyphema
Iritis
Orbital Cellulitis
Retinal Detachment
Retinal Vascular Occlusion
Temporal Arteritis
Chemical Eye Burns
Red Eyes
Ear Disorders
Barotrauma
Presbycusis
Tympanic Membrane Perforation
Nose/Sinus Disorders
Epistaxis
Nasal Fractures
Foreign Bodies
Mouth/Throat Disorders
Peritonsillar Abscesses
Airway Management
Dental Abscess
Foreign Bodies
Dermatologic System
Desquamation
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Insects/Parasites
Spider bites
Other
Burns
Urticaria
Angioedema/Anaphylaxis
The Pulmonary System
Infectious Disorders
Pneumonia
Tuberculosis
Pleural Diseases
Acute Pulmonary Edema
Pleural Effusion
Pneumothorax
Obstructive Pulmonary Diseases
Asthma
Other Pulmonary Disease
Foreign Body Aspiration
Near Drowning
Pulmonary Circulation
Pulmonary Embolism
43
The Cardiovascular System
Conduction Disorders
Atrial Fibrillation and Flutter
Atrioventricular Block
Bradycardia
Bundle Branch Block
Paroxysmal Supra-Ventricular Tachycardia
Premature Beats
Ventricular Tachycardia
Ventricular Fibrillation & Flutter
Ischemic Heart Disease
Acute Myocardial Infarction
Congestive Heart Failure
Vascular Disease
Aortic Aneurysm/Dissection
Arterial Embolism/Thrombosis
Chronic/Acute Arterial Occlusion
Venous Thrombosis
Hypertension
Malignant
Hypotension
Cardiogenic Shock
Angina Pectoris
Stable
Unstable
Variant
Cardiac Death (SCD)
Acute Coronary Syndromes
Other Forms of Heart Disease
Cardiac Tamponade
Pericardial Effusion
Pericarditis
Syncope
Endocarditis
Anaphylaxis
Chest Pain
The Gastrointestinal/Nutritional System
Esophagus
Mallory Weiss Tear
Esophageal Varices
Small Intestine/Colon
Appendicitis
Diverticulosis
Diverticulitis
Obstruction
Toxic Megacolon
Stomach
Ulcer Disease
Peptic Duodenal
Pancreas
Acute Pancreatitis
Liver
Hepatitis
Acute Liver Failure
Rectum
Pilonidal disease
Anorectal abscess/fistula
44
Other
Abdominal Pain
Diarrhea
Gall Bladder Disease
Gastrointestinal Bleeding
Splenic Rupture
Ulcerative Colitis
Vomiting/Diarrhea/Constipation
The Renal/Genitourinary System
Renal Diseases
Acute/Chronic Renal Failure
Infectious/Inflammatory
Conditions
Pyelonephritis
Urinary tract infections
Benign Conditions of the GU Tract
Nephro/Urolithiasis
Paraphimosis/phimosis
Testicular Torsion
The Musculoskeletal System
Disorders of the Shoulder
Fractures/Dislocations/ Separations
Rotator Cuff Disorders
Sprain/Strain
Disorders of the
Forearm/Wrist/Hand
Fractures/Dislocations
Boxer’s
Colles’
Gamekeeper’s Thumb
Humeral
Nursemaid’s Elbow
Scaphoid
Sprains/Strains
Tenosynovitis
Carpal Tunnel Syndrome
de Quervain’s Tenosynovitis
Elbow tendonitis
Epicondylitis
Disorders of the Back/Spine
Spinal Cord Injuries
Low Back Pain
Disorders of the Hip/Pelvis
Aseptic Necrosis
Disorders of the Knee
Meniscal Injuries
Knee trauma
Disorders of the Ankle/Foot
Sprains/Strains
Other
Clavicular Fractures
Salter-Harris classification
The Neurologic System
Diseases of Peripheral
Nerves
Bell’s Palsy
Headaches
Cluster
Migraine
Tension
Encephalitis
Meningitis
Seizure Disorders
Status Epilepticus
Generalized Convulsive Disorder
Generalized Nonconvulsive Disorder
Vascular Diseases
Transient Ischemic Attack
Cerebral Aneurysm
Stroke
Other
Altered Mental Status
Head Injury
Concussions
Intracerebral Hemorrhage
Syncope
Vertigo/Dizziness
45
The Endocrine System
Diseases of the Thyroid
Gland
Hyperthyroidism
Hypothyroidism
Adrenal Crisis
Addisons
Diabetes
Type I
Type II
Diabetic Ketoacidosis
Hypoglycemia
Hyperglycemia
Psychiatry/Behavioral Science
Other Behavior/Emotional Disorders
Child/Elder Abuse
Domestic Violence
Suicidal Ideation
Substance Use Disorders
Alcohol abuse/dependence
Drug Overdose/Toxicity
Eating Disorders
Anorexia nervosa
Bulemia
Infectious Diseases
Fungal Disease
Pneumocystis
Parasitic Disease
Amebiasis
Bacterial Disease
Diphtheria
Shigellosis
Tetanus
Salmonellosis
Chlamydial Infection
Spirochetal Disease
Syphilis
Lyme Borreliosis
Rocky Mountain Spotted Fever
Mycobacterial Disease
Tuberculosis
Atypical Mycobacterial Disease
Viral Diseases
Rabies
Condylomata Acuminata
Rotavirus
Human Immunodeficiency Virus
Other
Sepsis
Herpetic Whitlow
Osteomyelitis
The Hematologic System
Anemias
Sickle Cell Disease
Iron Deficiency
Coagulation Disorders
Factor VIII Disorders
Factor IX Disorders
Factor XI Disorders
Disseminated Intravascular
Coagulopathy (DIC)
46
Thrombocytopenia
Von Willebrand’s Disease
Idiopathic Thrombocytopenic Purpura
Thrombotic Thrombocyotopenic Purpura
The Reproductive System
Complicated Pregnancy
Pregnancy Induced Hypertension
Ectopic pregnancy
Postpartum hemorrhage
Abortion
Abruptio placentae
Uterus
Dysfunctional Uterine Bleeding
Pelvic Inflammatory Disease
Miscellaneous
Wound Management
Basic suture techniques
Anesthesia and regional blocks
Chemical Warfare
Biotoxins
Ricin
Blister Agents
Mustard Gas
Blood Agents
Cyanide
Choking Agents
Chlorine
Phosgene
Nerve Agents
Sarin
Tabun
Organophosphate
Biological Warfare
Anthrax
Botulism
Plague
Smallpox
Tularemia
Viral Hemorrhagic Fevers
Other
Poisoning
Anaphylaxis
Bite Injury
SKILLS
This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical
rotation. It is desirable that the PA student reach a performance level commensurate with his or her
peers.
Labs/Diagnostics
Radiographs: limb, spine, KUB, etc.
MRI and CT
ECG
Urinalysis – routine, microscopic
Venipuncture for CBC, electrolytes, blood chemistries and cultures
IV therapy indications for various IV fluids
Procedures
Cardioversion
Cardiopulmonary resuscitation
Endotracheal intubation
Cricothyroidectomy
Defibrillation
Cardioversion
ACLS protocols
Gastric lavage
Urinary bladder catheter
Various intravenous catheters
Central line placement – subclavian, internal jugular and femoral
47
Suture lacerations
Venous and arterial blood samples
Lumbar puncture
Local anesthesia
Short arm, long arm, long leg, and short leg splints
Immobilization techniques
Provide patient education and counseling in the following areas: medication compliance
48
COURSE SYLLABUS
Family Medicine Rotation
PASS 0645
Credit Hours 6.00
COURSE PURPOSE
The overall educational goal for the Family Medicine Rotation is to train physician assistant students in all
aspects of continuing and comprehensive primary health care. The student learns to care for patients of
both genders, all ages, and all diseases from many different cultural and economic backgrounds. More
than any other specialty, family medicine is holistic and blends biological, clinical and behavioral
sciences.
COURSE COORDINATOR
[email protected]
Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment.
