CLINICAL PHASE MANUAL
A Guide for Clinical Year
2015-2016
PHYSICIAN ASSISTANT PROGRAM
University of Wisconsin – La Crosse
Gundersen Medical Foundation
Mayo School of Health Sciences
(608) 785-8470
(608) 785-8460 (fax)
ADDRESS INQUIRIES TO:
Dr. Sandra Sieck
Program Director
(608) 785-6621
ssieck@uwlax.edu
UW- LA CROSSE
GUNDERSEN
MAYO
PA Program Office
4th Floor, Health Science Center
1300 Badger Street
La Crosse, WI 54601
(608) 785-8470
fax (608) 785-8460
1836 South Avenue
La Crosse, WI 54601
200 First Street SW
Rochester, MN 55905
Gregory Thompson, MD
Medical Director
(608) 775-2791
gpthomps@gundersenhealth.org
Robert Adams, RPA
Educational Coordinator
(507) 284-6822
(507) 284-0656 (fax)
radams@mayo.edu
Sandra Sieck, MD
Program Director
HSC room 4050
(608) 785-6621
ssieck@uwlax.edu
Pat Campbell, PA-C
Clinical Coordinator
HSC room 4051
pcampbell@uwlax.edu
Gene Roberts, PA-C
Educational Coordinator
(608) 782-7300, ext. 5096
(608) 791-6642 (fax)
herobert@gundersenhealth.org
Ryan Meverden, PA-C
Educational Coordinator
Meverden.ryan@mayo.edu
Andrew Horstman, PA-C
Educational Coordinator
alhorstm@gundersenhealth.org
Mary Rathgaber, MD
PA Program Faculty
mrathgaber@uwlax.edu
Martin Devine, MD
PA Program Faculty
mdevine@uwlax.edu
Karen Graham, PhD, PA-C
PA Program Faculty
kgraham@uwlax.edu
Jennifer Hayes, PA-C
PA Program Faculty
jhayes@uwlax.edu
Manual revised 04/15
SAS
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Table of Contents
Guidance for the Clinical Phase
Introduction…………………………………………………………………………………….….3
Professional Conduct……………………………………………………………………………...4
Dress Code…………………………………………………………………………………………4
Communicable Diseases……………………………………………………………………….…..5
Blood & Body Fluid Exposures ……………………………………………………………….…5
Injury and Incident Reporting…………………………………………………………………….6
Rotations, Assignments,Changes, Removal………………………………………………………6
Rotation Attendance and Hours……………………………………………………………….….7
Rotation Absences ……………………………………………………………..…………………8
Prescriptive Activities……………………………………………………………………………….9
Clinical Procedures………………………………………………………………………………..9
Course Information…………………………………………………………………………………9
Assessment and Tests ……………………………………………………………………………...11
Student Evaluation of Preceptors and Sites……………………………………………...…………12
Summative Examination………………………………………………………………………….12
Textbooks…………………………………………………………………………………………14
Course Descriptions………………………………………………………………………………16
Attachment 1 – Guidelines for Ethical Conduct……………………………………………..…...64
Attachment 2 – General Incident Report……………………………………………………………66
Attachment 3 – Addendum to Internship Waiver………………………………………… …. ….68
Attachment 4 – First Week Report………………………………………………………… ….….69
Attachment 5 – Preceptor Evaluation of the Student……………………………………………….70
Attachment 6 - Student Evaluation of the Preceptor and Clinical Site ………………………......73
Attachment 7 – Influenza Immunization Verification………………………………………….75
Attachment 8 – Student Clinical Phase Manual Acknowledgement form ………… …………76
Cognitive and Skill Objectives and Skill Checklists
PAS 732 Emergency Medicine Rotation……………………………………………………..…19
PAS 720 Family Medicine Rotation……………………………………………………………..23
PAS 724 General Surgery Rotation……………………………………………………………..…32
PAS 722 Internal Medicine Rotation…………………………………………………….…….…37
PAS 726 Obstetrics and Gynecology Rotation…………………………………………………...44
PAS 728 Pediatrics Rotation……………………………………………………………………...52
PAS 730 Psychiatry Rotation………………………………………………………………… ….58
PAS 756-759 Selectives1-4………………..………………………………………………………62
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GUIDELINES FOR THE CLINICAL PHASE
I.
INTRODUCTION
Congratulations, and welcome to clinical medicine! You have completed the preclinical phase of your
Physician Assistant education, and you have earned the privilege to enter the world of patient care.
Now, the real work begins - the work and patient care will become real. The next 12 months will be
challenging and rewarding. This guide, along with good communication between you, your preceptor,
and the Program, will optimize your clinical medicine experience.
The opportunity for learning, enhancing your skills, and developing your Physician Assistant identity
will never be greater than it is during this clinical year. The Program encourages you to take advantage
of this opportunity. You have tremendous responsibilities to yourself and to your patients. Just as selfdiscipline and motivation were necessary for maximal learning in the preclinical phase, they will be
equally important throughout the clinical year.
Challenge yourself to make the most of the coming year. Remember, each rotation will be different,
and the ideal method of learning will vary from one rotation to the next. In some rotations, you will
gain more knowledge from observing and working closely with your preceptor. In other rotations, you
may see fewer patients but have more time to seek out other clinical experiences, such as reading films
with the radiologist, spending time with a dietitian, or observing therapy. So, adapt your learning style
to the rotation. In addition to clinical work, you must take time to read and learn about medical topics.
You are ultimately responsible for mastering each rotation’s cognitive and skill objectives.
During the next 12 months, you will represent the Physician Assistant profession, the University, and
our institutional partners. At times, you will be the only PA that a patient or other healthcare
professional has encountered, so make every attempt to portray a positive image and be an
"ambassador" to each organization.
The Program faculty and staff want to help and guide you through the clinical year--they are only a
phone call away. The faculty and staff wish you good luck and hope that your clinical phase is
enjoyable and rewarding!
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II.
PROFESSIONALISM
A. CONDUCT
In the clinic and hospital setting, you will constantly be observed by patients, their families, and other
professionals. They will notice and judge your personal and professional behavior. The Program
expects exemplary, professional, ethical and legal conduct at all times.
In your student role, you will have direct access to private, sensitive patient information. At all times, it
is imperative that you obey rules and regulations that protect confidential information. For example,
never discuss patient names, room numbers, diagnoses, or other identifying information in any public
place (e.g., elevator, hallway, lunch room).
Unprofessional, unethical, or illegal behavior on the student’s part is cause for review by the Student
Progress and Conduct Committee. Refer to the Physician Assistant Program Student Policy Manual for
more information. No diagnostic or therapeutic procedure is to be performed without the direct,
explicit consent of the supervising physician or PA-C. It is the student’s responsibility to be aware of
institution-specific policies at the beginning of each rotation. In addition, please review the “Guidelines
for Ethical Conduct for the Physician Assistant Profession” - an electronic reference is located in
Attachment 1 at the end of this manual. Depending on the seriousness of the misconduct, there may
be grounds for dismissal from the Program.
B. DRESS CODE
Students are expected to appear professional in dress and hygiene while on rotations. Be aware of and
follow the dress code at each rotation site; dress codes will likely differ. Fair or not, your colleagues
and patients will judge your abilities by your appearance. If your clinical site requires a lab coat, the
Program standard is a half-length white coat. You must clean and iron your coat, when it is visibly
soiled. Bring your lab coat to each rotation site on the first day. You must either wear your Program
name tag or a site-specific name tag at all times when working with patients. The name tag must clearly
state that you are a physician assistant student.
III.
ILLNESSES AND INJURIES
You will care for patients with a variety of diseases, and you will encounter hazards in the work
environment. Through education and strict adherence to standard precautions and safety, the risk of
unsafe exposure and injury is minimized but not eliminated. Thus, you must follow the Program’s
injury and illness policies and procedures.
Injury prevention and injury management will vary from site to site. Gundersen, Mayo, and
independent partner sites will likely have different training, reporting, medical treatment, and record
keeping. Therefore, you shall be aware of and follow site-specific policies.
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A. COMMUNICABLE DISEASES
If you contract or are exposed to a communicable disease, you shall inform your preceptor or other
appropriate supervisor as soon as possible. Work restrictions may be necessary, so follow your
Preceptor’s advice and the specific policies at your clinical site. Each student shall inform the PA
Program of any work restrictions that are imposed. (See the Attendance section below).
B. BLOOD & BODY FLUID EXPOSURES
If you are accidently splashed with blood or body fluids, bitten, or stuck with a contaminated sharp
object, seek immediate medical care to minimize your risk of contracting HIV or Hepatitis. If
prophylactic medication is recommended, it must be initiated within two hours of exposure. The
student should seek this care under their own health insurance policy, though in some institutions the
cost of this care may be covered by that institution. As noted in the Student Policy Manual, each
student must have health, disability and life insurance as a condition of participation in the Program.
1) WHERE TO SEEK CARE
a. Gundersen Health System
At Gundersen in La Crosse, you will receive care through the Occupational Health Services
Department on the 3rd Floor of Founder’s Building. If you are accidently exposed to blood or body
fluids during standard business hours (Monday through Friday from 7:30 a.m. to 5 p.m.), immediately
page #3799 to reach a nurse. After standard business hours, immediately go to the Gundersen Trauma
Emergency Center.
At regional Gundersen sites, exposure and injury care shall be provided by an on-site healthcare
provider who consults the Occupational Health Department as necessary. Students assigned to
Gundersen clinical sites shall be financially responsible for all medical care received.
b. Mayo Health System
If a work-related injury or illness occurs at Mayo in Rochester, students shall do the following: 1)
immediately obtain first aid and 2) arrange for medical care. Dial "111" if emergency medical
assistance is needed. During regular clinic hours (Monday through Friday from 7:30 a.m. to 5:00 p.m.),
students shall immediately contact the Employee Health Service for assistance (Baldwin 5-A, 4-3211;
Domitilla MN-112, 5-5509; Eisenberg SL-49, 6-7078). On weekends and holidays and after regular
business hours, students shall page 127-2222, and injured persons shall be evaluated at either the Urgent
Care Center or Saint Mary’s Emergency Room. All work-related injuries and illnesses at Mayo in
Rochester should be reported to Bob Adams, RPA (ext. 4-6822), so required injury records can be
completed. For additional information, see the Mayo School of Health-Related Sciences Student
Handbook.
For incidents that occur at regional Mayo sites, students shall seek immediate local care. If necessary,
consultation with the Mayo Employee Health Service may be obtained.
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c. Independent Clinical Sites
If you are injured at an independent clinical rotation site, seek immediate medical care on-site.
2) INJURY AND INCIDENT REPORTING
Because you are a registered University of Wisconsin - La Crosse student, you must complete a
“General Incident Report” for any injury or blood or body fluid exposure that occurs during your
clinical experience. This report is located in Attachment 2 and may be photocopied for use. The
following instructions are helpful:
•
•
The student shall list his or her name, current address, and permanent address.
The Work Phone number is the clinical site phone number and student’s permanent home phone
number.
• The location of the incident shall be described as completely as possible, and shall include a full
mailing address for the clinical site.
Completed incident reports shall be mailed to the PA Program Office, Department of Health
Professions, Health Science Center, 4th Floor, 1300 Badger Street, La Crosse, WI 54601.
Alternatively, they may be scanned and emailed to the Program Director at ssieck@uwlax.edu.
The Program will send a copy of the report to the UW-L Protective Services Office. If the Protective
Services Office does not find suspicious information or a pattern of injury, no additional investigation
will be pursued. Students should keep a copy of their completed General Incident Report. For
questions about injury and incident reporting, contact Sandra Sieck, MD, PA Program Director at (608)
785-6621.
IV.
