Department of Physician Assistant Studies
Learning. Caring. Serving. Leading.
PAS 630: Primary Care
3 Semester Hours
Course Director:
Diane Duffy, MD
Tracey Tonsor, PA-C
Office
FC 205
FC 207
Phone
336-278-6848
336-278-6852
E-mail
dduffy2@elon.edu
ttonsor@elon.edu
Course Description: The Primary Care rotation is designed to give students exposure to the spectrum
of adult outpatient medical practice. Students will learn the principles of routine (well) care,
management of acute illnesses, and management of chronic/multiple diagnoses.
Course Goals: The educational goals of the Clinical: Adult Medicine Outpatient rotation include:
1. To apply the medical content and principles that define the care of primary care patients.
2. To provide opportunities for each student to develop the core PA competencies in a supervised
primary care setting
3. To expose each student to an experienced and competent medical provider role model for the
primary care of patients.
Learning Outcomes:
Upon completion of this clinical rotation clinical phase PA students will:
1. Demonstrate the ability to obtain accurate and complete information via the patient interview
and conduct an appropriate physical examination for the various types of visits seen in adult
outpatient medicine.
2. Demonstrate the ability to apply principles of clinical epidemiology and probabilistic reasoning
to develop preliminary assessments/diagnoses and treatment plans.
3. Demonstrate familiarity with the common clinical presentations, physical exam findings,
appropriate diagnostic tools and evidence-based treatments for common adult medicine
patient problems including acute and chronic medical problems, common mental health
problems and emotional illnesses.
4. Demonstrate familiarity with preventive care recommendations for promotion of health in the
adult patient, identifying risks for specific illnesses that affect screening and treatment
strategies.
5. Demonstrate the ability to effectively communicate with patients and other medical providers.
6. Demonstrate awareness of the impact of culture, ethnicity, socioeconomic status, advancing
age and gender on the patient’s expression of illness and response to treatment, and
demonstrate ability to incorporate that awareness into patient interactions.
7. Demonstrate proficiency in documenting medical care
8. Participate in and analyze the process of referral/consultation of a patient.
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9. Recognize clinical processes established to improve performance of a clinical site.
Teaching Methodologies: The content of this module will be presented through a variety of methods
that include observation and participation at the clinical site, independent reading and participation in
online activities developed to guide experiential learning.
Accommodations: Students requiring academic accommodations must follow the “Academic Support”
policy in the Elon University DPAS Student Handbook.
Academic Honesty: All Elon PA students acknowledged their commitment to abide by the Elon Honor
Code by signing the Honor Pledge during orientation. Students will sign an Honor Pledge (electronically
or manually) each time an assignment is turned in or an examination is started to reaffirm their
complete understanding of the Honor Code of Elon University and their affirmation that their work
abides by that Code.
Required Textbooks:
1. All required first year text books
2. Clinician’s Pocket Reference, 11th Edition (Paperback)
3. The Washington Manual of Medical Therapeutics, 33rd Edition (Paperback)
Other Resources:
1. *Moodle: Please check the course site frequently for new announcements, updated
schedules, assignments and other course communication.
2. Practicing physician assistants, physicians, allied health care providers and laboratory
teaching aids.
