Wayne State University – Physician Assistant Studies
Direct Hands on Patient Care Experience Form
The information requested is directly from the guidelines on the Wayne State University Physician Assistant Studies
webpage concerning direct hands on patient experience. Please fill out the form, save a copy, and upload into your
Wayne State University Graduate Application.
This will be used in the evaluation of your patient care experience in the admissions process. Please be assured that we
have reviewed your CASPA application and related health care experience information. With this document, we are
seeking details to more fully understand your role and duties of your direct hands on, patient care experience.
Name:
Patient Contact Experience:
*List most current job first
Job 1:
Position Title/Employer/Location/Supervisor:
Paid/Volunteer: Select One
Job 2:
Position Title/Employer/Location/Supervisor:
Paid/Volunteer: Select One
Job 3:
Position Title/Employer/Location/Supervisor:
Paid/Volunteer: Select One
Dates (MM/YYYY – MM/YYY):
Dates (MM/YYYY – MM/YYY):
Dates (MM/YYYY – MM/YYY):
To be acceptable for admission, the direct hands on patient care experience must:
1. Require the applicant's use of medical terminology on a regular basis. Please describe the use of medical
terminology in your patient care experience(s):
2. Require the applicant’s knowledge of anatomy, physiology, and pathophysiology. Please describe how
your health care experience requires your knowledge of principles and detail of anatomy, physiology, and
pathophysiology:
3. Demonstrate the applicant's familiarity with medical documentation and patient education. Please describe
your experiences with medical documentation and patient education:
4. Provide regular, direct hands on contact with patients in a health care environment. Please describe how
your current and/or past experiences with patients in a health care environment has prepared you for the Wayne
State University Physician Assistant Studies Program:
5. Health care experience involving the evaluation of all organ systems and a variety of disease states is
preferred. Please explain how your health care experience fulfills this preference:
If you have any further health care related positions than the slots above allowed, or any other information that you would
like to convey to the admissions committee concerning your health care experience, please enter it here:
Please state, in detail, your health care experience work plan to cover the time span from the submission of the CASPA
application to May 2014.