ROTATIONS
As a student healthcare provider, you will be monitored, instructed and supervised by preceptors primarily physicians and PAs. After earning trust and demonstrating proficiency, you may be permitted
to undertake specific activities with more flexible supervision and direction. You cannot, however,
substitute for or accept the responsibilities of licensed, qualified staff. Additionally, you cannot accept
or receive payment for any services that you provide as a student.
A. ASSIGNMENT OF ROTATIONS
According to PA Program policy, students will be assigned to clinical sites on the basis of site
availability and the Program's educational goals and mission statement. You are never permitted to
arrange your own preceptor or clinical sites. All clinical rotations will be secured by the Clinical
Education Coordinator of the UW-L-Gundersen-Mayo Physician Assistant Program. To ensure that you
understand and comply with this policy, you will be required to sign the “Addendum to Internship
Waiver” (Attachment 3).
The Program makes every attempt to fairly and equitably assign rotations. Unfortunately, it is possible
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that the Program will need to alter your rotation schedule as the year progresses. Be assured that these
changes will be minimized. Students are expected to accept their rotation assignments with
professionalism and without complaint.
1) Changes to a Clinical Site
With rare exception, it is NOT appropriate for students to request rotation changes, once rotations are
confirmed. Some examples of legitimate reasons for change are the terminal illness of a family member
or a significant personal health problem that requires special medical treatment. The following are not
acceptable reasons to request rotation changes: difficulty finding housing, distance from family
members, and seeking employment at a particular site. If you wish to change a rotation, you must
submit a written change request to the Clinical Education Coordinator or the Program Director. The
final decision of placement is at the discretion of the PA Program. If an additional site is necessary, the
Program is only obligated to find one alternate clinical site.
2) Removal from a Clinical Site
On rare occasion, it may be necessary to remove a student from a clinical site. The reasons for removal
can include, but are not limited to, the following:
•
•
•
•
An inadequate learning environment, as determined by the Clinical Coordinator
Inappropriate preceptor behavior
Preceptor request for student removal
Unprofessional, unethical, or illegal student behavior
If a student is removed, the Program is only obligated to find one additional clinical site. Students who
are removed for unprofessional, unethical, or illegal behavior can be dismissed from the Program.
B. ATTENDANCE & HOURS
You are required to attend all scheduled patient care and learning activities that are assigned by your
preceptor. Some examples include clinics, rounds, and noon conferences. You are expected to attend
the rotation every schedule day, and students are not permitted to ask for specific days or weekends off
from a rotation.
Student “work” hours will vary from one rotation to the next. Hours of attendance may even change
within a rotation. In some rotations, students will be obligated to “work” 6 or 7 days per week. You are
expected to “work” 40 - 60 hours per week on average. If you are consistently asked to “work” less
than 36 hours per week, please notify the Clinical Education Coordinator. Similarly, if you are asked to
“work” more than 60 hours per week, and you feel that the hours are negatively impacting your
education, please notify the Clinical Education Coordinator.
On some rotations, students may be required to take periodic evening or weekend call. If call is not
required for a certain rotation, the Program encourages you to request call at least one night a week and
one weekend a month. Students often experience unique and interesting patient care opportunities
while on-call. This is particularly true in Obstetrics, Psychiatry, Family Medicine, General Surgery,
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Pediatrics and Orthopedics. For optimal learning on the Emergency Medicine Rotation, you should
arrange to “work” at least one night shift per week.
Note: The word “work” means that you are present as a student on a clinical rotation, and as such you
are NOT permitted to be reimbursed for duties performed while on a rotation.
C. ABSENCES
1) Unplanned Absences
Students shall ensure that unplanned absences, late arrivals and early departures are very rare. These
situations are not excusable when related to other employment, extracurricular activities, or vacations.
If you are ill and will miss any schedule rotation time, you shall immediately notify your clinical site
Preceptor or other appropriate supervisor and the PA Program Office. If a student is ill and absent for
more than 2 (two) days, he or she may be required to verify their illness with a healthcare provider. At
the discretion of the Program, the student may be required to “work” additional hours to accrue
sufficient clinical experience. Even though each absence is managed on an individual basis, unexcused
rotation absence may be grounds for dismissal from the Program.
2) Planned Absences
Students have the privilege to request an excused absence during the clinical year. At least 2 weeks
prior to the first requested date of absence, the student must submit a written request via e-mail to
either the Program Director or Clinical Coordinator. Requests submitted in a lesser time frame may
be considered under extenuating circumstances. Before making the request, students should
consider how the absence impacts their education and their Preceptors’ schedule; options for
remediating lost attendance; and the Program’s commitment to consistency and excellence.
Excused absence requests will be discussed at weekly PA Faculty meetings. Approval, conditions
of approval, or denial will be based on majority vote. If votes are tied, the final decision will reside
with the Program Director. Within 48 hours of the Faculty meeting, the student will be notified of
the decision and the plan to notify affected staff, faculty, Preceptors, and clinical sites. Students
may appeal a decision in writing that shall state the rationale for appeal. The appeal will be
discussed with PA Faculty. If Faculty consensus cannot be obtained, the PA Administrative
Committee will be involved and their decision considered. Failure to comply with this policy may
require the student to repeat the entire rotation.
The total number of excused days during the second year shall not exceed 4 (four) days. No more
than 2 (two) days shall be missed from any single clinical rotation. Missing more than 2 days may
require that the student repeat the entire rotation. Students are encouraged to search for jobs on
weekends, holidays and scheduled curricular breaks.
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D. COMPLETION OF ROTATIONS
1) Completion of Rotations
All clinical rotations must successfully be completed within 24 months of the end of the didactic phase.
E. ROTATION POLICIES
1) Prescriptive Activities
As a student, you CANNOT prescribe drugs or medications of any kind. It is acceptable and legal,
though, to fill out a written prescription, review it with your preceptor, and obtain his or her signature.
You can neither sign a physician’s name nor write your initials behind the physician's name, even if
other office staff does this. Furthermore, it is illegal for a PA student to use a pre-signed prescription
pad. All prescriptions must be signed by a physician or certified physician assistant with prescriptive
authority and privileges. Any student who violates this prescriptive policy may be suspended from the
rotation and may be dismissed from the PA Program. If you have questions or need clarification while
on rotation, please contact the Clinical Education Coordinator or Program Director.
2)
Performing Clinical Procedures
As a student, you may have the opportunity to perform clinical procedures on patients. Note that no
diagnostic or therapeutic procedure is to be performed without the direct, explicit consent of the
supervising preceptor.
IV. COURSE INFORMATION
Required clinical rotations include: PAS 720: Family Medicine, PAS 722: Internal Medicine, PAS 724:
General Surgery, PAS 726 Obstetrics & Gynecology, PAS 728: Pediatrics, PAS 730: Psychiatry, PAS
732: Emergency Medicine. In addition, students will choose 2 selective rotations within the Gundersen
or Mayo Health Systems and 2 additional selective rotations within or outside of the Gundersen or
Mayo Health Systems. Each rotation is a 4-credit course and each course has a list of Cognitive
Objectives and Skill Objectives that are provided in this manual. These objectives shall guide your
clinical learning and your selection of reading and study materials. Your preceptors will receive the
same rotation-specific Cognitive Objectives.
A. Cognitive Objectives
Your preceptor will guide your clinical experience. However, he or she is not responsible for teaching
you the cognitive objective. Rather, the Cognitive Objectives are guidelines for your personal
disciplined study. Because the Program does not assign specific reading, you shall develop your own
reading approach of appropriate depth and breadth to fulfill all Cognitive Objectives. These readings
9
will 1) enhance your understanding of the medical disciplines through which you rotate, 2) prepare you
for the end-of-rotation exams, 3) prepare you for the Program’s final comprehensive exam, and 4)
prepare you for the Physician Assistant National Certification Exam (PANCE). The required textbooks
should facilitate the fulfillment of most objectives; however it may be necessary to locate and read
additional references.
You will take a written examination following every required and Selective 1 and 2 rotations.
Objectives for Selectives 1 and 2 will be based on the selective chosen. So, even if you select an
internal medicine subspecialty, you will be required to take the more comprehensive, general Internal
Medicine II examination. If a surgical subspecialty is chosen, you will be required to take the more
comprehensive, general Surgical II examination. Please study accordingly.
Note that preceptors may also assign separate readings, presentations, or papers. You are responsible
for graciously accepting and completing these assignments.
B. Skills Objectives
You and your preceptor shall work together to meet the Skill Objectives. Note that no diagnostic or
therapeutic procedure is to be performed without the direct, explicit consent of the supervising
physician or PA-C. The Skills Checklist will verify the completion of the objectives. You shall turn in
this checklist to the Clinical Education Coordinator at the end of each rotation. Not every skill will be
available during every rotation. In addition, some rotations may offer skills that are not listed. This is
especially true for the selective rotations, PAS 756, 757, 758 & 759. If you perform a skill that is not
listed, please add the task, date, and preceptor’s initials to the bottom or back of the Skills Checklist.
C. Assigned Reading
At a minimum, you should plan on reading for one hour per evening-even if you had the opportunity to
read during the day while on your rotation. This is a good habit to get into now and one to continue
when you have completed the program and are practicing.
D. Capstone Seminar
Students are required to return to the La Crosse campus periodically (every 4 weeks) during the clinical
year to attend the Capstone Seminar Day. This is the last Friday (usually) of the rotation and is held at
the Health Science Center in La Crosse or Mayo campus in Rochester. The day will include written
testing of cognitive objectives from the rotation (the EoR exams), presentations, lectures and activities
pertaining to the development of your professional practice skills. This day is considered part of your
rotation. It is NOT optional. Asking to miss this day or leave early from this day requires a written
request and permission in advance, similar to requests for a rotation absence.
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E. Assessment
Students will be assessed through written End of Rotation exams, Clinical Skills exams, Preceptor
evaluations, timely completion of activities and assignments related to the clinical rotation and Capstone
course syllabi.
1) First Week Report
For each clinical rotation, you must submit a First Week Clinical Rotation Report to the Clinical
Education Coordinator by the date specified in the course syllabus. Although the format is informal, the
content shall include specific information about your preceptor(s), a summary of your typical day, a list
of things that are going well, and a description of your concerns, if any. An example report is included
in Attachment 4 of this manual.
2) Daily Patient Logging
During your clinical rotations, you are required to document your patient care activities using
TYPHON® on-line software. This information should be entered daily. Before beginning your
rotations, you will receive TYPHON® training at the University. The Program uses patient care data to
track your progress during through rotations and to evaluate the quality of clinical sites. In addition, the
logged information may be useful when you apply for job-related hospital and clinic privileges. Failure
to log patient information in a timely manner or falsification of logged information can lead to failure of
a clinical rotation.
3) End of Rotation (EoR) Examinations
You will take a written examination following EVERY required and Selective 1 & 2 rotations. The
selective EoR exam content will reflect general medicine content for primary care
specialties/subspecialties and surgical medicine content for surgical specialties/subspecialties. The
focus of the exam content will be determined by the Clinical Coordinator at the start of the rotation.
Please study accordingly.
4) Preceptor Evaluation of the Student
Each preceptor will evaluate your performance using the established PA Student Clinical Performance
Evaluation form, an example of which is found in this manual (Attachment 5). Often times, only one
preceptor will submit an evaluation of your rotation performance. In this case, the preceptor will solicit
information from other preceptors who have been substantively involved with your clinical education on
the rotation. If you are unclear as to whom your primary preceptor is, please ask the Clinical
Coordinator. The Program encourages the student and preceptor to discuss student progress at the
midpoint of the rotation, and again near the end of the rotation. The evaluation form can provide a basis
for such discussion.
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5) Rotation Grade
A letter grade A - F will be assigned to you for each required and selective I and II rotation based on the
criteria set forth in the course syllabi; this will include your preceptor evaluation(s) and your
performance on the EoR examination. Failure to achieve a "C" on any one rotation (60%) may require
a repeat of the rotation, which could jeopardize your ability to complete the program. Selectives III and
IV are graded Pass/Fail.