Principal and instructional faculty will provide content for the Clinical Assessment Day.
This rotation will take place in clinic or private practice settings for 6 weeks in the clinical year. When the
family practice setting includes the Preceptor making hospital rounds, students are required to participate.
Students are required to take call, attend conferences, provide patient presentations, and read required
textbooks. Students are responsible for assigned reading material even if those topics are not
experienced on the rotation.
rd
Mosby; 2005. ISBN-10: 0323039030
Required for Family Medicine Rotation:
McPhee, SJ, Papadakis, MA
th
Current Medical Diagnosis and Treatment 2010. 49 Ed.
McGraw-Hill Lange, 2009. ISBN: 978-0-07-162444-2
Marcdante K, Kliegman RM, Behrman R.
th
Nelson Essentials of Pediatrics, 6 Ed.
Saunders; 2011. ISBN-13: 978-1-4377-0643-7
49
th
Current Diagnosis and Treatment – Obstetrics/Gynecology. 10 Ed.
Recommended for Family Medicine Rotation:
Mengel, MB, Schwiebert, LP
th
Family Medicine Ambulatory Care and Prevention. 5 Ed.
Kahan, S, Ashar, BH.
nd
Medicine In a Page. 2 Ed.
Blackwell Publishing; 2009. ISBN: 9780781770354
1.
2.
3.
4.
5.
6.
7.
50
Recognize the importance of preventive care in family medicine and demonstrate counseling
and the delivery of patient education in nutrition, exercise, smoking cessation, and
participating in regular health-maintenance visits.
Describe the pathophysiology, prevention, diagnosis and treatment of common medical
problems in primary care including episodic illness and chronic disease management such as
diabetes, hypertension, dyslipidemia, and global health issues.
Perform and interpret routine screening evaluations and diagnostic tests for the common
primary malignancies encountered in primary care.
Recognize psycho-social issues that impact patients in primary care such as alcoholism,
substance abuse, smoking, domestic violence, anxiety and depression, sedentary lifestyle,
and personal and family stress.
Demonstrate competence in clinical problem solving in the clinical care of children, women,
and men of all ages from a variety of cultural and economic backgrounds.
Demonstrate proficiency in each of the topics listed in the Disease and Disorders section of
the clinical handbook. Particular attention should be given to the etiology, epidemiology,
prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic
testing, interpretation of findings, medical management, non-pharmacologic treatment
(including surgical intervention), complications, patient education and counseling.
Perform or assist in the performance of and interpret and explain labs, diagnostic procedures
outlined in the Skills Section of the clinical handbook.
on Certification of Physician Assistants and others pertinent to Family Medicine.
Dermatological System
Eczematous Eruptions
Dermatitis
Atopic
Contact
Nummular eczematous
Perioral
Seborrheic
Stasis
Dyshidrosis
Lichen simplex chronicus
Acneiform Lesions
Acne vulgaris
Rosacea
Folliculitis
Papulosquamous Diseases
Dermatophyte infections
Tinea versicolor
Tinea corporis/pedis
Drug eruptions
Lichen planus
Pityriasis rosea
Psoriasis
Desquamation
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Erythema multiforme
Verrucous Lesions
Seborrheic keratosis
Actinic keratosis
Neoplasms
Basal cell carcinoma
Melanoma
Squamous cell carcinoma
Hair and Nails
Alopecia areata
Androgenetic alopecia
Onychomycoses
Paronychia
Bacterial Infections
Cellulitis
Erysipelas
Impetigo
Viral Diseases
Exanthems
Herpes simplex
Molluscum contagiosum
Verrucae
Varicella-zoster virus infections
Other
Acanthosis nigricans
Hidradenitis suppurativa
Urticaria
Vitiligo
Eye, Ear, Nose and Throat
Eye Disorders
Blepharitis
Cataract
Chalazion
Conjunctivitis
Ectropion
Entropion
Glaucoma
Hordeolum
Pterygium
Acute/chronic sinusitis
Rhinitis
Ear Disorders
Acute/chronic otitis media
Hearing impairment
Labyrinthitis
Otitis externa
Vertigo
Acute pharyngitis
Laryngitis
51
Oral candidiasis
Oral herpes simplex
Sialadenitis
Acute bronchitis
Influenza
Pneumonias
Obstructive Pulmonary Disease
Asthma
Restrictive Pulmonary Disease
Idiopathic pulmonary fibrosis
Pneumoconiosis
Sarcoidosis
Cardiovascular System
Hypertrophic cardiomyopathy
Hypertension
Essential
Secondary
Hypotension
Orthostasis/postural
Valvular Disease
Aortic stenosis/insufficiency
Mitral stenosis/insufficiency
Mitral valve prolapse
Tricuspid stenosis/insufficiency
Pulmonary stenosis/insufficiency
Atrial fibrillation/flutter
Atrioventricular block
Bundle branch block
Paroxysmal supraventricular tachycardia
PACs
PVCs
Angina pectoris
Stable
Unstable
Prinzmetal’s/variant
Other Conditions
Acute pericarditis
Acute rheumatic fever
Giant cell arteritis
Peripheral vascular disease
Acute/chronic arterial occlusion
Venous insufficiency
Phlebitis/thrombophlebitis
Varicose veins
Gastrointestinal System
Liver
Acute/chronic hepatitis
Metabolic Disorders
Lactose intolerance
Rectum
Anal fissure
Hemorrhoids
Gallbladder
Acute/chronic cholecystitis
Cholelithiasis
Cholangitis
Constipation
Diverticular disease
Irritable bowel syndrome
Infectious Diarrhea
52
Upper GI
Esophagitis
Gastroesophageal reflux disease
Gastritis
Peptic ulcer disease
53
Urinary/Renal System
Conditions affecting Males
Prostatitis
Benign prostatic hyperplasia
Erectile dysfunction
Infertility
Contraception options
Epididymitis
Orchitis
Testicular torsion
Hydrocele/varicocele
Nephro/urolithiasis
Infectious/Inflammatory Conditions
Cystitis
Pyelonephritis
Urethritis
Renal Diseases
Glomerulonephritis
Nephrotic syndrome
Polycystic kidney disease
Musculoskeletal System
Osteoarthritis
Osteoporosis
Bursitis
Back strain/sprain
Cauda equina
Herniated nucleus pulposus
Kyphosis/scoliosis
Low back pain
Disorders of the Ankle/Foot
Sprains/strains
Meniscal injuries
Sprains/strains
Rotator cuff disorders
Adhesive capsulitis/frozen shoulder
Disorders of the Forearm/Wrist/Hand
Tenosynovitis
De Quervain’s tenosynovitis
Elbow tendonitis
Epicondylitis
Rheumatologic Conditions
Ankylosing spondylitis
Fibromyalgia
Gout/pseudogout
Polyarteritis nodosa
Polymyositis
Polymyalgia rheumatica
Reactive arthritis (Reiter's syndrome)
Rheumatoid arthritis
Systemic lupus erythematosus
Scleroderma
Neurological System
Diseases of Peripheral Nerves
Bell's palsy
Trigeminal neuralgia
Carpal tunnel syndrome
Tarsal tunnel syndrome
Headaches
Cluster headache
Migraine
Tension headache
Seizure Disorders
Generalized convulsive disorder
Generalized nonconvulsive disorder
Endocrine System
Hyperthyroidism
Hypothyroidism
Thyroiditis
Diabetes mellitus Type 2
Hypoglycemia
Hypercholesterolemia
Hypertriglyceridemia
Infectious Disease
Candidiasis
Botulism
Chlamydia
Cholera
Diphtheria
Gonococcal infections
Salmonellosis
Shigellosis
Tetanus
Tuberculosis
Amebiasis
Nematode infections/infestations
Toxoplasmosis
Lyme borreliosis/disease
Rocky Mountain spotted fever
Syphilis
Epstein-Barr virus infections
Herpes simplex
HIV infection
Influenza
Varicella-zoster virus infections
Hepatitis A
Malaria
Hematological System
Iron deficiency anemia
Thalassemia
Sickle cell anemia
55
Malignancies (clinical features, diagnosis)
Acute/chronic lymphocytic leukemia
Acute/chronic myelogenous leukemia
Lymphoma
Multiple myeloma
Psychiatric/Behavioral Conditions
Anxiety disorders
Depressive disorders
Substance abuse/addiction
Domestic/intimate partner/child/elder abuse/violence
Uncomplicated bereavement
SKILLS
This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation. It is
desirable that the PA student reach a performance level commensurate with his or her peers.
