Preceptorship Manual
2010-2011
Clinical Preceptor Manual
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INTRODUCTION
This manual is a resource and a guide for the second year Physician Assistant
students at Lock Haven University of Pennsylvania and for their gracious
preceptors. The program’s faculty would like to thank our preceptors for their
generous support.
Included in this manual are the following:
 a description of the PA student’s pre-clinical phase training.
 the role and responsibilities of the preceptor
 the goals and objectives of each clinical rotations / preceptorships
 the duties and responsibilities of the student.
If you have suggestions regarding this manual, the program, or the clinical
preparation of the students, please forward them to the program so they may be
incorporated as appropriate. Also, feel free to contact the PA Program Clinical
Coordinator at any time either by phone or e-mail:
a) E-mail:lbower@lhup.edu
b) Office number: 570-484-2199
Last Revised:
June, 2011
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Table of Contents
INTRODUCTION..................................................................................................................................... 2
Section One:
PHYSICIAN ASSISTANT PROGRAM PRECEPTOR .................................................... 5
HISTORY .............................................................................................................................................. 6
MISSION............................................................................................................................................... 6
ACCREDITATION ............................................................................................................................... 6
PRE-PROFESSIONAL PROGRAM..................................................................................................... 7
Admission Requirements ........................................................................................................................ 7
PROFESSIONAL PROGRAM ............................................................................................................. 7
PA STUDENT PROFILE ...................................................................................................................... 7
DIDACTIC CURRICULUM ................................................................................................................ 8
YEAR 1: Summer Session ..................................................................................................................... 8
YEAR 1: Fall Semester .......................................................................................................................... 8
YEAR 1: Spring Semester ...................................................................................................................... 9
YEAR 2: Summer Session ..................................................................................................................... 9
YEAR 2: Fall Semester .......................................................................................................................... 9
YEAR 2: Spring Semester ...................................................................................................................... 9
COURSE DESCRIPTIONS .................................................................................................................10
PYAS600—Service Learning Module ..................................................................................................10
PYAS602—Introductory Module ..........................................................................................................10
PYAS604—Women’s Health Module ..................................................................................................10
PYAS606—Urology & Sexually Transmitted Diseases Module ..........................................................11
PYAS608—Human Sexuality Module ..................................................................................................11
PYAS610—Infectious Disease Module ................................................................................................11
PYAS612—Allergy & Immunology Module ........................................................................................11
PYAS614—Hematology Module ..........................................................................................................12
PYAS616—Oncology Module ..............................................................................................................12
PYAS618—Endocrinology Module ......................................................................................................12
PYAS620—Cardiology Module ............................................................................................................12
PYAS622—Pulmonary Module ............................................................................................................13
PYAS624—Nephrology Module ..........................................................................................................13
PYAS626—Psychiatry Module .............................................................................................................13
PYAS628—Ophthalmology Module.....................................................................................................13
PYAS630—Neurology Module ............................................................................................................14
PYAS632—Orthopedics Module ..........................................................................................................14
PYAS634—Rheumatology Module ......................................................................................................14
PYAS636—Dermatology Module.........................................................................................................14
PYAS638—Gastroenterology Module ..................................................................................................15
PYAS640—Obstetrics Module .............................................................................................................15
PYAS642—Otorhinolaryngology Module ............................................................................................15
PYAS644—Pediatrics Module ..............................................................................................................15
PYAS646—Geriatrics Module ..............................................................................................................16
PYAS648—Surgery Module .................................................................................................................16
PYAS650—Emergency Medicine Module ...........................................................................................16
PYAS652—Alternative Medicine Module ............................................................................................16
PYAS654—Occupational Medicine Module ........................................................................................17
PYAS603—Gross (Cadaver) Anatomy .................................................................................................17
PYAS659—Underserved Populations ...................................................................................................17
PYAS601—Medical Decisions .............................................................................................................17
PYAS661 – Evidence Based Medicine I ...............................................................................................17
PYAS662- Evidence Based Medicine II ...............................................................................................18
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PYAS 663 – Evidence Based Medicine III ...........................................................................................18
PYAS664 – Clinical Rotations I ...........................................................................................................18
PYAS665 – Clinical Rotations II .........................................................................................................18
PYAS 666 – Clinical Rotations III .......................................................................................................18
A NOTE TO OUR CLINICAL PRECEPTOR .....................................................................................19
PRECEPTORSHIPS ............................................................................................................................20
PROCEDURE FOR ESTABLISHING A LOCK HAVEN UNIVERSITY PHYSICIAN ASSISTANT
PRECEPTORSHIP ..............................................................................................................................22
Section Two: POLICIES AND PROCEDURES ..........................................................................................23
POLICIES AND PROCEDURES: STUDENT ....................................................................................24
POLICIES AND PROCEDURES: PRECEPTOR ...............................................................................26
POLICIES AND PROCEDURES: PHYSICIAN ASSISTANT PROGRAM ......................................27
Section Three: GOALS AND OBJECTIVES ..............................................................................................28
PA STUDENT GENERAL CLINICAL GOALS AND OBJECTIVES...............................................30
ROTATION OBJECTIVES GENERAL INTERNAL MEDICINE ...............................................37
ROTATION OBJECTIVES OBSTETRICS AND GYNECOLOGY .............................................44
ROTATION OBJECTIVES GENERAL SURGERY ......................................................................49
ROTATION OBJECTIVES PEDIATRICS ......................................................................................55
ROTATION OBJECTIVES CARDIOLOGY ..................................................................................60
ROTATION OBJECTIVES ENT ......................................................................................................68
ROTATION OBJECTIVES ORTHOPEDICS .................................................................................71
ROTATION OBJECTIVES PSYCHIATRY ....................................................................................76
ROTATION OBJECTIVES EMERGENCY MEDICINE ..............................................................80
ROTATION OBJECTIVES CORRECTIONS MEDICINE ...........................................................84
TOPICS LIST - GERIATRICS..........................................................................................................88
TOPICS LIST - MENTAL HEALTH ...............................................................................................90
TOPICS LIST - OBSTETRICS & GYNECOLOGY .......................................................................91
TOPICS LIST - PEDIATRICS ..........................................................................................................92
Long Term Care Objectives ...............................................................................................................95
Section Four: GENERAL REQUIREMENTS FOR CLINICAL YEAR ...................................................101
Section Five: EVALUATION FORMS......................................................................................................115
STUDENT CRITIQUE FORM ..........................................................................................................116
Section Six: AGREEMENT FORMS .........................................................................................................120
AFFILIATION AGREEMENT ..........................................................................................................121
MEMORANDUM AGREEMENT ....................................................................................................128
PRECEPTORSHIP APPLICATION FORM......................................................................................129
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Section One: PHYSICIAN ASSISTANT PROGRAM PRECEPTOR
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LHUP MASTER OF HEALTH SCIENCE--PHYSICIAN ASSISTANT
PROGRAM
HISTORY
During the summer of 1994 Lock Haven University and its sister universities
within the SSHE system were approached regarding the feasibility of starting a
program to educate mid-level primary health care providers for medically
underserved areas within the state. After initially seeking the support of the local
medical community, the University developed an advisory committee to look into
such an undertaking. This committee overwhelmingly felt that the existing
resources of Lock Haven University could be augmented to provide both the
prerequisite requirements and the graduate curriculum required to provide a high
quality Master’s level program to educate and place Physician Assistants in rural
communities. The support of the medical community has been overwhelming. In
June, 1996 the Physician Assistant Program enrolled its first class of 24 students
and became the first state-supported Physician Assistant program within the
Commonwealth. Since its inception the PA Program has received National
Recognition ranking 34th, out of the over 140 PA Programs nationally, in US
News and World Report. The program has been successful in fulfilling its mission
with over 60% of graduates remaining in Pennsylvania, and over 45% acquiring
positions in primary care specialties. The program has expanded to four campus
locations including Harrisburg, Clearfield, Coudersport, and main campus in Lock
Haven PA enrolling 72 new students each year.
MISSION
The mission of the program is to educate and train highly-skilled physician
assistants who:
 are capable of providing quality health care,
 have expertise in the health care needs of the medically underserved,
 are prepared to critically evaluate, and become leaders in bringing about
improvement in, the medical and social systems that affect the health of
underserved populations,
 will seek and retain employment as primary care physician assistants in
medically underserved areas of the Commonwealth of Pennsylvania.
ACCREDITATION
The Lock Haven University Physician Assistant Program is fully accredited in
accordance with the standards set forth by the Accreditation Review Committee
for the Physician Assistant. The Physician Assistant Program resides within the
Department of Physician Assistant Studies.
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PRE-PROFESSIONAL PROGRAM
Pre-professional requirements are designed to provide the student with a firm
foundation in the basic sciences. The following are prerequisite courses for
matriculation into the physician assistant program:
Admission Requirements
Baccalaureate degree from a regionally accredited institution with the
following course requirements:
 Chemistry I & II
 Biology/Zoology (6 semester hours)
 Human Anatomy
 Human Physiology
 Microbiology
 Genetics
 Statistics
Further requirements include:
 Computer literacy – demonstrated through course work or
experience
 GRE scores – students must have completed the Graduate Record
Examination.
PROFESSIONAL PROGRAM
The professional phase consists of a rigorous 24-month combination of didactic and
clinical work. The first 12 months are devoted to the didactic (classroom) phase as
outlined on the following pages. The second year is divided into five six-week clinical
rotations in the disciplines of internal medicine, pediatrics, either obstetrics and
gynecology or emergency medicine, surgery, and an elective of the student’s choice.
Following these five rotations is a single eighteen-week or two nine-week clinical
preceptorships in a primary care setting. The program’s masters level design is
commensurate with current trends within the PA education. As part of that masters
level design, students will be required to complete coursework in research design
and complete an Evidence Based Medicine Project.
PA STUDENT PROFILE
107 Currently enrolled
Average age is 23
Undergrad GPA is 3.46
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DIDACTIC CURRICULUM
YEAR 1: Summer Session
Gross (Cadaver) Anatomy
4.0 sh
Service Learning Module
1.0 sh
Introductory Module
5.0 sh
Women’s Health Module
1.5 sh
Urology & Sexually Transmitted Diseases Module
0.5 sh
Human Sexuality Module
0.5 sh
Infectious Disease Module
2.0 sh
Total
14.5 sh
YEAR 1: Fall Semester
Allergy & Immunology Module
1.0 sh
Hematology Module
1.0 sh
Dermatology Module
1.0 sh
Endocrinology Module
1.5 sh
Cardiology Module
3.0 sh
Pulmonary Module
2.0 sh
Nephrology Module
1.5 sh
Ophthalmology Module
1.0 sh
Neurology Module
2.0 sh
Psychiatry Module
2.0 sh
Underserved Populations
3.0 sh
Total
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19 sh
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YEAR 1: Spring Semester
Orthopedics Module
1.0 sh
Rheumatology Module
Oncology Module
1.5 sh
Gastroenterology Module
1.5 sh
Obstetrics Module
1.5 sh
Otorhinolaryngology Module
1.0 sh
Pediatrics Module
2.0 sh
Geriatrics Module
1.0 sh
Surgery Module
1.5 sh
Emergency Medicine Module
1.5 sh
Alternative Medicine Module
0.5 sh
Occupational Medicine Module
1.0 sh
Medical Decisions
3.0 sh
Total
First Year Total
18 sh
51.5 sh
YEAR 2: Summer Session
Clinical Rotations 1EBM 1Total
11.0 sh
1.0 sh
12.0 sh
YEAR 2: Fall Semester
Clinical Rotations 2EBM 2Total
17.0 sh
1.0 sh
18.0 sh
YEAR 2: Spring Semester
Clinical Rotations 3EBM 3Total
17.0 sh
1.0 sh
18.0 sh
Second Year Total
48 sh
Grand Total of Years 1 & 2
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99.5 sh
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COURSE DESCRIPTIONS
PYAS600—Service Learning Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It prepares the student to participate in program
service learning projects that focus on the health care needs of rural
communities. Content areas in this module include: introduction to community
health and preventive medicine, community health needs assessment,
community screening and health promotion/disease prevention programs,
diagnostic procedures used in health screening programs, and alternative
therapies. Each student will participate in designing, implementing, and
assessing community-based service learning projects in designated
communities within proximity to the university.
PYAS602—Introductory Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It introduces the student to fundamental concepts
essential to understanding subsequent components of the curriculum. Content
areas in this module include: fundamentals of medical research and reasoning,
an overview of pathophysiology, introductory patient assessment including the
medical history and physical examination, pharmacokinetics and
pharmacodynamics, health promotion and disease prevention, medical records,
and rural and professional issues.
PYAS604—Women’s Health Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
gynecology and women’s health. Content areas in this module include:
medical research and reasoning, anatomy, pathophysiology, patient
assessment, diagnostic procedures, therapeutics, patient education, service
learning, medical record keeping, and rural and professional issues.
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PYAS606—Urology & Sexually Transmitted Diseases Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides both a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
urology, including sexually transmitted diseases. Content areas in this module
include: medical research and reasoning, anatomy, pathophysiology, patient
assessment, diagnostic procedures, therapeutics, patient education, service
learning, medical record keeping, and rural and professional issues.
PYAS608—Human Sexuality Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. Personal attitudes toward sexual issues are
explored in order to prepare the student to discuss issues of sexuality with
patients. Other topics include human sexual response, sexual diversity, and
the diagnosis and treatment of disorders of human sexual response.
PYAS610—Infectious Disease Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides both a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
infectious diseases. Content areas in this module include: medical research
and reasoning, medical microbiology, pathophysiology, patient assessment,
diagnostic procedures, therapeutics, patient education, service learning,
medical record keeping, and rural and professional issues.
PYAS612—Allergy & Immunology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides both a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
allergy and immunology. Content areas in this module include: medical
research and reasoning, anatomy, pathophysiology, patient assessment,
diagnostic procedures, therapeutics, patient education, service learning,
medical record keeping, and rural and professional issues.
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PYAS614—Hematology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides both a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
hematology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS616—Oncology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
oncology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS618—Endocrinology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
endocrinology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS620—Cardiology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach for understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
cardiology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
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PYAS622—Pulmonary Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
pulmonary medicine. Content areas in this module include: medical research
and reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS624—Nephrology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
nephrology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS626—Psychiatry Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
psychiatry. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS628—Ophthalmology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
ophthalmology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
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PYAS630—Neurology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
neurology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS632—Orthopedics Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
orthopedics. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS634—Rheumatology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
rheumatology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS636—Dermatology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
dermatology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
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PYAS638—Gastroenterology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
gastroenterology. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS640—Obstetrics Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
obstetrics. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS642—Otorhinolaryngology Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
otorhinolaryngology. Content areas in this module include: medical research
and reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS644—Pediatrics Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
pediatrics. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
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PYAS646—Geriatrics Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
geriatrics. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS648—Surgery Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
surgery. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS650—Emergency Medicine Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
emergency medicine. Content areas in this module include: medical research
and reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
PYAS652—Alternative Medicine Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. This module provides the student with an
orientation to alternative methods of health care, including such fields as
acupuncture, chiropractic, massage, naturopathy, and culturally based
therapies. Content areas in this module include: medical research and
reasoning, anatomy, pathophysiology, patient assessment, diagnostic
procedures, therapeutics, patient education, service learning, medical record
keeping, and rural and professional issues.
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PYAS654—Occupational Medicine Module
Description: This module is one of the series of modules that comprises the didactic
curriculum of the program. It provides a disease oriented and problemoriented approach to understanding the etiology, pathophysiology,
manifestations, diagnosis and treatment of specific diseases encountered in
occupational medicine, with special emphasis on those occupations that
predominate in rural areas. Content areas in this module include: medical
research and reasoning, epidemiology, anatomy, pathophysiology, patient
assessment, diagnostic procedures, therapeutics, patient education and
prevention, service learning, medical record keeping, and rural and
professional issues.
PYAS603—Gross (Cadaver) Anatomy
Description: Gross anatomy is studied regionally stressing relationships of major
structures, organs, vessels and nerves. Human cadaver observation and
dissection by students are included in the laboratory sessions. All major areas
of the body are covered. References to the relationship of anatomical
structures to pathology, traumatic injury and medicine are stressed.
PYAS659—Underserved Populations
Description: An exploration of factors, especially historical, racial, ethnic,
socioeconomic, and geographic, determined to create disparities in
healthcare access, delivery, and policy. The course will specifically
encompass/consider barriers known to affect these disparities in rural and
urban regions as well as various healthcare settings including correctional
facilities.
PYAS601—Medical Decisions
Description: An exploration of the many influences in medical decisions made by
providers, patients, communities and governments. Institutional and
psychological constraints will be considered when looking at legal, ethical,
moral and personal medical decisions. Medical decisions will also be viewed
through various multicultural prisms. Throughout the course, we will examine
the balance of pragmatism and compassion in the quickly changing medical
arena.
PYAS661 – Evidence Based Medicine I
Description: The first of three complimentary courses that will develop skills in
Evidence Based Medicine (EBM). Students will build upon skills acquired
during the first year of the program and apply EBM skills to authentic
patient cases. Students will explore the limitations and the ethical
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implications of evidence based practice. The overall goal of this course
will be to extrapolate (EBM) use into their future practice as clinicians.
PYAS662- Evidence Based Medicine II
Description: The second of three complimentary courses that will develop skills in
Evidence Based Medicine (EBM). Students will build upon skills acquired
during the first year of the program and EBM I. Students will apply EBM
skills to authentic patient cases. Students will explore the limitations and
ethical implications of Evidence Based Practice. The overall goal of this
course will then be to extrapolate evidenced based medicine use into their
future practice as clinicians.
PYAS 663 – Evidence Based Medicine III
Description: The third of three complimentary courses that will build upon skills
acquired during EBM I & II. Students will further develop skills using the
concepts of variability, validity, sensitivity, specificity and probability of
testing. Students will apply EBM to their daily clinical practice. This course
culminates in the written and oral presentation of the EBM capstone
project.
PYAS664 – Clinical Rotations I
Description: The first in a series of three rotations, 12 weeks in duration,
designed to allow students to develop the knowledge, skills, abilities and
attitudes required to care for patients of all age groups seen in primary
care. Students will be assigned to a minimum of two clinical rotation sites
in any of the following disciplines; surgery, internal medicine, pediatrics,
OB/GYN, emergency medicine, or any subspecialty discipline that will
develop skills required for generalist/primary care practice.
PYAS665 – Clinical Rotations II
Description; An eighteen-week clinical experience, the second in a series of three
courses, that allows students to develop the knowledge, skills, abilities
and attitudes required to care for patients of all age groups seen in
primary care. Students will be assigned to a minimum of three clinical
rotation sites in any of the following disciplines; surgery, internal medicine,
pediatrics, OB/GYN, emergency medicine, or any subspecialty discipline
that will develop skills required for generalist/primary care practice.
PYAS 666 – Clinical Rotations III
An eighteen-week clinical experience, the third in a series of three courses, that
allows students to develop the knowledge, skills, abilities and attitudes
required to care for patients of all age groups seen in primary care.
Students will develop an understanding of the health promotion, disease
prevention needs of communities and refine skills that develop problemfocused and disease-oriented approach diseases commonly seen in the
primary care setting.
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A NOTE TO OUR CLINICAL PRECEPTOR
Inherent in the role of the primary care provider is that of a teacher. You teach
your patients, your staff, your colleagues, and perhaps the community at large.
Teaching provides the opportunity to stay current by responding to the inquiries
of bright young students. "To Teach is to Learn Twice”; the first time for your own
benefit the second for the benefit of the student you mentor.
The preceptor provides a central role in the clinical education of Physician
Assistants. Since the emphasis of the PA's role is teamwork with his or her
supervising physician, development of these characteristics starts here. Students
look to the preceptor for answers to clinical questions and guidance in patient
management problems.
Specific guidelines for the clinical experience are outlined in the clinical education
objectives section of this manual. The preceptor should provide the student an
opportunity to accomplish those objectives that are applicable to their practice
setting, and facilitate and encourage the student to find ways to accomplish the
remaining objectives through other sources. The preceptor evaluates the clinical
acumen, knowledge, skills and abilities of the student and documents it in the
Clinical Evaluation Form included in this manual.
Early conferencing with the student will assure that an open line of
communication exists, expectations are not disparate, and that the student
and the preceptor both have an enjoyable experience. This opportunity is
facilitated by the rotations first written assignment due from every student
to the program: “Individual Goal Assessment”. This assessment allows
you the preceptor to sit down with the student and review your goals and
expectations for the rotation. We thank you for your time in doing this with
the student.
The program further looks to the clinical preceptor for other areas of expertise.
They play an important role in improving curriculum, clinical objectives, and other
requirements of the clinical experience. Additional guidelines are provided in
Section II, Policies and Procedures in this manual.
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PRECEPTORSHIPS
OBJECTIVES: The overall goal of clinical rotations and preceptorships is to
provide both breadth and depth of experience in primary care, under the
physician’s supervision, in clinical practice settings, with a significant portion of
clinical experience taking place in rural areas. Specific goals and objectives are
listed in Section III of this manual.
LENGTH: The second year of the program consists of five, six-week rotations and
two nine-week rotations (or one 18 week rotation) called preceptorships. The 6-week
rotations are in pediatrics, internal medicine, surgery, emergency medicine or
obstetrics, gynecology and an elective. The preceptorship rotations are
recommended to be in rural primary care.
PRECEPTORS: Preceptors are Physicians or Physician Assistants throughout the
United States with the majority coming from primary care specialties and
subspecialties. Preceptors are responsible for the organization and administration of
local resources, including the provision of patients. The preceptors and their
colleagues act as instructors and supervisors of the student while in the clinical
environment.