You must have a minimum score of 60% on the written examination AND a minimum score of 60% on
the preceptor evaluation to pass the rotation. If you fail to achieve a 60% on the written examination,
you will have the opportunity to repeat the written examination one time. Your written examination
score for the rotation is computed as an average of the first and second attempts to pass the examination.
The average of these two examination attempts must be greater than 60%. If you fail to achieve a
written examination score of 60% upon averaging the two scores you will receive a “D” or an “F” for
the rotation. If you receive a score of less than 60% on the preceptor evaluation, a remediation plan will
be offered at the discretion of the Clinical Coordinator and Program Director, based on the deficiency
noted by the preceptor and student’s prior performance within the program.
Rotation Failures during the Clinical Year
Earning a “D” or an “F” in a course leads to automatic dismissal from the graduate school at UW-La
Crosse. A student has the option to appeal the grade in the course. If the grade is upheld, the student
can appeal the dismissal to the Program. Please see the student policy manual regarding dismissal from
the program and appeals process regarding dismissal.
6) Student Evaluation of Preceptors and Clinical Sites
You will complete a Student Evaluation of the Clinical Site and Preceptor(s) (Attachment 6) after each
rotation. This information is used to evaluate site and preceptor suitability in meeting course
objectives. The information is also used to help determine clinical schedules for future years. There is
an example of this form at the end of this manual.
7) Summative Examinations
Each student must successfully complete a comprehensive examination at the end of the clinical year in
order to graduate from the PA Program. The examination will include a written component and a
clinical skills component. The standard level of performance on the Summative Exam required for
graduation from the program is:
The student must pass both exams independently with a minimum score of 66% or 1.5 standard
deviations below the class mean, whichever is lower, in the context of the student's overall academic
12
and professional performance in the program.
In addition, the last Capstone Seminar course (PAS 794) includes your grades on the written exam,
clinical skills exam, and Capstone project. In order to receive a passing grade for this course, the
Capstone project must be completed with a passing grade. Failure to complete and meet the minimum
standards outlined above for all three components will result in a failing grade (i.e. “D” or “F”). If a
student receives a failing grade for this last Capstone course, as with any other course, the student will
NOT have successfully met the requirements for graduation from the Program. In addition, a grade of
“D” or “F” will be cause for automatic dismissal from Graduate Studies at UW-L. The appeal process
for appealing the course grade as well as appealing for reinstatement to the Program and Graduate
Studies would follow the same process as outlined in the Student Policy Manual and the UW-L
Graduate Catalog.
The experiences of reviewing for and taking these tests will help prepare you for the Physician Assistant
National Certification Exam (PANCE).
HAVE A GREAT YEAR!
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TEXTBOOKS FOR THE CLINICAL PHASE
(Rev. 4/9/2015)
REQUIRED REFERENCES
PAS 732 - Emergency Medicine
Lange Current Diagnosis and Treatment, Emergency Medicine, 7th Edition. 2011. McGraw-Hill.
PAS 720 - Family Medicine
Rakel, Robert E. Textbook of Family Practice, 8th Edition. 2011, Saunders.
PAS 726 - Ob/Gyn
Beckmann, et al. Obstetrics and Gynecology, 7th Edition. 2013, Williams & Wilkins.
PAS 728 - Pediatrics
Behrman, et al. Nelson Essentials of Pediatrics, 7th Edition, 2014, Saunders.
PAS 730 - Psychiatry
Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, 2013, American Psychiatric
Association
PAS 722 - General Internal Medicine
Cecil’s Essentials of Internal Medicine, 9th Edition, Andreoli, Benjamin, Griggs, Wing, Saunders
Elsevier
PAS 724 - Surgery
Dougherty, G.M., Lange’s Current Surgical Diagnosis and Treatment, 14th Edition.McGraw-Hill.
.
RECOMMENDED REFERENCES
Herring, W. Learning Radiology: Recognizing the Basics, 2nd Edition. 2012, McGraw-Hill.
Longo, D. et. al. Harrison's Principles of Internal Medicine, 19th Edition. 2015, McGraw-Hill.
Pagana, K.D. et. al. Mosby’s Manual of Diagnostic and Laboratory Tests, 5th Edition. Mosby
14
McConnell, T.H. The Nature of Disease: Pathology for the Health professions. 2nd edition, 2014,
Lippincott, Williams and Wilkins.
Bickley, et al. Bate’s Guide to Physical Examination and History Taking, 11th edition. 2012, Lippincott.
Skinner, H.B. Lange’s Current Orthopedics Diagnosis and Treatment, 5th Edition. 2013, McGrawHill.
Washington University Manual of Medical Therapeutics, 34th edition. 2013, Lippincott, Williams &
Wilkins.
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Course Descriptions
The Clinical Phase courses involve supervised, practical learning in a variety of practice settings. The
student’s role is similar to the role of the practicing physician assistant and will include diagnostic and
therapeutic management of inpatients and outpatients, observation of clinical procedures, preparation of
written and oral patient communications, and where possible, participation in educational sessions.
Students are expected to spend an average of 40 to 60 hours each week in the supervised setting. In most
rotations, students are also expected to be on-call one night per week and one weekend per month.
Students are also expected to conduct self-directed study to achieve the cognitive course skills.
Student performance for each course is evaluated by preceptor evaluation of clinical skills and written
examination of cognitive objectives. When appropriate, PA Program faculty may perform a site visit. At the
end of each rotation, students will return to campus for written examinations and participation in program
seminars. Successful completion of all clinical rotation courses is required for graduation.
PAS
720
Family Medicine
Rotation
This 4-week rotation provides students with clinical experience in
broad, primary care setting during which students refine their skills in
performing the history and physical exam, ordering and interpreting
diagnostic tests, and developing treatment plans for the diversity of
patients in a typical family medicine practice. Where possible,
students participate in grand rounds, noon conferences and other
clinically relevant didactic presentations. A set of cognitive
objectives guides student reading in preparation for a written
examination at the end of the rotation.
PAS
722
Internal Medicine This 4-week rotation provides students with clinical experience in an
Rotation
inpatient or an outpatient internal medicine setting during which
students refine their skills in performing the history and physical
exam, ordering and interpreting diagnostic tests, and developing
treatment plans for the diversity of patients in a typical internal
medicine practice. Where possible, students participate in grand
rounds, noon conferences and other clinically relevant didactic
presentations. A set of cognitive objectives guides student reading in
preparation for a written examinations at the end of the rotation.
PAS
724
General Surgery
Rotation
This 4-week rotation provides students with clinical experience in a
general surgery setting during which students refine their skills in
performing the history and physical exam, ordering and interpreting
diagnostic tests, assisting with surgery and developing treatment plans
for the diversity of patients in a typical general surgery practice.
Where possible, students participate in grand rounds, noon
16
conferences and other clinically relevant didactic presentations. A set
of cognitive objectives guides student reading in preparation for a
written examinations at the end of the rotation.
PAS
726
Obstetrics and
Gynecology
Rotation
This 4-week rotation provides students with clinical experience in an
obstetrics and gynecology setting during which students refine their
skills in performing the history and physical exam, ordering and
interpreting diagnostic tests, assisting with deliveries and gynecologic
surgery, and developing treatment plans for the diversity of patients in
a typical ob/gyn practice. Where possible, students participate in
grand rounds, noon conferences and other clinically relevant didactic
presentations. A set of cognitive objectives guides student reading in
preparation for a written examinations at the end of the rotation.
PAS
728
Pediatric Rotation This 4-week rotation provides students with clinical experience in a
pediatric setting during which students refine their skills in
performing the history and physical exam, ordering and interpreting
diagnostic tests, and developing treatment plans for the diversity of
patients in a typical pediatric practice. Where possible, students
participate in grand rounds, noon conferences and other clinically
relevant didactic presentations. A set of cognitive objectives guides
student reading in preparation for a written examinations at the end of
the rotation.
PAS
730
Psychiatry
Rotation
This 4-week rotation provides students with clinical experience in a
psychiatry setting during which students refine their skills in
performing the history and physical exam, ordering and interpreting
diagnostic tests, and developing treatment plans for the diversity of
patients in a typical psychiatric practice. Where possible, students
participate in grand rounds, noon conferences and other clinically
relevant didactic presentations. A set of cognitive objectives guides
student reading in preparation for a written examinations at the end of
the rotation.
PAS
732
Emergency
Medicine
Rotation
This 4-week rotation provides students with clinical experience in an
emergency medicine setting during which students refine their skills
in performing the history and physical exam, ordering and
interpreting diagnostic tests, and developing treatment plans for the
diversity of patients in a typical emergency medicine practice. Where
possible, students participate in grand rounds, noon conferences and
other clinically relevant didactic presentations. A set of cognitive
17
objectives guides student reading in preparation for a written
examinations at the end of the rotation.
PAS
756
and
757
Selective I
PAS
758
and
759
Selective III
Selective II
Selective IV
The student selects a clinical area for the selective clinical rotation(s)
with the approval of program faculty. The clinical rotation is to be
completed within the student’s assigned health system. Students
may select clinical experiences from specialty areas not included in
the required rotations, or in one of the required clinical areas. During
this rotation, students will refine their skills in performing the history
and physical examination, ordering and interpreting diagnostic tests,
and developing plans for the diversity of patients in the chosen
medical or surgical specialty. Where possible, students participate in
grand rounds, noon conferences and other clinically relevant didactic
presentations. A set of cognitive objectives guides student reading in
preparation for a written examination at the end of the rotation.
The student selects a clinical area for the selective clinical rotation with the
approval of program faculty. The clinical rotation may be completed within
or outside of the student’s assigned health system. Students may select
clinical experiences from specialty areas not included in the required
rotations, or in one of the required clinical areas. With the consultation and
approval of program faculty, the student develops an individualized learning
contract that includes objectives for the rotation, and a method to
demonstrate achievement of these objectives at the conclusion of the
rotation. When possible and appropriate, students participate in grand
rounds, noon conferences and other clinically relevant didactic presentations.
18
EMERGENCY MEDICINE ROTATION
PAS 732
4 semester credits
During this clinical rotation, the physician assistant (PA) student is expected to attain an adequate level
of knowledge in the areas listed below. An adequate level of knowledge is defined as sufficient
knowledge, when combined with adequate clinical skills, to treat or refer conditions as encountered in a
primary care or family practice setting.
COGNITIVE OBJECTIVES
1. Describe the pathophysiology, diagnosis and management of the following disorders and
diseases in the emergency room patient:
acute respiratory distress
acute abdomen
anaphylaxis
animal / human bites
appendicitis
asthma
blunt / sharp trauma
burns
cardiac arrest
cerebral vascular accident
chest pain / angina / acute MI
coma
congestive heart failure
diabetic emergencies
drowning
drug/alcohol abuse / overdose / intoxication
esophageal varices and GI bleeding
farming / occupational accidents
foreign bodies
fractures / dislocations
head and neck injuries
hemorrhage
hunting and fishing accidents
hypertensive crisis
hypo / hyperthermia
lacerations
obstetric emergencies
ocular emergencies
orthopedic emergencies
pericarditis
pneumothorax
poisoning
psychiatric emergencies
pulmonary embolism
renal and urinary tract infections
respiratory and HEENT infections
seizures
sexual assault
shock
2. Describe the indications and procedures for Basic Life Support (BLS), Advanced Cardiac
Life Support (ACLS), and Advanced Trauma Life Support (ATLS) in the adult and pediatric
emergency patient.
3. Know how to appropriately order and interpret diagnostic and laboratory tests as they pertain
to the emergency medicine patient.
19
4. Describe the process of patient triage in both the pre-hospital and hospital emergency room
environments.
5. Identify and describe equipment, instruments and medications commonly used in emergency
medicine.