Lab/Diagnostics
Perform and interpret the following:
ECG
KOH and mineral oil skin preps
Cervical cancer screening
Wet mount/pH assessment of vaginal fluids
Throat culture and rapid strep testing
TB testing (skin, blood, sputum, urine)
Stool testing-ova and parasites
Stool hemoccult
Urinalysis
Venipuncture
Joint fluid analysis
Wound cultures
Peak flow assessments
Tests for STIs
Order and evaluate reported findings:
Radiographs – chest, KUB, GI, head, C-spine, L-S spine, hip, extremities and contrast studies
Mammogram and breast ultrasound
Ultrasound studies – GI, GU, MS, CV (including Echocardiography)
DEXA scan
Nuclear medicine reports
CT (CTA)
MRI (MRA)
Pulmonary function tests
Audiometry
Procedures
Anoscopy, proctoscopy, sigmoidoscopy, colonoscopy
Assessment of urinary problems, bladder aspiration, catheterization, tests for urinary incontinence
Dermatologic procedures: skin biopsies, cryotherapy, tissue destruction, use of Wood’s lamp
Ear irrigation
Visual acuity assessments
Fluorescein eye staining and irrigation
Injections: intramuscular, subcutaneous, and intradermal
Arthrocenteses/joint injection
Nebulizer treatments
56
Splinting extremities
Tonometry
Tympanography
Audiometry
Nutrition evaluation and initial diet recommendations
Physical activity/exercise recommendations
Substance abuse, safety counseling
Intimate partner/domestic/child and elder abuse
End-of-life issues
Family history and interpretation of the pedigree
Immunization schedules
Desensitization to allergens
Preconception care/Family Planning
57
58
COURSE SYLLABUS
Geriatric Medicine Rotation
PASS 0646
Credit Hours 6.00
COURSE PURPOSE
The overall educational goal for the Geriatric Medicine Rotation is to train physician assistant students in all aspects
of health care as it relates to the geriatric population. The rotation is designed to prepare students to identify the
physiological, behavioral, psychological, and social changes associated with aging, manage acute medical illnesses,
recognize common chronic disease processes specific to the elderly, and to perform exams and procedures with
proficiency and skill.
COURSE COORDINATOR
[email protected]
This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students are
required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are
responsible for assigned reading material even if those topics are not experienced on the rotation.
rd
Mosby; 2005. ISBN-10: 0323039030
Required for Geriatrics Rotation:
th
Primary Care Geriatrics, A Care-Based Approach. 5 Ed.
Ham RJ, Sloane PD, Warshaw GA, Bernard MA, Flaherty E.
Mosby; 2006
ISBN-10: 323039308
Recommended:
th
Geriatrics At Your Fingertips. 12 Edition.
Reuben DB, Herr KA, Pacala JT, Pollack BG, Potter JF, Semla TP.
American Geriatric Society; 2010 ISBN-10: 9781886775541
59
This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and
satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and
Procedures section of this handbook for expectations regarding clinical rotations.
The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation.
Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for
each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies
and procedures which govern evaluation and grading.
1. Understand the physiological, behavioral, and psychological changes associated with aging.
2. Recognize the common chronic medical conditions affecting older persons including diseases affecting
cognition and mood.
3. Recognize the importance of preventive care, health maintenance, recommended immunizations, and
patient education and counseling in older persons.
4. Understand the effects of medication dosing regimens in older persons with respect to nutritional status
and organ function.
5. Recognize psycho-social issues that impact older persons, such as living conditions, sources of social
support, disability, and loss of independence.
6. Understand the appropriate management of a terminally ill patient including hospice care, pain control,
and symptom management.
7. Understand the importance of advance directives and medical power of attorney.
8. Master each of the topics listed in the Diseases and Disorders Section of the clinical handbook,
focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology,
non-pharmacological treatment (including surgical options), complications, patient education and
counseling.
9. Perform or assist in the performance of and interpret and explain the labs, diagnostic procedures outlined
in the Skills Section of the clinical handbook.
The topics listed below are those included on the Content Blueprint prepared by the National Commission on
Certification of Physician Assistants and others pertinent to Geriatric Medicine.
The Dermatological System
Verrucous Lesions
Actinic Keratosis
Seborrheic Keratosis
Viral Diseases
Zoster/Varicella
Neoplasms
Basal Cell
Melanoma
Squamous Cell
60
Hair and Nails
Onychomycosis
Paronychia
Cellulitis/Vasculitis
Decubitus Ulcers/Leg Ulcers
Vesicular Bullae
Bullous Pemphigoid
Eye Disorders
Cataracts
Acute-angle glaucoma
Chronic glaucoma
Diabetic Retinopathy
Macular Degeneration
Ear Disorders
Cerumen Impaction
Hearing Impairment
Presbycusis
Vertigo
Acute Bronchitis
Influenza
Pneumonias
Aspiration
Bacterial
Viral
Asthma
Chronic Bronchitis
Emphysema
Pulmonary Embolism
Cardiomyopathy
Dilated
Hypertrophic
Restrictive
Hypotension
Orthostatic/Postural
Angina Pectoris
Stable
Unstable
Variant
Atrial Fibrillation and Flutter
Paroxysmal Supraventricular
Tachycardia
Peripheral Vascular Disease
Carotid Stenosis
Giant Cell Arteritis
Hypertension
Essential
Secondary
Malignant
Esophagus
Esophagitis
GERD
Stomach
Gastritis
Neoplasm
Peptic Ulcer Disease
Nutritional deficiencies
Niacin
Thiamine
Vitamin A
All B Vitamins
Vitamin C
Vitamin D
Vitamin K
Pancreas
Neoplasm
Constipation
Diverticular Disease
Neoplasm
Ischemic Bowel Disease
Gallbladder
Cholelithiasis
Cholecystitis
Rectum
Fecal Impaction
Hemorrhoids
61
The Genitourinary System
Benign Conditions-GU Tract
Benign Prostatic Hypertrophy
Incontinence
Nephrolithiasis
Urethrolithiasis
Renal Diseases
Acute/Chronic Renal Failure
Neoplasm
Cystitis
Prostatitis
Pyelonephritis
Urethritis
Prostate Cancer
Bladder Cancer
Rotator Cuff Disorders
Separations
Sprain/Strain
Frozen Shoulder
Back Strain/Sprain
Low Back Pain (Lumbago)
Spinal Stenosis
Kyphosis
Fibromyalgia
Gout/Pseudogout
Paget’s Disease
Polymyalgia Rheumatica
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Disorders of the Hip
Sprains/Strains
Bursitis
Osteoporosis
Osteoarthritis
Dementias
Alzheimer’s Disease
Vascular Dementia
Dementia of Lewy Body Type
Pick’s Disease
Normal Pressure Hydrocephalus
Vascular Diseases
Cerebral Aneurysm
Stroke
Transient Ischemic Attacks (TIA)
Delirium
Movement Disorders
Essential Tremor
Parkinson’s Disease
Seizure Disorders
Generalized Convulsive
Generalized Non-convulsive
Status Epilepticus
Syncope
Diabetes Mellitus
Type 1
Type 2
62
Hypothyroidism
Hypoglycemia
Anemias