CLINICAL FACILITIES: The clinical facilities used in the instruction of students
during rotations and preceptorships are those in which the physician preceptors
have privileges. Most preceptors offer exposure not only in the clinic and the
hospital but also, to a limited degree, in nursing homes and other clinical facilities
in the community. The preceptor acts as a liaison with the health care facility
administration and the Lock Haven University Physician Assistant Program.
SUPERVISON AND EVALUATION: Students will return to campus at the
completion of each rotation for comprehensive testing, clinical skills evaluation,
patient management seminars, and lectures on professional and medical topics.
Prior to the preceptorship experience, new preceptors will be oriented to their role
as a preceptor. A report of the student’s academic performance, didactic and
clinical strengths and weaknesses, and a personal profile will be provided to each
preceptor prior to the beginning of each clinical assignment. This will help to
individualize instruction. During the clinical assignment the preceptor will become
more familiar with each student’s strengths, and can provide individualized
teaching, supervision, and clinical experience accordingly.
Clinical Preceptor Manual
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The preceptor must complete an evaluation of the student. To this end, a “Clinical
Evaluation Form” appears in Section V of this manual. The preceptor’s evaluation
will form a portion of the student’s grade. Students are asked to evaluate their
clinical experiences to assist the preceptor and program in evaluating the
preceptorship experience. A “Student Critique Form” can be found in Section V.
Preceptors will periodically be asked to evaluate the overall program and its
success in providing well-trained Physician Assistants geared toward service in
primary care.
APPOINTMENT: Participating Physicians and Physician Assistants will receive
an appointment as a Preceptor in the Physician Assistant Program. This
appointment, without compensation, is granted in official recognition of your
involvement in the education and professional development of students.
Preceptors are provided with guest e-mail accounts to facilitate ongoing
communication. This, along with electronic access to the University’s Expanded
Academic Index and the Internet, will provide current medical resources for the
preceptor and student in remote locations. Preceptors are also entitled to utilize
the University’s facilities to help in their own personal and professional
development.
HOUSING: Many preceptors are able to provide or arrange for housing at their
site. Accommodations range from a room in the community hospital, to a spare
room in someone’s home, to an apartment or room that is leased for the period
involved. Since the cost of the preceptor year is very burdensome for many
students, any arrangements made for housing and/or meals are very much
appreciated. Being unable to provide for housing does not eliminate you from
consideration as a preceptor.
LIABILITY: The student is required to maintain liability coverage throughout the
two years of the program. Arrangements have been made through Chicago
Insurance Company, a contracted carrier for medical malpractice insurance
through the American Academy of Physician Assistants, to provide low cost
coverage for physician assistant students. Limits of liability will be furnished upon
request.
AGREEMENTS: Agreements will be completed prior to commencement of the
clinical rotation. Memorandum agreements will be completed by the supervising
preceptor (M.D., PA, NP, etc.) and affiliation agreements will be completed as
necessary.
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PROCEDURE FOR ESTABLISHING A LOCK HAVEN UNIVERSITY
PHYSICIAN ASSISTANT PRECEPTORSHIP
The physician or PA interested in serving as a preceptor to a PA student
completes the application form contained in Section VI of this manual and
returns it along with a current curriculum vitae to the Department of
Physician Assistant Studies.
1. The Clinical Coordinator and Program or Medical Director review this data
and mail a Memorandum Agreement to prospective preceptors. A
Memorandum Agreement is included in Section VI.
2. In the interim, the Clinical Coordinator generally corresponds with, or
schedules a preceptorship site visit to meet with the prospective preceptor
and answer any additional questions.
3. Each site will be evaluated as to its appropriateness for student rotations prior
to, or at the signing of the Memorandum Agreement.
4. The prospective preceptor signs the Memorandum Agreement, or similar
agreement, and returns it to the program for final approval of either the
Program Director or Medical Director.
5. The Clinical Coordinator adds the physician’s name to the list of preceptors
and assigns students depending on the availability of the preceptor and the
needs of the program and students.
6. Current licensure information is verified by the PA Program administrative
staff
7. Contact is made with, and appropriate agreements established, ancillary sites
where the PA student may be working with the preceptor.
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Section Two: POLICIES AND PROCEDURES
Clinical Preceptor Manual
*23
POLICIES AND PROCEDURES: STUDENT
The physician assistant student will be required to adhere to the regulations and
policies as set forth in the Lock Haven University Handbook as well as the Physician
Assistant Student Handbook.
In addition the student will:
1.
Be responsible to the preceptor for reporting at the assigned times,
on call responsibilities of the site, and satisfactory performance on
each learning rotation. The student will also be responsible for any
other stipulations set forth by the preceptor.
2.
Request permission for absences from clinical sites from the
preceptor. Program authorization is required for any absence
exceeding one day. Failure to notify the Clinical Coordinator of
absences greater than one day will result in grade reduction.
3.
Wear an identification tag that identifies the student by first and last
names as well as the words "Physician Assistant Student" in 16 point
lettering while carrying out any responsibilities entailed in his/her
clinical training.
4.
Comply with preceptorship dress requirements and/or those found in
the Physician Assistant Student Handbook.
5.
Sign all notes documented in patient records with "PA Student" or
PA-S following their name. All entries shall be legible.
6.
Conduct him/herself in a professional manner at all times. Students
should consider themselves as ambassadors of Lock Haven
University, the Department of Physician Assistant and Graduate
Studies in Education and the physician assistant profession. This
includes behavior toward patients, faculty, peers, and other members
of the community. Ethical behavior should adhere to the code of
ethics set forth by the American Academy of Physician Assistants.
Students shall also be required to abide by all applicable state laws
pertaining to physician assistant practice.
7.
Write prescriptions only when directed by the supervising preceptor
to do so. The preceptor must sign all such prescriptions.
8.
Respect patient confidentiality at all times. Exclude all identifying
information when discussing cases in and outside the clinical setting.
Remove all identifying information from assignments forwarded to the
PA Program.
Clinical Preceptor Manual
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9.
Confer immediately with the preceptor and the program if he or she
becomes aware of any potential medical liability incident regarding
his or her activities.
10. Be certain that all personal and financial obligations with individuals
or institutions are satisfied prior to leaving.
11. Be responsible to his or her preceptor, follow the rules and regulations
of the hospital or other institutions in which he or she works.
12. Successfully complete the requirements of the rotation/preceptorship
as outlined in this manual including timely submission of journals and
patient logs.
13. Notify the precepting physician and the program director immediately
of any sharps, injuries or other biohazard contamination.
14. If upon receipt of grades from the preceptor, should the student feel
that the grades assigned were inconsistent with their perceived level
of competency, the student shall notify his/her faculty supervisor.
Under no circumstances will a student directly contact the preceptor
to argue his/her point for a higher grade. Failure to comply with this
policy will result in disciplinary action being taken.
15. Dismissal from a clinical rotation site due to behavioral or other
reasons of professional misconduct will result in failure of the course
that the student is enrolled in.
16. Any absence from the clinical year of greater than 30 days will
require the student to undergo testing, both written and practical,
prior to resuming clinical training.
Failure to comply with the above policies and procedures may jeopardize the
student’s standing in the program. Non compliance will result initially in grade
reduction, including the possibility of course failure, and may ultimately result in
dismissal from the program.
Clinical Preceptor Manual
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POLICIES AND PROCEDURES: PRECEPTOR
The policies and procedures listed below are intended to assist in the overall
administrative process of the clinical preceptorship experience.
The preceptor:
* Holds an appointment as “Clinical Faculty” within the Physician Assistant Program,
within the Department of Physician Assistant and Graduate Studies in Education,
College of Health and Human Services. This appointment is effective with the date of
appointment and continues until the appointment is terminated.
The preceptor will:
* Be the individual at the clinical site who is designated to provide supervision and
related assessments of the student’s progress in achieving program requirements.
* Be responsible for the organization and administration of local resources to meet the
goals and objectives of the Physician Assistant Program. This includes:
* The provision of patients (both ambulatory and in the hospital) and associate
preceptors to share and assist in the teaching program, and other resources available
in the community that might strengthen the clinical educational experiences for the
student.
* Assigning students to various learning situations during the clinical experience.
* Assist with arrangements for housing when possible.
* Complete and return to the program a Clinical Evaluation Form for each student’s
performance.
* Countersign the student’s notes and work-ups on the patient's records within a
reasonable time and consistent with the guidelines of the institution.
* Countersign all prescriptions and/or orders originated by the student.
* In the event of any potential medical liability in which the student may be involved,
confer immediately with the Physician Assistant Program.
* Participate in program accreditation reviews as able.
* Participate in program educational conferences and/or programs to enhance
clinical educational experiences.
* Directly supervise all student activities related to diagnostic/therapeutic care
Clinical Preceptor Manual
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POLICIES AND PROCEDURES: PHYSICIAN ASSISTANT PROGRAM
The Clinical Coordinator of the Physician Assistant Program is responsible to the
Director of the Physician Assistant Program, and the Chair of the Department of
Physician Assistant and Graduate Studies in Education and the Dean of the
College of Education and Human Services. The policies set forth by the program
and the university will be followed.
In addition, the Physician Assistant Program will:
*
Maintain all department and academic files on each student.
*
Be responsible for the assignment of students to preceptors.
*
Be responsible for maintaining open lines of communication with
students who are on preceptorships.
*
Provide academic information about the student to the preceptor
and/or cooperating medical facility, including a biographical sketch,
prior to the beginning of each preceptorship.
*
Be responsible to excuse student absences of more than one day
from the preceptor sites and, after consultation with the preceptor,
determine remedial action and progress criteria for each student.
*
Communicate with the preceptor at appropriate intervals regarding
student progress, as well as present status of the preceptorship site.
*
Along with the faculty supervisor, will determine final grades for
students in their clinical course.
*
Accept feedback from preceptors on ways to improve student
preparation during the didactic and clinical phases of training.
*
Provide feedback to preceptors from the Student Critique Form and
other information gathered in the clinical year.
*
Provide assistance and instruction to the preceptor regarding
methods and techniques for facilitating clinical instruction.
*
Assure students receive training in areas that are mandated for all
healthcare workers including HIPPA, Universal Precautions and
other areas that assure patient safety and confidentiality.
Clinical Preceptor Manual
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Section Three: GOALS AND OBJECTIVES
Clinical Preceptor Manual
*28
PHYSICIAN ASSISTANT PROGRAM—Competencies
Consistent with the mission of the LHU PA Program to prepare highly
skilled physician assistants with expertise related to medically
underserved regions of the Commonwealth the program has adopted the
Competencies for the Physician Assistant Profession as promulgated by
the major professional organizations. Each student will demonstrate
minimal competency n each of the following areas:
MEDICAL KNOWLEDGE Medical knowledge includes an understanding of
pathophysiology, patient presentation, differential diagnosis, patient management, surgical
principles, health promotion and disease prevention. Physician assistants must
demonstrate core knowledge about established and evolving biomedical and clinical
sciences and the application of this knowledge to patient care in their area of practice. In
addition, physician assistants are expected to demonstrate an investigatory and analytic
thinking approach to clinical situations. Physician assistants are expected to:
1.
understand etiologies, risk factors, underlying pathologic process, and
epidemiology for medical conditions
2.
identify signs and symptoms of medical conditions
3.
select and interpret appropriate diagnostic or lab studies
4.
manage general medical and surgical conditions to include understanding the
indications, contraindications, side effects, interactions and adverse reactions of
pharmacologic agents and other relevant treatment modalities
5.
identify the appropriate site of care for presenting conditions, including
identifying emergent cases and those requiring referral or admission
6.
identify appropriate interventions for prevention of conditions
7.
identify the appropriate methods to detect conditions in an asymptomatic
individual
8.
differentiate between the normal and the abnormal in anatomic, physiological,
laboratory findings and other diagnostic data
9.
appropriately use history and physical findings and diagnostic studies to formulate
a differential diagnosis
10.
provide appropriate care to patients with chronic conditions
INTERPERSONAL & COMMUNICATION SKILLS Interpersonal and communication
skills encompass verbal, nonverbal and written exchange of information. Physician assistants
must demonstrate interpersonal and communication skills that result in effective information
exchange with patients, their patients’ families, physicians, professional associates, and the
health care system. Physician assistants are expected to:
1. create and sustain a therapeutic and ethically sound relationship with patients
2. use effective listening, nonverbal, explanatory, questioning, and writing skills to elicit
and provide information
3. appropriately adapt communication style and messages to the context of the
individual patient interaction
4. work effectively with physicians and other health care professionals as a member or
leader of a health care team or other professional group
5. apply an understanding of human behavior
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6. • demonstrate emotional resilience and stability, adaptability, flexibility and tolerance
of ambiguity and anxiety
7. • accurately and adequately document and record information regarding the care
process for medical, legal, quality and financial purposes
PA STUDENT GENERAL CLINICAL GOALS AND OBJECTIVES
While emphasizing the health care needs of medically underserved populations,
the following general objectives will be achieved:
1. HISTORY: Elicit an appropriate complete, interval or acute history from
patients of any age and either sex in any setting.
A. Obtain a clear, concise chief complaint and history of the present
illness.
B. Obtain a complete past medical history including illnesses,
hospitalizations, surgeries, trauma, and childhood illnesses.
C. Obtain a history of allergies, transfusion reactions, and reactions to
medications.
D. Obtain a pertinent social history including occupation, current life
situation, nutrition, uses of tobacco, alcohol and other drugs.
E. Obtain a list of current medications along with details as to use, dose
and schedules, including the use of over-the-counter medications.
F. Obtain a family history pertaining to exposure to illness, familial
predisposition to disease, or genetic transmission.
G. Obtain a pertinent review of body systems.
H. Obtain an interval history pertaining to progression, regression or
stability of chronic illness.
I.
Obtain a brief outpatient history pertaining to an acute illness.
J.
Record all pertinent historical data on the defined database in a clear,
concise and relevant manner.
2. PHYSICAL EXAMINATION: Perform, as appropriate, a complete or
partial physical examination of a patient of any age, sex or condition in
any setting.
A. Demonstrate ability to gain the patient’s confidence and provide
reassurance about the examination.
B. Demonstrate appropriate use of the instruments for the physical
examination.
C. Perform a complete, logical and sequential physical examination.
While emphasizing the health care needs of underserved populations,
the following general objectives will be achieved:
A. Demonstrate the ability to alter the sequence and content of the
examination according to the special need of the individual patient.
B. Perform an appropriate limited examination pertaining to progression,
regression or stability of chronic illness.
C. Perform an appropriate physical examination on an acute illness.
D. Recognize the physical examination findings that are normal and
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E.
abnormal for the patient’s age and gender.
Record all normal and abnormal findings on the defined database.
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*31
3. DIAGNOSTIC STUDIES: Identify, perform, order and/or interpret
appropriate, cost-effective, routine diagnostic procedures, based on
history and physical examination findings, and be able to assist the
physician with other diagnostic procedures as directed.
A. Identify the appropriate and available diagnostic tests for a particular
problem based on the history and physical examination findings.
B. Identify and discuss indications and contraindications of the various
diagnostic tests.
C. Identify and describe the risks, costs and patient inconvenience of
various diagnostic tests.
D. Demonstrate skills required to collect routine specimens.
1. bacteriologic samples
2. bloods, venous and arterial
3. gastric contents
4. sputum
5. stool
6. tissues
7. urine
E. Demonstrate skills necessary to perform and/or interpret basic laboratory
tests.
1. CBC
2. gram stain
3. stool, O&P
4. stool, guaiac
5. urinalysis, dipstick
6. wet prep/KOH
7. pregnancy test
8. alcohol screening
F. Demonstrate skills necessary to perform and interpret a 12 lead EKG
and rhythm strip.
G. Administer, interpret and record results of intradermal skin test.
H. Demonstrate skills necessary to perform and interpret screening
tonometry and audiometry tests.
I.
Identify, order and/or perform and/or interpret other selected diagnostic
tests.
J. Order and make preliminary assessment of routine radiologic studies,
including PA and lateral chests, KUB, GI, GB and extremity films.
K. Know routine preparation for common X-ray studies.
L. Be familiar with techniques of anoscopy, proctoscopy, sigmoidoscopy,
bronchoscopy, gastroscopy and endoscopy and colonoscopy.
M. Be familiar with techniques of thoracentesis, paracentesis,
arthrocentesis, pericardiocentesis and lumbar puncture.
N. Be familiar with routine nuclear medicine studies/reports.
O. Be familiar with the technique of excisional biopsy.
P. Recognize the signs and symptoms of complications of diagnostic
procedures performed or ordered.
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4. DIFFERENTIAL DIAGNOSIS: Develop a differential diagnosis and
diagnostic impression considering the database.
A. Develop a differential diagnosis and diagnostic impression at each stage
of data collection.
B. Demonstrate ability to organize and integrate data from the medical
history, physical examination and diagnostic studies.
C. Demonstrate sound medical judgment in formulating a differential
diagnosis and reaching a diagnostic impression.
D. Be familiar with the common medical problems seen in rural primary
care and their modes of presentation.
5. THERAPEUTICS: Identify, perform and/or order appropriate, costeffective, routine therapeutic procedures and be able to assist the
physician with other therapeutic procedures.
A. Administer intravenous infusions utilizing appropriate equipment
including scalp vein needle, butterfly needle, intravenous catheter,
heparin lock and infusion pumps.
B. Calculate infusion rate.
C. Administer injections by a variety of routes including intradermal,
subcutaneous, intramuscular and intravenous.
D. Be familiar with normal nutritional requirements.
E. Be familiar with dietary treatment of health problems including weight
reduction, diabetic, low fat, low cholesterol and low sodium diets.
F. Be familiar with the drugs used most frequently in treatment or health
problems including basic modes of action, indications, contraindications
and complications.
G. Be familiar with the management of common medical problems.
6. HEALTH PROMOTION/DISEASE PREVENTION: Recognize, develop and
implement effective strategies for incorporating health
promotion/disease prevention into rural primary care practice.
A. Know the appropriate, recommended health screening services for each
gender through the lifespan.
B. Know the risk factors for preventable diseases.
C. Know the personal health behaviors that can predispose to illness.
D. Know the recommended immunizations for each gender throughout the
lifespan.
E. Know the various chemoprophylactic regimens that can be offered to
patients before they develop clinical evidence of disease.
F. Instruct the female patient in self-breast examination technique and its
importance.
G. Recognize the importance of patient education in effecting change in the
health status of both individuals and groups.
7. EMERGENCY SKILLS: Be able to recognize and manage lifethreatening emergencies jointly with, and in the absence of, the
physician.
A. Recognize signs and symptoms of common emergencies and take
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*33
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.
L.
M.
N.
O.
appropriate action to sustain life.
Apply basic techniques of CPR.
1. establish an airway
2. initiate or sustain effective ventilation
3. perform external cardiac massage
Assist with or perform other techniques frequently indicated in lifethreatening situations.
1. endotracheal/nasogastric intubation
2. cricothyrotomy
3. defibrillation/cardioversion
4. central line insertion
5. central venous pressure monitoring
Initiate hemostasis in patients with hemorrhage.
Assess and treat hemorrhagic shock.
Support and treat patients with anaphylactic reaction.
Communicate with the physician regarding the patient’s emergency
status as soon as possible.
Administer and/or advise regarding the first aid indicated in the
overdose, accidental ingestion or attempted suicide with drugs and other
chemical agents.
Know the reference sources regarding toxic materials.
Recognize potentially lethal cardiac dysrhythmias and know the current
treatment for each.
Recognize altered mental status and its common causes and treatment.
Understand the use of and indications for standard emergency
medications and administer if appropriate.
Be familiar with triage procedures in mass casualty situations.
Respect the decision of the patient and/or family for no advanced life
support procedures.
Assess patients with multiple trauma, skull and/or spinal injuries.
8. COMMUNICATION: Be able to communicate in a medically professional
manner, both orally and in writing, to the patient, the family and with
health care professionals.
A. Present to the physician a brief synopsis of the patient’s present illness,
pertinent positive and negative findings and the diagnostic and
therapeutic regimen instituted.
B. Communicate effectively with both patient and family by using a
vocabulary familiar to all concerned.
C. Counsel patient and family regarding the health problem including an
explanation of the disease process, therapy and its rationale, therapeutic
options, prognosis and health care services available.
D. Write routine and all other admission orders by the problem number.
E. Write in a SOAP format, clear concise and relevant progress notes
including diagnostic, therapeutic and patient education plans.
F. Fill out routine laboratory test and diagnostic procedure request forms
accurately and with pertinent data.
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G.
H.
I.
J.
K.
L.
Maintain a complete up-to-date problem list.
Initiate requests for patient services including public health and home
nursing, school testing and evaluation and release of medical records.
Report communicable diseases utilizing appropriate forms and follow-up.
Write interval notes.
Perform discharge summaries.
Give empathetic support to both patient and family in all
communications.
9.
RESEARCH: Demonstrate knowledge of medical research
methodologies and their application to rural primary care medicine.
10. ATTITUDE: Be able to appreciate the perceptions and reactions to
health problems of the individual patient as well as those of culturally
diverse population groups and approach each with sensitivity and an
attitude of professional concern.
A. Appreciate the physical, psychic, social and economic distress created
by the health problem.
B. Maintain the objectivity necessary to permit logical perspective,
assessment and solution of the health problem.
C. Appreciate the difficulty frequently encountered by patients in their attempts
to comply with therapeutic regimens and the health care delivery system.
D. Respect the right of the patient to be informed regarding his/her physical status,
therapy, costs, therapeutic alternatives, prognosis and services available.