6. Develop knowledge of CPT and ICD codes for emergency medicine procedures and diseases.
SKILL OBJECTIVES
The PA student shall reach a skill performance level commensurate with his or her peers in the
following areas:
1. Obtain an appropriate and complete history from the emergency room patient, including:
Allergies
Chief complaint
Family history
History of present illness
Medications
Past medical history
Social history
Surgical history
2. Collect a focused history from the patient or a third party representative, if the patient is unable
to provide a competent history.
3. Perform an appropriate and complete physical examination of the emergency room patient
guided by pertinent data from the patient’s history.
4. Perform a methodical, rapid and accurate screening physical examination in the emergency
medicine patient, including:
Abdomen
Chest
Extremities
General appearance
HEENT
Mental status
Neurological
5. Ventilate a patient with an Ambu bag or demand valve and face mask in an emergency situation.
6. Perform an arterial puncture to obtain ABG information.
7. Outline the steps of BLS and ACLS in a cardiac arrest situation.
8. Observe, perform or assist with endotracheal intubation.
9. Observe, perform or assist urinary bladder catheterization in both male and female patients.
10. Administer local infiltrative anesthesia.
11. Cleanse and debride wounds and burns.
12. Close uncomplicated lacerations. (suture, derm glue, staples)
13. Observe, perform or assist with a lumbar puncture.
14. Interpret an emergency EKG, and order and interpret imaging studies and lab tests in the
emergency department setting.
15. Observe, perform or assist with reduction of a fracture/dislocation.
16. Apply and remove circumferential casts.
17. Apply extremity splints.
20
18. Apply slings or ace bandages to upper and lower extremities.
19. Provide appropriate patient education to the emergency room patient or third-party
representative regarding proper medication use and care of injuries and illnesses.
20. Apply fluorescein eye drops to the patient with a suspected corneal abrasion.
20. Assist with or perform the insertion of a nasogastric tube.
21. Observe or perform a slit lamp examination.
22. Obtain intravenous access for the purpose of administering fluids or medications.
21
Emergency Medicine Skills Checklist
Name____________________________________
Date ______________________________
Preceptor_________________________________ Site ______________________________
The Preceptor or clinical staff member shall initial the following skills as they are completed.
Task
Date
Obtain a complete history, physical exam, differential
diagnosis, and treatment plan from an emergency patient,
and present it to the preceptor.
Ventilate a patient in an emergency situation.
Outline the steps in BLS and ACLS in a cardiac arrest
situation.
Perform an arterial puncture for ABG’s.
Observe, perform or assist with endotracheal intubation.
Observe, perform, or assist with urethral catheterization of
a male and female patient.
Administer local anesthesia.
Cleanse and debride a wound.
Close a wound or laceration. (Suture, staple, derm glue)
Observe, perform or assist with a lumbar puncture.
Interpret an EKG obtained in the emergency setting.
Apply or remove a circumferential cast.
Apply an extremity splint.
Apply an upper extremity sling or other extremity device.
Perform patient education regarding proper use of
medications and/or home care of an injury or illness.
Instill fluoroscein eye drops.
Insert or assist with insertion of a nasogastric tube.
Observe or perform a slit lamp examination.
Obtain intravenous access for fluids or medications.
Reduction of a fracture/dislocation
22
Initials
FAMILY MEDICINE ROTATION
PAS 720
4 semester credits
The ideal Family Medicine preceptor site offers prenatal obstetrical care and includes at least one family
physician, who supervises one or more advanced practice providers.
The site shall identify a primary preceptor with whom the student will spend 50 – 80% of his or her
time.
COGNITIVE OBJECTIVES
During this clinical rotation, the physician assistant (PA) student is expected to attain an adequate level
of knowledge in the areas listed below. An adequate level of knowledge is defined as sufficient
knowledge, when combined with adequate clinical skills, to treat or refer conditions as encountered in a
primary care or family practice setting.
1. Describe the pathophysiology, diagnosis, and management of the following diseases and
disorders:
Abdominal pain
Acne
Actinic keratosis
Alcohol/drug overuse / abuse
Amenorrhea
Anemia
Angina
Anxiety disorders
Arthritis
Asthma
Benign prostatic hypertrophy
Bipolar disorder
Bowel obstruction
Breast masses and malignancies
Bronchitis
Burns, chemical and thermal
Carpal tunnel syndrome
Cataracts
Cellulitis
Cerebrovascular accident
Cervical dysplasia
Cholelithiasis/cholecystitis
Irritable Bowel Disease
Iritis
Ischemic heart disease
Labyrinthitis
Low back pain
Lyme disease
Mastitis
Menorrhagia
Mitral valve prolapse
Multiple sclerosis
Obesity
Otitis externa
Otitis media (serous/purulent)
Osteomyelitis
Osteoporosis
Parkinson’s disease
Pelvic inflammatory disease
Peptic ulcer disease
Peripheral neuropathy
Pharyngitis
Pneumonia
Psoriasis
23
Coagulopathies
Colon cancer
Common knee injuries
Common skin cancers
Congestive heart failure
Conjunctivitis
Contact dermatitis
COPD
Corneal abrasion / foreign body
Croup
Cystic fibrosis
Decubitus ulcer
Dementia
Depression
Diabetes mellitus type 1 and type 2
Diarrhea
Dysfunctional uterine bleeding
Eczema
Epididymitis
Epiglottitis
Esotropia and exotropia
Fractures, sprains, and strains
Gastroenteritis
Gastrointestinal bleeding
Glaucoma
Gout
Headache
Hearing loss
Hemorrhoids
Hematuria
Hepatitis
Hernias
Herpes Zoster
HIV/AIDS
Hyperlipidemia
Hypertension
Hypertensive cardiovascular disease
Hyperthyroidism
Hypothyroidism
Impetigo
Inflammatory bowel disease
Prostate carcinoma
Pyelonephritis
Pulmonary embolism
Scabies / lice
Seborrheic keratosis
Seizure disorder
Sexually transmitted diseases
Sinusitis
SLE
Sleep disorders
Tendonitis
Tennis elbow
Testicular torsion
Thrush
Tonsillitis
Transient ischemic attack
Tuberculosis
Ureteral calculi / nephrolithiasis
Urinary tract infection
Upper respiratory infections
Urinary incontinence
Urinary tract infection
Vaginitis
Varicocele
Varicose veins
Vertigo
Viral exanthems
Prostate carcinoma
2. Understand and manage the following health maintenance issues:
Accident prevention in children
Cancer screening (breast, colon, prostate,
skin)
Cardiovascular fitness
Childhood growth/development
24
Hypertension screening
Immunizations
Lipid screening
Tobacco cessation
Diabetes screening
Weight management
3. Discuss appropriate pharmacologic management of the following:
Acne
Bacterial meningitis
Bronchitis
Candidiasis
Conjunctivitis
Depression
Influenza
Onychomycosis
Osteomyelitis
Otitis externa
Otitis media
Pelvic inflammatory disease
Pharyngitis
Pneumonia
SBE
Sinusitis
Soft tissue infections
Urinary tract infections
Vaginitis / vaginosis
4. Explain the physiology and clinical significance, and list a differential diagnosis for the
following heart sounds:
Cardiac rub
Ejection click
Innocent murmur
Murmur of aortic insufficiency
Murmur of aortic stenosis
Murmur of mitral insufficiency
Murmur of mitral stenosis
Opening snap
S3, S4 gallop
5. Develop sufficient knowledge to appropriately order and interpret the following laboratory
and diagnostic tests:
Abdominal x-rays (flat & upright)
Barium enema
Blood gas and pH
Glucose tolerance test
Gram stain
Hematologic evaluation (Hgb, Hct, RBC
indices, reticulocytes, arterial Coombs test,
iron and iron binding)
HgbA1c
Pulmonary function test
Renal function tests
Serum electrolytes
Skeletal x-rays
T4
TSH
Upper GI (barium swallow)
Urinalysis
Vitamin B12
Bone densitometry
Blood chemistry profile
Blood lipid studies
Cardiac enzymes
CBC with differential
Chest x-ray
Coagulation studies
Culture and antibiotic sensitivities
Direct and indirect bilirubin
Electrocardiogram
Ferritin
Folate
25
6. Understand basic electrocardiography concepts and interpretation, including:
• axis deviation
• diagnosis of supraventricular arrhythmias
• diagnosis of ventricular arrhythmias
• ventricular hypertrophy
• diagnosis / location of acute transmural MI
7. Understand the indications, contraindications, and methodology for treadmill exercise
testing.
8. Differentiate the pain of stable and unstable angina pectoris from non-cardiac chest pain.
9. Define hypertensive cardiovascular disease and clinical methods for making the diagnosis.
10. Describe the appropriate history, physical and diagnostic evaluation, and provide a
differential diagnosis for the following complaints or symptoms:
Chronic cough
Hemoptysis
Hoarseness
Shortness of breath
Sputum production
11. Identify individuals and agencies that might assist with diagnosis and management of
patients with psychiatric problems.
12. Identify clinical indicators for psychiatric referral, and assess suicide risk factors in
adolescent, adult and geriatric populations.
13. Develop knowledge of current CPT and ICD coding of common diagnoses and procedures in
family medicine.
14. Describe the principles of wound healing and closure.
15. Describe the indications for surgical consultation and/or operative treatment in disorders
such as abdominal pain, gastrointestinal bleeding, lesion biopsy, and chest and abdominal
trauma.
16. Describe the indications for the following outpatient procedures: vasectomy, excisional
biopsy of skin lesions, flexible sigmoidoscopy or colonoscopy, joint/bursa aspirations and
injections.
17. List the risk factors, diagnostic and therapeutic considerations, and indications for referral of
patients with neurologic deficits possibly caused by ischemic stroke or intracerebral
hemorrhage.
18. Identify diagnostic and therapeutic considerations and indications for referral of patients
with ophthalmic foreign bodies and trauma.
19. Describe the indications, contraindications, and potential complications of applying long
arm, short arm, short leg and thumb spica casts, and upper and lower extremity splints.
20. Identify developmental milestones, health maintenance issues, and immunization schedules
for children from birth through adolescence.
21. Describe clinical indicators of abuse, neglect, dehydration, meningitis, and failure to thrive
in the pediatric and geriatric populations.
26
22. Identify the clinical indicators and techniques for managing the following complications of
diabetes mellitus:
Cardiovascular disease
Altered immunity
Hypoglycemic reactions
Diabetic Ketoacidosis
Nephropathy
Neuropathy
Retinopathy
23. Describe the indications, contraindications and appropriate dose of the following
medications used to treat diabetes mellitus:
alpha glucosidase inhibitors
biguanides
insulin
meglitinides
sulfonylureas
thiazolidinedione
24. Describe the innervation of the bladder and the consequences of loss of innervation.
25. Describe the indications and contraindications for the following medications used to treat
thyroid disease:
levothyroxine
methimazole
propylthiouricil
radioactive iodide
SKILL OBJECTIVES
The PA student shall reach a skill performance level commensurate with his or her peers in the
following areas:
1. Reach a performance level in primary care commensurate with peers in the following skill
areas:
• eliciting an appropriate medical history
• performing an appropriate physical exam including rectal examination with
hemoccult testing
• ordering and interpreting appropriate laboratory tests
• formulating and implementing a medical management plan
2. Demonstrate proper technique when performing the following physical examinations, and
verify by documentation that the student has been observed performing:
• Breast examination
• Female bimanual examination
• Pelvic speculum examination of the vagina and cervix
• Rectal examination with hemoccult testing
27
•
3.
Testicular examination
Perform the following skills at the level of a graduate PA:
• Applying and removing casts and splints
• Applying dressings
• Biopsying and excising superficial skin lesions
• Collecting culture specimens
• Interpreting EKGs
• Performing pelvic exams and Pap smears
• Suturing lacerations
• Treating warts and calluses
• Treating or removing an injured or diseased toe nail
4. Identify the following landmarks on the chest x-ray:
aortic knob
left atria
left atrial appendage
left ventricle
main pulmonary artery segment
right ventricle
5. Observe physical therapy, occupational therapy, medical nutrition therapy, and speech
therapy in the hospital or outpatient setting.