Iron Deficiency
B12 Deficiency
Folate Deficiency
Hemolytic Anemia
Malignancies
Acute/Chronic Myeloid Leukemia
Acute/Chronic Lymphoid Leukemia
Lymphoma
Multiple Myeloma
Breast Cancer
Menopause
Psychiatry
Anxiety
Depression
Other Behavioral/Emotional Disorders
Acute Reaction to Stress
Elder Abuse
Domestic Violence
Uncomplicated Bereavement
Infectious Diseases
Bacterial Diseases
Community-Acquired Pneumonia
Nosocomial Pneumonia
Viral Diseases
HIV
Influenza
Mycobacterial Diseases
Atypical Mycobacterium
Tuberculosis
Skills
Order, perform, and/or interpret the following labs and diagnostic tests:
Arterial puncture for arterial blood gases
ECG
Mental status examination
Nutritional assessment
PPD
Rapid strep testing
Sputum cultures
Stool testing – ova & parasites, hemoccult
Urinalysis, routine and microscopic
Venipuncture for CBC, electrolytes, blood serum chemistries and cultures
Wound cultures
IV therapy–indications for various IV fluids (D5, Ringer’s lactate, D5W, NS, hypotonic/hypertonic saline)
Routine radiographs – chest, KUB, GI, back, C-spine and extremity, including contrast studies
Nuclear medicine read outs – CT, MRI, PET
Order, perform and assist, and/or explain to patients the following procedures:
Bladder catheter insertion/removal
63
Bone marrow biopsy
Cardioversion
Central Line placement – subclavian, femoral, internal jugular
Dermatologic procedures - shave and punch biopsies, cryotherapy, and application of podophyllin or
bi/trichloroacetic acid
Snellen eye chart
Fluorescein staining of eye and irrigation
Intravenous line insertion
Joint injection/aspiration
Lumbar puncture
Nutritional support
Nasogastric tube insertion
Paracentesis
Thoracocentesis
Tonometry – Schiotz
Tracheostomy
Tympanogram
Exercise/physical activity recommendations
Nutrition – low fat, low cholesterol, weight reduction, diabetic and low salt diet
Preparation for x-ray studies/special testing
General age-associated changes in physiology in geriatrics
Drug therapies unique for the geriatric patient
Evaluation and prevention of falls
Hazards of hospitalization of the elderly
Problems associated with immobility
Nursing home care and home care of the elderly patient
64
COURSE SYLLABUS
Internal Medicine Rotation
PASS 0641
Credit Hours 6.00
COURSE PURPOSE
The overall educational goal for the Internal Medicine Rotation is to train physician assistant students in all aspects of
care for the adult patient and to guide them in their evolution into respectful and professional health care providers in
the setting of a general medical practice. The rotation is designed to prepare students to care for adults with common
clinical problems in the ambulatory and/or hospital setting, to do so with respect and sensitivity, and to perform
necessary exams and procedures with proficiency and skill.
COURSE COORDINATOR
[email protected]
Lendell Richardson, MD
Medical Director and Assistant Professor
[email protected]
This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students are
required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are
responsible for assigned reading material even if those topics are not experienced on the rotation.
rd
Mosby; 2005. ISBN-10: 0323039030
Required for Internal Medicine Rotation:
th
Cecil Essentials of Medicine, 8 Ed.
Andreoli, TE, Carpenter, CCJ, Griggs, RC, Benjamin, IJ.
Saunders, 2011
ISBN-10: 9781416061090
Recommended for Internal Medicine Rotation:
th
Harrison’s Principles of Internal Medicine, 17 Edition
Fauci, AS, et al
McGraw-Hill, 2008
ISBN-10: 9780071466332
65
This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and
satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and
1. Recognize the importance of preventive care in the health of the adult patient.
2. Demonstrate the ability to counsel and educate patients in order to promote health and prevent disease
(or better manage disease, once established).
3. Understand the pathophysiology, prevention, diagnosis and treatment of common medical problems in
the care of the adult patient.
4. Develop a problem-based approach to the diagnosis and management of a wide spectrum of common
(and less common) acute and chronic adult illnesses.
5. Obtain a focused, relevant medical history and perform a focused physical examination based on the
patient’s chief complaint and clinical presentation.
6. Formulate a differential diagnosis based on chief complaint, history and physical exam.
7. Master each of the topics listed in the Diseases and Disorders section of the clinical handbook, focusing
on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs,
laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacologic
treatment (including surgical options), complications, patient education and counseling.
8. Order, perform (or assist in the performance of), explain and interpret the labs and diagnostic procedures
Certification of Physician Assistants and other topics pertinent to Internal Medicine.
66
Eye Disorders
Retinopathy
Diabetic
Hypertensive
Macular degeneration
Iritis
Keratitis
Ear Disorders
Mastoiditis
Ménière’s Disease
Vertigo
Oral leukoplakia
Infectious Diseases
Pneumonias
Tuberculosis
Pulmonary Circulation
Cor pulmonale
Pulmonary Embolism
Pulmonary Hypertension
The Pulmonary System (cont)
Pleural Diseases
Pleural Effusion
Neoplastic Disease
Bronchogenic
Carcinoid Tumors
Metastatic Tumors
Pulmonary Nodules
Restrictive Pulmonary Disease
Idiopathic Pulmonary Fibrosis
Sarcoidosis
Bronchiectasis
Chronic Bronchitis
Emphysema
ARDS
The Dermatologic System
Vesicular Bullae
Bullous pemphigoid
Pemphigus vulgaris
Cardiomyopathy
Dilated
Hypertrophic
Restrictive
Peripheral Vascular Disease
Phlebitis and Thrombophlebitis
Venous Thrombosis
Varicose Veins
Angina Pectoris
Stable
Unstable
Variant
Acute Coronary Syndrome
Hypotension
Orthostatic/Postural
Hypertension
Essential
Secondary
Malignant
Valvular Disease
Tricuspid Stenosis/Insufficiency
Pulmonary Stenosis/Insufficiency
67
Aortic Stenosis/Insufficiency
Mitral Stenosis/Insufficiency
Mitral Valve Prolapse
Other Forms of Heart Disease
Endocarditis
Myocarditis
Atrial Fib./Flutter
Atrioventricular Block
Bundle Branch Block
Supraventricular Tachycardia
V. fib/V. tach
Vascular Disease
Arterial Embolism and Thrombosis
Chronic/Acute Arterial Occlusion
Giant Cell Arteritis
Esophagus
Esophagitis
Motility Disorders
Mallory-Weiss Tear
Neoplasms
Strictures
Varices
Inflammatory Bowel Disease
Irritable Bowel Syndrome
Neoplasms
Polyps
Obstruction
Toxic Megacolon
Stomach
Gastritis
Neoplasms
Peptic Ulcer Disease
GERD
Infectious Diarrhea
Liver
Acute/Chronic Hepatitis
Cirrhosis
Neoplasms
Nutritional Deficiencies
Niacin
Thiamine
Vitamin A
All B vitamins
Vitamin C
Vitamin D
Vitamin K
Pancreas
Acute/Chronic Pancreatitis
Neoplasms
Metabolic Disorders
Lactose Intolerance
Celiac Sprue
Gallbladder
The Genitourinary System
Renal Disease
Acute Renal Failure
Chronic Renal Failure
Nephrotic Syndrome
Polycystic Kidney Disease
Benign Conditions of the GU Tract