E. Respect the patient’s rights to individuality and privacy, and treat
confidential information with professional discretion.
11. ETHICS: Act consistently and responsibly for the patient’s welfare and
best interests, showing respect for persons and their autonomy.
A.
Be committed to providing competent medical care, assuming as a primary
responsibility the health, safety, welfare and dignity of all humans.
B.
Extend the full measure of ability as a dedicated, empathetic health care
provider and assume responsibility for the skillful and proficient transaction
of professional duties.
C.
Deliver needed health care services to health consumers without regard to
sex, age, race, creed, sexual orientation, socio-economic and political status.
D.
Adhere to all state and federal laws governing informed consent
concerning the patient’s health care.
E.
Seek consultation with their supervising physician, other health providers,
or qualified professionals having special skills, knowledge or experience
whenever the welfare of the patient will be safeguarded or advanced by
such consultation.
F.
Take personal responsibility for being familiar with and adhering to all
federal/state laws applicable to the practice of their profession.
G.
Provide only those services for which qualified via education and/or
experiences and by pertinent legal regulatory process.
H.
Not misrepresent on any manner, either directly or indirectly, their skills,
training, professional credentials, identity or services.
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I.
J.
K.
L.
M.
N.
O.
Uphold the doctrine of confidentiality regarding privileged patient information,
unless required to release such information by law or such information
becomes necessary to protect the welfare of the patient or the community.
Strive to maintain and increase the quality of individual health care service
through individual study and continuing education.
Accept the duty to respect the law, uphold the dignity of the physician
assistant profession and to accept its ethical principles.
Not participate in or conceal any activity that will bring discredit or dishonor
to the physician assistant profession and shall expose, without fear or favor,
any illegal or unethical conduct in the medical profession.
Use the knowledge and experience acquired as professionals to contribute
to an improved community.
Place service before material gain and carefully guard against conflicts of
professional interest.
Strive to maintain a spirit of cooperation with professional organizations and
the general public.
12. SOCIAL/HISTORICAL:
A. Rural Primary Care
1. Describe the historical processes that have created the contemporary health
care system in the United States and in Appalachia particularly.
2. Interpret the unique historical forces that have shaped the Appalachian region.
3. Identify the exceptional health care needs of rural Appalachian citizens and
evaluate the difficulties of health care delivery in rural communities.
4. Explain the historical development of the medical profession and evaluate the
consequences of the elevation of physicians above other health care workers.
5. Define the relationships among various categories of health care professionals
and analyze the historical role of each of these groups on the delivery of
medical services to rural Appalachia.
6. Critique the current status of health care in Appalachia.
7. Become familiar with the sociologic concepts, theories and research methods
in rural sociology.
8. Understand the structure and development of urban-rural patterns in the
United States.
9. Become familiar with some of the major issues of rural sociology.
B. Corrections Medicine
1. Describe the historical processes that have lead to the increased demand for
providers to care for the incarcerated patient.
2. Identify the specific health care needs that are unique to patients within
correctional facilities.
3. Identify the unique sociologic environment present within correctional facilities.
4. Critique the current status of health care within correctional settings.
5. Describe current sociologic concepts, theories, and research methods in the
corrections environment.
6. Define the reporting relationships of personnel working within correctional
settings.
7. Describe a plan that could serve to improve care to the incarcerated patient.
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ROTATION OBJECTIVES GENERAL INTERNAL MEDICINE
During the six-week general internal medicine rotation the PA student will
develop appreciation for the care of the adult and geriatric patient with particular
emphasis being placed on the uniqueness of such care in a rural setting. In
addition to the requirements set forth in the segment “General Clinical Goals and
Objectives” the student will:
HISTORY
1. Be able to elicit an appropriate history from the adult or geriatric patient.
a. Elicit detailed history regarding dietary habits, sleep patterns behavior
changes use of medications (prescription or OTC), drugs or alcohol.
b. Elicit history of hearing or visual disturbances
c. Elicit information regarding patient’s home environment, support network
and financial status.
d. Elicit a careful comprehensive history through several interview sessions.
e. Appropriately utilize a second party to augment information obtained from a
patient.
f. Be aware that the process of aging alters both the historical and physical
manifestations of certain diseases.
g. Be aware that geriatric patients may underreport illness.
PHYSICAL EXAMINATION
1. Perform a physical examination on the adult or geriatric patient allowing for:
a. Variations in physical findings among the elderly population.
b. Common normal physical findings in the geriatric population.
c. Abnormal physical findings that are found with increased frequency in this
population.
DIAGNOSTIC STUDIES
1. Identify, perform, order and/or interpret appropriate, cost-effective, routine
diagnostic procedures, based on history and physical examination findings,
and be able to assist the physician with other diagnostic procedures as
directed.
a. Identify the appropriate and available diagnostic tests for a particular
problem based on the history and physical examination findings.
b. Identify and discuss indications and contraindications of the various
diagnostic tests.
c. Identify and describe the risks, costs and patient inconvenience of various
diagnostic tests.
Clinical Preceptor Manual
*37
d. Demonstrate skills required to collect routine specimens.
1. bacteriologic samples
2. bloods, venous and arterial
3. gastric contents
4. sputum
5. stool
6. tissues
7. urine
e. Demonstrate skills necessary to perform and/or interpret basic laboratory tests.
1. CBC
2. gram stain
3. stool, O&P
4. stool, guaiac
5. urinalysis, dipstick
6. wet prep/KOH
7. pregnancy test
8. alcohol screening
f. Demonstrate skills necessary to perform and interpret a 12 lead EKG and rhythm
strip.
g. Administer, interpret and record results of intradermal skin test.
h. Demonstrate skills necessary to perform and interpret screening tonometry and
audiometry tests.
i. Identify, order and/or perform and/or interpret other selected diagnostic tests.
j. Order and make preliminary assessment of routine radiologic studies, including PA
and lateral chests, KUB, GI, GB and extremity films.
k. Know routine preparation for common X-ray studies.
l. Be familiar with techniques of anoscopy, proctoscopy, sigmoidoscopy,
bronchoscopy, gastroscopy and endoscopy and colonoscopy.
m.Be familiar with techniques of thoracentesis, paracentesis, arthrocentesis,
pericardiocentesis and lumbar puncture.
n. Be familiar with routine nuclear medicine studies/reports.
o. Be familiar with the technique of excisional biopsy.
p. Recognize the signs and symptoms of complications of diagnostic procedures
performed or ordered.
DIFFERENTIAL DIAGNOSIS
1. Develop a differential diagnosis and diagnostic impression considering the database
a. Develop a differential diagnosis and diagnostic impression at each stage of
data collection.
b. Demonstrate the ability to organize and integrate data from the medical
history, physical examination, and diagnostic studies.
c. Demonstrate sound medical judgment in formulating a differential diagnosis.
d. Demonstrate skills necessary to accurately record and present data in a
manner appropriate to the setting.
e. Be familiar with the common medical problems and their modes of
presentation, including:
Clinical Preceptor Manual
*38
CARDIOLOGY
Cardiac Risk Factors
Coronary Artery Disease
Angina/Myocardial Infarction
Pericarditis
Congestive Heart Failure
Arrhythmias
Arterial Disease
Aneurysm/Occlusion
Venous thrombosis/Insufficiency
Valvular Heart Disease
Endocarditis
Hypertension
Cardiac Rehabilitation
PULMONARY MEDICINE
Chronic Obstructive Pulmonary Disease
Asthma
Bronchitis/Acute & Chronic
Emphysema
Infections-pneumonia
Cancers of the lung and pleura
Pulmonary Function Testing/Arterial Blood
Gases
Pulmonary
Embolism/Pneumothorax/Hemothorax
Inhalational and Environmental Injury
Silo-Fillers Disease(Hypersensitivity
Pneumonitis)
Farmer’s Lung
Black Lung-Coal worker’s Pneumoconiosis
Tobacco abuse/cessation
Pulmonary Edema/Hypertension
NEPHROLOGY/UROLOGY
Acid Base Balance and Electrolyte Disturbances
Urinary Tract Infections /Pyelonephritis
Glomerulonephritis/Nephrotic Syndrome
Acute Renal Failure
Chronic Renal Failure/Dialysis Nephrolithiasis
Prostatitis
Sexually Transmitted Diseases
Nephrotoxins
NEUROLOGY
Seizure Disorder
Headaches
Meningitis/Encephalitis
Cerebrovascular Disease:TIA/CVA
Multiple Sclerosis
Tremors/Parkinson’s
Neuropathies: Cranial/Peripheral
Spinal Disc Disease
Coma/CNS Trauma
GASTROENTEROLOGY
GERD/Spasm, Stricture, Dysmotility
PUD/Gastritis
Pancreatitis
Malabsorption
Ulcerative Colitis
Crohn’s Disease
Diverticular Disease
Hemorrhoids/Fissures/Fistulas
Neoplasms of the GI Tract
Hepatitis: Infectious/Non-Infectious
Jaundice
Alcoholic Liver Disease
Cholecystitis/Cholelithiasis
Cholangitis
Diarrhea/Constipation
Infections: Viral, Bacterial, Parasitic
Irritable Bowel Syndrome
RHEUMATOLOGY
Osteoarthritis
Infectious Arthritis: Viral/Bacterial/Lyme
Clinical Preceptor Manual
*39
Rheumatoid Arthritis
Gout/Psuedogout
Spondyloarthropathies
Collagen Vascular Disease
ENDOCRINOLOGY
Diabetes Mellitus
Hypoglycemia
Diabetes Insipidus
Thyroid Disease
Hyperlipidemia
Adrenal Cortical Insufficiency
DERMATOLOGY
Allergic/Contact Dermatitis
Acne
Skin Tumors
Infection: Viral, Bacterial Fungal, Parasitic
Psoriasis/Eczema
Dermatologic Manifestations of Systemic
Disease
IMMUNOLOGY/HEMATOLOGY
Anemias
Bleeding Disorders
Leukemias
Lymphomas/Hodgkin’s/ Non-Hodgkin’s
Immune Deficiencies
ALLERGY
Anaphylaxis
Hypersensitivity
OPHTHAMOLOGY
Conjunctivitis/Uveitis/Iritis-The Red Eye
Cataracts
Glaucoma
Corneal Abrasion
Retinal Changes Secondary to Systemic
Disease
ENT
Hearing Loss
Vertigo
Infections: Viral/Bacterial
Allergic Rhinitis/Sinusitis
MENTAL HEALTH
Neurotic Disorders
Psychiatric Emergencies
Depression
Sleep Disorders
Bipolar Disorder
Post Traumatic Stress Syndrome
Schizophrenic Disorders
Anxiety
Paranoid Disorders
Somatoform Disorders
Affective Disorders
Personality Disorders
Dementia
Substance Abuse and Dependence
Clinical Preceptor Manual
*40
THERAPEUTICS
1. Identify, perform and/or order appropriate, cost-effective, routine therapeutic
procedures and be able to assist the physician with other therapeutic procedures.
a. Administer intravenous infusions utilizing appropriate equipment including
butterfly needle, intravenous catheter, heparin lock and infusion pumps.
b. Calculate infusion rate.
c. Administer injections by a variety of routes including intradermal,
subcutaneous, intramuscular and intravenous.
d. Be familiar with normal nutritional requirements.
e. Be familiar with dietary treatment of health problems including weight
reduction, diabetic, low fat, low cholesterol and low sodium diets.
f.
Be familiar with the drugs used most frequently in treatment or health
problems including basic modes of action, indications, contraindications
and complications.
g. Be familiar with the management of common medical problems.
HEALTH PROMOTION/DISEASE PREVENTION
1. Recognize, develop and implement effective strategies for incorporating
health promotion/disease prevention into rural primary care practice.
a. Know the appropriate, recommended health screening services for each gender
through the lifespan.
b. Know the risk factors for preventable diseases.
c. Know the personal health behaviors that can predispose to illness.
d. Know the recommended immunizations for each gender throughout the lifespan.
e. Know the various chemoprophylactic regimens that can be offered to patients
before they develop clinical evidence of disease.
f.
Instruct the female patient in self-breast examination technique and its
importance.
g. Recognize the importance of patient education in effecting change in the health
status of both individuals and groups.
EMERGENCY SKILLS
1. Be able to recognize and manage life-threatening emergencies jointly with,
and in the absence of, the physician.
a. Recognize signs and symptoms of common emergencies and take
appropriate action to sustain life.
b. Apply basic techniques of CPR.
1. establish an airway
2. initiate or sustain effective ventilation
3. perform external cardiac massage
c. Assist with or perform other techniques frequently indicated in lifethreatening situations.
1. endotracheal/nasogastric intubation
2. cricothyrotomy
Clinical Preceptor Manual
*41
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
3. defibrillation/cardioversion
4. central line insertion
5. central venous pressure monitoring
Initiate hemostasis in patients with hemorrhage.
Assess and treat hemorrhagic shock.
Support and treat patients with anaphylactic reaction.
Communicate with the physician regarding the patient’s emergency
status as soon as possible.
Administer and/or advise regarding the first aid indicated in the overdose,
accidental ingestion or attempted suicide with drugs and other chemical agents.
Know the reference sources regarding toxic materials.
Recognize potentially lethal cardiac dysrhythmias and know the current
treatment for each.
Recognize altered mental status and its common causes and treatment.
Understand the use of and indications for standard emergency
medications and administer if appropriate.
Be familiar with triage procedures in mass casualty situations.
Respect the decision of the patient and/or family for no advanced life
support procedures.
Assess patients with multiple trauma, skull and/or spinal injuries.
COMMUNICATION
1. Be able to communicate in a medically professional manner, both orally and
in writing, to the patient, the family and with health care professionals.
a. Present to the physician a brief synopsis of the patient’s present illness,
pertinent positive and negative findings and the diagnostic and therapeutic
regimen instituted.
b. Communicate effectively with both patient and family by using a
vocabulary familiar to all concerned.
c. Counsel patient and family regarding the health problem including an
explanation of the disease process, therapy and its rationale, therapeutic
options, prognosis and health care services available.
d. Write routine and all other admission orders by the problem number.
e. Write in a SOAP format, clear concise and relevant progress notes
including diagnostic, therapeutic and patient education plans.
f.
Fill out routine laboratory test and diagnostic procedure request forms
accurately and with pertinent data.
g. Maintain a complete up-to-date problem list.
h. Initiate requests for patient services including public health and home
nursing, school testing and evaluation and release of medical records.
i.
Report communicable diseases utilizing appropriate forms and follow-up.
j.
Write interval notes.
k. Perform discharge summaries.
l.
Give empathetic support to both patient and family in all communications.
Clinical Preceptor Manual
*42
RESEARCH
1. Demonstrate an awareness of the recognized internal medicine literature,
current issues and controversies in the literature and methods of accessing
current literature while in rural sites.
ATTITUDE
1. Demonstrate an understanding of the effects of illness on the patient, family
and the community.
2. Demonstrate an understanding of the difference between minor problems and
those that require intense therapy and treatment.
3. Demonstrate awareness that drug and alcohol abuse is a common problem.
4. Demonstrate an understanding of the medical/legal aspects of dealing with
health problems.
5. Demonstrate an appreciation for the need to refer patients to community
agencies and therapists.
6. Demonstrate an appreciation for awareness of age dependent mental health
problems.
7. Demonstrate awareness for the scope of the health care system and
understand how it affects scope and access to patient care services.
8. Demonstrate awareness for the respect of the legal rights of patients, including
confidentiality.
Clinical Preceptor Manual
*43
ROTATION OBJECTIVES OBSTETRICS AND GYNECOLOGY
During the six-week obstetrics and gynecology rotation exposure to some or all
of the following subject matter will be provided. In addition to the general
objectives, the student on the Obstetrics and Gynecology rotation should achieve
the following objectives:
HISTORY
1. Elicit an appropriate complete obstetrical and gynecologic history.
a. Elicit a pertinent review of symptoms of pregnancy.
b. Elicit a comprehensive obstetrical history
c. Elicit a history of untoward reaction to anesthesia
d. Elicit a history pertaining to sexuality, STD, menstrual cycles, and
contraceptive use.
2. Calculate the EDC
PHYSICAL EXAMINATION
1. Demonstrate the appropriate use of the fetoscope
2. Perform a pelvic examination
a. Prenatal
b. Postpartum
c. Gynecologic
d. Under anesthesia
3. Perform thorough examination of the prenatal abdomen.
a. Measure uterine height
b. Auscultate the fetal heart and note discrepancies from gestational dates
c. Determine fetal lie
4. Perform Pelvimetry.
5. Assess and document membrane rupture.
6. Determine cervical dilation, effacement and station.
7. Examine the placenta for abnormalities
8. Examine the postpartum abdomen for uterine size
DIAGNOSTIC STUDIES
1.
2.
3.
4.
5.
6.
7.
8.
9.
Formulate a high-risk pregnancy problem list
Apply fetal monitoring system electrodes
Interpret fetal monitoring tracings
Assist in performing amniocentesis
Assist/observe obstetric ultrasound
Assist in performing contraction stress and nonstress testing
Assess contractions, vital signs, and reflexes during labor.
Obtain Pap smears as indicated.
Obtain various cultures as indicated:
a. Gonorrhea
Clinical Preceptor Manual
*44
b. Chlamydia
c. Herpes simplex
d. Group B beta strep
10. Demonstrate skills necessary to perform and/or interpret basic laboratory
tests.
a. CBC
b. stool, guaiac
c. urinalysis, dipstick
d. wet prep/KOH
e. pregnancy test
f. hormonal assays: LH, FSH, Prolactin, Testosterone, DHEAS, Thyroid
Function Tests
11. Assist/perform biopsies:
a. Vulvar
b. Cervical
c. Endocervical
d. Endometrial
12. Be familiar with the techniques of:
a. Post-coital test
b. Basal body temperature charting and interpretation
c. Artificial insemination
d. Hysterosalpingogram
e. Pelvic ultrasound
13. Participate in diagnostic laparoscopy, colposcopy
DIFFERENTIAL DIAGNOSIS
1. Demonstrate and discuss the common obstetric and gynecologic conditions
and problems and their typical presentations including:
OBSTETRICS
Fetal Development
Prenatal Care
Normal Labor and Delivery
High Risk Pregnancy
Toxemia of Pregnancy/PIH
Medical Complications of Pregnancy
Obstetrical Anesthesia
Postpartum Care
Abruptio Placenta
Placenta Previa
Ectopic Pregnancy
Abortion
Intrauterine Death
Cesarean Section
Genetic Counseling
Amniocentesis
Ultrasonography/Fetal Monitoring
Fetal Activity Testing
Clinical Preceptor Manual
*45
GYNECOLOGY
Menstruation/normal and altered
throughout the life cycle
Osteoporosis and prevention
Dysfunctional Uterine Bleeding
Menopause
Contraception
Premenstrual Syndrome
Infertility
PID
Endometriosis
Breast Disease
Benign/Malignant Lesion of the Reproductive Tract
Vaginitis
Sexual Dysfunction
Amenorrhea
Common Gynecologic Surgeries
THERAPEUTICS
1. Know the accepted treatment for the above conditions.
2. Describe and discuss the dietary treatment of obstetrical problems and
special dietary needs of the obstetrical patient.
3. Give support to the patient in labor.
4. Employ proper delivery room protocol.
5. Manage a normal delivery.
6. Recognize the indication for episiotomies.
7. Know which drugs are safe to use during pregnancy and lactation and which
should not be used and why.
8. Insert/Remove IUD’s and manage side effects or complications related to them.
9. Fit diaphragms and cervical caps.
10. Insert/remove Norplant and manage side effects or complications related to
them.
11. Prescribe oral contraceptives and Depo-Provera and manage side effects or
complications related to them.
HEALTH PROMOTION/DISEASE PREVENTION
1. Know, and counsel the obstetric patient about, the current recommendations
regarding:
a. Screening for HIV
b. Screening for chlamydial infections
c. Screening for genital herpes
d. Screening for asymptomatic bacteriuria
e. Screening for rubella
f. Screening ultrasonography
g. Screening for preeclampsia
h. Screening for RH incompatibility
i. Screening for neural tube defects
j. Screening for hemoglobinopathies
k. Screening for PKU
l. Screening for congenital hypothyroidism
m.Intrapartum electronic fetal monitoring
Clinical Preceptor Manual
*46
2. Know, and counsel the gynecologic patient about, the current
recommendations regarding:
a. Screening for breast cancer, including self-breast exam and mammography
b. Screening for cervical cancer
c. Screening for ovarian cancer
d. Screening for osteoporosis
e. Prevention of osteoporosis
f. Hormone replacement therapy in the postmenopausal patient
g. Screening for sexually transmitted diseases
EMERGENCY SKILLS
1. Recognize and institute the initial management of emergency gynecologic and
obstetric emergencies in the absence of the physician, such as:
a. ectopic pregnancy
b. obstetrical hemorrhage
c. preeclampsia/eclampsia/PIH
d. preterm labor
e. intrapartum fetal distress
f. postpartum hemorrhage/infection
g. sepsis
h. embolic phenomena
i. dysfunctional uterine bleeding
j. pelvic inflammatory disease
k. torsion of ovarian cyst
l. know the protocol for medical evaluation of rape/domestic abuse
COMMUNICATION
1. Counsel patients and their family regarding pregnancy and childbirth,
explaining the normal processes, complications and instruct regarding the
importance of adequate nutrition and prenatal and postpartum care.
2. Counsel patients regarding breastfeeding vs. bottle feeding.
3. Maintain a complete prenatal and L&D record.
4. Counsel patients regarding birth control and sexual concerns.
5. Counsel patients regarding premenstrual syndrome.
6. Counsel patients regarding menopausal symptoms, osteoporosis, and
hormone replacement therapy.