6. Observe audiometric and pulmonary function testing.
7. Participate in the longitudinal management of nursing home residents.
8. Participate in the care of acutely hospitalized patients by performing admission history and
physical examinations, progress notes and patient rounds.
9. Demonstrate appropriate skill in reading 12-lead EKGs and plain films of the extremities
and chest.
10. Identify common landmarks and pathology on upper and lower extremity radiographs.
28
Family Practice Skills Checklist
Name____________________________________
Date ______________________________
Preceptor_________________________________ Site ______________________________
The Preceptor or clinical staff member shall initial the following skills as they are completed.
29
Task
Date
Perform a complete history and physical examination
along with differential diagnosis and treatment plan, and
present it to the preceptor.
Apply and remove a cast.
Apply a splint.
Manage a wound: cleanse, debride, dress
Biopsy or excise a superficial skin lesion.
Collect a throat culture specimen/influenza swab
Collect a wound culture specimen.
Interpret an EKG.
Perform a gynecologic exam – breast, pelvic speculum &
bimanual exam, Pap smear
Close a wound/laceration with sutures, staples or derm
glue
Treat warts. (acid, cautery, liquid nitrogen)
Treat an ingrown toenail or remove a toe nail.
Identify routine landmarks on a chest x-ray.
Observe PT in an inpatient or outpatient setting.
Observe OT in an inpatient or outpatient setting
Observe speech therapy in an inpatient or outpatient
setting
Observe medical nutrition therapy in an inpatient or
outpatient setting
Observe audiometric testing.
Observe pulmonary function testing.
Perform ear irrigation
Removal of a foreign body
30
Initials
Family Practice Skills Checklist, con’t
Participate in the longitudinal management of a nursing
home resident.
Perform an admission history and physical exam.
Perform a focused (system) examination.
Perform a preoperative history and physical exam.
Accurately read a plain film of the upper extremity.
Accurately read a plain film of the lower extremity.
Perform a rectal examination with hemoccult testing.
Perform a testicular examination.
31
GENERAL SURGERY ROTATION
PAS 724
4 semester credits
During this clinical rotation, the physician assistant (PA) student is expected to attain an adequate level
of knowledge in the areas listed below. An adequate level of knowledge is defined as sufficient
knowledge, when combined with adequate clinical skills, to treat or refer conditions as encountered in a
primary care or family practice setting.
COGNITIVE OBJECTIVES
1. Describe the pathophysiology, diagnosis and management of the following disorders and
diseases as they relate to the surgical patient:
abdominal aortic aneurysm
acute abdomen
adenocarcinoma of the prostate
adenomatous polyp of the colon
adhesions
adult respiratory distress syndrome
anal fissure and fistula
appendicitis
arteriosclerosis obliterans
ascites
benign prostatic hyperplasia
bowel infarction
breast cancer
carcinoma of the lung
carotid artery stenosis
cholangitis
cholecystitis
choledocholithiasis
cirrhosis
colon cancer
Crohn’s disease
dialysis access
disseminated intravascular coagulation
diverticulitis
diverticulosis
ectopic pregnancy
esophageal varices
gastric carcinoma
gastric ulcer
gastrointestinal bleeding
hemorrhoids
hepatomas
hepatomegaly
hernias
hiatal hernia
intestinal obstruction
jaundice
kidney stone
lipoma
malignant hyperthermia
melanoma
morbid obesity
pancreatic carcinoma
pancreatitis
peptic ulcer disease
reflux esophagitis
splenomegaly
stress ulcer (Curling’s)
testicular mass
thyroid nodule
thyroid carcinoma
trauma to thorax, abdomen, pelvis
ulcerative colitis
varicose veins
32
fecal impaction
fibroadenoma of the breast
fibrocystic breast changes
vascular disease
venous stasis disease and ulcers
2. Describe the various metastatic pathways associated with the malignancies listed above.
3. Recognize and describe common radiographic findings in studies used in the surgical
setting, such as:
abdominal / pelvic ultrasound
arteriography
cervical spine x-ray
chest x-ray
CT scan of the abdomen
double contrast barium enema
KUB, flat and upright
lumbosacral spine
mammography
MRI
pelvic films
skeletal studies
skull films
upper GI with barium swallow
4. Describe the physiology and management of fluid and electrolyte balance in the surgical
patient.
5. Recognize and describe electrocardiographic abnormalities in the surgical patient.
6. Recognize and describe abnormal laboratory and diagnostic data in the surgical patient.
Relate that data to the patient’s pathophysiology.
7. Describe common medicinal agents used in the induction and maintenance of anesthesia,
including paralytic agents. Understand their indications, contraindications, side effects, and
drug interactions. Know the various local anesthetics used, time of onset and duration of
action.
8. Recognize and describe anaphylaxis and drug reactions and their management in the surgical
patient.
9. Describe the pathophysiology and management of post-operative sequelae in the surgical
patient including:
acute renal failure
adult respiratory distress syndrome
arterial occlusion
cardiac arrhythmias
decubitus ulcers
deep venous thrombosis
dehiscence
fluid overload
myocardial infarction
nosocomial infections
pneumonia
postop bleeding
pulmonary embolism
septic shock
urinary tract infection
urinary retention
wound infection
10. Describe wound healing principles and wound closure techniques in the surgical patient.
Know the pros, cons and indications for the different suture materials.
11. Develop knowledge of current CPT and ICD codes for surgical procedures and disease.
33
SKILL OBJECTIVES
The PA student shall reach a skill performance level commensurate with his or her peers in the
following areas:
1. Obtain an appropriate and complete history from the surgical patient including:
allergies
chief complaint
family history
history of present illness
medications
past medical history
review of systems
social history
surgical history
2. Perform an appropriate and complete physical examination of the surgical patient guided by
pertinent data from the patient’s history and illness.
3. Order and interpret appropriate laboratory and diagnostic tests in the pre- and postoperative
surgical patient.
4. Collect fluid samples from wounds or drains for bacterial culture.
5. Employ proper sterile technique in the surgical setting.
6. Assist the surgeon in major and minor surgical procedures.
7. Suture and staple surgical incisions, and remove sutures and staples when appropriate.
8. Observe or assist with the insertion, removal and adjustment of wound drains.
9. Describe and record characteristics of drainage fluid from percutaneous drains.
10. Apply, check or change wound dressings.
11. Perform routine preoperative and postoperative care in the surgical patient.
12. Describe surgical procedures and potential complications.
13. Understand the definition, purpose and process of informed consent in surgical practice.
14. Clean and debride cuts, abrasions, burns or wounds and note progress of healing.
15. Assist with or perform an excisional biopsy.
16. Administer a tissue infiltration anesthetic.
17. Observe a colonoscopy and gastric endoscopy. If necessary, schedule time in the
Gastroenterology department.
18. Observe or assist with the placement of an endotracheal tube.
19. Document or prepare routine surgical orders, progress notes and discharge summaries for the
patient chart.
20. Observe placement of central venous lines.
34
General Surgery Skills Checklist
Name____________________________________
Date ______________________________
Preceptor_________________________________ Site ______________________________
The Preceptor or clinical staff member shall initial the following skills as they are completed.
Task
Date
Obtain a complete history and physical exam from a
surgical patient, and present it to a preceptor along with
the differential and a treatment plan.
Obtain a wound culture.
Obtain a drain culture.
Employ proper sterile technique in the surgical setting.
Assist the surgeon in a major surgical procedure.
Close a surgical incision with staples or sutures.
Remove sutures.
Remove staples.
Observe or assist with the insertion, removal or
adjustment of a wound drain.
Describe and record the characteristics of drainage from a
percutaneous drain.
Check and change a wound dressing.
Observe the acquisition of informed consent for a surgical
procedure.
Describe a surgical procedure and potential complications
to an attending physician, PA or patient.
Clean and debride a cut, abrasion or burn.
Perform or assist with an excisional biopsy.
Administer a local anesthetic.
Observe a colonoscopy.
Observe an esophagogastroduodenoscopy.
35
Initials
General Surgery Skills Checklist, con’t
Observe, peform or assist with the placement of an
endotracheal tube.
Observe the placement of a central venous line.
Observe, assist or perform urethral catheterization of a
male or female patient
Observe, assist or perform insertion of NG tube.
Prepare a discharge summary.
Order and interpret appropriate laboratory and diagnostic
tests in the pre- and postoperative surgical patient.
Observe or assist with patient education.
36
INTERNAL MEDICINE ROTATION
PAS 722
4 semester credits
During this clinical rotation, the physician assistant (PA) student is expected to attain an adequate level
of knowledge in the areas listed below. An adequate level of knowledge is defined as sufficient
knowledge, when combined with adequate clinical skills, to treat or refer conditions as encountered in a
primary care or family practice setting.
COGNITIVE OBJECTIVES
1. Describe the pathophysiology, diagnosis, and management of the following diseases and
disorders:
adult respiratory distress syndrome
anemia
angina
aortic valve insufficiency
aortic valve stenosis
arthritis
asthma
arteriosclerotic cardiovascular disease
benign prostatic hypertrophy
bronchitis
bursitis
cardiac tamponade
cardiogenic shock
Cardiomyopathies (congestive, restrictive,
obstructive)
cerebral vascular accident
Chlamydia
cholecystitis/cholelithiasis
common arrhythmias
community acquired pneumonia
congenital cardiac abnormalities
congestive heart failure
conjunctivitis
Cushing’s syndrome
delirium
dementia
diabetes mellitus, type 1 and type 2
37
hypertension
hypertensive crisis
hypertensive cardiovascular disease
hyperthyroidism
hyperventilation
hypothyroidism
infectious and noninfectious diarrhea
inflammatory bowel disease
lung cancer
migraine and tension headache
mitral valve stenosis
mitral valve insufficiency
mitral valve prolapse
mononucleosis
multiple sclerosis
myocardial infarction
osteoporosis
peptic ulcer disease
pericarditis
peripheral vascular disease
pernicious anemia
pertussis
pneumonthorax
pseudogout
pulmonary embolism
pulmonary edema
diphtheria
emphysema
folate deficiency
glaucoma
goiter
gonorrhea
gout
hemolytic anemia
hemorrhoids
hepatitis
herpes simplex
herpes zoster
HIV infection
hyperlipidemia
rheumatic fever
sepsis
septic arthritis
strep pharyngitis
subacute bacterial endocarditis
syphilis
tuberculosis
thyroiditis
thyroid nodules
trichomonas
unstable vs. stable angina
vaginitis
venous stasis
venous thrombosis
2. Demonstrate general knowledge of the following patient monitoring devices or methods and
describe indications for each:
Arterial line
Mechanical ventilator
Pulse oximeter
telemetry
3. Gain knowledge sufficient to appropriately order and interpret the following laboratory and
diagnostic exams:
abdominal x-rays (flat plate and upright)
acid fast stain
barium enema
blood chemistry profile
blood gases and pH
blood lipid studies
cardiac enzymes
chest x-ray
coagulation tests
coronary artery angiography
CT of head, chest and abdomen
culture and antibiotic sensitivities
cytological exam
direct and indirect bilirubin
echocardiogram
electrocardiogram
exercise stress test
38
glucose tolerance test
gram stain
hemoccult
hematologic evaluation (reticulocytes,
Coombs test, iron & iron binding)
HgbA1c
inflammatory screen (ESR, CBC with
differential ANA, RA, ASO titer)
pulmonary function test
renal function tests
serology (VDRL, FTA)
serum electrolytes
skull and cervical spine x-rays
sputum smear, culture, and EEG
TSH, FTI, T4, and other thyroid tests
thoracentesis
urinalysis
upper GI (barium swallow)
ventilation perfusion scan
extremity x-rays
ferritin
vitamin B12 and folate
4. Understand the anatomic and physiologic changes unique to the geriatric population for the
following issues:
• drug interactions (including over-the-counter drugs)
• effects of aging on pharmacologic properties of medications
• drug level monitoring
• polypharmacy
• age-related changes in bladder function
• problems associated with these common medications
o
o
o
o
o
o
o
o
anticholinergics and antispasmodics
benzodiazepines
antidepressants
digoxin
antihypertensives
diuretics
antipsychotics
laxatives
5. Understand the significance of the following ethical issues:
• Advance directives
• Autonomy
• Beneficence
• Competence/informed consent
6. List the major causes of falls in the elderly.
7. List current immunization recommendations for the elderly.
8. Select appropriate antibiotics for a specific clinical diagnosis (e.g., pneumonia, UTI,
osteomyelitis) or a specific pathogen (e.g., Mycobacterium tuberculosis, Klebsiella sp.)