Benign Prostatic Hyperplasia
Erectile Dysfunction
Incontinence
Electrolyte and Acid/Base Disorders
Hypo/hypernatremia
Hypo/hyperkalemia
Hypo/hypercalcemia
Hypomagnesemia
Metabolic alkalosis/acidosis
Respiratory alkalosis/acidosis
Volume depletion
Volume excess
SIADH
Disorders of Back/Spine
Ankylosing Spondylitis
Back Strain/Sprain
68
Osteoporosis
Cauda Equina
Herniated Disc Pulposus
Low Back Pain (Lumbago)
Spinal Stenosis
Fibromyalgia
Gout/Pseudogout
Polyarteritis Nodosa
Polymyositis
Polymyalgia Rheumatica
Reiter’s Syndrome
The Musculoskeletal System (cont)
Infectious
Acute/Chronic Osteomyelitis
Septic Arthritis
Osteoarthritis
Rheumatologic Conditions (cont)
Rheumatoid Arthritis
Systemic Lupus Erythematosus
Scleroderma
Sjogren’s Syndrome
Alzheimer’s Disease
Movement Disorders
Essential Tremor
Huntington’s Chorea
Parkinson’s Disease
Multiple Sclerosis
Diseases of Peripheral Nerves
Diabetic Peripheral Neuropathy
Guillian-Barré Syndrome
Myasthenia Gravis
Trigeminal Neuralgia
Vascular Diseases
Cerebral Vascular Accident
Transient Ischemic Attacks
Cerebral Aneurysm
Thyroid Disease
Hyperparathyroidism
Hypoparathyroidism
Hyperthyroidism
Graves’ Disease
Thyroid Storm
Hypothyroidism
Thyroiditis
Hashimoto’s Thyroiditis
Thyroid Neoplasm
Lipid Disorders
Hypertriglyceridemia
Pituitary Gland Disease
Acromegaly/Gigantism
Dwarfism
Diseases of the Adrenal Glands
Cushing’s Syndrome
Adrenocortical Insufficiency
Diabetes Insipidus
Diabetes Mellitus
Type 1
Type 2
Hypoglycemia
Infectious Diseases
Fungal Disease
Candidiasis
Cryptococcosis
Histoplasmosis
Pneumocystis Carinii
Gram Positive Bacteria
Botulism
Gram Negative Bacteria
Cholera
Parasitic Disease
Amebiasis
Hookworms
Malaria
Toxoplasmosis
Spirochetal Disease
Lyme Borreliosis
Rocky Mountain Spotted Fever
Syphilis
69
Chlamydial Infection
Gonococcal Infections
Gram Negative Bacteria (cont)
Salmonellosis
Shigellosis
Mycobacterial Disease
Tuberculosis
Atypical Disease
Viral Diseases
CMV Infections
Epstein-Barr Infections
Human Immunodeficiency Virus
Epstein-Barr Infections
Human Papilloma Virus
Influenza
Varicella-Zoster Infections
Anemias
Aplastic Anemia
B12 Deficiency
Folate Deficiency
Iron Deficiency
Thalassemia
G6PD Deficiency
Hemolytic
Factor V Leiden
Factor VII Deficiency
Factor VIII Deficiency
Factor IX Deficiency
Factor XI Deficiency
Factor XII Deficiency
Factor XIII Deficiency
Disseminated Intravascular Coagulation
Disorders of Platelet Number or Function
Idiopathic Thrombocytopenic Purpura
Thrombotic Thrombocytopenic Purpura
Von Willebrand’s Disease
Thrombocytopenia
Malignancies
Acute Lymphoblastic Leukemia
Chronic Lymphocytic Leukemia
Acute/Chronic Myelogenous Leukemia
Multiple Myeloma
Lymphoma
SKILLS
It is desirable that the PA student reaches a performance level in primary care/family medicine commensurate with
his/her peers. This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical
rotation.
Labs/Diagnostics
Perform and interpret the following:
ECG
KOH preps
PPD
Rapid strep testing
Sputum cultures
Stool testing – ova & parasites, hemoccult
Wet mount
Labs/Diagnostics (cont)
Wound cultures
70
IV therapy-indications for various IV fluids (D5, Ringer’s lactate, D5W, NS, hypotonic and hypertonic saline)
Routine X-ray studies-chest, KUB, GI, back, C-spine, and extremity, including contrast studies
Nuclear medicine read outs-CT, MRI
Procedures
Order, perform (and/or assist), explain to patients, and interpret the following procedures and tests:
Bone marrow biopsy
Cardioversion
Central line placement-subclavian, internal jugular and femoral
Dermatologic procedures: shave and punch biopsies, cryotherapy, application of podophyllin or
bi/trichloroacetic acid
Ear irrigation
Endotracheal tube insertion
Snellen eye chart reading
Eye staining and irrigation
Injections: intramuscular and subcutaneous
Joint injection/aspiration
Lumbar puncture
Paracentesis
Thoracocentesis
Tonometry-Schiotz
Tracheostomy
Tympanogram
Exercise program
Medication
Common primary-care medical conditions (acute & chronic):
Diabetes
Hypertension
Family planning/Contraception
Infection prevention
Nutrition: low fat, low cholesterol, weight reduction, diabetic and low salt
Preparation for x-ray studies/special testing
71
72
COURSE SYLLABUS
Pediatric Medicine Rotation
PASS 0648
Credit Hours 6.00
COURSE PURPOSE
The overall educational goal for the Pediatrics Rotation is to train physician assistant students in all aspects of
medical care for children and adolescents and to guide the student in developing the medical, technical, and
interpersonal skills needed to provide competent, respectful, and professional care for the pediatric patient and his
or her parent(s) or guardian(s).
COURSE COORDINATORS
[email protected]
Program Director and Associate Professor
[email protected]
This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students
are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students
are responsible for assigned reading material even if those topics are not experienced on the rotation.
rd
Mosby; 2005. ISBN-10: 0323039030
Required for Pediatrics Rotation:
th
Nelson Essentials of Pediatrics, 6 Edition
Kliegman RM, Marcdante K, Jenson H, Behrman R.
Saunders, 2011
ISBN-13: 978-1-4377-0643-7
This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions
and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and
73
1. Understand the role of the pediatrician and the physician assistant in the practice of pediatrics in both
outpatient and inpatient settings.
2. Describe the appropriate use of consultants in pediatric care, including but not limited to
obstetrician/gynecologists, perinatologists, neonatologists, and pediatric subspecialists.
3. Discuss the importance of the medical home and cost-effective care for pediatric patients.
4. Understand the normal process of growth and development in children and adolescents.
5. Perform a complete age-appropriate history and physical examination in children of all ages.
6. Provide age-appropriate anticipatory guidance and prevention education.
7. Detail the recommended routine vaccinations across the pediatric age span, and understand the issues
and controversies surrounding pediatric vaccination.
8. Complete and interpret routine pediatric screening tools, including newborn assessment, Denver
Development scale, CDC growth charts, and the calculation of body mass index.
9. Communicate respectfully, compassionately, and effectively with the pediatric and adolescent patient
as well as with the patient’s parent(s) and/or guardian(s).
10. Demonstrate respect for the privacy of pediatric patients and for their dignity as persons.
non-pharmacological treatment (including surgical options), complications, patient education,
anticipatory guidance, and counseling.
12. Perform or assist in the performance of and interpret and explain the labs, diagnostic procedures
Certification of Physician Assistants and others pertinent to Pediatric medicine.