7. Counsel patients regarding sexually transmitted diseases.
8. Counsel patients regarding infertility.
9. Counsel patients regarding keeping a basal body temperature chart and in
the use of ovulation predictor kits.
10. Counsel patients regarding the normal menstrual cycle and expected
changes over the lifespan.
11. Counsel patients regarding rape and domestic abuse.
Clinical Preceptor Manual
*47
RESEARCH
1. Demonstrate an awareness of the recognized obstetric and gynecologic
medical literature, current issues and controversies in the literature and
methods of accessing current literature while in rural sites.
ATTITUDE
1. Demonstrate an understanding of the role and range of female sexuality,
showing sensitivity to its variable expression among individuals and different
social and cultural groups.
2. Demonstrate an understanding of, and show sensitivity to, the emotional and
physical changes experienced by women throughout the lifespan.
Clinical Preceptor Manual
*48
ROTATION OBJECTIVES GENERAL SURGERY
During the six-week general surgical rotation, exposure to some or all of the
following subject matter will be provided. In addition to the general objectives
previously listed the student will accomplish the following:
HISTORY
1. Elicit a history of untoward reactions to anesthesia.
2. Elicit a history of diseases that affect the advisability of surgery.
3. Elicit a history of recurrent or progressive surgical problems.
4. Elicit a history pertaining to prior surgical complications.
5. Elicit a post-operative history.
PHYSICAL EXAMINATION
Perform an appropriate physical examination for the surgical patient
DIAGNOSTIC STUDIES
1. Identify, perform, order and/or interpret appropriate, cost-effective, routine
diagnostic procedures, based on history and physical examination findings,
and be able to assist the physician with other diagnostic procedures as
directed.
a. Identify the appropriate and available diagnostic tests for a particular
problem based on the history and physical examination findings.
b. Identify and discuss indications and contraindications of the various
diagnostic tests.
c. Identify and describe the risks, costs and patient inconvenience of various
diagnostic tests.
d. Demonstrate skills required to collect routine specimens.
1. bacteriologic samples
2. blood, venous and arterial
3. gastric contents
4. sputum
5. stool
6. tissues
7. urine
e. Demonstrate skills necessary to perform and/or interpret basic laboratory
tests.
1. CBC
2. gram stain
3. stool, O&P
4. stool, guaiac
5. urinalysis, dipstick
6. wet prep/KOH
7. pregnancy test
Clinical Preceptor Manual
*49
8. alcohol screening
f. Demonstrate skills necessary to perform and interpret a 12 lead EKG and
rhythm strip.
g. Administer, interpret and record results of intradermal skin test.
h. Demonstrate skills necessary to perform and interpret screening tonometry
and audiometry tests.
i. Identify, order and/or perform and/or interpret other selected diagnostic
tests.
j. Order and make preliminary assessment of routine radiologic studies,
including PA and lateral chests, KUB, GI, GB and extremity films.
k. Know routine preparation for common X-ray studies.
l. Be familiar with techniques of anoscopy, proctoscopy, sigmoidoscopy,
bronchoscopy, gastroscopy and endoscopy and colonoscopy.
m.Be familiar with techniques of thoracentesis, paracentesis, arthrocentesis,
pericardiocentesis and lumbar puncture.
n. Be familiar with routine nuclear medicine studies/reports.
o. Be familiar with the technique of excisional biopsy.
p. Recognize the signs and symptoms of complications of diagnostic
procedures performed or ordered.
DIFFERENTIAL DIAGNOSIS
1. Describe and discuss common surgical problems, concerns and their modes
of presentation, including:
GENERAL
pre/post operative care
wound care and infections
Anesthesia
aseptic technique
principles of suturing
fluid and electrolyte balance and acid base
surgical nutrition/hyperalimentation
shock
trauma care
burns
organ transplantation
SYSTEMS
Breasts-Tumors/reconstruction
CARDIOVASCULAR
Arterial by-pass grafting
Aneurysms
Venous ligation
Arterial reconstruction
THORAX
Lung biopsy/resection
Clinical Preceptor Manual
*50
ABDOMEN
Acute surgical abdomen
Appendectomy
Bowel resection
Laparscopic procedures
Cholecystectomy
Liver Bx
Herniorrhaphy
Gastric Procedures-fundoplication/V&P/
UROLOGY
Prostatectomy
Nephrolithiasis
Prostatic/Testicular tumors
TURP
Vasectomy
ORTHOPEDICS
Common Knee Injuries
Common Shoulder Injuries
Arthroscopy/Arthroplasty
Hand Injuries
ORIF Fractures
NEUROSURGERY
Cervical/lumbar disc disease
Common cranial tumors
VP Shunts for hydrocephalus
Management of increased intercranial
pressure
Repair AVM
THERAPEUTIC SKILLS
The PA student will demonstrate the following knowledge, skills and abilities
during their surgical rotation.
1. Discuss the composition of fluids that are frequently lost from the body
including urine, gastric secretions, diarrhea, third space fluids, and
hemorrhage.
2. Discuss the relationships between serum electrolytes and IV therapy and the
need to adjust therapy based on lab results and physical signs.
3. Recognize the problems associated with hypo and hypervolemia.
4. Describe blood and blood products utilized in IV therapy and the indications,
precautions, contraindications, and complications of their use.
5. Recognize the drugs most frequently used in treatment of surgical problems,
including basic modes of actions, indication, contraindications, and
complications.
6. Describe pre-op and post-op management of surgical patients.
7. Discuss anesthetics, their indications, modes of action, contraindications,
complications, and combinations in:
a. General anesthesia
b. Spinal and regional anesthesia
c. Regional anesthesia/field blocks
Clinical Preceptor Manual
*51
8. Utilize infiltration anesthesia.
9. Apply casts, splints, or wraps to immobilize the injured structure.
10. Assemble surgical instruments necessary for wound closure and use these
instruments appropriately.
11. Set up a sterile field and prep the injured area.
12. Employ proper techniques for closing wounds.
a. Aseptic technique
b. Hemostasis
c. Closure of dead space
d. Approximation of like tissues
e. Know various techniques for dermal closure
1. Simple stitch
2. Vertical/horizontal mattress
3. Running stitch
4. Running subcuticular
5. Specialty closure techniques
13. Discuss the different types of suture materials and their uses including silk,
gut, chromic, nylon, dacron, vicryl, and PDS.
14. Demonstrate I&D of an abscess.
15. Instruct the patient in proper wound care.
16. Assess wound healing.
17. Remove sutures/staples.
18. Describe fluid therapy in burn patients.
19. Demonstrate proper use of topical antibiotics.
20. Demonstrate how to dress wounds including burn dressings.
21. Demonstrate management of burn patients, including nutrition and burn
complications.
22. Demonstrate/Discuss the management of common surgical problems as
listed above.
HEALTH PROMOTION/DISEASE PREVENTION
1. Recognize, develop and implement effective strategies for incorporating
health promotion/disease prevention into rural primary care practice.
a. Know the appropriate, recommended health screening services for each
gender through the lifespan.
b. Know the risk factors for preventable diseases.
c. Know the personal health behaviors that can predispose to illness.
d. Know the recommended immunizations for each gender throughout the
lifespan.
e. Know the various chemoprophylactic regimens that can be offered to
patients before they develop clinical evidence of disease.
f.
Instruct the female patient in self-breast examination technique and its
importance.
g. Recognize the importance of patient education in effecting change in the
health status of both individuals and groups.
Clinical Preceptor Manual
*52
EMERGENCY SKILLS
1. Be able to recognize and manage life-threatening emergencies jointly with,
and in the absence of, the physician.
a. Recognize signs and symptoms of common emergencies and take
appropriate action to sustain life.
b. Apply basic techniques of CPR.
1. establish an airway
2. initiate or sustain effective ventilation
3. perform external cardiac massage
c. Assist with or perform other techniques frequently indicated in lifethreatening situations.
1. endotracheal/nasogastric intubation
2. cricothyrotomy
3. defibrillation/cardioversion
4. central line insertion
5. central venous pressure monitoring
d. Initiate hemostasis in patients with hemorrhage.
e. Assess and treat hemorrhagic shock.
f.
Support and treat patients with anaphylactic reaction.
g. Communicate with the physician regarding the patient’s emergency
status as soon as possible.
h. Administer and/or advise regarding the first aid indicated in the
overdose, accidental ingestion or attempted suicide with drugs and other
chemical agents.
i.
Know the reference sources regarding toxic materials.
j.
Recognize potentially lethal cardiac dysrhythmias and know the current
treatment for each.
k. Recognize altered mental status and its common causes and treatment.
l.
Understand the use of and indications for standard emergency
medications and administer if appropriate.
m. Be familiar with triage procedures in mass casualty situations.
n. Respect the decision of the patient and/or family for no advanced life
support procedures.
o. Assess patients with multiple trauma, skull and/or spinal injuries.
COMMUNICATION
1. Be able to communicate in a medically professional manner, both orally and
in writing, to the patient, the family and with health care professionals.
a. Present to the physician a brief synopsis of the patient’s present illness,
pertinent positive and negative findings and the diagnostic and
therapeutic regimen instituted.
b. Communicate effectively with both patient and family by using a
vocabulary familiar to all concerned.
c. Counsel patient and family regarding the health problem including an
explanation of the disease process, therapy and its rationale, therapeutic
Clinical Preceptor Manual
*53
d.
e.
f.
g.
h.
i.
j.
k.
l.
options, prognosis and health care services available.
Write routine and all other admission orders by the problem number.
Write in a SOAP format, clear concise and relevant progress notes
including diagnostic, therapeutic and patient education plans.
Fill out routine laboratory test and diagnostic procedure request forms
accurately and with pertinent data.
Maintain a complete up-to-date problem list.
Initiate requests for patient services including public health and home
nursing, school testing and evaluation and release of medical records.
Report communicable diseases utilizing appropriate forms and follow-up.
Write interval notes.
Perform discharge summaries.
Give empathetic support to both patient and family in all
communications.
RESEARCH
1. Demonstrate knowledge of medical research methodologies and their
application to rural primary care medicine.
2. Demonstrate the ability to obtain current surgical literature when located in
remote areas.
ATTITUDE
1. Demonstrate an understanding for the anxiety produced by the prospect of
surgery and/or anesthesia for the patient and the family.
2. Demonstrate an understanding for the patient’s concern over body
disfigurement.
3. Demonstrate an understanding for the emotional sequelae experienced by
the victim of acute trauma.
Clinical Preceptor Manual
*54
ROTATION OBJECTIVES PEDIATRICS
During the six-week pediatric rotation exposure to some, or all of, the following
subject matter will be provided. In addition to the objectives previously listed the
student will be responsible for the following:
HISTORY
1. Obtain a complete or partial history from or regarding pediatric patients of any age.
2. Elicit a well baby history including physical growth, mental and emotional
development, immunizations, and the historical components of Denver
Developmental Screening Exam.
3. Elicit dietary history including formula used, amount taken, feeding per twentyfour hours, dates starting new foods, food intolerance, and history of pica.
4. Utilize techniques required to obtain an adolescent history including school
performance, peer interactions, substance abuse, sexual activity, and tobacco use.
PHYSICAL EXAMINATION
1. Be able to perform a complete and partial physical examination on pediatric
patients.
2. Develop skills that assist in the examination of the uncooperative child.
3. Perform examination of the newborn
4. Demonstrate APGAR Scoring
5. Determine gestational age by examination.
6. Measure, record and chart height, weight, and head circumference on
standard nomograms.
7. Utilize screening exams to augment the basic physical examination.
DIAGNOSTIC STUDIES
1. Identify, perform, order and/or interpret appropriate, cost-effective, routine
diagnostic procedures, based on history and physical examination findings,
and be able to assist the physician with other diagnostic procedures as
directed.
a. Identify the appropriate and available diagnostic tests for a particular
problem based on the history and physical examination findings.
b. Identify and discuss indications and contraindications of the various
diagnostic tests.
c. Identify and describe the risks, costs and patient inconvenience of various
diagnostic tests.
d. Demonstrate skills required to collect routine specimens.
1. bacteriologic samples
2. blood, venous and arterial
3. gastric contents
4. sputum
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5. stool
6. tissues
7. urine
e. Demonstrate skills necessary to perform and/or interpret basic laboratory
tests.
1. CBC
2. gram stain
3. stool, O&P
4. stool, guaiac
5. urinalysis, dipstick
6. wet prep/KOH
7. pregnancy test
8. alcohol screening
f. Demonstrate skills necessary to perform and interpret a 12 lead EKG and
rhythm strip.
g. Administer, interpret and record results of intradermal skin test.
h. Demonstrate skills necessary to perform and interpret screening
audiometric testing.
i. Identify, order and/or perform and/or interpret other selected diagnostic tests.
j. Order and make preliminary assessment of routine radiologic studies,
including PA and lateral chests, KUB, GI, and extremity films.
k. Know routine preparation for common X-ray studies.
l. Be familiar with techniques of anoscopy, proctoscopy, sigmoidoscopy,
bronchoscopy, gastroscopy and endoscopy and colonoscopy.
m.Be familiar with techniques of thoracentesis, paracentesis, arthrocentesis,
pericardiocentesis and lumbar puncture.
n. Be familiar with routine nuclear medicine studies/reports.
o. Be familiar with the technique of excisional biopsy.
p. Recognize the signs and symptoms of complications of diagnostic
procedures performed or ordered.
DIFFERENTIAL DIAGNOSIS
1. Describe and discuss common pediatric problems and concerns and their
modes of presentation including:
GENERAL
Newborn Exam
Problems in the neonate
Fluids and Electrolytes
Poisonings
Mental Retardation
Child Abuse
Failure to Thrive
Well Baby/Child Exams
Acid Base Balance
Growth and Development
Genetic Disorders/Counseling
Fever of unknown origin
Communicable Disease
Immunizations
Learning Disabilities
Adolescent Medicine
Depression/Suicide
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CARDIOLOGY
Congenital Heart Disease
RESPIRATORY
URI
Pharyngitis
Pneumonia
Respiratory Distress Syndrome
Cystic Fibrosis
Otitis Media/Otitis Externa
Croup/Epiglottitis
Bronchitis/Bronchiolitis
Asthma
GASTROINTESTINAL
Infection: bacterial, viral, parasitic
Hyperbilirubinemia
Congenital anomalies
Diarrhea/Dehydration
Constipation
GENITOURINARY
Urinary Tract infections
Vaginitis
Vesicoureteral reflux
Hematuria
Tumors
ORTHOPAEDICS
Common Fractures
Congenital abnormalities
Dislocations/Subluxations
ENDOCRINE
Diabetes
Thyroid Disease
Congenital Endocrinopathies
NEUROLOGY
Meningitis
Seizure Disorder
Encephalitis
Pediatric Headaches
DERMATOLOGY
Viral exanthems
Parasitic Infections
Acne
Contact Dermatitis
Impetigo
Miliaria
Eczema
Tinea/Monilial Infections
Allergic Dermatitis
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THERAPEUTICS
1.
2.
3.
4.
5.
Monitor serum drug levels in patients on long term treatment.
Remove cerumen from the external auditory canal using various techniques.
Perform and or interpret audiometry and/or tympanometry.
Administer immunizations using the recommended schedule.
Demonstrate techniques that are unique to the pediatric patient in advanced life
support.
6. Obtain IV access on the pediatric patient.
7. Perform urethral catheterization on the pediatric patient.
8. Demonstrate appropriate treatment of the above conditions.
HEALTH PROMOTION/DISEASE PREVENTION
1. Recognize, develop and implement effective strategies for incorporating
health promotion/disease prevention into rural primary care practice.
a. Know the appropriate, recommended health screening services for each
gender through the lifespan.
b. Know the risk factors for preventable diseases.
c. Know the personal health behaviors that can predispose to illness.
d. Know the recommended immunizations for each gender throughout the
lifespan.
e. Know the various chemoprophylactic regimens that can be offered to
patients before they develop clinical evidence of disease.
f.
Instruct the female patient in self-breast examination technique and its
importance.
g. Recognize the importance of patient education in effecting change in the
health status of both individuals and groups.
EMERGENCY SKILLS
1. Be able to recognize and manage life-threatening emergencies jointly with,
and in the absence of, the physician.
a. Recognize signs and symptoms of common emergencies and take
appropriate action to sustain life.
b. Apply basic techniques of CPR and Pediatric Advanced Life Support.
1. establish an airway
2. initiate or sustain effective ventilation
3. perform external cardiac massage
c. Assist with or perform other techniques frequently indicated in lifethreatening situations.
1. endotracheal/nasogastric intubation
2. defibrillation/cardioversion
3. central line insertion
d. Initiate hemostasis in patients with hemorrhage.
e. Assess and treat hemorrhagic shock.
f.
Support and treat patients with anaphylactic reaction.
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g.
h.
i.
j.
k.
l.
m.
n.
o.
Communicate with the physician regarding the patient’s emergency
status as soon as possible.
Administer and/or advise regarding the first aid indicated in the
overdose, accidental ingestion or attempted suicide with drugs and other
chemical agents.
Know the reference sources regarding toxic materials.
Recognize potentially lethal cardiac dysrhythmias and know the current
treatment for each.
Recognize altered mental status and its common causes and treatment.
Understand the use of and indications for standard emergency
medications and administer if appropriate.
Be familiar with triage procedures in mass casualty situations.
Respect the decision of the patient and/or family for no advanced life
support procedures.
Assess patients with multiple trauma, skull and/or spinal injuries.
COMMUNICATION
1. Counsel the patient and parents on a variety of subjects including, but not
limited to, growth and development, nutrition, childhood fears, accident
prevention, preparation for school, obesity, immunizations, and discipline.
2. Counsel the adolescent regarding common adolescent concerns
a. Explain the process of physical and emotional maturing.
b. Reassure the patient about sexually related matters including development,
menstruation, masturbation, sexual intercourse, birth control, and abortion.
c. Explain disease processes as they relate to the adolescent’s medical
problems.
d. Counsel the adolescent in problems related to smoking, drugs and alcohol use.
RESEARCH
1. Demonstrate an awareness of the recognized pediatric medical literature,
current issues and controversies in the literature and methods of accessing
current literature while in rural sites.
ATTITUDE
1. Demonstrate an understanding of the parents’ concern for the child, and their
anxiety over any pediatric problems.
2. Demonstrate an understanding of the emotional trauma suffered by the
battered/abused child as well as the psychiatric problems of the adult inflicting
the injury.
3. Demonstrate an understanding of the increasing incidence of adolescent suicide.
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ROTATION OBJECTIVES CARDIOLOGY
During the students rotation in cardiology exposure to some or all of the following
subject matter will be provided. The student will gain experience and proficiency
working as a member of an organized health care team. Emphasis shall be
placed on developing skills and cognitive knowledge that will help the student
perform well in a primary care setting. Additional objectives to be attained by the
student are as follows:
BASIC SCIENCE
1. Describe the anatomy of the cardiovascular system
2. Describe the physiologic function of the cardiovascular system
3. Describe pathophysiologic mechanisms involved in the following
a. Ischemic Heart Disease and Acute MI
b. Congestive Heart Failure
c. Cardiomyopathies and Myocarditis
d. Pericardial Disease
e. Hypertension
f. Arteriosclerosis
g. Cardiac Arrhythmias
h. Cardiogenic Shock
HISTORY
1. Elicit and record an appropriate cardiovascular history including:
a. Cardiovascular review of systems
b. Past medical history pertinent to the cardiovascular system
c. Social history pertinent to the cardiovascular system
d. Family history pertinent to the cardiovascular system
e. Current medications
f. Drug allergies
g. Cardiovascular disease risk factors
2. Recognize the classic historical presentation of the following etiologies of
chest pain and shortness of breath
a. Angina Pectoris
b. Acute Myocardial Infarction
c. Congestive Heart Failure
d. Pericarditis
e. COPD
f. Musculoskeletal including muscle strain and costochondritis
g. Neurogenic including Herpes Zoster and radiculopathies
h. Pulmonary Embolus
i. Pneumonia
j. Pleuritis
k. Pneumothorax/hemothorax
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PHYSICAL EXAMINATION
1. Given a patient or historical, and laboratory data perform a comprehensive
cardiovascular examination
2. Describe various normal and abnormal findings on the cardiovascular
examination and further describe their etiology including:
a. Normal heart sounds (S1, S2, physiologic splitting, Physiologic S3)
b. Abnormal heart sounds(S3, S4, murmurs, rubs, valvular opening sounds,
etc)
c. Lifts, heaves and thrills
d. Diminished or absent pulses
e. Bruits
f. Venous hums
g. JVD and Hepatojugular reflux
h. Skin changes consistent with various types of cardiovascular
disease(cyanosis etc)
DIFFERENTIAL DIAGNOSIS
1. Given a patient or historical, physical and laboratory findings differentiate
between the following:
a. Stable and unstable angina
b. Acute myocardial infarction
c. Variant angina
d. Pericarditis
e. Cardiomyopathy
f. Pulmonary embolus
g. Pneumonia
h. Pneumothorax
i. Herpes Zoster or other chest pain of neurogenic etiology
j. Atypical chest pain
k. Musculoskeletal chest pain
l. Psychogenic chest pain
DIAGNOSTIC STUDIES
1. Given a rhythm strip differentiate between the following
arrhythmias/conditions:
a. Tachy-arrhythmias
1. Atria Fib Flutter
2. PSVT
3. Sinus tachycardia
4. Ventricular tachycardia/fibrillation
5. WPW syndrome
b. Brady-arrhythmias
c. Sinus bradycardia
1. 1st, 2nd, and 3rd degree heart block
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2. Asystole
d. Premature contractions from various locations (APC’s VPC’s, JPC’s, etc)
3. Given a 12 lead EKG be able to identify the following conditions:
a. Myocardial infarct patterns
b. Pericarditis
c. Bundle branch blocks
d. LVH
e. RVH
4. Describe the possible etiologies of abnormal cardiac enzymes including
a. CPK/Fractions
b. SGOT
c. LDH
5. Classify various lipid abnormalities (hyper and dyslipidemias), describe
secondary etiologies and prescribe treatment based on NCEP guidelines
THERAPEUTIC
1. Describe an approach to management, following JNC guidelines, of hypertension
2. Describe an approach to management of the patient with ischemic heart
disease including acute MI and angina pectoris
3. Describe an approach to management of asystole, tachy & brady arrhythmias
4. Describe and approach to managing the patient with CHF
HEALTH PROMOTION AND DISEASE PREVENTION
1. List the risk factors for atherosclerotic cardiovascular disease
2. Given a patient database prescribe preventive measures to be taken to
overcome reversible risk factors
3. Counsel patients on the advantages of exercise, smoking cessation, and
prudent diet
COMMUNICATION
1. Be able to communicate in a medically professional manner, both orally and
in writing, to the patient, the family and with health care professionals.
a. Present to the physician a brief synopsis of the patient’s present illness,
pertinent positive and negative findings and the diagnostic and therapeutic
regimen instituted.
b. Communicate effectively with both patient and family by using a
vocabulary familiar to all concerned.
c. Counsel patient and family regarding the health problem including an
explanation of the disease process, therapy and its rationale, therapeutic
options, prognosis and health care services available.
d. Write routine and all other admission orders by the problem number.
e. Write in a SOAP format, clear concise and relevant progress notes
including diagnostic, therapeutic and patient education plans.
f. Fill out routine laboratory test and diagnostic procedure request forms
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accurately and with pertinent data.
g. Maintain a complete up-to-date problem list.
h. Initiate requests for patient services including public health and home
nursing, school testing and evaluation and release of medical records.
i. Report communicable diseases utilizing appropriate forms and follow-up.
j. Write interval notes.
k. Perform discharge summaries.
l. Give empathetic support to both patient and family in all communications.