9. Explain the physiology and clinical significance, and list a differential diagnosis for the
following heart sounds:
Cardiac rub
Ejection click
Innocent murmur
Murmur of aortic insufficiency
Murmur of aortic stenosis
Murmur of mitral insufficiency
Murmur of mitral stenosis
Opening snap
S3, S4 gallop
10. Understand how the following pharmacologic agents are used to manage diabetes:
• Insulin (pens, pumps and injections)
• Oral antihyperglycemic agents, including: biguanides/metformin, meglitinides,
biguanides, thiazolidinediones, alpha-glucosidase inhibitors, incretin mimetics, DPPIV inhibitors)
11. Understand how the following pharmacologic agents are used to manage thyroid disease:
39
Levothyroxine
Methimazole
Propylthiouracil (PTU)
Radioactive iodine
12. Describe the appropriate evaluation of the following symptoms:
Abdominal pain
Chest pain
Constipation
Cough
Diarrhea
Dyspnea
Fever
Headache
Hemoptysis
Hoarseness
Sputum production
Weight gain
Weight loss
13. Define the following terms:
Acidemia
Acidosis
Alkalemia
Alkalosis
Cheyne-Stokes respiration
Hyperventilation
Hypoventilation
Hypoxemia
Hypoxia
14. Develop knowledge of current CPT and ICD coding of common diagnoses and procedures in
internal medicine.
SKILL OBJECTIVES
The PA student shall reach a skill performance level commensurate with his or her peers in the
following areas:
1. Demonstrate and reach a performance level commensurate with peers in the following skill
areas:
• obtaining an appropriate and complete history for patients with the variety of
problems and in a variety of general internal medicine care settings
• performing an appropriate and complete physical examination
• ordering and interpreting appropriate laboratory tests
• formulating an appropriate differential diagnosis and problem list
• proposing an appropriate treatment plan
• providing appropriate medical instruction and patient education to help patients
understand their conditions
• selecting and implementing an appropriate treatment and evaluation plan
• determining an appropriate frequency for follow up
40
2. Identify the following landmarks on chest x-ray:
aortic knob
Kerley B lines
left atrial appendage
left atrium
left ventricle
main pulmonary artery segment
right ventricle
tracheal bifurcation
3. Observe or assist with the following tests and procedures:
cardiac catheterization
colonoscopy
endoscopic gastroscopy
exercise stress test
pulmonary function test
4. Participate in the management of several ICU, CCU, and /or critical care patients.
5. Observe and/or participate in diabetic education and cardiac rehabilitation programs.
6. Develop skills in continuity of care by participating in the care of patients with chronic
medical problems such as diabetes mellitus, hypertension, atherosclerotic heart disease, and
chronic obstruction pulmonary disease.
7. Demonstrate appropriate skill in reading chest x-rays.
8. Understanding of basic EKG concepts and interpret EKG findings including:
Acute transmural myocardial infarction
Atrial and ventricular hypertrophy
Atrial fibrillation and flutter
Atrial enlargement
AV blocks
Axis deviation
Bundle branch blocks
Myocardial ischemia
Supraventricular tachycardia
Supraventricular arrhythmias
Ventricular arrhythmias
Ventricular hypertrophy
9. Observe or assist in the placement of a chest tube.
10. Observe, assist or perform a paracentesis.
41
Internal Medicine Skills Checklist
Name____________________________________
Date ______________________________
Preceptor_________________________________ Site ______________________________
The Preceptor or clinical staff member shall initial the following skills as they are completed.
Task
Date
Perform a complete history and physical examination with
differential diagnosis and treatment plan, and present it to
a preceptor.
Recognize normal landmarks and pathological findings on
a chest x-ray.
Observe or assist with cardiac catheterization.
Observe or assist with a colonoscopy.
Observe or assist with an esophagogastroduodenoscopy
(EGD).
Observe or assist with an exercise stress test.
Observe pulmonary function testing.
Participate in the management of an ICU patient.
Observe or participate in diabetic education.
Observe or participate in the administration of a cardiac
rehabilitation program.
Recognize or describe common EKG findings as listed
below:
Acute transmural myocardial infarction
Atrial and ventricular hypertrophy
Atrial fibrillation
Atrial flutter
Axis deviation
Bundle branch blocks
AV blocks
42
Initials
Internal Medicine Skills Checklist, con’t
Myocardial ischemia
Supraventricular arrhythmias
Ventricular arrhythmias
Observe or assist with the placement of a chest tube.
Observe, perform or assist with a paracentesis.
43
OBSTETRICS AND GYNECOLOGY ROTATION
PAS 726
4 semester credits
During this clinical rotation, the physician assistant (PA) student is expected to attain an adequate level
of knowledge in the areas listed below. An adequate level of knowledge is defined as sufficient
knowledge, when combined with adequate clinical skills, to treat or refer conditions as encountered in a
primary care or family practice setting.
COGNITIVE OBJECTIVES
1. Describe the pathophysiology, diagnosis and management of the following conditions
related to gynecology:
breast abscess
breast fibroadenoma
cysts, Bartholin’s & Nabothian
cystocele
endometriosis / adenomyosis
fibrocystic breast disease
infertility
intraductal papilloma
leiomyoma / myoma
mastitis
ovarian cysts
ovarian torsion
polycystic ovary syndrome
polyps
rectocele
uterine prolapse
urinary incontinence (stress, urge)
intrauterine DES exposure
vulvar dystrophies
2. Describe the pathophysiology, diagnosis and management of the following common
gynecological infectious conditions:
cervicitis-gonorrhea, chlamydia, herpes
simplex, HPV
chancroid
lymphogranuloma venereum
pelvic inflammatory disease (PID)
Syphilis
vaginitis-atrophic, bacterial vaginosis,
candidiasis, trichomoniasis
HPV-genital warts
cystitis
3. Describe the pathophysiology, diagnosis and management of the following common
gynecological neoplastic conditions. Know the primary and secondary prevention measures
and the evidence-based risk factors for each:
breast cancer
cervical dysplasia
endometrial cancer
ovarian neoplasms
44
cervical carcinoma
osteoporosis
vaginal/vulvar neoplasms
4. Describe the normal and abnormal menstrual cycles and the pathophysiology, diagnosis
and management of the following menstrual disorders:
amenorrhea, primary & secondary
dysfunctional uterine bleeding
dysmenorrhea
menopause
post-menopausal bleeding
premenstrual syndrome
5. Identify and describe sexual function and dysfunction.
6. Identify the indications, contraindications, and procedures for the following contraceptive
methods including:
abstinence
natural family planning
barrier methods (condom, diaphragm & spermicide
cervical cap)
Depo-Provera injection
tubal ligation
hormonal contraception (oral, patch, ring)
vasectomy
IUD
7. Identify and describe appropriate methods for diagnosing pregnancy.
8. Identify and describe the methods for estimating gestational age throughout pregnancy.
9. Identify and describe the appropriate laboratory and sonographic procedures employed to
identify at-risk fetuses throughout pregnancy.
10. Identify risks associated with prenatal exposures to infections and substances known to have
potential teratogenic effects (toxoplasmosis, CMV, prescribed and/or illicit drugs, rubella, etc.).
11. Identify and describe the maternal and fetal physiologic changes that occur throughout the
course of pregnancy and routine gestational screenings (e.g., diabetes, group B strep).
12. Describe the process and indicators of a normal versus abnormal labor and delivery,
indications for use of Pitocin, and indications for Cesarean delivery.
13. Identify and describe complications arising with pregnancy and/or labor and delivery:
abdominal trauma
abortion
abruptio placentae
breech presentation
diabetes-gestational, type 1 & 2
dystocia
ectopic pregnancy
fetal distress
fetal demise
gestational trophoblastic disease
hyperemesis gravidarum
incompetent cervix
intrauterine growth retardation
multiple gestation
placenta previa
pregnancy-induced hypertension
preeclampsia/eclampsia
premature rupture of membranes
prolapsed umbilical cord
preterm labor
45
hemorrhoids
Rh-incompatibility
14. Describe and interpret APGAR scores.
15. Describe the physiologic changes during the post-partum period and management of perineal
laceration, postpartum hemorrhage/uterine atony and endometritis.
16. Identify the indications for and describe the following procedures:
amniocentesis
assisted delivery (forceps/vacuum)
cervical LEEP
chorionic villus sampling
circumcision
colposcopy
cryotherapy
episiotomy
hysterectomy
induction of labor
internal / external fetal monitoring
laparoscopy
ultrasonography
17. Describe appropriate evaluation of the following:
abdominal pain in pregnancy
abnormal Pap smear
anemia
breast mass
breast pain
hirsuitism
nipple discharge
18. Understand how to appropriately order and interpret the following laboratory and diagnostic
exams as they pertain to the Ob/Gyn patient:
abdominal and pelvic ultrasound
ABO and Rh blood typing
amniocentesis
CBC with differentia
creatinine and BUN
endometrial biopsy
glucose screen and glucose tolerance test
gram stain
group B strep cultures
hemoglobin and hematocrit
KOH wet prep
mammography
Pap smear
PT and PTT
thyroid function studies
urinalysis
VDRL, RPR
19. Develop knowledge of CPT and ICD codes for Ob/Gyn procedures and diseases.
thrombophlebitis
46
SKILL OBJECTIVES
The PA student shall reach a skill performance level commensurate with his or her peers in the
following areas:
1. Obtain an appropriate and complete history from the Ob/Gyn patient including:
chief complaint
contraceptive use
family history
genetic/prenatal screening
gynecologic history
history of present illness
menstrual history
obstetric history
sexual history
social history
2. Perform an appropriate and complete physical examination of the Ob/Gyn patient including:
abdominal exam
bimanual exam
breast exam
cardiovascular exam
fundoscopic exam
lung exam
lymph node exam
rectal exam
thyroid exam
vaginal speculum exam with Pap
3. Order and interpret appropriate laboratory tests for the following conditions in the Ob/Gyn
patient:
diabetes
ectopic pregnancy
evaluation of infertility
genetic screening
HIV / AIDS
menopause
menstrual disorders
pelvic inflammatory disease
sexually transmitted diseases
uterine pregnancy
vaginal discharge
4. Interpret the appropriate laboratory tests or procedures in the Ob/Gyn patient, including:
fetal heart tones with Doppler
KOH wet prep
Leopold maneuvers
Pap smear collection
STD culture collection
urinalysis
urine HCG pregnancy test
vaginal speculum exam
5. Provide appropriate counsel, patient education, and instruction to the Ob/Gyn patient for the
following topics:
breast feeding
breast self-exam
menstrual disorders
osteoporosis
47
contraception options / family planning
evaluation of infertility
group B strep collection
hormone replacement therapy
HIV pre- and post-test counseling
menopause
Domestic violence
pre- and postpartum care
pregnancy
Sexually transmitted diseases
STD testing
urinary tract infection
vaginitis
Sexual assault
6. Provide appropriate counsel, patient education, and instruction to the Ob/Gyn patient regarding
family planning and contraceptive options including:
abstinence
natural family planning
barrier methods (condom, diaphragm & hormonal contraception
cervical cap)
Depo-Provera injections
spermicide
diaphragm and cervical cap
tubal ligation
IUD
vasectomy
7. Formulate a problem list with an appropriate differential diagnosis, and propose appropriate
corresponding evaluation and treatment for the Ob/Gyn patient.