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TOPICS LIST
Urgent Care
Respiratory failure/arrest
Deteriorating mental status/
unconscious patient
Allergic reaction/anaphylaxis
Acute abdomen
Burns
Third trimester bleeding
Bites/stings
Foreign body aspiration
Cardiac failure/arrest
Fractures/dislocations
Sprains/strains
Myocardial infarction
Hypertensive crisis
Pulmonary embolus
Pneumothorax
Ingesting harmful substances
(poisoning)
Orbital cellulitis
Pulmonary
Asthma
Bronchitis
COPD
Pneumonia
Tuberculosis
Lung cancer
Sleep disorders
Tobacco use/dependence
Cardiovascular
Hypertension
Coronary artery disease
Peripheral vascular disease
Arrhythmias
Endocarditis
Hyperlipidemia
Hypertriglyceridemia
Angina
Congestive heart failure
Chest pain
Valvular disease
Dermatology
Dermatitis (eczema/
seborrhea)
Nummular eczema
Dyshidrosis
Lichen simplex chronicus
Drug eruptions
Lichen planus
Pityriasis rosea
Psoriasis
Erythema multiforme
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Bullous pemphigoid
Acne vulgaris
Rosacea
Actinic keratosis
Seborrheic keratosis
Lice
Scabies
Spider bites
Basal cell carcinoma
Kaposi sarcoma
Melanoma
Alopecia
Onychomycosis
Paronychia
Condyloma acuminatum
Exanthems
Molluscum contagiosum
Verrucae
Cellulitis
Erysipelas
Impetigo
Acanthosis nigricans
Hidradenitis suppurativa
Lipomas/epithelial inclusion
cysts
Melasma
Pilonidal disease
Pressure ulcers
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Dermatology (cont’d)
Urticaria
Vitiligo
Folliculitis
Tinea infections
Tinea versicolor
EENT
Pharyngitis/tonsillitis
Acute/chronic sinusitis
Aphthous ulcers
Blepharitis
Conjunctivitis
Dacryocystitis
Hordeolum
Labyrinthitis
Tinnitus
Laryngitis
Otitis externa
Otitis media
Tympanic membrane
perforation
Ectropion
Entropion
Corneal abrasion
Corneal ulcer
Glaucoma
Hyphema
Macular degeneration
Papilledema
Pterygium
Retinal detachment
Retinopathy
Cholesteatoma
Ménière disease
Allergic rhinitis
Epistaxis
Nasal polyps
Peritonsillar abscess
Paritotis
Sialadenitis
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TOPICS LIST (cont’d)
Infectious diseases
Mononucleosis
Lyme disease
HIV
Influenza
Meningitis
Salmonellosis
Shigellosis
Gastrointestinal
Colorectal cancer/
colonic polyps
Anal fissure
Peptic ulcer disease
Gastritis
Gastroenteritis
Diarrhea/constipation
Pancreatitis
Inflammatory bowel disease
Appendicitis
Gastrointestinal bleeding
Hemorrhoids
Bowel obstruction
Viral hepatitis
Jaundice
Cholecystitis/cholelithiasis
Cirrhosis
Giardiasis and other parasitic
Infections
Hiatal hernia
Gastroesophageal reflux
disease
Irritable bowel syndrome
Esophagitis
Hematology
Anemia
Leukemia
Thrombocytopenia
Clotting disorders
Lymphomas
Polycythemia
Genitourinary
Hernias
Cystitis
Pyelonephritis
Glomerulonephritis
Nephrolithiasis
Benign prostatic
hypertrophy
Prostatitis
Epididymitis
Gonorrhea
Chlamydia
Urethritis
Orchitis
Balanitis
Testicular cancer
Reproductive system
Dysmenorrhea
Dysfunctional uterine
bleeding
Vaginitis
Pelvic inflammatory disease
Breast mass
Breast cancer
Cystocele
Rectocele
Menopause
Intrauterine pregnancy
Contraception
Cervical cancer
Spontaneous abortions
Endocrinology
Diabetes mellitus
Adrenal insufficiency
Cushing disease
Hyperthyroidism
Hypothyroidism
Musculoskeletal/
Rheumatology
Acute and chronic lower
back pain
Costochondritis
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Musculo/Rheum (cont’d)
Rheumatoid Arthritis
Reactive arthritis
Osteoarthritis
Gout
Sprains/strains
Ganglion cysts
Systemic lupus erythematosus
Osteoporosis
Fibromyalgia
Plantar fasciitis
Overuse syndrome
Bursitis/tendonitis
Neurology
Dizziness
Vertigo
Syncope
Seizure disorders
Transient ischemic attack
Cerebral vascular accident
Alzheimer’s disease
Parkinson’s disease
Essential tremor
Bell’s Palsy
Dementia
Delirium
Headaches (cluster, migraine
tension)
Psychiatry/Behavioral Science
Depression
Generalized anxiety disorder
Panic disorder
Phobias
Post traumatic stress
disorder
Insomnia
Anorexia
Bulimia
Mood disorders
Substance abuse disorders
Domestic violence
Suicide
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Assessment Activities:
Exams/quizzes (25%), Preceptor Evaluation (65%), Professionalism (10%).