2. Understand the roles of the various health care providers in performing
primary screening for cardiovascular disease.
3. Communicate effectively the breadth and scope of services needed when
consulting and/or referring a patient for cardiac consultation.
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ROTATION OBJECTIVES DERMATOLOGY
During the student’s rotation in dermatology exposure to some or all of the
following subject matter will be provided. The student will gain experience and
proficiency working as a member of an organized health care team. Emphasis
should be placed on developing skills and cognitive knowledge that will help the
student perform well in a primary care setting. Additional objectives to be attained
by the student are as follows:
BASIC SCIENCE
1. Describe the anatomy and components of the integumentary system
2. Describe the physiologic function of the integumentary system
3. Describe the physiologic and pathophysiological affects of UV radiation on the
skin
HISTORY
1. Elicit an appropriate complete dermatologic history
a. elicit an appropriate dermatologic review of systems and medical review of
systems that may lead the clinician to discover dermatologic
manifestations of systemic disease
b. elicit an appropriate dermatologic and systemic past medical history
c. elicit an appropriate social and occupational history pertinent to
dermatologic disease
d. record the database acquired on the office or hospital record using the
traditional or problem oriented format
2. Recognize classic historical presentations of primary dermatologic diseases
and develop the ability to expand the database by exploring the following:
a. risk factors
b. exacerbating factors/conditions
c. results of personal or medical attempts to treat the condition
d. exposure to vocational or avocational skin irritants or common allergens
e. use of personal hygiene products
f. current or previous UV exposure
PHYSICAL EXAMINATION
1. Describe a technique used for and the environment most conducive to
performing an examination of the skin
2. Demonstrate the technique used for palpating the skin, hair and nails and list
characteristics to be noted during this examination
3. Describe the normal and abnormal color characteristics of the skin and list
common causes for abnormal findings
4. List commonly found nevi and describe characteristics that will help identify
them
5. Describe various vascular lesions and list their etiology
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6. List characteristics to observe when examining the skin including the following
characteristics of skin, rashes, and/or lesions:
a. color
b. distribution
c. type
d. grouping or configuration
e. edema
f. temperature
g. texture
h. thickness
i. mobility & turgor
7. List the most common types of primary skin lesions and describe their
appearance
8. Describe the characteristics to be noted when inspecting and palpating the
hair
9. Describe the common characteristics to be noted when inspecting and
palpating the nails
10. List common normal and abnormal variations in the skin examination found in
the newborn and children
11. List common normal and abnormal variations in the skin examination found in
the elderly
12. List common non malignant skin abnormalities and be able to describe and
recognize them
13. List common cutaneous malignancies and be able to recognize and describe
them
14. List risk factors for Malignant Melanoma and other cutaneous neoplasms
15. List common nail pathologies and be able to identify them
16. List common hair pathologies and be able to identify them
DIFFERENTIAL DIAGNOSIS
1. Differentiate between the following common dermatologic conditions:
a. intradermal, junctional, hairy, halo, compound, and dysplastic nevi
b. purpura, petechiae, spider angioma, and venous stars
c. primary lesions such as macule, papule, patch, plaque, wheel, nodule,
tumor, vesicle, bullae, & pustule
d. secondary lesions such as scale, crust, lichenification, scar, keloid,
excoriation, fissure, ulcer, erosion, atrophy
2. When presented with the following conditions develop a differential diagnosis,
describe a diagnostic and therapeutic approach
a. contact dermatitis
b. dermatophyte, viral and bacterial infections of the skin, hair and nails
c. infestations
d. Lichen Planus
e. urticaria
f. verrucae
g. molluscum contagiosum
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h. sebaceous cysts
i. seborrheic keratosis
j. xerosis
3. When presented with a dermatitis differentiate between primary skin
conditions and manifestations of systemic disease such as:
a. xanthomas
b. malar rash of systemic lupus erythematosus
c. scarlatina
d. erythema infectiosum
e. Kaposi’s sarcoma
f. septicemia(petechiae, etc)
g. nail changes such as clubbing, spooning, Beau’s lines, splinter
hemorrhages, etc
DIAGNOSTIC
1. Describe the indications for, complications of, and technique to perform the
following procedures
a. punch biopsy
b. excisional biopsy
c. incisional biopsy
d. skin scraping
2. Describe the indications for and perform the following diagnostic tests
a. KOH prep
b. Wood’s light examination
c. Transillumination
THERAPEUTIC
1. Describe a therapeutic approach to the conditions listed above
2. Describe the indications, contraindications and adverse reactions for
prescribing common topical dermatologic agents
3. Describe the indications, contraindications, and adverse reactions to common
oral agents used to treat dermatologic conditions including, but not limited to,
antipruritics, corticosteroids, and antifungal agents
HEALTH PROMOTION AND DISEASE PREVENTION
1. Counsel patients on the importance of protection from UV radiation exposure
2. Counsel patients on the importance of routine self skin examinations and
indications for self referral for dermatologic care
3. Counsel patients regarding the risk factors and warning signs for skin cancer
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COMMUNICATION
1. Be able to communicate in a medically professional manner, both orally and
in writing, to the patient, the family and with health care professionals.
a. Present to the physician a brief synopsis of the patient’s present illness,
pertinent positive and negative findings and the diagnostic and therapeutic
regimen instituted.
b. Communicate effectively with both patient and family by using a
vocabulary familiar to all concerned.
c. Counsel patient and family regarding the health problem including an
explanation of the disease process, therapy and its rationale, therapeutic
options, prognosis and health care services available.
d. Write routine and all other admission orders by the problem number.
e. Write in a SOAP format, clear concise and relevant progress notes
including diagnostic, therapeutic and patient education plans.
f. Fill out routine laboratory test and diagnostic procedure request forms
accurately and with pertinent data.
g. Maintain a complete up-to-date problem list.
h. Initiate requests for patient services including public health and home
nursing, school testing and evaluation and release of medical records.
i. Report communicable diseases utilizing appropriate forms and follow-up.
j. Write interval notes.
k. Perform discharge summaries.
l. Give empathetic support to both patient and family in all communications.
2. Understand the roles of the various health care providers in performing
primary screening for dermatologic disease.
3. Communicate effectively the breadth and scope of services needed when
consulting and/or referring a patient for dermatologic consultation
RESEARCH
1. Demonstrate an awareness of the recognized dermatologic literature, current
issues and controversies in the literature and methods for accessing current
medical literature while in rural sites
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ROTATION OBJECTIVES ENT
During the students rotation in ENT exposure to some or all of the following
subject matter will be provided. The student will gain experience and proficiency
working as a member of an organized health care team. Emphasis should be
placed on developing skills and cognitive knowledge that will help the student
perform well in a primary care setting. Additional objectives to be attained by the
student are as follows:
BASIC SCIENCE
1. Describe the anatomic components of the ear, nose, and throat
2. Describe the physiologic function of the ear, nose and throat
3. Describe common pathophysiological mechanisms involved in otolaryngology
HISTORY
1. Elicit an appropriate complete history relative to common ENT problems
2. Record the database acquired on the office or hospital record using a
traditional or problem oriented format
3. Recognize the classic historic presentations of disorders of the ear, nose or
throat and further develop the database by exploring risk factors, vocational
and avocational factors, and noise exposure
PHYSICAL HISTORY
1. Perform and appropriate physical examination of the ear, nose, and throat
2. Recognize the multiple organ systems that may be responsible for common
ENT complaints
3. Identify common normal and abnormal findings on physical examination of
the ear nose and throat
DIAGNOSTIC
1. Given a patient or historical, physical, and laboratory data, be able to
diagnose and initiate treatment or appropriate referral for the following
common problems:
a. hearing loss
b. sinusitis
c. foreign body: (ear, nose, and throat)
d. otitis externa
e. otitis media
f. perforated tympanic membrane
g. pharyngitis/tonsillitis
h. Meniere’s disease
i. labyrinthitis
j. epistaxis
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k. rhinitis
l. septal deviation
m. nasal polyps
2. Know the indications, contraindications, and technique for performing the
following:
a. audiometry
b. tympanograms
c. radiologic evaluation including plain films and CT scans
THERAPEUTIC
1. Perform, or assist the physician in performing, the following therapeutic
procedures:
a. cerumen removal
b. sinus lavage
c. otic wick insertion
2. Perform or assist in the following procedures developing an awareness of
their indications, complications, appropriate equipment, and technique:
a. surgical scrub
b. donning of gown, gloves and mask
c. proper draping of the patient
d. proper application of wound dressings
e. surgical closure
3. Participate in postoperative care by:
a. ordering appropriate IV fluids
b. maintaining appropriate IV fluids
c. maintaining patient on appropriate diet
d. administering wound care with special attention to drains and tubes
e. monitoring patients with nasogastric catheters in place
f. progressing patient’s ambulation at the appropriate times
g. demonstrate measures to prevent post-operative thrombophlebitis/pulmonary
emboli
4. List common complications of ENT surgeries and treatments for each
complication
5. Describe the indications and contraindications as well as possible
complications for the following surgical cases:
a. tonsillectomy and/or adenoidectomy
b. myringotomy with or without insertion tubes
c. tympanoplasty
HEALTH PROMOTION AND DISEASE PREVENTION
1. Counsel patients regarding the following primary preventive measures:
a. appropriate use of hearing protection
b. smoking cessation as a mechanism to decrease the incidence of
respiratory disease and promote healthy living
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COMMUNICATION
1. Be able to demonstrate both orally in writing a complete database in a
concise, orderly fashion.
2. Develop an appreciation for the contribution of all health care providers in
performing primary screening services for ENT disease and communicate
effectively the breadth and scope of services needed when consulting and/or
referring a patient for ENT problems.
RESEARCH
Demonstrate an awareness of the recognized ENT literature, current issues and
controversies in the literature and methods for accessing current medical
literature while in rural sites.
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ROTATION OBJECTIVES ORTHOPEDICS
During the student’s six-week elective rotation in orthopedics the PA student will
develop an appreciation for the care of musculoskeletal diseases and trauma
unique to the discipline. Emphasis shall be placed on the elements of this
discipline essential to the practice of primary care. In addition to the requirements
set forth in the segment general clinical goals and objectives the student will:
HISTORY
1. Be able to elicit a first or second party history pertinent to care of the
orthopedic patient developing skills in data base gathering and competence in
common diagnosis.
2. Recognize that musculoskeletal problems rank sixth as a cause for all patient
complaints and that 70% of musculoskeletal problems will be cared for by
primary care providers and not orthopedists
3. Recognize the importance of discovering abuse or neglect as the etiology of
musculoskeletal injuries during all ages of the lifespan.
4. Discover underlying risk factors for recurrent orthopedic injuries.
PHYSICAL EXAMINATION
1. Demonstrate knowledge of musculoskeletal anatomy, pathology, and
physiology applicable to the diagnosis, treatment, and prevention of
musculoskeletal disease.
2. Develop proficiency in performing a musculoskeletal examination
3. Identify abnormal findings on the musculoskeletal examination
4. Record and/or present orally the data base in a concise, orderly, and accurate fashion.
DIAGNOSTIC STUDIES
1. Identify, perform, or and/or interpret appropriate cost effective routine
diagnostic procedures based on history and physical examination
2. Identify the appropriate and available diagnostic studies for a particular
problem based on the history and physical examination.
3. Identify and describe the risks, costs, and patient inconvenience of various
diagnostic studies
DIFFERENTIAL DIAGNOSIS
1. Based on a given patient’s history, physical examination, or diagnostic studies
develop a comprehensive differential diagnosis
2. When presented with the following symptoms develop a differential diagnosis
and diagnostic impression consistent with the data base:
a. Back Pain
b. Oligo-articular joint pain
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c. Polyarticular joint pain
3. When presented with a patient exhibiting symptoms consistent with the
following disorders develop the ability to differentiate them from conditions
that mimic their presentation:
a. skeletal fractures/dislocations
b. bursitis/tendonitis
c. carpal tunnel syndrome
d. sprains/strains
e. low back pain/sciatica
f. osteoarthritis
g. crystalline arthropathies
h. meniscal injuries
i. rotator cuff injuries
j. Reiter’s syndrome
k. Chondromalacia
l. Osgood-Slachter’s disease
m. Legg-Cathe Perthe’s disease
n. multiple myeloma
o. scoliosis
p. TMJ syndrome
q. AC joint separation/dislocation
r. Duputyren’s contracture
4. Given an x-ray film with good exposure and patient positioning identify the
following:
a. Normal anatomic landmarks
b. Fractures
c. Dislocations
d. Osteoblastic/lytic lesions
e. Abnormal calcifications
f. Growth deformities
g. Osteoarthritic changes
THERAPEUTICS
1. Identify and initiate treatment for the following classifications of emergent
conditions:
a. Orthopedic Emergencies
1. infection
2. osteomyelitis
3. septic joints
4. slipped epiphysis
5. acute neurologic deficit
b. Urgencies
1. congenital dislocated hip
2. club feet
3. tumors
4. acute bursitis
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c. Trauma-life saving
1. cardiac and/or respiratory resuscitation
2. bladder trauma
3. bleeding
4. traumatic amputations
d. Limb saving
1. spine injuries
2. open fractures
3. open dislocations
4. vascular occlusions
5. supracondylar fracture of the humerus in children
6. dislocated knee
7. neurovascular injuries
8. fractures
9. dislocations
2. Develop familiarity with the following techniques, common surgical procedures to
include anatomic landmarks and common post-operative care and complications:
a. Closed reductions
b. Open reductions
c. Skeletal traction
d. Joint replacements
e. Carpal tunnel release/neurolysis
f. amputations including AK and BK
g. Back surgery procedures to include microsurgery
h. bracing
i. prosthetic devices
j. arthroscopic procedures
3. Perform or assist the following procedures knowing their indications,
contraindications, complications, and appropriate equipment and techniques:
a. Incision and drainage
b. Wound débridement
c. Joint aspiration/injection
d. Closed management of simple fractures to including casting/splinting
e. OR Protocol
1. surgical scrub
2. gowning and gloving
3. prepping the patient
4. proper draping of the patient
5. proper application of wound dressings
f. Lacerations/surgical closure
1. cleansing and débridement of the wound
2. administration of local infiltrative anesthetics including hematoma
and regional blocks
3. determine neurovascular involvement
4. suture lacerations
5. administer appropriate tetanus therapy
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g. Participate in post operative care by:
1. ordering appropriate laboratory and diagnostic tests
2. ordering appropriate IV fluids
3. maintaining patient on correct diet
4. administering wound care with special attention being paid to drains
and tubes
5. monitoring patients postoperatively for complications
6. progressing the patient’s activity at appropriate times
7. develop knowledge of the appropriate use of anticoagulant therapy
8. implement measures to reduce the risks of post operative embolic
phenomena
HEALTH PROMOTION AND DISEASE PREVENTION
1. Recognize, develop and implement effective strategies for incorporating
health promotion and disease prevention as it relates to the discipline of
orthopedics in primary care including:
a. Prevention of osteoporosis
b. Reducing risk of falls in the geriatric patient
c. Prevention of sports related injury
COMMUNICATION
1. Be able to communicate in a medically professional manner, both orally and
in writing, to the patient, the family, and with health care professionals
a. Communicate to the physician a brief synopsis of the patient’s present
illness/condition
b. Communicate effectively with both the patient and family using a
vocabulary familiar to all concerned
c. Counsel the patient and family regarding the health problem including
an explanation of the disease process, therapy and its rationale,
therapeutic options, prognosis, and health care services available
d. Write routine and all other admission orders
e. Write in a SOAP format, clear concise and relevant progress notes
f. Maintain a complete and up to date progress list
g. Write interval notes
h. Perform discharge summaries
i. Give empathetic support to both patient and family in all
communications
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RESEARCH
1. Demonstrate an awareness of the recognized Orthopedic literature, current
issues and controversies in the literature and methods of accessing current
literature while in rural sites.
ATTITUDE
1. Demonstrate an understanding of the effects of illness and injury on the
patient, family and community
2. Demonstrate an understanding of minor problems and those which require
intense therapy and treatment
3. Demonstrate an awareness of the implication of drug and alcohol use/abuse
in the orthopedic patient
4. Demonstrate an awareness for the respect of legal rights of patients including
confidentiality
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ROTATION OBJECTIVES PSYCHIATRY
During the student’s six-week rotation in psychiatry exposure to some or all of the
following subject matter will be provided. The student will gain experience and
proficiency working as a member of an organized health care team working in
psychiatry. Emphasis should be placed on developing those skills and cognitive
knowledge that will help the student perform well in a primary care setting.
Additional objectives to be attained by the student are as follows:
HISTORY
1. Elicit an appropriate complete psychiatric
a. history and medical review of systems that may present as psychiatric
disease
b. past medical history
c. risk factors profile
d. database stressing the cognitive and affective information and develop
skills which will enable recognition of normal and deviation from normal
2. Record the database acquired on the office or hospital record using the
traditional or problem oriented medical record system
PHYSICAL EXAMINATION
1.
2.
3.
4.
Perform a directed physical examination on the patient with suspected
psychiatric disease.
Perform and interpret the results of a complete mental status examination
including:
a. appearance and behavior
b. thought process and perceptions
1. coherency and relevance
2. thought content
3. perception
c. cognitive factors
1. orientation
2. attention and concentration
3. memory
4. information and vocabulary
5. abstract reasoning
6. judgment
7. perception and coordination
d. evaluation of suicidal risks
Identify abnormal findings on the physical examination that may lead the
clinician to consider a secondary cause for the psychiatric manifestation of
the patient.
Record the physical examination on the office or hospital record using the
traditional or problem oriented medical record.
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DIAGNOSTIC
1. Given the database collected:
a. develop a problem list and tentative diagnosis
b. develop a plan of investigation and order appropriate laboratory and
diagnostic tests
c. understand and apply the current method of diagnostic criteria for
psychiatric disorders
2. Identify and be able to discuss the indication for performing standardized
psychiatric screening, and other examinations:
a. EEG
b. Brain Scan
c. Cat Scan
d. intelligence tests (Wechsler Adult Intelligence scale)
e. tests of perceptual and motor function (Bender Gestalts)
f. personality inventories (MMPI)
g. projective tests (Rorschach, Thematic Apperception Test)
h. Denver Developmental Screening Test
DIFFERENTIAL DIAGNOSIS
1. List the criteria, clinical features, differential diagnosis, and treatment of the
following psychiatric and associated disorders.
a. affective disorders
1. bipolar disorder
2. cyclothymic disorder
3. dysthymic disorder
b. anxiety disorders
1. phobic disorders
2. anxiety states
3. post traumatic stress disorder
c. somatoform disorders
1. somatization disorder
2. conversion disorder
3. psychogenic pain disorder
4. hypochondriasis
d. psychosexual dysfunction
e. adjustment disorders
f. pediatric disorders
1. mental retardation
2. attention deficit disorder
3. conduct disorder
4. anxiety disorder
5. eating disorders: anorexia nervosa/bulimia
g. organic mental disorder
h. substance abuse disorders
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i.
j.
k.
l.
schizophrenic disorders
paranoid disorders
brief reactive psychosis
personality disorders
1. paranoid
2. schizoid
3. schizotypal
4. histrionic
5. narcissistic
6. antisocial
7. borderline
8. avoidant
9. dependent
10. compulsive
11. passive-aggressive
m. other conditions
1. malingering
2. uncomplicated bereavement
3. marital problems
4. parent child problems
n. autism
o. stress related medical disorders
THERAPEUTICS
1. Understand the treatment modalities listed including indications,
contraindications, and side effects of:
a. psychotherapy
b. electroconvulsive therapy
c. neurosurgical approaches
d. hospitalizations
e. social approaches
f. common psychiatric pharmacologic agents including:
1. minor tranquilizers
2. major tranquilizers
3. sedative hypnotics
4. phenothiazine derivatives
5. antidepressants
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HEALTH PROMOTION AND DISEASE PREVENTION
1. Know and counsel the psychiatric patient about the current recommendations
regarding:
a. importance of medication compliance to maintain disease control
b. importance of non pharmacologic mechanisms in prevention of stress
mediated psychiatric disease
c. availability of community based psychiatric services
EMERGENCY SKILLS
1. List the indications for immediate psychiatric referral and evaluation by a
psychiatrist
2. List the indications for involuntary commitment of the psychiatric patient
3. List the indications, contraindications, and adverse reactions of commonly
used psychotropic drugs in an emergency setting
COMMUNICATION
1. Be able to present both orally and in writing a complete database in a concise
and orderly fashion
2. Develop an appreciation for the contribution of other health care providers in
evaluating, managing and treating psychiatric disease and communicate
effectively the breadth and scope of services needed when referring a
psychiatric patient
RESEARCH
1.