8. Observe or assist with an uncomplicated delivery, including assessment of effacement,
dilatation, station and fetal presentation during labor.
9. Observe or assist with Cesarean section delivery.
10. Observe the use of internal fetal monitors during labor.
11. Observe colposcopy.
12. Observe or assist with gynecologic surgeries such as dilatation and curettage, hysterectomy,
tubal ligation, and laparoscopic procedures.
13. Perform or assist with the fitting, placement and removal of contraceptive devices.
14. Observe, assist or perform with pessary fitting, insertion and removal.
48
Obstetrics & Gynecology Skills Checklist
Name____________________________________
Date ______________________________
Preceptor_________________________________ Site ______________________________
The Preceptor or clinical staff member shall initial the following skills as they are completed.
49
Task
Date
Perform a complete gynecologic history and physical
examination along with a differential diagnosis and
treatment plan, and present it to the preceptor.
Perform a pelvic examination.
Obtain vaginal fluid cultures and a KOH wet prep.
Perform a pap smear and sample collection.
Observe or assist with an uncomplicated vaginal delivery.
Observe or assist with a Caesarean section.
Observe the use of internal fetal monitors during labor.
Observe a colposcopy.
Observe or assist with a gynecologic surgery such as a
dilation and curettage, hysterectomy, tubal ligation or
laparoscopic procedure.
Provide appropriate counseling about contraception
options and/or family planning.
Fit, insert and remove a contraceptive device.
Fit, insert and remove a pessary.
Observe or assist with removal of vaginal foreign body
Educate patients or the preceptor about one or more of the
following topics:
Breast feeding
Breast self-exam
Evaluation of infertility
Pregnancy
Sexually transmitted diseases and testing
50
Initials
Hormone replacement therapy
Urinary tract infection
Vaginitis
Osteoporosis
Contraceptive options/family planning
Urinary Incontinence
51
PEDIATRIC ROTATION
PAS 728
4 semester credits
The student shall achieve these rotation objectives when precepted by a pediatrician, a PA specializing
in Pediatrics, or a board-certified pediatric nurse practitioner. The student shall participate in rotation
activities approximately 40 hours per week for 4 weeks. Each student is responsible for learning the
cognitive objectives. The preceptor, however, shall provide learning opportunities for the skills
objectives.
During this clinical rotation, the physician assistant (PA) student is expected to attain an adequate level
of knowledge in the areas listed below. An adequate level of knowledge is defined as sufficient
knowledge, when combined with adequate clinical skills, to treat or refer conditions as encountered in a
primary care or family practice setting.
COGNITIVE OBJECTIVES
20. Recognize and describe the following anticipatory guidance and healthcare maintenance
issues as they pertain to the pediatric patient including:
appropriate pediatric nutrition
assessment of growth & development
contraindications
Denver Developmental screening
emergency care of the newborn
immunization guidelines
infant feeding
prenatal / neonatal history
routine care of the newborn
21. Describe the pathophysiology, diagnosis and management of the following common
pediatric HEENT and pulmonary conditions:
allergic rhinitis
asthma / reactive airway
bronchitis / bronchiolitis
conjunctivitis
croup
Cystic fibrosis
epistaxis
hearing impairment
Hyaline membrane disease
mastoiditis
oral candiasis (thrush)
orbital cellulitis
otitis-acute/chronic, media & externa
pharyngotonsillitis, acute
pneumonia
RSV
strabismus
TM perforation
52
22. Describe the pathophysiology, diagnosis and management of the following common
pediatric cardiovascular and hematologic conditions:
ASD
anemias
bleeding disorders
coarctation of the aorta
Hematologic neoplasia
hemophilia
hypertrophic cardiomyopathy
Kawasaki disease
Lead poisoning
Leukemia
Lymphoma
PDA
Rheumatic fever
syncope
Tetralogy of Fallot
VSD
23. Describe the pathophysiology, diagnosis and management of the following common
pediatric dermatologic conditions:
acne
androgenetic alopecia
dermatitis-atopic (eczema), contact, diaper
erythema multiforme
exanthems
hemangiomas
impetigo
intertrigo
lichen planus
molluscum contagiosum
pediculosis (lice)
perioral dermatitis
Pityriasis rosea
psoriasis
scabies
seborrhea
tinea
urticaria
verrucae/warts
viral exanthem
24. Describe the pathophysiology, diagnosis and management of the following common
pediatric neurologic/developmental and behavioral conditions:
ADHD
anxiety disorders
autism spectrum disorder
child abuse/neglect
conduct disorder
depression/suicide
Down syndrome (trisomy 21)
eating disorders
teething
Turner syndrome
25. Describe the pathophysiology, diagnosis and management of the following common
pediatric musculoskeletal conditions:
avascular necrosis of the proximal femur
congenital hip dysplasia
juvenile rheumatoid arthritis
neoplasia of the MS system
53
Nursemaid’s elbow
Osgood-Schlatter’s disease
Scoliosis
Slipped capital femoral epiphysis
26. Describe the pathophysiology, diagnosis and management of the following common
pediatric endocrine conditions:
Diabetes mellitus
Hypercalcemia
Hyperthyroidism
Hypothyroidism
Obesity
Short stature
27. Describe the pathophysiology, diagnosis and management of the following pediatric
gastrointestinal/nutritional conditions:
Appendicitis
Colic
Constipation/encopresis
Duodenal atresia
Gastroenteritis
GERD
Hepatitis
Hernias (inguinal, umbilical)
Hirschsprung disease
jaundice
Lactose intolerance
Nutrient deficiencies
Pyloric stenosis
28. Describe the pathophysiology, diagnosis and management of the following common
pediatric genitourinary conditions:
Cryptorchidism
Cystitis
Enuresis
Glomerulonephritis
Hypospadias
Hydrocele
Paraphimosis
Phimosis
Testicular torsion
Vesicourethral reflux
29. Describe the pathophysiology, diagnosis and management of the following common
pediatric infectious disease conditions:
Atypical mycobacterial disease
Epstein-Barr viral disease
Erythema infectiosum
Hand-food-and-mouth disease
Herpes simplex
Influenza
Measles
Mumps
Pertussis
Pinworms
Roseola
Rotavirus
Rubella
Varicella infection
54
30. Describe the pathophysiology, diagnosis and management of the following pediatric
urgencies/emergencies:
acute airway obstruction
burns
chemical ingestion
child abuse / neglect
dehydration
epiglottitis
failure to thrive
foreign body
fractures / dislocations
heart failure
intussusception
meningitis
peritonsillar abscess
seizures (febrile, epilepsy)
sepsis
Stevens-Johnson syndrome
sudden infant death (SIDS)
toxic epidermal necrolysis
trauma
31. Appropriately order and interpret laboratory and diagnostic tests in pediatric practice.
32. Develop knowledge of current CPT and ICD codes for pediatric procedures and diseases.
SKILL OBJECTIVES
The PA student shall reach a skill performance level commensurate with his or her peers in the
following areas:
1. Obtain an appropriate and complete history of the pediatric patient including:
chief complaint
communicable disease exposures
developmental history
dietary history
family history
genetic screening
history of present illness
immunization history
past medical history
prenatal / birth / neonatal history
safety issues history
social history
2. Perform an appropriate and complete physical examination of the pediatric patient,
including:
abdominal exam
cardiovascular exam
developmental exam
external genitalia exam
extremities exam / hip exam
hearing and visual acuity
HEENT exam
measurement of head circumference
measurement of length / height
red reflex / fundoscopic exam
test for reflexes
test for strabismus / amblyopia
test function of cranial nerves
test sensation
55
lung exam
measurement of chest circumference
vital signs and BP
3. Obtain and interpret AGPAR scores.
4. Perform a routine screening exam in the newborn infant.
5. Provide patient education to parents regarding:
behavioral expectations
frequency of well-child exams
general care of infants and children
home care of the ill pediatric patient
immunization schedules
eating/feeding
normal and abnormal growth
nutritional requirements
safety
6. Know how to screen for and identify children with developmental delays.
7. Remove impacted cerumen from the external auditory canal of the pediatric patient.
8. Record and interpret data on growth charts, and write orders and progress notes as
appropriate for the pediatric patient.
9. Perform a comprehensive history and physical for the acute hospitalization of the pediatric
patient.
10. Observe or participate in the following:
• speech therapy evaluation of a child
• genetic counseling with the family of a pediatric patient
• circumcision of an infant
• attention deficit disorder evaluation
• removal of a foreign body
56
Pediatric Skills Checklist
Name____________________________________
Date ______________________________
Preceptor_________________________________ Site ______________________________
The Preceptor or clinical staff member shall initial the following skills as they are completed.
Task
Date
Obtain a complete history, physical exam, differential
diagnosis and treatment plan from a pediatric patient or
his parents, and present it to the preceptor.
Obtain and interpret APGAR scores.
Perform a routine newborn screening examination.
Provide patient education for the following: scheduled
immunizations, frequency of well-child exams, feeding
and eating, nutritional requirements, safety, normal
growth, expected behavior, and how to care for the ill
child at home.
Perform a developmental screen.
Remove impacted cerumen.
Record and interpret data on a growth chart.
Perform a complete history and physical examination for
the acute hospitalization of a pediatric patient.
Observe or participate in a speech therapy, OT, PT,
audiology evaluation of a child.
Observe or participate in a genetic counseling session
with the family of a pediatric patient.
Observe or participate in the circumcision of an infant.
Observe or participate in the evaluation of a child with
possible attention deficit disorder.
Observe, perform, or assist in removal of foreign body.
57
Initials
PSYCHIATRY ROTATION
PAS 730
4 semester credits
During this clinical rotation, the physician assistant (PA) student is expected to attain an adequate level
of knowledge in the areas listed below. An adequate level of knowledge is defined as sufficient
knowledge, when combined with adequate clinical skills, to treat or refer conditions as encountered in a
primary care or family practice setting.
COGNITIVE OBJECTIVES
1. Describe the natural history, signs and symptoms, laboratory studies, medical and psychiatric
differential diagnosis, management, and purported pathophysiologic mechanism of disease
for the following disorders:
Mood Disorders
• Major depressive disorder
• Bipolar disorder
• Cyclothymia/dysthymia
• Adjustment disorder
Anxiety Disorders
• Generalized anxiety disorders
• Panic disorder
• Post-traumatic stress disorder
• Phobic disorder
Personality Disorders
• Antisocial
• Avoidant
• Borderline
• Dependent
• Histrionic
• Narcissistic
Schizophrenia & Other Psychotic Disorders
• Schizophrenia
• Delusional disorder
• Schizoaffective disorder
• Schizophreniform disorder
Paraphilias & Sexual Dysfunction Disorders
• Hypoactive sexual desire disorder
• Sexual aversion disorder
• Exhibitionism
• Fetishism
• Pedophilia
• Sexual masochism
• Voyeurism
Eating Disorders
• Anorexia nervosa
• Bulimia nervosa
Attention-Deficit Disorder & Disruptive
Behavioral Disorders
• Attention deficit hyperactivity disorder
• Conduct disorder
• Oppositional defiant disorder
Substance-Related & Addictive Disorders
• Alcohol-related disorders
• Drug & other substance-related disorders
• Obsessive compulsive
• Paranoid
• Schizoid
• Schizotypal
Somatoform/Factitious Disorders
• Body dysmorphic disorder
58
•
•
Factitious disorder
Hypochondriasis
•
•
Malingering
Somatization disorder
•
•
Tobacco-related disorders
Non-substance-related disorders
(Gambling)
2. Utilize the DSM classification of psychiatric disorders to evaluate and care for patients.
3. Identify factors for assessing the suicide potential of patients.
4. Identify indications, contraindications, potential side effects, and typical dosage ranges for
common psychotherapeutic agents.