Grade Scale and Grade Points
Percentage
89.50-100
85.50-89.49
79.50-85.49
75.50-79.49
69.50-75.49
Below 69.50
There is no rounding of grades.
Letter Grade
A
B+
B
C+
C
U
Grade points
4.0
3.3
3.0
2.3
2.0
0
Note: For further information regarding academic standing in the Department of Physician
Assistant Studies, please see the Student Handbook.
Grading Criteria:
1. Demonstrate acquisition of a strong basic science and medical science knowledge base as
demonstrated on the written examination/quizzes.
2. Demonstrate satisfactory self-directed learning skills, clinical reasoning skills, commitment to
patient-centered care and professionalism as evidenced by satisfactory performance on the
preceptor evaluation.
3. Demonstrate a commitment to learning and professionalism by actively participating in all
clinical activities and exceeding the professional behavior standards and minimum requirements
for clinical rotations available in the Elon PA Student Handbook.
Instructional Objectives:
Upon completion of the clinical rotation clinical phase physician assistant students will be able to:
1. Clinical Skills
a. Demonstrate the ability to obtain accurate and complete information via the
patient interview in the following clinical situations:
1. An acute medical problem
2. A chronic medical problem.
3. A patient presenting with multiple problems.
4. Routine health care
b. Demonstrate the ability to conduct a complete physical exam and a problem
focused physical exam based on the stated reason for the visit.
2. Core Presentations
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a. Acute Care: Differentiate among common etiologies based on the presenting
symptom. Recognize “don’t miss” conditions that may present with a particular
symptom. Elicit a focused history and perform a focused physical examination.
Discuss the importance of a cost-effective approach to the diagnostic work-up.
Describe the initial management of common and dangerous diagnoses that present
with a particular symptom. For the following:
i. Upper respiratory symptoms
ii. Joint pain and injury
iii. Pregnancy (initial presentation)
iv. Abdominal pain
v. Common skin lesions
vi. Common skin rashes
vii. Abnormal vaginal bleeding
viii. Low back pain
ix. Cough
x. Chest pain
xi. Headache
xii. Vaginal discharge
xiii. Dysuria
xiv. Dizziness
xv. Shortness of breath/wheezing
xvi. Fever
xvii. Depression (initial presentation)
xviii. Male urinary symptoms/prostate
xix. Dementia
xx. Leg swelling
b. Chronic disease management: Apply diagnostic criteria. Elicit a focused history that
includes information about adherence, self-management, and barriers to care.
Perform a focused physical examination that includes identification of
complications. Assess improvement or progression of the chronic disease. Describe
major treatment modalities. Propose an evidence based management plan that
includes pharmacologic and non-pharmacologic treatments and appropriate
surveillance and tertiary prevention. Communicate appropriately with other health
professionals. Document a chronic care visit. Communicate respectfully with
patients who do not fully adhere to their treatment plan. For the following:
i. Multiple chronic illnesses (e.g., depression, hypertension, hypothyroidism,
type 2 diabetes mellitus)
ii. Hypertension
iii. Type 2 diabetes mellitus
iv. Asthma/chronic obstructive pulmonary disease
v. Hyperlipidemia
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vi. Anxiety
vii. Arthritis
viii. Chronic back pain
ix. Coronary artery disease
x. Obesity
xi. Heart failure
xii. Depression (previously diagnosed)
xiii. Osteoporosis/osteopenia
xiv. Substance use, dependence, and abuse
c. Atypical presentation of disease:
i. Identify physiologic changes of aging for each organ system and their impact
on the patient, including their contribution to homeostenosis (the agerelated narrowing of homeostatic reserve mechanisms).
ii. Generate a differential diagnosis based on recognition of the unique
presentations of common conditions in older adults, including acute
coronary syndrome, dehydration, urinary tract infection, acute abdomen,
and pneumonia.