The Dermatological System
Eczematous Eruptions
Dermatitis
Atopic
Contact
Diaper
Papulosquamous Diseases
Dermatophyte Infections
Tinea Versicolor
Tinea Corporis, Pedis
Drug Eruptions
Pityriasis Rosea
Desquamation
Stevens-Johnson Syndrome
Erythema Multiforme
Acneiform Lesions
Acne Vulgaris
Insect/Parasites
Lice
Scabies
Viral Diseases
Exanthems
Herpes Simplex
Molluscum Contagiosum
Verrucae
Impetigo
Other
Acanthosis Nigricans
74
Birthmarks/Hemangiomas
Harlequin change
Henoch-Schönlein purpura
Mongolian spots
Urticaria
The Eye, Ear, Nose and Throat
Eye Disorders
Amblyopia
Congenital cataracts
Conjunctivitis
Orbital cellulitis
Retinoblastoma
Strabismus
Acute Pharyngitis
Parotitis
Acute Tonsillitis
Oral Herpes Simplex
Aphthous Ulcers
Acute/Chronic Sinusitis
Allergic Rhinitis
Nasal Polyps
Epiglottitis
Laryngitis
Obstructive Sleep Apnea
Oral Candidiasis
Retropharyngeal Abscess
Peritonsillar Abscess
Ear Disorders
Acute/Chronic Otitis Media
Cerumen Impaction
Hearing Impairment
Otitis Externa
Tympanic Membrane Perforation
Acute Bronchitis
Acute Bronchiolitis
Croup
Pertussis
Pneumonias
Tuberculosis
Asthma
Cystic Fibrosis
Foreign Body Aspiration
Respiratory Distress Syndrome
Paroxysmal Supraventricular
Tachycardia (PSVT)
Innocent/Still murmur
Other forms of heart disease
Acute Rheumatic Fever
Endocarditis
Hypertrophic Cardiomyopathy
Long QT syndrome
SLE-related heart block
Congenital Heart Disease
Atrial Septal Defect
Coarctation of Aorta
Hypoplastic left heart
Patent Ductus Arteriosus
Tetralogy of Fallot
Ventricular Septal Defect
Stomach
Infectious diarrhea
75
Gastroesophageal Reflux
Pyloric stenosis
Vomiting
Tracheoesophageal Fistula
Hernia
Inguinal
Umbilical
Anal fissure
Chronic diarrhea
Metabolic Disorders
Phenylketonuria
Appendicitis
Constipation
Intussusception
Hirschprung’s disease
Necrotizing enterocolitis
Childhood obesity
Failure to thrive
Vitamin deficiencies
Genitourinary System
Benign Conditions of GU Tract
Paraphimosis/Phimosis
Cryptorchidism
Vesicoureteral Reflux
Hydrocele/Varicocele
Cystitis
Pyelonephritis
Neoplastic Diseases
Wilms’ Tumor
Testicular carcinoma
Renal Diseases
Glomerulonephritis
Nephrotic syndrome
Disorders of the Forearm/
Wrist/Hand
Nursemaid’s Elbow
Boxer’s fracture
Infectious Diseases
Osteomyelitis
Septic Arthritis
Transient (Toxic) Synovitis
Disorders of the Hip
Developmental Dysplasia of the Hip (DDH)
Slipped Capital Femoral Epiphysis (SCFE)
Legg-Calvé-Perthes Disease
Juvenile Arthritis
Osgood-Schlatter Disease
Tibial torsion
Talipes equinovarus
Other
Bowing deformity
Clavicle fracture
Greenstick fracture
Monteggia fracture
Scoliosis
Spina bifida
Toddler fracture
Torus fracture
Growing pain
Cerebral Palsy
Headache
Cluster
Migraine
Tension
Meningitis
76
Neurocutaneous
Neurofibromatosis
Tuberous Sclerosis
Sturge-Weber
Generalized Convulsive Disorders
Generalized Nonconvulsive Disorders
Hypotonia
Muscular Dystrophy
Neuroblastoma
Syncope
Pseudoseizure
Status Epilepticus
Diseases of the Pituitary
Acromegaly/Gigantism
Dwarfism
Diseases of the Thyroid
Congenital hypothyroidism
Diabetes mellitus
Type 1
Type 2
Infant of diabetic mother
Congenital Adrenal Hyperplasia
Infectious Diseases
Parasitic Disease
Pinworms
Spirochetal Disease
Lyme Disease
Kawasaki Disease
Reye Syndrome
Viral Diseases
Cytomegalovirus infections
Epstein-Barr infections
Erythema Infectiosum
Herpes Simplex Virus
Influenza
Measles
Mumps
Roseola
Rubella
Rubeola
Varicella-Zoster infections
Anemias
Iron deficiency
Sickle Cell
Thalassemia
Malignancies
Bone Tumors
CNS Tumors
Acute Lymphocytic
Leukemia
Lymphoma
Hemophilia
Thrombocytopenia
Idiopathic Thrombocytopenic Purpura (ITP)
Jaundice
Lead Poisoning
Occult bacteremia
The Psychiatric/Behavioral System
Attention Deficit Hyperactivity Disorder (ADHD)
Autistic Spectrum Disorder
Child abuse/neglect
Tics
Tourette syndrome
Eating disorders
Anorexia
Bulimia
Common Problems
Colic
Discipline
Enuresis
Encopresis
School avoidance
Sleep disorders
Toilet training
77
The Adolescent Reproductive System
Vaginitis
Sexually Transmitted Infections
Pelvic Inflammatory Disease
Contraceptive Methods
Pubertal development
Amenorrhea
Pediatric emergencies
Neonatal fever/sepsis
Pediatric head trauma
Poisoning/ingestions
Shaken baby syndrome
Sudden Infant Death Syndrome (SIDS)
Shock
Acetaminophen toxicity
Adverse drug reactions
Burns-body surface area
Dehydration
Drug reactions
SKILLS
Labs/Diagnostics
ECG
PPD or TB Tine Test
Rapid strep testing
Sputum cultures
Stool testing-ova & parasites, hemoccult
Wound cultures
Order, make preliminary assessment; and/or evaluate reported findings:
IV therapy: indications for various IV fluids
Routine X-ray studies-chest, KUB, GI, back, C-spine and extremity; contrast studies incl. CT, MRI
Procedures
Debride and dress minor wounds
Dermatologic procedures: cryotherapy, shave & punch biopsies, application, tissue destruction
Ear irrigation
Endotracheal intubation
Eye staining and irrigation
Fracture reduction
Injections: intramuscular and subcutaneous
Lumbar puncture
Nebulizer therapy
Suture lacerations
Tympanogram
Vision and hearing screening
Obtain specimens to detect sexually transmitted infections
78
Behavioral expectations and discipline
Immunizations
Importance of routine well visits
Normal and abnormal development
Proper nutrition: breast feeding, infant diet, failure to thrive, obesity, hypercholesterolemia
Knowledge of chromosomal abnormalities and evaluation of an infant with dysmorphic features
Safety and accident prevention
Treatment plan for acutely ill child
79
80
COURSE SYLLABUS
General Surgery Rotation
PASS 0643
Credit Hours 6.00
COURSE PURPOSE
The overall educational goal for the General Surgery Rotation is to train physician assistant students in all aspects
of care of the surgical patient. The rotation is designed to prepare the student for providing preoperative and
postoperative care for patients, for being effective first assistants in the operating room, for performing exams and
minor surgical procedures, and for caring for patients with respect and sensitivity.
COURSE COORDINATION
[email protected]
Instructor
[email protected]
This rotation will take place in hospital, surgical center, and outpatient clinic settings for 6 weeks in the clinical year.
Students are required to take call, attend conferences, provide patient presentations, and read required textbooks.
Students are responsible for assigned reading material even if those topics are not experienced on the rotation.
rd
Mosby; 2005. ISBN-10: 0323039030
Required for Surgery Rotation
th
Essentials of General Surgery. 4 Ed.
Lippincott, Williams and Wilkins; 2006.
ISBN-10: 0781750032
th
Surgical Recall. 5 Ed.
Blackbourne, LH.
Lippincott, Williams and Wilkins; 2008.
ISBN-10: 0781770769
81
Recommended for Surgery Rotation:
rd
Essentials of Surgical Subspecialties. 3 Ed.
Lippincott, Williams and Wilkins 2007.
ISBN-100781750040
and learning activities in their entirety.
1. Understand the pathophysiology, prevention, diagnosis and treatment of common clinical problems that
require surgical intervention.
2. Perform a complete and focused pre-surgical history and physical exam as it relates to the presenting
surgical condition.
3. Provide postoperative assessment and care of surgical patients.
4. Appropriately interpret laboratory and imaging abnormalities that indicate the necessity for surgical
intervention.
5. Demonstrate the principles of sterile technique.
6. Identify basic anatomical structures related to the surgical cases and their neurovascular relationships.
7. Understand the principles of perioperative hemodynamic monitoring and fluid management.
counseling.
DISEASES AND DISORDERS
Certification of Physician Assistants and others pertinent to Surgery.