Demonstrate an awareness of the recognized psychiatric literature, current
issues and controversies in the literature and methods of accessing current
literature while in rural sites.
ATTITUDE
1.
Demonstrate an understanding of the range of psychiatric disease showing
sensitivity to its variable expression among individuals and various cultural
and social groups.
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ROTATION OBJECTIVES EMERGENCY MEDICINE
1. Develop an awareness of:
a. The need for methodical, rapid, and accurate assessment of the
acutely ill or injured patient is the primary concern of the emergency
department.
b. Patient anxiety and apprehension during times of crisis and the need
for empathy, confidence, and appropriate reassurance that should be
exhibited by the student
c. The need to inform and educate the patient’s family regarding the
current emergent condition and progress.
2. General Objectives:
a. Elicit an appropriate complete or partial history from the patient or
“third” party should the patient be unconscious or a child.
b. Perform a methodical, rapid, comprehensive, and accurate immediate
assessment of patients presenting to the emergency department with
life threatening emergencies.
c. Perform a methodical, rapid, comprehensive, and accurate secondary
assessment of patients presenting to the emergency department,
being careful to examine for the following:
1. Vital signs, facial and extremity coloration
2. Head
3. Chest
4. Abdomen
5. Extremities
6. Pelvis
7. Perineum
8. Back and Buttocks
d. Given a patient presentation either historical, physical, or laboratory
based:
1. Develop a problem list and tentative diagnosis
2. Develop a plan of investigation and order the appropriate
laboratory and diagnostic tests
3. Develop a plan of therapy appropriate for the patients condition
e. Record the data base on the emergency room record using both
traditional and problem oriented medical record approach.
f. Present orally the complete database in a concise and orderly fashion
3. Specific Objectives
a. Given a patient or appropriate historical, physical or laboratory data, be
able to diagnose and initiate treatment for the following common
conditions seen in the emergency department
1. Fractures and dislocations
2. Deteriorating or changing mental status
3. Penetrating ocular injuries
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4. Acute endocrine emergencies(diabetic coma, adrenal
insufficiency, thyroid storm, etc)
5. Chest Pain (Angina/MI)
6. Abdominal Pain, (Appendicitis, Cholecystitis, Bowel Obstruction,
Perforated Ulcer, Renal Colic, etc)
7. Ingestion of Poisons etc
8. Drug Overdose/Abuse
9. First, Second, or Third degree thermal, chemical, or electrical
burns
10. Hypertensive Emergency/Urgency
11. Acute arterial occlusion
12. Intrapartum Hemorrhage
13. Threatened/Spontaneous AB
14. Precipitous delivery
15. Seizures
16. Severe Dehydration
17. Shock
18. Arrhythmias/Cardiac Arrest
19. Congestive Heart Failure/Pulmonary Edema
20. Acute Respiratory Distress Syndrome/ Respiratory Arrest
b. Identify indications and complications of ACLS and perform Advanced
Life support on
1. Newborn
2. Young Child
3. Adult
c. Identify the presentation of and describe appropriate therapy for
harmful bites from:
1. Humans
2. Snakes (Hemotoxic and Neurotoxic Venom)
3. Spiders
4. Animals
5. Insects
d. Identify and initiate treatment for the following common conditions seen
in the emergency room
1. Allergic
12. Glomerulonephritis
Reactions/Anaphylaxis
13. Otitis Media
2. Lacerations/abrasions
14. Tonsillitis
3. Puncture/Stab wounds
15. Epistaxis/emoptysis
4. Cellulitis
16. Conjunctivitis
5. Rashes
17. URIs
6. Hematoma
18. Pneumonia
7. Herpes Zoster
19. Otitis Externa
8. Pharyngitis
20. Exac COPD
9. Headache
21. CVA
10. Sinusitis
22. Gastroenteritis
11. Pyelonephritis
23. Gastritis
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24. Hepatitis
33. Back Pain
25. Hiatal Hernia/GERD
34. Muscle Spasm
26. Peptic Ulcer Disease
35. Costal Chondritis
27. UTI
36. Acute Anxiety
28. STDs
37. Depression
29. Kidney Stones
38. Alcohol Abuse
30. Vaginitis
39. Gunshot wounds
31. PID
40. Syncope
32. Sprains/Strains
e. Perform the following procedures
1. Initiate IV Therapy using Intracath, Jelco, or butterfly
2. Insert and remove a central line under supervision
3. Insert and remove a nasogastric tube
4. Perform gastric lavage
5. Insert and remove a urinary bladder catheter
6. Obtain bacteriologic, viral, fungal cultures
f. Perform and or interpret the following laboratory procedures
1. Venipuncture for CBC, Lytes, SMA-12, and Blood Cultures
2. Arteriopuncture for ABG’s
3. Micro-hematocrit
4. Urinalysis including microscopic examination
5. feces, urine, sputum, gastric contents for occult blood
6. 12 lead EKG
g. For each of the following procedures identify
1. Indications, contraindications, and complications
2. Appropriate equipment to be used
3. Appropriate technique to be used
4. Perform, or assist in performing, under appropriate supervision
a. defibrillation
b. chest tube insertion
c. venous cutdown
d. thoracentesis
e. paracentesis
f. lumbar puncture
g. joint aspiration
h. tracheostomy
i. cast application
j. endotracheal intubation
h. Perform the following clinical procedures for lacerations under
responsible physician supervision.
1. cleansing and débridement of wounds
2. administration of local infiltrative anesthesia, or digital blocks
as appropriate
3. determination of major vessel, nerve, or tendon involvement
4. suturing of the laceration in the absence of the above
conditions
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5. assisting the physician in repair of the above conditions
6. administer appropriate tetanus therapy
i. Given a patient or simulated model demonstrate the following
principles of splinting including the use of
1. Rigid Splints
2. Air Splints
3. Traction Splints
4. Apply Slings
5. Proper application of ACE wrap
j. Given AP/Lateral View of any bone in the skeleton identify the
following
1. Fractures
2. Dislocations
3. Osteolytic and Osteoblastic Lesions
4. Osteoporosis
5. Degenerative changes
k. Given a flat plate and upright of the abdomen x-ray with good
exposure and patient positioning, identify the following:
1. Free intraperitoneal air
2. Air/Fluid levels within the bowel
3. Intra-abdominal calcification
4. Hepatic and splenic margins
5. Psoas shadows
6. Non specific Abdomen
7. Dilated Intestine
l. Given a PA and Lateral Chest x-ray with good exposure and
patient positioning, identify the following
1. Pulmonary Infiltrates
2. Pulmonary Nodules
3. Atelectasis
4. Cardiomegaly
5. Rib Fractures
6. Widened Mediastinum
7. Pleural Effusions
8. Normal Chest X-ray
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ROTATION OBJECTIVES CORRECTIONS MEDICINE
1. Be able to identify and define the following relationships and concepts inherent
to the corrections setting.
a. Care, custody and control of the inmates
b. Medical and correction staff interaction
c. Medical staff and inmates relationship
d. Medical staff and Psychiatric/Psychological staff interdependence
e. Staff/inmate abuse issues
f. Deliberate indifference
g. Malpractice issues
h. Civil rights issues
2. Approach a patient of any age in the corrections setting and:
a. Acquire partial or complete historical data pertinent to the patient’s
presenting complaint
b. Perform a partial or complete physical examination appropriate to the
patients presenting complaint
c. Synthesize the data obtained into a current problem list
d. Address and prioritize the following:
1. the patient’s purpose for presenting to their primary care provider
2. significant findings identified at the time of their visit
3. maintenance of chronic disease states, and health promotion and
disease prevention issues.
3. Develop a differential diagnosis of acute presenting complaints based on
historical and physical findings.
4. Order appropriate laboratory and/or diagnostic tests to confirm, or rule out
preliminary diagnostic impressions.
5. Present data gathered to the supervising physician in an organized and logical
manner.
6. Develop a patient management plan based on data gathered.
7. Provide necessary patient education to assure understanding and compliance
with treatment regimen.
8. Arrange timely and appropriate patient follow up or referral.
9. Develop an approach, based on location and nature of a given encounter to the
following:
a. Initial Workups - encounter characterized by initial assessment and
management of clinical problems
b. Continued Care - encounter characterized by management of a previously
diagnosed condition or health maintenance visit
c. Emergency Care - encounter characterized by prompt assessment and
management of life threatening conditions
d. Perform the following evaluative tasks:
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1.
2.
3.
4.
History taking and performance of physical examinations
Perform and /or order appropriate laboratory and diagnostic studies
Formulation of differential diagnosis
Evaluation of the patient’s presenting problem
10. Management of the patient including health maintenance and disease
prevention, appropriate clinical intervention, employment of appropriate clinical
therapeutics, and awareness of legal and ethical considerations.
11. Apply scientific concepts focusing on physiologic or disease processes
12. Describe presentations and management of the most common diseases
encountered in correctional settings, with particular emphasis placed on
epidemiology, natural history, historical and physical manifestations,
management, and prevention, within the following categories:
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
Disease /Disorders of the Central Nervous System
Disease/Disorders of the Sensory Organs
Disease/Disorders of the Respiratory System
Disease/Disorders of the Circulatory System
Disease/Disorders of the Digestive System
Behavioral/Emotional disorders
Disease/Disorders of the Musculoskeletal System
Disease/Disorders of the Skin/Subcutaneous Tissue
Disease/Disorders of the Endocrine/Nutrition/Metabolism/Immune System
Disease/Disorders of the Kidneys/Urinary Tract
Diseases/Disorder of the Male/Female Reproductive System
Disease/Disorders of the Blood/Blood-Forming Organs
Infectious/Parasitic Diseases
Injuries/Wounds/Toxic Effects/Burns
Health Maintenance
13. Presentations of Ill Defined Symptom Complexes
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TOPICS LIST - ADULT MEDICINE
CARDIOLOGY
Cardiac Risk Factors
Coronary Artery Disease Angina/Myocardial
Infarction
Arterial Disease - Aneurysm/Occlusion
Venous Disease - Thrombosis/Insufficiency
Valvular Heart Disease Murmurs/Endocarditis
Hypertension
Cardiac Rehabilitation
Pericarditis
Congestive Heart Failure
Arrhythmias
PULMONARY MEDICINE
Chronic Obstructive Pulmonary Disease:
Asthma, Chronic Bronchitis, Emphysema
Infection:
Pneumonia/AcuteBronchitis/Pleuritis
Adult Respiratory Distress Syndrome
(ARDS)
Neoplasms
Pulmonary Function Testing/Arterial
Blood Gasses
Pulmonary Embolism/Pneumothorax/Hemothorax
Pulmonary Rehabilitation
Pulmonary Edema/Hypertension
NEPHROLOGY/UROLOGY
Acid Base and Electrolyte Balance
Urinary Tract Infection/Pyelonephritis
Glomerulonephritis/Nephrotic Syndrome
Acute Renal Failure
Chronic Renal Failure/Dialysis
Nephrolithiasis
Prostatitis/Epididymitis/Male STD’s
Nephrotoxins
GASTROENTEROLOGY
Esophageal Reflux, Spasm, Stricture
Peptic Ulcer Disease/Gastritis
Pancreatitis
Malabsorption
Ulcerative Colitis
Crohn’s Disease - Regional Enteritis
Diverticular Disease
Hemorrhoids/Fissures/Fistulas
Neoplasms of GI System
Hepatitis: Infectious/Non-Infectious
Jaundice
Alcoholic Liver Disease
Cholecystitis/Cholelithiasis/Cholangitis
Diarrhea/Constipation
Infections: Viral, Bacteria, Parasitic
Spastic/Irritable Colon-Irritable Bowel
Syndrome
NEUROLOGY - Seizure Disorders
Headaches
Infection: Meningitis, Encephalitis
Cerebrovascular disease: TIA, CVA
Multiple Sclerosis
Tremors/Parkinsonisms
Neuropathies: Cranial Nerves, Peripheral
Disc Disease: Trauma, Osteoporosis
Coma/Trauma of CNS
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RHEUMATOLOGY
Osteoarthritis
Rheumatoid Arthritis
Gout/Pseudogout
Infectious Arthritis
Spondyloarthropathies
Collagen Vascular Diseases
ENDOCRINOLOGY
Diabetes Mellitus/IDDM-NIDDM
Hypoglycemia
Hyperlipidemia
Adrenal Suppression Secondary to Steroid
Use
Thyroid Disease: Hyperthyroidism,
Hypothyroidism, Thyroiditis, Nodules
DERMATOLOGY
Allergic/Contact Dermatitis
Acne
Skin Tumors
Infection: Viral, Bacteria, Parasitic, Fungal
Psoriasis
Eczema
IMMUNOLOGY
Anemias
Bleeding Disorders
Leukemias
Lymphomas/Hodgkins
Immune Deficiencies
ALLERGY
Anaphylaxis
Hypersensitivity
OPHTHALMOLOGY
Conjunctivitis/Red Eye
Cataracts
Glaucoma
Corneal Abrasion
Retinal Changes Secondary to Systemic
Disease (Hypertension, Diabetes
Mellitus)
ENT
Vertigo
Infections: Viral, Bacterial
Allergic Rhinitis/Sinusitis
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TOPICS LIST - GERIATRICS
GENERAL
Biological Process of Aging
Infectious Disease of Elderly
Alcoholism
Dementia/Depression/Suicide
Pharmacology in the Elderly
Human Sexuality
Death and Dying
Problems of Institutionalization
Elder Abuse
Home Health Care
Nutrition
Community Senior Citizen Resources
SYSTEMS
HEENT
Glaucoma/Cataracts/Presbyopia
Loss of Hearing/Sense of Taste
Dental Problems
Cardiovascular
Hypertension
CAD-ASCVD
Arrhythmias
Syncope
Thrombophlebitis
Arterial Occlusion
Respiratory
COPD: Asthma/Chronic Bronchitis/
Emphysema
Pneumonia/Bronchitis
Cancer
Gastrointestinal
Constipation
Hiatal Hernia/Reflux
PUD/Gastritis
Cancer: Esophagus, Stomach, Colon
Malabsorption
Diverticular Disease
Appendicitis
Cholelithiasis
Intestinal Obstruction
Genitourinary
Incontinence
Urinary Tract Infections
Acute/Chronic Renal Failure
(Male) Prostatic/Testicular
Tumors/Impotence/Hernias
(Female) Atrophic Vaginitis/Uterine
Prolapse/Tumors: Breast Uterus, Vulva
Musculoskeletal
Osteoarthritis
Osteoporosis
Paget’s Disease
Stress Fractures/Hip Fractures
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Endocrine
Diabetes/Hypoglycemia
Thyroid Disorders
Obesity
Hematology
Anemia
Leukemia
Neoplasms
Prostate
Breast
Lung
Colon
Skin
Keratoses
Skin Cancers
Dermatitis: Contact, Seborrheic, Dry Skin
Fungal Infections
Pigmentary Changes
Decubitus Ulcers
Neurology
Cerebrovascular Disease
Falls/TIA’s
Tremors/Parkinsonism
Dementia/Alzheimer’s Disease
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TOPICS LIST - MENTAL HEALTH
Neurotic Disorders
Psychiatric Emergencies
Depression
Sleep Disorders
Bipolar Disorder
Post-Traumatic Stress Syndrome
Schizophrenic Disorders
Anxiety
Paranoid Disorders
Somatoform Disorders
Affective Disorders
Personality Disorders
Dementia
Child Psychiatry
Childhood Developmental Disorders
Substance Abuse and Dependence
Mental Retardation
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TOPICS LIST - OBSTETRICS & GYNECOLOGY
GYNECOLOGY
Menstruation
Menopause/Osteoporosis
Contraception
Dysfunctional Uterine Bleeding
Premenstrual Syndrome
High Risk Pregnancy
Infertility
Vaginitis/STD’s/PID
Endometriosis
Breast Disease
Benign/Malignant Lesions of the
Reproductive Tract
Sexual Dysfunction/Counseling
Gynecological Surgery/Laparoscopy
Ultrasonography/Colposcopy
Amenorrhea
Genetic Counseling
OBSTETRICS
Fetal Development/Fetal
Prenatal Exam/care
Labor and Delivery
High Risk Pregnancy
Toxemia of Pregnancy
Medical Complications of Pregnancy
Obstetrical Anesthesia
Post-Partum Care
Abruptio Placenta/Placenta Previa
Ectopic Pregnancy
Abortion
Intrauterine Death
Cesarean Section
Genetic Counseling/Amniocentesis
Ultrasonography/Fetal Monitoring/Fetal
Activity Testing
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TOPICS LIST - PEDIATRICS
GENERAL
Newborn Exam
Problems in the Neonate
Well Baby/Well Child Exams
Immunizations
Growth and Development
Failure to Thrive
Fever of Unknown Origin
Fluids and Electrolytes/Acid-Base
Communicable Diseases
Poisonings
Learning Disabilities/Mental Retardation
Genetic Disorders/Counseling
Adolescent Medicine
Child Abuse
Depression/Suicide in Teenagers
SYSTEMS
Cardiology
Congenital Heart Disorders
Respiratory
URI including Otitis Media, Otitis Externa,
Pharyngitis, Croup Epiglottis
Bronchitis/Bronchiolitis
Respiratory Distress Syndrome
Pneumonia
Asthma
Cystic Fibrosis
Gastrointestinal
Infection: Bacterial, Viral, Parasitic
Diarrhea/Dehydration
Constipation
Hyperbilirubinemia
Congenital Malformations
Genitourinary
Urinary Tract Infections
Vaginitis
Orthopedics
Common Fractures
Congenital Abnormalities
Hematology
Anemia
Childhood Leukemias
Endocrinology
Diabetes
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Neurology
Meningitis
Encephalitis
Seizure Disorders
Skin
Viral Exanthems
Contact Dermatitis
Eczema
Parasitic Infections
Impetigo
Tinea/Monilial Infections
Acne
Miliaria
Allergic Dermatitis
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TOPICS LIST - SURGERY
GENERAL
Pre/Post Operative Care
Wound Care and Infections
Anesthesia
Aseptic Techniques
Principals of Suturing
Fluid and Electrolytes/Acid-base
Surgical Nutrition/Hyperalimentation
Shock
Trauma Care
Burns
Organ Transplantation
SYSTEMS
Breast
Tumors/Reconstruction
Cardiovascular
By-Pass Grafting
Aneurysms
Valve Replacements
Venous Ligation
Arterial Reconstruction
Thorax
Lung Biopsy/Resection
Abdomen
Acute Surgical Abdomen
Appendectomy
Bowel Resection
Cholecystectomy
Liver Biopsy
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Urology
Herniorrhaphy
Prostatic/Testicular Tumors/Testicular
Torsion
Nephrolithiasis
TURP-BPH
Orthopedics
Arthroscopy/Arthroplasty
Common Knee Injuries
Common Shoulder Injuries
Hand Injuries
Sprains/Strains
Neurosurgery
Lower Back Problems
Cervical Disc Disease
Long Term Care Objectives
All LHUP PA students will obtain clinical experiences in long term care settings. These
experiences begin during the first year of the program whereby students spend on day
during the didactic year completing an assessment of a long term care patient,
including:
 Attain a history and comprehensive physical examination

Review and make suggested changes to a long term care plan based
on current standards of care

Assessing polypharmacy issues and other common areas whereby
medical errors occur and making recommended changes

Develop a health maintenance and disease prevention plan
Students are also required to obtain exposure to long term care facilities throughout
the clinical year. All experiences in long term care must be logged into the LHUP PA
Program web portal.
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BASIC SCIENCE
1. Upon written, oral, or practical examination the PA student will:
a. Describe normal human aging, age-related changes in tissues, organs and
physiologic function, and homeostasis.
b. Describe age-related changes in epidemiology of diseases, presentation of
illnesses, response to therapy, pharmacokinetics and pharmacodynamics.
c. Discuss Principles of biomedical ethics, including an understanding of
decision-making capacity, competence, and autonomy.
d. Describe nutritional needs of older persons, including recognition and
treatment of malnutrition.
e. List age specific health promotion, disease prevention screening
assessments that should be completed
HISTORY
1. Be able to elicit and record an appropriate first or second person history from a
geriatric patient and further:
a. Make appropriate adjustments necessary in history taking and physical
examination.
b. Describe the elements and conduct of Comprehensive Geriatric Assessment.
c. Elicit detailed history regarding dietary habits, sleep patterns behavior changes
use of medications (prescription or OTC), drugs or alcohol.
d. Elicit history of hearing or visual disturbances
e. Elicit information regarding patient’s home environment, support network and
financial status.
f. Appropriately utilize a second party to augment information obtained from a
patient.
g. Demonstrate awareness that the process of aging alters both the historical and
physical manifestations of certain diseases.
h. Demonstrate awareness that geriatric patients may underreport illness.