5. Describe medico-legal aspects of psychiatric practice.
6. Define and understand the clinical significance of the following terms:
Delirium
Delusion
Hallucination
Psychosis
7. Be familiar with the manifestation of psychiatric problems in the pediatric population.
8. Develop knowledge of current CPT, DSM, and ICD codes for psychiatric procedures and
diseases.
SKILL OBJECTIVES
The PA student shall reach a skill performance level commensurate with his or her peers in the
following areas:
1. Obtain an appropriate and complete history from the patient in psychiatry, including:
Chief complaint
Family history
History of present illness
Past medical history
Past psychiatric history
Review of systems
Social history
2. Perform an appropriate and complete physical examination of the patient in psychiatry,
including:
Comprehensive general physical exam
Formal mental status exam
Neurological exam
Psychological testing instruments
3. Develop an appropriate differential diagnosis for more common psychiatric disorders and
develop a strategy by which to make a diagnosis.
4. Develop, in consultation with the precepting psychiatrist and other staff, a treatment plan for
more common psychiatric disorders.
59
5. Observe the roles of the psychiatrist, psychologist, psychiatric nurse, and social worker in
the care of the mentally ill, and make appropriate psychiatric referrals from primary care.
6. Observe or participate in the psychotherapy of a patient.
7. Participate in the pharmacologic management of patients in psychiatry, including evaluating
side effects, ordering laboratory tests, and assessing therapeutic effectiveness.
8. Observe or participate in the interdisciplinary care of patients in psychiatry.
9. Observe the following:
• administration of electroconvulsive therapy
• detoxification of a chemically dependent patient
• therapeutic intervention of a chemically dependent patient
• ongoing outpatient management of those with chronic mental illness
• group support therapy for the chemically dependent (e.g., Alcoholics Anonymous)
• neuropsychological testing of a patient by a psychologist
10. Observe or participate in the application of medico-legal procedures for psychiatric patients.
60
Psychiatry Skills Checklist
Name____________________________________
Date ______________________________
Preceptor_________________________________ Site ______________________________
The Preceptor or clinical staff member shall initial the following skills as they are completed.
Task
Date
Perform a complete history, physical examination,
differential diagnosis and treatment plan, and present it to
the preceptor.
Perform a comprehensive, formal mental status
examination, and present it to the preceptor.
Observe or participate in the psychotherapy of a patient.
Observe or participate in the interdisciplinary care of a
patient.
Observe or participate in the administration of ECT.
Attend a group support meeting, such as AA, for a
chemically dependent person.
Observe or participate in the medico-legal proceedings
involving a psychiatric patient.
Observe or participate in the neuropsychological testing of
a patient by a psychologist.
Participate in the detoxification of a patient who is
chemically dependent.
61
Initials
Selectives I, II, III & IV
PAS 756, 757, 758 & 758
4 semester credits
Selective clinical rotation choices are intended to broaden the PA student’s knowledge base and
skill set. Rotation selections shall be approved by PA Program faculty. The student will select a
medical specialty, sub-specialty or a core rotation type with approval of the PA Program faculty.
Students are expected to participate in grand rounds, noon conferences and other clinically relevant
didactic presentations appropriate to the selective rotation type.
Cognitive and skills objectives are determined by the specific selective chosen. In conjunction with
Program faculty, the student shall develop an individualized learning contract that includes objectives
for the rotation and a method to demonstrate achievement of the objectives by the conclusion of the
rotation (utilizing the following template as a guide).
During this clinical rotation, the physician assistant (PA) student is expected to attain an adequate level
of knowledge in the areas listed below during a medical subspecialty selective. An adequate level of
knowledge is defined as sufficient knowledge, when combined with adequate clinical skills, to treat or
refer conditions as encountered in a primary care or family practice setting.
COGNITIVE OBJECTIVES
1. Describe the pathophysiology, diagnosis, and management of the following diseases and
disorders relevant to this selective rotation. (Please list)
2. Describe disease screening methods that are relevant to this selective rotation. (Please list)
3. Understand the physiology, clinical significance, and differential diagnosis of common
physical findings seen during this selective rotation. (Please list)
4. Develop knowledge sufficient to appropriately order and interpret the following laboratory
and diagnostic tests. (Please list)
62
5. List the indications, contraindications, complications and basic methods of administration
for common medical procedures that are performed in this selective rotation. (Please list)
6. List the indications, contraindications, and basic pharmacology for medications that are
commonly used to treat conditions seen in this selective rotation. (Please list)
7. Develop knowledge of current CPT and ICD codes for common diagnoses and procedures
relevant to this selective rotation.
SKILL OBJECTIVES
The PA student shall reach a skill performance level commensurate with his or her peers in the
following areas:
1. Demonstrate and reach a performance level commensurate with peers in the following skill
areas:
• gathering an appropriate medical history
• performing a focused physical examination guided by the patient’s chief complaint,
history of present illness and symptoms
• performing a complete physical examination guided by the patient’s chief complaint,
history of present illness and symptoms
• ordering and interpreting appropriate laboratory tests
• observing, assisting or performing select procedures appropriate to the rotation
• formulating an appropriate differential diagnosis and problem list
• selecting and implementing an appropriate treatment and evaluation plan
• determining an appropriate frequency for follow up
• providing appropriate medical instruction and patient education to help patients
understand their conditions
2. Participate in the care of acutely hospitalized patients by performing admission history and
physical examinations, patient rounds, and progress notes.
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Attachment 1
American Academy of Physician Assistants
Guidelines for Ethical Conduct for the Physician Assistant Profession
(Adopted 2000, amended 2004, 2006, 2007, 2008, reaffirmed 2013)
This .pdf document can be viewed in entirety at the following website:
https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=815
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Attachment 2
University of Wisconsin – La Crosse
General Incident Report
65
66
Instructions for Completing the University of Wisconsin-La Crosse General
Incident Report:
Immediately after treating the injury, complete both sides of this form, and mail it to:
PA Program Office
University of Wisconsin La Crosse
1725 State Street
La Crosse, WI 54601
Student’s name and address should include both the current (clinical site) address and the student’s
permanent address.
The work phone number is the clinical site’s phone number.
The home phone number is the student’s phone number used during the clinical rotation and the
permanent home phone number.
Location of the Incident should be listed as completely as possible, with full mailing address.
The remainder of the form is self-explanatory. Important - be as complete as possible, and attach
additional pages to the final report if needed.
For the PA Program file, please write a brief description of the medical care received, including the
specific time, location and services received.
Further information regarding injuries and incidents during clinical rotations can be found in
Section 5 of this manual.
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Attachment 3:
Addendum to Internship Waiver:
All clinical rotations will be secured by the clinical coordinator of the UW-L-Gundersen LutheranMayo Physician Assistant Program. Students must submit all requests for clinical rotations
exclusively to the clinical coordinator. The Clinical Coordinator will then submit a formal request to
the appropriate affiliate institution. A student of this program may in no circumstance contact
preceptors, clinical or institutional departments or institutional representatives independently from
the clinical coordinator. Failure to follow this protocol is considered a breach of program policy and
may result in disciplinary action at the discretion of the PA Administrative Student Conduct and
Progress Committee.
As a student enrolled in the UW-L-Gundersen Lutheran-Mayo Physician Assistant Program, I
understand and agree to follow the above outlined procedure for obtaining clinical rotations.
PRINT Name:______________________________________________________
Signature (upon entrance into Program):________________________________Date:___________
Signature (upon entrance into clinical year):_____________________________ Date:___________
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Attachment 4:
First-Week
Report
1. Name ____________________________________________________________________
2. Date _____________________________________________________________________
3. Rotation Information
a. Number (i.e., 1, 10) ____________________________________________________
b. Name (i.e., Ob/Gyn) ___________________________________________________
c. Type (i.e., required, selective) ___________________________________________
d. Location ____________________________________________________________
e. Primary Preceptor ____________________________________________________
4. Describe your typical day.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
5. What is going well?
__________________________________________________________________________
__________________________________________________________________________
6. What, if anything, are your concerns?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
UW La Crosse – Gundersen – Mayo
Physician Assistant Program
4054 Health Science Center, University of Wisconsin-La Crosse, 1725 State Street, La Crosse, WI 54601
Main Office: (608) 785-8470, Fax: (608) 785-8460
69
Attachment 5:
Preceptor Evaluation of the Student
UW-La Crosse, Gundersen, Mayo PA Program
Student __________________________________ Date ______________________________
Preceptor_________________________________ Site ______________________________
70
Note: A grade of 60% (an average of “3” for the entire evaluation) or above is considered a passing score for
the rotation. An average less than “3” for the evaluation typically will necessitate a repeat of the rotation.
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Comments regarding student’s performance and/or professionalism:
Recommendations for improving the preparation of our students for a rotation on your service:
Please contact the Clinical Education Coordinator at (608) 785-5067, if you would like to
discuss this evaluation.
Evaluator___________________________________________
Date_______________________________________________
Return this evaluation to: PA Program, UW-La Crosse, 1725 State Street, La Crosse, WI 54601
72
Attachment 6
Student Evaluation of the Preceptor and Clinical Site
UW-La Crosse, Gundersen, Mayo PA Program
Student _________________________________ Date ______________________________
Preceptor_________________________________ Site ______________________________
73
1. Strongly disagree
2. Disagree
3. Neutral
4. Agree
5. Strongly agree
NA. Not applicable
Statement
1
2
3
4
5
1.
1
2
3
4
5
2.
1
2
3
4
5
3.
1
2
3
4
5
4.
1
2
3
4
5
5.
1
2
3
4
5
6.
1
2
3
4
5
7.
1
2
3
4
5
8.
1
2
3
4
5
9.
1
2
3
4
5
10.
1
2
3
4
5
11.
1
2
3
4
5
12.
1
2
3
4
5
13.
1
2
3
4
5
14.
1
2
3
4
5
15.
Yes
No
16.
Yes
No
17.
Comments
The goals and objectives of this
rotation were clear to me.
This rotation was well organized and
my responsibilities were clear to me.
The majority of the learning objectives
were appropriate for this rotation
I was able to complete the Program’s
Cognitive objectives for this rotation
while at this site.
I was able to complete the Program’s
Skill Objectives for this rotation with
this site/preceptor(s)
My preceptor clearly understood
his/her role in my education as a
teaching clinician.
I was able to interview and do physical
exams on patients, develop differential
diagnoses and treatment plans.
I was taught and allowed to perform
some procedures with supervision.
I was able to prepare SOAP notes
and/or H&P notes.
I was able to dictate notes for the
patient record.
My preceptor(s) provided me with
useful feedback on my performance in
the course of this rotation.
This rotation was valuable to my
medical education as a PA
I made significant growth in my ability
to evaluate and treat patients during
this rotation.
I would recommend this rotation to a
friend in my class.
I was able to find sufficient time for
reading/studying during this rotation.
Medical teaching conferences were
available to me during this rotation.
Did you feel treated in a professional
manner during this rotation?
19. During this rotation, did any specific person play an especially helpful role? If so, who? (Use the reverse side if needed)
Influenza Vaccine Documentation
20. Please offer additional comments about this rotation that you deem appropriate. (Use the reverse side if needed)
74
Attachment 7
Fall 2015
Form due by October 31, 2015
I, __________________________________, received the influenza vaccine on this
date_____________________ at this location___________________________________
Signature of provider_________________________________________
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Attachment 8
I acknowledge that I have received and read the University of Wisconsin-La Crosse-GundersenMayo Physician Assistant Clinical Phase Manual. I agree to abide by the policies and procedures
outlined in the handbook.
___________________________________
________________
(Signature)
(Date)
___________________________________
(Print name)
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