Pulmonary System
Neoplastic Disease
Bronchogenic carcinoma
Carcinoid tumors
Metastatic tumors
Pulmonary nodules
Mesothelioma
Trauma
Penetrating
Blunt
82
Pleural Diseases
Pleural Effusion
Pneumothorax
Empyema
Pulmonary circulation
Pulmonary Emboli
Other
Lymphoma-staging
Cardiovascular System
Cardiac Disease
Pacemaker/AICD
Coronary artery disease
Catheterization
Vascular Disease
Carotid Stenosis
Aortic Aneurysm/Dissection
Arterial Embolism/Thrombosis
Peripheral Vascular
Ulcer
Ischemia
Venous Thrombosis
Varicose Veins
Congenital Heart Disease
Atrial Septal Defect
Coarctation of the Aorta
Ventricular Septal Defect
Patent Ductus Arteriosus
Tetralogy of Fallot
Valvular disease
Aortic stenosis/insufficiency
Mitral stenosis/insufficiency
Tricuspid stenosis/insufficiency
Pulmonary stenosis/insufficiency
Mitral valve prolapse
Trauma
Penetrating
Blunt
Other
Pericardial effusion
Cardiac tamponade
Cardiac neoplasm
Cardiogenic shock
Breast Disorders
Abscess
Carcinoma
Fibroadenoma
Fibrocystic disease
Mastitis
Gastrointestinal System/Nutritional
Esophagus
Barrett’s esophagus
Neoplasm
Mallory-Weiss tear
Stricture
Varices
Stomach
Neoplasms
Ulcer Disease gastric/duodenal
Pyloric stenosis
Gallbladder
Acute/Chronic Cholecystitis
Cholelithiasis
Biliary obstruction
Hernia
Femoral
Hiatal
Incisional
Inguinal
Umbilical
Ventral
Liver
Neoplasm
Portal hypertension
Rectum
Anal Fissure
Anorectal Abscess/Fistula
Fecal impaction
Hemorrhoids
Neoplasms
Pilondial disease
Appendicitis
Diverticulosis/Diverticulitis
Intussusception
Ischemic Bowel Disease
Neoplasms
Obstruction
Meckels diverticulum
Pancreas
83
Acute/Chronic pancreatitis
Neoplasm
Trauma
Penetrating & Blunt
Spleen
Trauma
Splenomegaly
Endocrine System
Thyroid
Nodules
Neoplastic disease
Parathyroid
Hyper/Hypoparathyroidism
Genital/Urinary System
Neoplastic Diseases
Bladder carcinoma
Prostate carcinoma
Renal cell carcinoma
Testicular carcinoma
Wilms tumor
Benign Conditions
Incontinence
Benign Prostatic Hyperplasia
Hydrocele/Varicocele
Testicular torsion
Calculi
Electrolyte/AcidBase Disorders
Metabolic Alkalosis/Acidosis
Respiratory Alkalosis/Acidosis
Hypo/Hypercalcemia
Hypo/Hyperkalemia
Hypo/Hypernatremia
Hypomagnesemia
Volume depletion/Excess
Musculoskeletal System
Disorders upper extremities
Disorders lower extremities
Disorders lower extremities
Aseptic Necrosis
Neoplastic Disease
Bone cysts and tumors
Ganglion Cysts
Osteosarcoma
Trauma
Soft tissue
Compartment syndrome
Disorders spine
Herniated disc
Dermatologic System
Neoplasms
Basal cell carcinoma
Squamous cell carcinoma
Melanoma
Viral Diseases
Condyloma Accuminata
84
Other
Burns
Ulcers
Decubitus and Leg
Hidradenitis suppurative
Lipomas
Epithelial inclusion cysts
SKILLS
It is desirable that the PA students reach a performance level in primary care commensurate with his/her peers.
This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation.
Lab/Diagnostics
Administer IV therapy for perioperative fluid management
Blood typing and cross-matching
Bleeding and coagulation studies
ECG
Radiographic imaging, CT, MRI:
Head and Neck
Chest
Abdomen and Pelvis
Spine
Extremities
Radiographic imaging - KUB
Wound culture
Procedures
Assist in major and minor procedures, learning the responsibility and skill of a surgical first assistant
Demonstrate knowledge of surgical procedure prior to start of case
Pre-op and post-op rounds and patient management
Scrub, gown, glove and set up sterile field
Understands and practices surgical aseptic technique
Suturing techniques (indications for choice suture, type of closure).
Clean and debride wounds; care of burns and lacerations; control bleeding/hemorrhage; infection control
Remove and apply wound dressings
Insert and remove drains
Perform I&D- localized abscess, paronychia, etc.
Assist with proctoscopy/colonoscopy/anoscopy
Assist/perform treatment of abrasions, lacerations, foreign body removal
Discuss fluid replacement, transfusion indication and mode of administration (needles, intracaths, butterflies).
Insertion of IVs
Placement of urethral catheters (male and female)
Remove sutures
Administer digital block anesthesia and topical local anesthesia
Biopsy/excise superficial skin lesions/tumors
Apply dry, and wet to dry dressings
Remove ingrown toenail
Assist in chest tube insertion
Assist in central line placement
Initial surgical evaluation, workup and diagnostic interventions
Surgical procedures indicated to specific diseases
Post-operative recovery, including follow-up and/or chemotherapy plans
Utilization of support networks
Genetic counseling
85
86
COURSE SYLLABUS
Women’s Health Rotation
PASS 0647
Credit Hours 6.00
COURSE PURPOSE
The overall educational goal for the Women’s Health Rotation is to train physician assistant students in all aspects
of care for women and to guide them in their evolution into respectful and professional health care providers to
women. The rotation is designed to prepare students to care for women with common clinical problems in the
ambulatory setting, to care for women with respect and sensitivity, and to perform exams and procedures common
in women’s health with proficiency and skill.
COURSE COORDINATOR
[email protected]
Kara N. Roman, MMS, PA-C
Associate Director and Assistant Professor
[email protected]
This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students
are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students
are responsible for assigned reading material even if those topics are not experienced on the rotation.
rd
Mosby; 2005. ISBN-10: 0323039030
Required for Women’s Health Rotation:
th
Current Diagnosis and Treatment – Obstetrics/Gynecology, 10 Ed.
DeCherney A, Nathan L, Goodwin TM, Laufer N
McGraw-Hill, 2006
ISBN-10: 0071439005
and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and
87
1. Recognize the importance of preventive care in women’s health and demonstrate counseling and the
delivery of patient education regarding nutrition, exercise, smoking cessation, pre-conceptual
counseling, sexually transmitted infections and pregnancy prevention.
2. Understand the pathophysiology, prevention, diagnosis and treatment of common clinic problems in
women’s health including breast, gynecologic, urinary, obstetric, and global health issues.
3. Perform and interpret Pap smear results and understand the triage of patients with abnormal Pap
smears.
4. Perform a complete breast exam and appropriately evaluate and manage a breast mass.
5. Recognize psycho-social issues that impact women’s health, such as cultural issues, sexuality, body
image, fertility, child care issues, domestic violence, and sexual abuse.
6. Employ shared problem solving in the clinical care of women of varying ages from varying cultural and
economic backgrounds.
counseling.
Certification of Physician Assistants and others pertinent to Women’s Health.