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PHYSICAL EXAMINATION
1. Perform a physical examination on the adult or geriatric patient allowing for:
a. Variations in physical findings among the elderly population.
b. Common normal physical findings in the geriatric population.
c. Abnormal physical findings that are found with increased frequency in this
population.
DIAGNOSTIC STUDIES
Order and interpret cost effective, appropriate diagnostic testing in the geriatric patient
considering:
1. Age related changes in lab values
2. Changes in the range of normal that may occur as a result of the aging
process
DIFFERENTIAL DIAGNOSIS
1. Develop a differential diagnosis and diagnostic impression for the following diseases
commonly seen in geriatric patients in long term care facilities:
a. Cognitive impairment/dementia
b. Depression
c. Incontinence (urinary and fecal)
d. Gait and balance disorders
e. Immobility
f. Pressure ulcers
g. Sensory impairment
h. Pain
i.
Falls
j.
Delirium
2. Compare and contrast the difference in incidence, natural history, presentation
management, and outcomes of medical problems when they occur in elderly persons.
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THERAPEUTICS
1. Identify, perform and/or order appropriate, cost-effective, routine therapeutic
procedures and be able to assist the physician with other therapeutic procedures.
a. administer intravenous infusions utilizing appropriate equipment including
butterfly needle, intravenous catheter, heparin lock and infusion pumps.
b. calculate infusion rate.
c. administer injections by a variety of routes including intradermal,
subcutaneous, intramuscular and intravenous.
d. be familiar with normal nutritional requirements of the elderly.
e. be familiar with dietary treatment of health problems including
hypertensive, diabetic, low fat, low cholesterol and low sodium diets.
f. be familiar with the drugs used most frequently in treatment or health
problems including basic modes of action, indications, contraindications
and complications as well as the role of polypharmacy as it relates to the
elderly..
g. be familiar with the management of common medical problems.
HEALTH PROMOTION/DISEASE PREVENTION
1. Describe the nutritional needs of older persons, including recognition and
treatment of malnutrition.
2. Describe age specific health promotion and disease prevention strategies.
3. Describe risks and benefits of surgical interventions, pre-operative evaluations
and post-operative care in the geriatric population.
4. Compare and contrast the organization and financing of health care for older
persons.
5. Discuss the principles of fitness, exercise and rehabilitation as applied to older
people.
EMERGENCY SKILLS
1. Demonstrate the ability to recognize and manage life-threatening emergencies
jointly with, and in the absence of, the physician.
a. Recognize signs and symptoms of common emergencies in geriatric patients
and take appropriate action to sustain life when appropriate.
b. Recognize common causes of altered mental status in the geriatric population
and treatment.
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c.
Describe the use of and indications for standard emergency medications and
administer if appropriate to geriatric patients
d. Respect the decision of the patient and/or family for no advanced life support
procedures
COMMUNICATION
1. Be able to communicate in a medically professional manner, both orally and in
writing, to the patient, the family and with health care professionals.
a. Present to the physician a brief synopsis of the patient’s present illness,
pertinent positive and negative findings and the diagnostic and therapeutic
regimen instituted.
b. Communicate effectively with both patient and family by using a vocabulary
familiar to all concerned.
c. Counsel patient and family regarding the health problem including an
explanation of the disease process, therapy and its rationale, therapeutic
options, prognosis and health care services available.
d. Write routine and all other admission orders by the problem number.
e. Write in a SOAP format, clear concise and relevant progress notes including
diagnostic, therapeutic and patient education plans.
f.
Maintain a complete up-to-date problem list.
g. Give empathetic support to both patient and family in all communications
including end of life issues and decisions.
RESEARCH
2. Demonstrate an awareness of the recognized geriatric literature, current issues
and controversies in the literature and methods of accessing current literature
while in rural sites.
ATTITUDE
A. Demonstrate an awareness of the various myths and stereotypes related to
older people.
B Discuss how ageism, like racism, affects all levels and aspects of society
including health professions and can adversely affect optimal care of elderly
patients.
C. Describe the heterogeneity of older persons--a diverse group with different
personalities, different values, different functional levels, and different medical
illnesses. The need for PA students to view geriatric patients as individuals
regardless of chronological age and to be cared for in a unique fashion.
D. Demonstrate Openness, willingness and necessity to work with other
disciplines in caring for older patients.
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E. Demonstrate self-awareness of the students’ personal attitudes towards their
own aging, disability, and death.
F. Demonstrate compassion and understanding attitude on the part of the PA
student for care givers of the frail elderly and the difficulties they face.
G. Demonstrate an appreciation of the need for improving and optimizing
function for older people, rather than just focusing on diseases.
H. Describe how maintenance of function and quality of life are more often
goals of care than cures of disease
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Section Four: GENERAL REQUIREMENTS FOR CLINICAL YEAR
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GENERAL REQUIREMENTS FOR THE CLINICAL YEAR
1. Communication
A. General
It is important that students maintain contact with the program throughout their
clinical rotations.
B. E-mail
Students are required to maintain a current Lock Haven University email
address and internet access while on all clinical rotations at all times. At a
minimum, students will check email at least every other day and it is
recommended that email be reviewed daily. Remember, local libraries and
sister PASSHE System Universities can provide computer/internet access
when not available at your site.
Failure to maintain a current LHUP email account may prevent students from
acquiring critical information during the clinical year. Students will be
responsible for all correspondence sent to their LHUP account. Failure to
maintain email communication on a regular basis may result in failure of the
rotation.
Students are advised to maintain copies of all email correspondence to their
faculty advisor and other program correspondence to assist them in settling
disputes over grades. Failure to produce copies of emails that were allegedly
sent will diminish chances for the student to be successful in resolving grade
disputes.
C. Phone Calls
If you wish to contact the Physician Assistant Program, the telephone number
is 570-484-2929. You may call this number 24 hours a day and leave voice mail
messages so that your call can be returned. Be sure to leave your name and a
time that will be most appropriate to return your call. You may also call your
faculty advisor at their contact number and leave a message any time.
D. Conference Phone Calls
Conference calls may be scheduled with each student periodically and at the
direction of the Clinical Coordinator.
E. Student Site Visitations
A PA program faculty member will visit at least twice during your clinical year.
Additional site visits will be scheduled on an as-needed basis.
Faculty Advisors
Students will be assigned a faculty advisor during the clinical year. The
assignments of faculty advisors are made by the PA program. If a student has
concerns regarding their assigned faculty advisor, they should first attempt to
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resolve the issue with the faculty member. If the issue cannot be resolved
directly with the faculty member, the student may petition the PA Program
Director for a change of faculty advisor. Students will maintain communication
with their faculty advisor by regularly turning in scheduled assignments,
journals, e-mail or by phone if they feel they are having urgent issues on their
rotation.
2. Work Hours, Meetings & Attendance
A. Rotation Work Hours
Students are expected to exhibit an exemplary work ethic by maximizing their
time at the clinical site in which they are assigned. This includes after hours
clinic assignments, on call time, rotating shifts, hospital rounds as required, and
any other clinical opportunities that may present themselves during the course
of the clinical experience. Students are required to log a minimum of 40 clinical
hours per week during the clinical experience. Not maximizing clinical
opportunities may result in grade reduction at the discretion of the faculty
advisor. These hours need to be accurately listed on the schedule you will turn
in on your first assignment of a “post card” (explained below). Likewise, your
journal will also reflect the hours you work each day.
B. Work Settings
Students are required to obtain experiences in emergency, ambulatory, long
term care, and inpatient settings during their educational experience. These
experiences can be obtained in a variety of ways including making rounds in
hospitals or nursing homes, seeing patients in an emergency room or caring for
emergencies in clinics equipped to do so. These settings are listed on your
student log page on the web. Be sure to indicate all settings in which you have
had experiences during your clinical training.
Long term care, prenatal care and emergency medicine experiences must
include the dates and locations of these experiences in the appropriate
fields in the student log page and documented in the student’s weekly
journal. Failure to provide this information will preclude the student from
meeting the minimum requirements for graduation.
Falsification of log information represents grounds for immediate dismissal from
the program. We will monitor your logs closely and if you have not attained
these experiences we will be required to adjust your future clinical experiences
accordingly to assure you have experienced a wide variety of clinical settings. If
you are uncertain as to how to classify settings contact your faculty advisor.
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C. PA Days
Students are required to attend all PA day activities at the end of each clinical
experience. PA days start at 7:45 AM and end at 4 PM each day. At the end of
Clinical Rotations II you will be on the LHU Main campus for one week for a
Board Review Course.
Students are required to be on campus for a week during the preceptorship
experience for summative testing.
Do not make any travel plans during these times.
Upon returning to campus for PA days you are required to provide the following
paperwork:
1. Original preceptor evaluation.
2. Preceptor grading sheet and attached write-ups for that clinical
experience.
3. Students are required to hand carry, or make arrangements
for the preceptor evaluations to be sent to the PA Program by PA days.
Ultimately, it is the student’s responsibility to insure that their preceptor
evaluation is received by the program
Prior to taking your end of clinical experience exam you will be required to fill
out your student critique for the clinical experience you just completed. You will
not be able to take your exam if you haven’t completed this critique.
D. Attendance & Punctuality
Students must report to their clinical experience site as per the agreed weekly
schedule sent via your first week “post card” assignment. Any absence from
your clinical site due to illness must be reported to your faculty advisor and the
clinical coordinator. Absence of two or more days will require a physician’s
excuse. Any absence for personal reasons, including job
interviews, must be approved in advance by your faculty advisor and the
clinical coordinator.
Punctuality is expected for all meetings, work days, and PA day activities.
E. Professional Behavior
Students are required to uphold the highest level of professional demeanor at
all times. Failure to abide by the PA Program policies set forth in the student
manual, or the PA Profession Code of Ethics, recurrent unexcused absences,
failure to submit assignments in a timely fashion, dishonesty, failure to respond
to emails, or unprofessional behavior will result in a
reduction of your overall grade for the rotation at the discretion of the faculty
advisor. Repeated violations after a verbal warning and written contract will
result in dismissal from the program.
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CLINICAL ROTATIONS I, II, III ASSIGNMENTS & GRADING
Following are tables showing assignments & grading for Clinical Rotations I
through III. All assignments are mandatory and failure to produce them will
result in failing that rotation.
All assignments must be uploaded into the PA Program Portal by midnight
Sunday of the fourth week for each clinical experience. A detailed explanation
of each type of assignment follows at the end of this section.
Students are required to complete an online evaluation of all their clinical sites.
Failure to complete the evaluation will result in a grade of incomplete for the
rotation. Incomplete grades convert to failing grades at the midpoint of the
following semester per University policy.
Clinical Rotations I and II Assignments for each clinical experience.
Due by
Week 1
Week 2
Week 3
4 Week
Week 5
Week 6
Journal 1
Journal 2
Journal 3
Journal 4
Journal 5 Journal 6
Quiz 1
Quiz 2
Quiz 3
Quiz 4
Quiz 5
1. Post
All writeCard
ups due
2. Indiv.
Goals.
Clinical Rotation III Assignments for each clinical experience (first 9 weeks)
Due by
Week 1
Week 2
Week 3
4 Week
Week 5
Week 6
Week 7
Journal 1 Journal 2 Journal 3 Journal 4
Journal
Journal
Journal
5
6
7
EBM
EBM
EBM
EBM
EBM
EBM
EBM
1. Post
All writeCard
ups are
2. Indiv.
due
Goals.
Week 8
Journal
8
EBM
Clinical Rotation III Assignments for each clinical experience (second 9 weeks)
Due by
Week 1
Week 2
Week 3
4 Week
Week 5
Week 6
Week 7
Week 8
Journal 1 Journal 2 Journal 3 Journal 4
Journal
Journal
Journal
Journal
5
6
7
8
Bates
Bates
Bates
Bates
Bates
Bates
Bates
Bates
Quiz 1
Quiz 2
Quiz 3
Quiz 4
Quiz 5
Quiz 6
Quiz 7
Quiz 8
1. Post
All writeCard
ups are
2. Indiv.
due
Goals.
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Week 9
Journal
9
EBM
Week 9
Journal
9
Bates
Quiz 9
Clinical Experience Grading Points for Clinical Rotations I and II
Faculty Assigned
Post Card, Individual Goals
Assessment, Prompt
Assignments, Journals, Quality
& Professionalism
Write-ups/Case Reports (30
points each)
Quizzes
Preceptor Assigned
Clinical Experience Exam
70
90
50
150
100
*minimum score of 70%
is required on each
exam. Re-takes of
exams will not improve
score for grade
Total
460
Clinical Rotations III
Faculty Assigned
75 points
Post Card, Individual Goals Assessment , Prompt
Assignments, Journals, Quality & Professionalism,
These items must be completed for all clinical
experiences that occur during course
H&P
H&P, SOAP NOTE, Procedure Note (25
points each)
Exit Interview with Advisor
Preceptor Assigned Grade
Rotation Exams
25
75
This grade will be derived from the
following examinations:
1) P1- post preceptorship psychiatry exam
(15%)
2) P2-PD Online Quizzes (15%)
3) Comprehensive written final
exam (70%)
35
150
100
*minimum score of 70% is required on each clinical
experience exam – retakes of exams will not improve score
for grade
Total
460
The clinical rotations course grade will be calculated on the sum total of each clinical
experience. The percentage of total points earned will be used for assigning a letter
grade according to the table below. Also, understand that your preceptor evaluation is
only part of your overall grade. As noted above your scores on write-ups, end of
clinical experience exams and faculty evaluations are integral in determining your final
grade.
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Final Rotation Grade Assignment
The grading assignment method for your clinical rotations is listed below:
Points
Percent
Grade Quality Points
431-460
412-430
398-411
379-397
365-378
351-364
333-350
319-332
274-318
<274
93.5-100%
89.5-93.4%
86.5-89.4%
82.5-86.4%
79.582.4%
76.5-79.4%
72.5-76.4%
69.5-72.4%
60-69.4%
0-59.9%
A
AB+
B
BC+
C
CD
E
4.0
3.7
3.3
3.0
2.7
2.3
2.0
1.7
1.3
0.0
Remediation
During the clinical year each student must continue to maintain an overall 3.0
GPA in order to receive the Master of Health Science degree and certificate as
a Physician Assistant. In addition to the overall GPA requirement students must
attain a minimum of a B- (2.7) in each clinical experience. An unsatisfactory
rating on any item on a clinical evaluation, or the clinical evaluation in total will
result in failure of the rotation. Failure to achieve a minimum of a B- in any
rotation will require that the student repeat the rotation.
A grade of less than B- in more than one clinical experience will result in the
student being dismissed from the program.
A. Submissions
Post Card
Within the first week of each clinical experience you must complete the
online postcard located on the student clinical web page entitled Update
"Postcard" Contact Information
If any information is missing from your “post card”, it will be considered
incomplete and late.
1. Your name
2. Your mailing address
3. Name of your primary preceptor
4. Name of your clinic / hospital
5. Your clinic and hospital contact numbers
6. Your home or cell phone numbers
7. Copy of planned weekly schedule
B. Individual Goal Assessment
Within the first week of each clinical experience, the student will discuss their
personal goals as well as objectives, as listed in the Preceptor manual, with the
preceptor. This discussion will provide a chance to hear the preceptor’s
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expectations and requirements for the student in that period. The student will
then write out a formal goal plan (using the template at the end of this section)
for that clinical experience which agrees with the discussion. All individual goal
assessments must be signed by your precepting physician.
Email or fax these to your faculty advisor by the end of the first week.
Clearfield Fax: 814-768-3440
Lock Haven Fax: 570-484-2540
Harrisburg Fax: 570-484-2624
Coudersport Fax: 570-484-2607
C. Case Reports
Case reports consist of a detailed discussion of the salient facts related to an
interesting or unusual case you have seen in clinical practice. Unlike a SOAP
note or H&P these reports contain a discussion of the critical history, physical
examination and laboratory findings that led the author to the diagnosis, a brief
summary of the pathophysiology involved, a differential diagnosis, and
information regarding how this particular patient was treated, the current
recommended treatment for the disorder and if variation in treatment occurred
the rationale that was used. All case reports are referenced utilizing APA style.
The exact requirements, including the grading rubric, can be found on the
clinical web page.
D. Write ups:
In order to assure the breadth of your clinical experience, you will be required to
submit various write-ups to your faculty advisor. Prior to the beginning of each
semester you will meet with your advisor and you will be assigned the write-ups
you need to submit by the end of each clinical experience. All write-ups, for
each clinical experience, must be turned in by the end of the 4th week. Grading
rubrics will be provided to assure students are clear regarding expectations for
these write-ups.
Students are required to complete the following write-ups during their clinical
year. Listed below are the minimum number of write-ups in each category that
you must complete. Write-ups can be combined to meet the requirements listed
below.
Case Reports-5
Complete H&P-4
Soap Notes-3
Admission H&P-1
Long term Care1
Pap/Pelvic Note1
Pre-natal Note1
Procedure Note1
Post-op Note-1
Out-patient
Note-1
Pediatric
Development
Note-1
In-patient note-1
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Discharge
Summary-1
Pediatric Well
Child Exam-1
Psychiatric Note1
1. Complete H&P
a. This assignment must contain a thorough and complete write-up including
exhaustive review of systems, past medical history, family history, social
history, meds, allergies, physical exam, assessment, & plan.
b. During the clinical year one of each of the following are required as a
component of a complete H&P:
I. Health Promotion and Disease Prevention Plan (HPDP) for
an adult patient
II. Long Term Care Unit complete write-up including HPDP,
assessment of long term care needs, and a thorough plan
for addressing them.
III. Pediatric H&P including anticipatory guidance that should
be provided for parents of children in the following age ranges:
a. 1-3
b. 4-6
c. 8-10
d. 10-15
e. >15
Write-ups will:
 be typewritten and submitted electronically to the Clinical PA Website
 be spell checked
 not contain any patient identifying information.
 be in standard format (S.O.A.P. , complete H&P, etc.)
 include the student’s impression of the patient’s diagnosis.
 include an appropriate treatment plan.
 not be done on pre-made office forms which uses check lists or the like
 be submitted via the Clinical PA Website for your faculty advisor to review and
grade.
 Your supervising physician will review the original write-up and attach and sign
the charting coversheet found at
http://gradprograms.lhup.edu/pa/files/File/PAStudent%20Charting%20Evaluation.p
df). You are to attach the grading sheet to the original write-up and hand carry

it to your faculty advisor during PA days. Failure to hand in the graded write up
will result in you receiving a zero for that assignment.
You will be graded on the first submission only. Unacceptable notes will be
returned to the student with suggestions for re-submission. After the
corrections are made the write-up will be re-submitted. Failure to resubmit
acceptable notes, prior to the end of the clinical experience, may result in
failure of the rotation.
E. Journals
A daily journal is required for each day on a rotation or preceptorship. At the
end of each week a journal entry must be entered into the online student
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journal found on the On Clinical Year Student Site
(http://gradprograms.lhup.edu/pa/).
The journal serves numerous purposes including;
1) to serve as a reflection on your day to day activities within the clinic;
2) to assist your faculty advisor in evaluating your clinical experience
3) to assure you are acquiring a wide variety of clinical experiences in
various settings.
To facilitate an accurate journal, we suggest you carry a
small notebook for notes during your workday. Your weekly journal is due
each Sunday by midnight. Warning- Failure to submit a weekly journal
entry on the online forms page will result in your failing the rotation!
Heading
1. Your Name,
2. Dates of the Week & which week of the clinical experience
3. Specialty Type & Where
Weekly Summary
1. A one-paragraph summary telling your feelings about that week’s
Clinical experience. How are your progressing and if there are any
problems.
Daily Summaries
1. Date
2. Total hours worked.
3. Total Number of patients seen
4. Count on number of patients seen with each diagnosis or procedure
and log them on the patient tally sheet.
5. Thought of the day: Either an interesting case or ethical issue or
interpersonal issue you encountered & your thoughts on them.
6. Breakout of the payer class and age group for total number of patients
seen (i.e. 16 Medicare, 12 Medicaid, 13 no insurance, 10 private
insurance)
7. The patient tally sheets are vital in documenting your clinical
experiences. After graduation insurance companies and hospital
credentialing committee’s will require specific information regarding your
training in order to grant privileges. These tally sheets serve as a
reference, documenting your experiences and are used to verify your
clinical experiences. We cannot verify this information if you fail to
document them on your tally sheet.
F. Quizzes on Readings
Each week, for the first five weeks of your clinical experience, you will go to the
LHUP Program website and find that week’s reading requirements. A link to a
quiz that covers those readings is also given. Each weekly quiz must be
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completed by midnight on Sunday. Quizzes completed after the deadline will
not be graded and you will not receive credit for it.
G. Preceptor Evaluation
The Preceptor Evaluation form is in the back of this section. Copy this form as
needed. Students are required to hand carry their preceptor evaluations to their
faculty advisor on PA days at the end of their clinical experience or the student
must make arrangements for the preceptor evaluations to be sent to the PA
Program prior to the end of that clinical experience. Failure to hand in this
evaluation could cause you to fail the clinical experience.