3. Understand the basis of health promotion and be able to apply the principles of primary,
secondary and tertiary prevention.
a. For women: elicit a full menstrual, gynecological and obstetric history
b. For men: Identify issues and risks related to sexual function and prostate health
c. Accurately identify clinical situations where life expectancy, functional status,
patient preference or goals of care should override standard recommendations for
screening tests in older adults.
d. Accurately identify clinical situations where life expectancy, functional status,
patient preference or goals of care should override standard recommendations for
treatment in older adults.
e. Assess and describe baseline and current functional abilities in an older patient by
collecting historical data from multiple sources and performing a confirmatory
physical examination.
f. Develop a preliminary management plan for patients presenting with functional
deficits, including adaptive interventions and involvement of interprofessional team
members from appropriate disciplines, such as social work, nursing, rehabilitation,
nutrition, and pharmacy.
g. Identify and assess safety risks in the home environment, and make
recommendations to mitigate these.
h. Apply the stages of change model and use motivational interviewing to encourage
lifestyle changes to support wellness (weight loss, smoking cessation, safe sexual
practices, exercise, activity, nutrition, diet)
i. Provide counseling related to health promotion and disease prevention.
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j.
Define and differentiate among types of code status, health care proxies, and
advanced directives in the state where one is training.
k. Discuss who should be screened and methods of screening for each of the following
health conditions:
i. Breast cancer
ii. Cervical cancer
iii. Colon cancer
iv. Coronary artery disease
v. Depression
vi. Fall risk in elderly patients
vii. Intimate partner and family violence
viii. Obesity
ix. Osteoporosis
x. Prostate cancer
xi. Sexually transmitted infection
xii. Substance use/abuse
xiii. Type 2 diabetes mellitus
4. Cognitive and Behavioral
a. Define and distinguish among the clinical presentations of delirium, dementia, and
depression.
b. Formulate a differential diagnosis and implement initial evaluation in a patient who
exhibits dementia, delirium or depression.
c. In an older patient with delirium, urgently initiate a diagnostic work-up to
determine the root cause (etiology).
d. Perform and interpret a cognitive assessment in older patients for whom there are
concerns regarding memory or function.
e. Develop an evaluation and non-pharmacologic management plan for agitated
demented or delirious patients.
5. Integrate the process of therapeutic review (review of current therapies and medications
the patient is using) into each patient encounter regardless of the reason for the visit.
a. Explain the impact of age-related changes on drug selection and dose based on
knowledge of age-related changes in renal and hepatic function, body composition,
and Central Nervous System sensitivity.
b. Identify medication, including anticholinergic, psychoactive, anticoagulant,
analgesic, hypoglycemic, and cardiovascular drugs that should be avoided or used
with caution in older adults and explain the potential problems associated with
each. Document a patient’s complete medication list, including prescribed, herbal
and over-the –counter medications, and for each medication provide the dose,
frequency, indication, benefit, side effects, and an assessment of adherence.
6. Demonstrate patient-centered communication skills:
a. Setting a collaborative agenda with the patient for an office visit.
b. Being able to elicit and attend to patients’ specific concerns
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7.
8.
9.
10.
c. Explain history, physical examination, and test results in a manner that the patient
can understand.
d. Clarify information obtained by the patient from such sources as popular media,
friends and family, or the internet.
e. Effectively incorporate psychological issues into patient discussions and care
planning.
f. Use effective listening skills and empathy to improve patient adherence to
medications and lifestyle changes.
g. Effectively describe the treatment plans for prevention and management of acute
and chronic conditions to the patient and work to formulate plan with patient.
h. Utilize motivational interviewing techniques with a patient to encourage behavior
change
i. Identify the psychological, social, and spiritual needs of patients with advanced
illness and their family members, and link these identified needs with the
appropriate interprofessional team members.
Demonstrate proficiency in creating the medical record. Create progress notes for each of
the following types of visits:
a. Acute medical problem visit
b. Chronic medical problem visit
c. Visit for patient with multiple medical problems
d. Preventive services visit
Demonstrate proficiency in the referral/consultation process by
a. Creating referral/consultation letter
b. Analyzing the process of referral/consultation
c. Determining the characteristics that contribute to a successful referral/consultation
Describe the use of a quality improvement protocol within a practice and how the protocol
might improve health care.
Describe methods of monitoring compliance with preventive services guidelines.
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