Menstruation Physiology, Disorders, and Conditions
Reproductive cycle
Puberty/Tanner stages
Menstrual cycle
Normal and abnormal
Dysmenorrhea
Premenstrual conditions
Perimenopause
Menopause/Osteoporosis
Ovary
Functional cysts
Neoplasms
Benign and malignant
Polycystic ovary syndrome (PCOS)
Premature ovarian failure
Vagina/Vulva
Urethral disorders
Vulvitis/Vaginitis
88
Bartholin’s gland disorders
Cystocele and prolapse
Rectocele and prolapse
Neoplasms
Cervix
Cervicitis
Abnormal Pap Smear/Cervical Cancer
Uterus
Abnormal/Dysfunctional Uterine Bleeding
Endometrial cancer
Endometriosis
Leiomyomas
Endometritis
Uterine prolapse
Sexually Transmitted Infections
Pelvic Conditions
PID
Chronic pelvic pain
Pelvic relaxation
Genitourinary Conditions
Urinary incontinence
Urinary tract infection
Contraceptive Methods/Surveillance
Sexual Function and Dysfunction
Intimate Partner Violence
Breast
Fibrocystic changes
Adenoma
Lactation
Mastitis
Abscess
Intraductal papilloma
Carcinoma
Infertility (male and female)
Evaluation of the Pregnant Patient
Uncomplicated Pregnancy
Prenatal care
Labor and delivery
Postpartum care
Complications in Pregnancy, Labor and Delivery, and Postpartum Period
Ectopic pregnancy
Infectious diseases – UTI, TORCH, HIV
Hypertension
Preeclampsia
Eclampsia
Gestational Diabetes
89
Thyroid disorders
Hematologic disorders
Neural tube defects
Gestational trophoblastic disease
Abortion
Chorioamnionitis
Rh incompatibility
Fetal growth abnormalities
Placenta previa
Abruptio placenta
Preterm labor
PROM
Abnormal fetal lie
Umbilical cord prolapse
Labor induction and augmentation
Surgical delivery
Post-term pregnancy
Multiple gestations
Shoulder dystocia
Melasma
Postpartum depression
Uterine atony
Postpartum hemorrhage
Skills
Order, perform, and/or interpret the following labs and diagnostic tests:
Thyroid function
Pregnancy
Group B Strep
Pap smear
Wet mount
STI evaluation
Rh, typing, antibody screening
Rubella titer
HIV
Hepatitis B
Antenatal screening – triple or quad screen
DEXA scan
Order, perform and assist, and/or explain to patients the following procedures:
Pelvic examination of the female patient
Clinical breast exam
Physical examination of the pregnant patient
Fetal auscultation
Estimate gestational age/EDD
Determine fetal lie, presenting part, station
Fetal and pelvic ultrasound
Biophysical profile
Electronic fetal monitoring
Amniocentesis
Labor and vaginal delivery
Surgical delivery
Induction and augmentation of labor
Forceps and vacuum-assisted deliveries
Colposcopy and biopsy
Vulvar biopsy and/or destruction of vulvar lesions
Endometrial biopsy
Bartholin gland I & D
Contraceptive fitting/insertion
90
Endometrial ablation
Dilation and curettage
Hysteroscopy
Laparoscopy
Hysterectomy
Tubal ligation
Sexual assault examination
Immunizations appropriate across the female life cycle
91
92
Request for Rotation Absence
Name: ________________________________
Date of Request: ___________________
Requested Absence Date(s): ______________________________
Reason for desired absence:
___
Personal Day
___
Professional Conference
___
Other: Describe reason for desired absence: ____________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
The student should submit the request to [email protected] as soon as he or she is aware of the need for the
absence.
The Clinical Coordinators will consider the request. If approved, the Clinical Coordinators will communicate with the
Preceptor to determine how the missed clinical hours will be reassigned. The student will be notified of the
decision.
The student may not plan any absence unless the Clinical Coordinators grant approval in advance. The student
should not, under any circumstances, ask a Preceptor for permission for an absence.
(for PA Program use only)
PA PROGRAM: APPROVED________NOT APPROVED________DATE: ________________
PRECEPTOR:
APPROVED________NOT APPROVED________DATE: ________________
NOTES:
93
94
Mid-Rotation Student Self-Evaluation Form
MIDWESTERN UNIVERSITY-PHYSICIAN ASSISTANT PROGRAM
555 31st Street Downers Grove, IL 60515
Phone: (630) 515-6034 Fax: (630) 971-6402
STUDENT:________________________________ ADVISOR:______________________________
ROTATION: _______________________________ PRECEPTOR:___________________________
ROTATION DATES:________________________________________________________________
Instructions to Student: Please complete this form at the end of the middle week of each rotation.
Evaluate your performance in each of the following areas thus far in your rotation.
Review it with your primary Preceptor and obtain their signature.
Fax the form to the PA Program Office.
4 = Excellent 3 = High Achievement 2 = Satisfactory 1 = Unsatisfactory
NA*
*Not applicable
I. ACADEMIC PERFORMANCE
1. Skill in obtaining an appropriate focused medical history.
4
3
2
1 NA
2. Skill in performing an appropriate focused physical examination.
4
3
2
1 NA
3. Demonstrates the ability to formulate appropriate differential diagnoses.
4
3
2
1 NA
4. Skill in appropriate use of laboratory and diagnostic tests.
4
3
2
1 NA
5. Demonstrates the ability to develop the appropriate treatment plans.
4
3
2
1 NA
6. Selects appropriate preventative measures and/or education.
4
3
2
1 NA
7. Skill in performance of technical procedures.
4
3
2
1 NA
8. Utilizes resources appropriately in medical decision making.
4
3
2
1 NA
9. Demonstrates overall clinical knowledge and competence.
4
3
2
1 NA
1. Demonstrates a professional demeanor at all times.
4
3
2
1 NA
2. Dedicated to providing the highest quality of care to patients.
4
3
2
1 NA
3. Punctual and prepared for all obligations.
4
3
2
1 NA
4. Able to effectively relate to patients, peers and colleagues.
4
3
2
1 NA
II. PROFESSIONAL BEHAVIOR
95
96
III. COMMENTS
Please describe your strengths in this rotation:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Please describe areas needing improvement and your goals for improving them during the remainder of
your rotation:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Instructions for Preceptor: Please briefly review this self-evaluation form with the student and then complete the
following statement(s):
1. I agree with the student’s self-assessment. Yes_________ No__________ If no, please explain
below.
2. I would like to see this student work on the following issues during the remainder of this rotation
(please list specific goals):
3. I consider this student’s progress so far in this rotation to be:
4 = Excellent
3 = High Achievement
4. Preceptor’s Signature:_______________________
Date:_______________________
2 = Satisfactory
1 = Unsatisfactory
Student’s Signature:_____________________
Date:_______________________
97
98
STUDENT PERFORMANCE EVALUATION FORM
Midwestern University-Physician Assistant Program
555 31st Street Downers Grove, IL 60515
Phone: (630) 515-6034 Fax: (630) 971-6402
STUDENT:________________________________ ADVISOR:______________________________
ROTATION:_______________________________ PRECEPTOR:___________________________
ROTATION DATES:________________________________________________________________
Please complete the following assessment for the student that you supervised during this rotation. We ask that you
complete the form and if possible, take time to review it with the student on the last day of their rotation. Thank you for
your help in training our students.
NA*
*Not applicable or not observed
I. ACADEMIC PERFORMANCE
1. Skill in obtaining an appropriate focused medical history.
4
3
2
1 NA
2. Skill in performing an appropriate focused physical examination.
4
3
2
1 NA
3. Demonstrates the ability to formulate appropriate differential diagnoses.
4
3
2
1 NA
4. Skill in appropriate use of laboratory and diagnostic tests.
4
3
2
1 NA
5. Demonstrates the ability to develop the appropriate treatment plans.
4
3
2
1 NA
6. Selects appropriate preventative measures and/or education.
4
3
2
1 NA
7. Skill in performance of technical procedures.
4
3
2
1 NA
8. Utilizes resources appropriately in medical decision making.
4
3
2
1 NA
9. Demonstrates overall clinical knowledge and competence.
4
3
2
1 NA
1. Demonstrates a professional demeanor at all times.
4
3
2
1 NA
2. Dedicated to providing the highest quality of care to patients.
4
3
2
1 NA
3. Punctual and prepared for all obligations.
4
3
2
1 NA
4. Able to effectively relate to patients, peers and colleagues.
4
3
2
1 NA
II. PROFESSIONAL BEHAVIOR
99
100
III. ATTENDANCE
Total number of days that the student arrived late during this rotation:___________.
Total number of days that the student was absent during this rotation:___________.
Total number of requests for special scheduling for personal reasons:___________.
IV. COMMENTS
Please describe the student’s strengths in this rotation:
_____________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Please describe areas needing improvement for this student:
_____________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
V. OVERALL EVALUATION FOR THE ROTATION: (Required – Circle one)
Preceptor’s Signature:_______________________
Date:_______________________
Student’s Signature:_____________________
Date:_______________________
101
102

Midwestern University College of Health Sciences Clinical Handbook

Transcription

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