H. End of Clinical Experience Testing
Upon completion of each clinical experience, the student will take an end of
clinical experience exam. These exams are important in preparing you for the
national certification exam and to that end you will be taking the 5 exams given
below. During your elective clinical experience you will do the readings, quizzes
and clinical experience exam in either OB-GYN or ER.
Due when you return from:
Clinical Rotations I, II
Exam(s)
1. Internal Medicine
2. Pediatrics
3. Surgery
4. Ob-Gyn
5. ER
Clinical Rotations III
Psychiatry
Summative Exam
Post Clinical Preceptorship exam
Pharmacy Exam
The topics covered in the exams can be found in Section III. These topics
correspond to those that are commonly encountered both in practice and on
national boards. You will need to do your own reading to assure your
competence in these areas. A score of 70 percent or better on each
examination is required in order to be eligible for graduation from the
Department of Physician Assistant Studies.
I. Practical Examination
During the clinical year each student will be scheduled for clinical skills
examinations with a faculty member. The PA student handbook addresses
oral/practical examination repeat and/or failure policies.
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1. The first unsatisfactory performance on a practical/oral will result in the exam being
re-scheduled, with a different faculty member, at a time convenient for the faculty
member.
2. If on the second attempt the student is unsuccessful in completing the exam the
student will be counseled and provided with a written contract that outlines the
requirements for successful completion of the assignment. A retake examination will
then be scheduled at the end of the semester, after the completion of all exams, on the
last day of final exams week, or at another end of semester time determined by the
faculty.
3. Failure of this third attempt will result in dismissal from the program.
PA Student Handbook 2010-2012
All clinical experience practical examinations must be completed by the last
day of the fall semester. Following each clinical experience students will return
to the University main campus for testing. Clinical skills examination will be
scheduled by the clinical coordinator. All students will complete a minimum of
two directed exams during the clinical year. The first practical will be
administered either following the first or second clinical experience. Students
who fail to meet the minimum requirements for these directed practical exams
will complete an additional practical exam following their third clinical
experience. All students will complete a second practical exam following clinical
experience 4 or 5... The following are examples of the topics that will be used,
as well as a sample evaluation format.
Chest Pain
Dyspnea
Abdominal Pain
Joint or Back Pain
Change in Mental Status
In addition, students are expected to be prepared to complete a thorough
directed history, physical exam, differential diagnosis, order appropriate
laboratory and imaging studies, develop an appropriate treatment and patient
education plan for:





Chest Pain: MI, Pericarditis, Costochondritis
Dyspnea: Pneumothorax, Pneumonia, Anemia, TB, Asthma
Abdominal Pain: Appendicitis, Diverticulitis, Cholecystitis, Irritable
Bowel Syndrome
Joint Pain: MS Strain, RA, Septic Joint, Metastatic Disease
Change in Mental Status: CVA, Alzheimer’s, Sub-Dural Hematoma,
Polypharmacy, Metabolic toxicity
Summative Evaluation
At the completion of your clinical experience all students will be required to
complete a summative evaluation process. This process will include written
examinations, clinical OSCE exams, a diagnostic station and therapeutics
station. All students must successfully complete these exams in order to
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successfully complete the program. Students will be allowed to remediate the
summative examination one time. If they remain unsuccessful then they will be
required to enroll in appropriate remedial activities that may result in delay of
their expected graduation.
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Lock Haven University of Pennsylvania
Physician Assistant Program
Fax 570-484 2540
Student’s Section
Student’s Name:
Faculty Advisor:
Date:
Clinical Specialty:
Rotation Location:
Preceptor’s Name:
Write ups that you are submitting:
1.________________________________________________________________
2.________________________________________________________________
3.________________________________________________________________
Preceptor’s Section
Unacceptable Poor
0 points
1 point
Average
2 points
Good
3 points
Superb
4 points
Legibility
Content
Preceptor’s Comments: (Optional)
Preceptor’s Signature _________________________________________________________
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Section Five: EVALUATION FORMS
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LOCK HAVEN UNIVERSITY OF PENNSYLVANIA
PHYSICIAN ASSISTANT PROGRAM
STUDENT CRITIQUE FORM
Student
Rotation/Preceptorship Site
Period (circle one)
I
II
III
IV
V
P1
P2
Utilizing the following scale, respond to each of the following statements by choosing a number from the scale that most
closely indicates the degree with which you agree or disagree. Please write “NA” if not applicable.
STRONGLY DISAGREE
1
2
3
1.
3.
Obtain and record a thorough and reliable history.
Obtain and record a thorough and reliable physical exam.
Develop a problem list.
Develop a list of possible etiologies (differential diagnosis).
Order appropriate studies.
Recommend rational therapy.
Communicate with health team.
Increase proficiency in technical procedures.
Increase knowledge of patient problems in primary care.
My responsibilities such as assignments, rules and regulations,
were clear to me.
My housing arrangements were adequate.
Costs: Room
Board
Other
4.
STRONGLY AGREE
5
6
This preceptorship enabled me to meet the following objectives:
a.
b.
c.
d.
e.
f.
g.
h.
i.
2.
4
/week
/week
/week
Describe housing arrangements
Estimate the number of hours “on the job” during an average week
Of these hours, how many were:
In the doctor’s office
In the hospital with inpatients
In the emergency room
In the nursing home
On a house call
Other (please describe)
hours/week
Number
Total
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5.
Were medical conferences, such as grand rounds, available?
Did you attend?
6.
Did you participate in any other community activities?
7.
At the beginning and end of this preceptorship my anxiety for encountering patients
was: (circle the number from the scale best expressing your anxiety):
(describe)
NO ANXIETY
a. At the beginning:
b. At the end:
8.
1
1
GREAT ANXIETY
2
2
3
3
4
4
5
5
6
6
Circle the amount of progress you have made during this preceptorship:
1
Minimal Progress
2
3
4
5
6
Maximum Progress
9.
The preceptor’s understanding of the role of the PA student was adequate:
Yes
No
Explain:
10.
List the physicians with whom you spent part of this preceptorship period, approximate
time spent with each and type of practice of each.
PHYSICIAN
11.
TYPE OF PRACTICE
The preceptor used the following teaching techniques:
NEVER
1
2
3
4
5
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
12.
% OF TIME
Directly observed the student
Confirmed student’s data by redoing or rechecking
Provided oral feedback on performance
Provided adequate “hands on” experience
Directed student to literature
Made reading assignments
Assigned research projects
Orally quizzed or questioned student
Demonstrated technique to student
Set specific goals for student
Asked student for self-evaluation
Directed student to lectures, grand rounds, CME, etc.
List ways in which this preceptorship could be improved:
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6
ALWAYS
Lock Haven University of Pennsylvania
Physician Assistant Program
432 Railroad Street, Lock Haven, PA 17745
570-484-2541
Fax 570-484-2540
PRECEPTOR EVALUATION
Student Name: _____________________________________________________________
Preceptor: _________________________________________________________________
Date: ______________________
Please select specialty:
o
o
o
o
o
o
o
Family Medicine/Primary Care
Obstetrics/Gynecology
Emergency Medicine
General Surgery
Internal Medicine
Pediatrics
Elective: ___________________________________________
Definition of Terms:
Honors-The student exceeded expectations throughout the rotation. They demonstrated the highest level of
intellectual ability,motivation, and self disciple which clearly set him/her apart from the majority of other students.
Above Average- The student perform at a high level of competency and exhibitied a significant degree of
intellectual ability,motivation, and self disciple. Areas of weakness were not substantial or were accountable to lack
of sufficient expereince.
Adequate- The student meet the minimum requirements established by the preceptor for this rotation. They had
clear areas of weakness but resonded well to remedition efforts.
Inadequate- The student did not meet the minimum standards. Areas of weakness were identified early in the
rotation but thte student was unresponsive to remedition efforts by the preceptor. Please document such efforts in the
remarks section for review by the PA Program.
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Did you identify any areas of weakness in the student’s preparation for this rotation?
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Section Six: AGREEMENT FORMS
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AFFILIATION AGREEMENT
This agreement is made and entered into as of this
day of
,
20
, by and between Lock Haven University of Pennsylvania of the State System of Higher
Education (“School”) and
(“Hospital”)
WITNESSETH:
WHEREAS, School offers to enrolled student a master’s degree program for the Physician
Assistant Program; and
WHEREAS, Hospital manages a comprehensive inpatient and outpatient facility; and
WHEREAS, School desires to provide to its students a clinical learning experience, under the
supervision of licensed physicians with medical staff privileges at Hospital; and
WHEREAS, Hospital has agreed to make its facility available to School for such purpose;
NOW, THEREFORE, in consideration of the mutual promises contained herein, the parties hereby
agree as follows:
1. Responsibilities of School
a. Clinical Program: School shall be responsible for the implementation and operation
of the clinical component of its program at Hospital (“Program”), which Program
shall include, but not be limited to, the following:
(1) provision of classroom theory and practical instruction to students prior to their
clinical assignment at Hospital;
(2) continuing oral and written communication with Hospital regarding student
performance and evaluation, absences and assignments of students, and other
pertinent information;
(3) periodic on-site visitation by Program faculty;
(4) participation, with the students, in Hospital’s Quality Assurance and related
programs;
(5) performance of such other duties as may from time to time be agreed to between
School and Hospital.
(6) all students, faculty, employees, agents, and representatives of School
participating in the Program at Hospital (“Program Participants”) shall be
accountable to the Hospital’s clinical education coordinator or other designee.
b. Student Statements: School shall require each Program Participant to sign a
Statement of Responsibility in the form attached hereto as Exhibit A, and a
Statement of Confidentiality in the form attached hereto as Exhibit B.
c. Insurance: School shall require that student Program Participants obtain and
maintain their own appropriate professional liability insurance coverage in amounts
acceptable to Hospital. Hospital understands and agrees that such student insurance
coverage is not provided to students by School itself. Hospital further understands
and accepts as sufficient that School’s faculty and other employees are covered by
the Commonwealth of Pennsylvania’s Tort Claims Self-Insurance Program,
administered by the Bureau of Risk and Insurance Management of the Department
of General Services.
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d. Health of Participants: All Program Participants shall pass a medical examination
acceptable to Hospital prior to their participation in the Program at Hospital. Program
Participant shall be responsible for arranging for the Program Participant’s medical care
and/or treatment, if necessary, including transportation. In no event shall Hospital be
financially or otherwise responsible for said medical care and treatment.
School will require each student upon their arrival at the Indian Health Service
facility to provide evidence of rubella and rubeola immunity and tuberculin skin test
status. If the latter is positive, there shall be evidence of treatment in accordance with
Centers for Disease Control and Prevention guidelines.
e. Dress Code: School shall require Program Participants to dress in accordance with
dress and personal appearance standards approved by School (and consistent with
Hospital’s standards regarding same), including a distinctive coat with the School
insignia and an identifying badge with the student’s name and “Physician Assistant
Student” clearly visible.
f. Performance of Services: All physician preceptors (Preceptor) supervising students
will be licensed physicians with staff privileges at Hospital.
(1) Preceptors will supervise and coordinate on a day to day basis the clinical
experiences of the student with Hospital.
(2) School acknowledges that Preceptor is neither the agent nor employee of
Hospital for purposes of supervision and coordination of student’s clinical
experiences at Hospital.
(3) School will provide a faculty member (“Clinical Coordinator”) who will
provide educational supervision of all students on behalf of the School, act as
liaison between the School and Hospital and Preceptor.
(4) School and all Program Participants shall perform their duties and services
hereunder in accordance with all relevant local, state and federal laws, comply
with the standards and guidelines of all applicable accrediting bodies, the
Bylaws and rules and regulations of Hospital, and any rules and regulations of
School as may be in effect from time to time. Neither School nor any
Program Participant shall interfere with or adversely affect the operation of
Hospital or the performance of services therein.
(5) School shall at all times remain solely responsible for the evaluation and
grading of Program Participants.
(6) Unless prior agreement otherwise, School agrees not to send any student(s)
who have, at the end of the didactic year, less than a 3.0 grade point average
(on a 4-point scale) to Hospital.
2. Responsibilities of Hospital
a. Hospital shall accept the students assigned to the Program by School and cooperate in
the orientation of all Program Participants to Hospital. Hospital shall provide the
opportunities for such students, who shall be immediately supervised by Preceptors,
to observe and assist in various aspects of patient care consistent with the role of
Physician Assistant students.
b. Hospital shall assist School in coordinating rotation and assignment schedules with its
own schedule and those of other educational institutions.
c. Hospital shall at all times retain ultimate control of the Hospital and responsibility for
hospital care of patients.
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3.
4.
5.
6.
d. Emergency Outpatient treatment for injuries sustained while performing assigned
services will be provided the intern/student/resident. They may also be provided
temporary care and treatment in HIS facilities under the same circumstances and to
the same extent such care and treatment may be provided to paid employees.
Responsibilities of the Student
a. Insurance: Student Program Participants shall be responsible to obtain and maintain
their own appropriate professional liability insurance coverage in amounts acceptable
to Hospital. Hospital understands and agrees that such student insurance coverage is
not provided to students by School itself. Hospital further understands and accepts as
sufficient that School’s faculty and other employees are covered by the
Commonwealth of Pennsylvania’s Tort Claims Self-Insurance Program, administered
by the Bureau of Risk and Insurance Management of the Department of General
Services.
b. During all activities in which students, volunteers, or residents will be interacting or
providing care to children less than 18 years old, such activities must be performed
within the sight and under the supervision of an Indian Health Service employee who has
satisfactorily completed the Child Care National Agency Check with Written Inquiries
(CNACI) Security Investigation.
Withdrawal of Program Participant
a. Hospital may request School to withdraw or dismiss a student from the Program at the
Hospital when his/her performance is unsatisfactory to Hospital, or his/her behavior is
disruptive or detrimental to Hospital and/or its patients.
b. Hospital may, at its discretion, immediately curtail activities of a Program
Participant if, in Hospital’s opinion, doing so is in the best interest of the Hospital
and/or its patients. In such event Hospital will immediately notify School and
Preceptor of its action.
Independent Contractor
a. The parties hereby acknowledge that they are independent contractors, and neither the
School nor any of its agents, representatives, faculty, students or employees shall be
considered agents, representatives, or employees of Hospital.
b. In no event shall this Agreement be construed as establishing a partnership or joint
venture of similar relationship between the parties hereto.
c. No Program Participant shall look to Hospital for any salaries, insurance or other
benefits.
d. All parties acknowledge that the student’s purpose in participating in a clinical
experience at Hospital is educational, and that the student, though he/she may
provide services to patients at the Hospital, shall not be used as a substitute for
regular staff.
Confidentiality
a. School and its agents, students, faculty, representatives and employees agree to keep
strictly confidential and hold in trust all confidential information of Hospital and/or
its patients and not disclose or reveal any confidential information to any third party
without the express prior written consent of Hospital.
b. Neither School nor Hospital shall disclose the terms of this Agreement with any
person who is not a party to this Agreement except as required by law or as
authorized by the other party to this agreement.
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7. Term; Termination
a. The initial term of this agreement shall be for one year and commence
. At the end of the initial term, unless otherwise terminated
as provided herein, this Agreement may be renewed for one year for up to four
successive terms upon mutual agreement of the parties.
b. Either party may terminate this Agreement at any time upon at least thirty (30) days
written notice. In the event the Hospital terminates the agreement any student
enrolled in the clinical program may continue his or her educational experience
until it would have concluded absent termination.
8. Nondiscrimination
a. Nondiscrimination. The parties agree to continue their respective policies of
nondiscrimination based on Title VI of the Civil Rights Act of 1964 in regard to
sex, age, race, color, creed, national origin, Title IX of the Education Amendments
of 1972 and other applicable laws, as well as the provisions of the Americans with
Disabilities Act.
9. Interpretation of the Agreement
a. The laws of the Commonwealth of Pennsylvania shall govern this Agreement.
10. Modification of Agreement
a. This Agreement shall only be modified in writing with the same formality as the
original Agreement.
11. Relationship of Parties
a. The relationship between the parties to this Agreement to each other is that of
independent contractors. The relationship of the parties to this contract to each other
shall not be construed to constitute a partnership, joint venture or any other
relationship, other than that of independent contractors.
12. Liability
a. Neither of the parties shall assume any liabilities to each other. As to liability to each
other or death to persons, or damages to property, the parties do not waive any defense
as a result of entering into this contract. This provision shall not be construed to limit
the Commonwealth’s rights, claims or defenses, which arise as a matter of law pursuant
to any provisions of this contract. This provision shall not be construed to limit the
sovereign immunity of the Commonwealth or of the State System of Higher Education
or the University.
13. Entire Agreement
a. This Agreement represents the entire understanding between the parties. No other
prior or contemporaneous oral or written understandings or promises exist in
regards to this relationship.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement.
Representative of Lock Haven University
Date
Representative of Hospital
Date
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EXHIBIT A
STATEMENT OF RESPONSIBILITY
For and in consideration of the benefit provided the undersigned in the form of experience in
evaluation and treatment of patients of Hospital, the undersigned, and his/her heirs, successors
and/or assigns does hereby covenant and agree to be solely responsible for any injury or loss
sustained by the undersigned while participating in the Program operated by Lock Haven
University at Hospital, unless such injury arises solely out of Hospital’s negligence or willful
misconduct.
Program Participant (Signature)
Date
Program Participant (Printed Name)
Witness
Date
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EXHIBIT B
CONFIDENTIALITY STATEMENT
The undersigned hereby acknowledges his/her responsibility under Federal applicable law and the
Agreement between Lock Haven University (School) and Hospital to keep confidential any and all
information of Hospital. The undersigned agrees, under penalty of law, not to reveal to any person
or persons except authorized clinical staff and associated personnel any specific information
regarding any patient, and further agrees not to reveal to any third party any confidential
information of Hospital.
Program Participant (Signature)
Date
Program Participant (Printed Name)
Witness
Date
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MEMORANDUM AGREEMENT
This agreement is entered into by and between the Lock Haven University of Pennsylvania,
Department of Physician Assistant and Graduate Studies in Education—Physician Assistant
Program (Program) and
(Preceptor)
for the purpose of providing a clinical experience, in conjunction with required course work, to
student within the Program.
1. The Program and the Preceptor agree that the policies, procedures and objectives of
the Program shall govern the operation of the clinical experience.
2. The Program agrees that each student will be required to maintain his or her own
professional liability insurance protection in the amount of $1,000,000 per plaintiff and
$3,000,000 per occurrence. Proof of such insurance protection will be provided to
Preceptor prior to the student being allowed to participate in any clinical activities.
Preceptor understands and agrees that such coverage is not provided to students by
the Program itself.
3. Program and Preceptor agree that Program faculty will establish the course objectives,
activities, requirements, standards and methods of evaluation for each course for which
clinical experiences are offered.
4. The Preceptor agrees to provide supervised clinical instruction.
5. The Preceptor agrees to coordinate the use of necessary health provider facilities
including hospitals, clinics and other facilities for the appropriate instruction of students.
6. The Preceptor agrees to complete, as required, an evaluation form regarding the
student’s performance, and to notify the Program Director or Medical Director
immediately of any adverse concerns, problems, incidents, claims or potential claims
arising from the actions of the student(s) during the course of the clinical experience.
7. This agreement shall be effective with the date of the preceptor’s appointment and will
continue until that appointment is terminated.
Signature of Preceptor
Date
Signature of Program Director
Date
OR
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Signature of Medical Director
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Date
Date
Physician Assistant Program
Lock Haven University of Pennsylvania
PRECEPTORSHIP APPLICATION FORM
PLEASE PRINT OR TYPE ALL INFORMATION
NAME
License #/State
Last
First
Middle
Office Address
Office Phone
(
)
Fax Number
Email
zip code
1. Physician Specialty
2. M.D.
D.O.
M
PA-C
F
Year received degree
Please attach a copy of your current Curriculum Vitae.
3. Are you now, or have you been, associated with professional medical personnel
training programs?
yes
no
If yes, please list:
4. List your current professional affiliations:
5. A representative number of patients seen in my office per day would be:
(1) none
(2) 1-5
(3) 6-10
(4) 11-15
(5) 16-20
(6) 21-25
(7) 26-30
(8) 31-35
(9) 36-40
(10) 41 plus
6. A representative number of patients I encounter in the hospital per day would be:
(1) none
(2) 1-5
(3) 6-10
(4) 11-15
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(5) 16-20
(6) 21 plus
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7. Indicate the areas in which the student will participate and estimate the % time for each.
Yes
No
Adult Medicine (Internal Medicine)
Surgery (includes specialty)
Pediatrics
Obstetrics
Gynecology
Geriatrics
Emergency Medicine
Other
Percent Time
%
%
%
%
%
%
%
%
8. As a component of your preceptorship, do you anticipate that the physician assistant
student will be involved in the care of your hospital patients?
yes
no
9. Please list all facilities where you have staff privileges:
10. Name of your office/clinic:
11. Number of examining rooms in your office/clinic:
12. Is a laboratory facility located in the office/clinic? yes
no
13. Estimate the average number of ACTUAL CONTACT HOURS OF TEACHING (one
to one or in a group) that you as preceptor provide, or will provide, to a student during
a six (6) week or eighteen (18) week clinical experience. Choose a time frame of a
day, a week, or a six (6) week or eighteen (18) week period to indicate your estimate
of teaching hours. Use only one time frame, that which is descriptive of your
practice.
hours/day
hours/week
hours/6 weeks
hours/18 weeks
14. Will other physicians, physician assistants, nurse practitioners, etc. in the
practice/group be involved in teaching the physician assistant student? yes
no
If YES to the preceding question, list the names of the physicians and other
professionals, who will be working with the physician assistant student during a six
week period (preceptorship).
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