2013 Clin HandbookNEW

Student Clinical Practicum Handbook
Class of 2013
Towson University CCBC Essex Physician Assistant Program

Table of Contents
Faculty and Staff Clinical Practicum Syllabus Introduction Requirements for Rotations and Student Responsibilities Preceptor Evaluation Mid-rotation Evaluations Patient Encounter Logs Skills Log Time Log Student Evaluation of the Clinical Rotations Clinical Seminars and Psychiatry Seminars Site Visit Evaluation Post-Rotation Examinations Attendance Planning Elective Rotations General Elective Final Preceptorships Student Responsibilities Course Grade Computations Description of Course Components and Requirements Preceptor Evaluation Professional Conduct Clinical Seminars Psychiatry/Behavioral Medicine Seminars On-site Faculty Evaluation Post-Rotation Examinations Standardized Patients General Elective Patient Community Medicine Report Final Course Grade What to Expect From Your Clinical Rotations How to Manage Clinical Practicum Seminar and Post-Rotation Exam Schedule 4
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19 20
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23 25 27
Rotation Objectives Emergency Medicine Family Practice/Ambulatory Medicine Internal Medicine Obstetrics/Gynecology Pediatrics General Surgery Community Medicine Rotation General Elective Rotation Out-of-State Rotation Guidelines Important Documents for Those Anticipating Out of State Travel Release of Liability, Waiver Emergency Medical Information International Studies Guidelines Clinical Coordinator Request for Out of State Rotation Full Faculty Approval for Out of State Rotation Underserved Populations Community Medicine and Cross-Cultural Clinical Project Letters of Intent (All Rotations) Final Preceptor Evaluation Fortnightly Evaluation Student Evaluation
28 30 33 36 39 42 45 47 50
51 54 56 59 60 61
62 71 76 77

FACULTY AND STAFF
Shawn McNamara Interim, Program Director

443-840-1807
smcnamara2@ccbcmd.edu
Steven J Schwartz, MD Medical Director 443-840-2854 Sschwa27@jhmi.edu
Robert J. Solomon, MS, PA-C Clinical Assistant Professor 443-840-1930 Rsolomon@ccbcmd.edu
Jack Goble Jr., PA-C InterimAcademic Coord, Asst. Professor 443-840-1159 jgoble@ccbcmd.edu Ted Wilson, PA Adjunct Faculty, Clinical Asst. tedsretired@yahoo.com
Melecia Helwig, MS, PA-C Clinical Coordinator, Asst. Professor 443-840-1885 Mhelwig@ccbcmd.edu Shirley Shaw Program Administrative Assistant 443-840-2854 Sshaw@ccbcmd.edu Robert J. Solomon, MS, PA-C Clinical Assistant Professor 443-840-1930 Rsolomon@ccbcmd.edu
Susan Landry Adjunct Faculty, Program Director Mental Health Slandry@ccbcmd.edu
University CCBC Essex Physician Assistant Program

Clinical Faculty / Preceptors 2012-2013
Claudia Kroker, MD Claudia.kroker@medstar.net 443-777-7116 Jesse Pratt, PA-C Jesse.e.pratt@medstar.net 410-777-8032 Steven Schwartz, MD Sschwa27@jhmi.edu 410-303-4999 Regina Martin, PA-C rmartin@lifebridgehealth.org 410-521-2200 Wilma Rowe, MD wrowe@mdmercy.com 410-332-9694 Erica McHugh, PA-C Emchugh7@aol.com 410-932-8230
Internal Medicine
Franklin Square Hospital 9000 Franklin Square Drive Baltimore, MD 21237
Internal Medicine
Internal Medicine
Internal Medicine
Internal Medicine
Johns Hopkins @ Bayview 4940 Eastern Avenue Baltimore, MD 21224 Northwest Hospital Center Dept. of Internal Medicine 5401 Old Court Road Randallstown, MD 21133 Mercy Medical Center Dept. of Internal Medicine 301 St. Paul Place Baltimore, MD 21202 Good Samaritan Hospital Dept. of Cardiology 5601 Loch Raven Boulevard Baltimore, MD 21239
Community Medicine
Access Carroll, Inc. 2 Locust Lane, Suite 301 Westminster, MD 21157 Concentra Medical Center York, PA UM/College Park Health Center Building 140, Campus Drive College Park, MD 20742 Total Urgent Care West Shore Professional Building 2120 Emmorton Park Road Suite E Edgewood, MD 21040 Baltimore City Health Dept. 1515 W. North Avenue, 2nd Floor Baltimore, MD 21217 Pioneer Health Center 8341 Pioneer Drive Severn, MD 21144
Tammy Black, Exec. Dir. tblack@carrollhospitalcenter.org 410-871-1478 Mark Frydenborg, MD markfrydenborg@concentra.com 410-247-9595 Heather Teitelbaum, PA-C hteitelbaum@health.umd.edu 301-314-8151
Community Medicine
Community Medicine
Community Medicine
Bruce Lewis, PA-C blewis@totalurgentcare.com 410-612-0374
Community Medicine
Jeanne Hoover Jeanne.hoover@baltimorecity.gov 410-396-0176 Marisa Garcia-Faust, PA-C Ms_garcia7@msn.com 410-467-6040
Community Medicine Family Medicine Family Medicine
Family Medicine
Family Medicine
Family Medicine
Private Practice 76 Frederick Street Taneytown, MD Primary and Alternative Medicine 10801 Lockwood Drive, Ste. 310 Silver Spring, MD 20901 Private Practice 4136 E. Joppa Road, Suite B Baltimore, MD 21236 Private Practice 6730 Holabird Avenue Baltimore, MD 21222
Jason Tate, MD Jtatemd@verizon.net Jean Welsh, MD Jwelsh23@hotmail.com 301-681-4860 Ann C. Morrill, MD 410-529-8334 Ali Sanai, MD Ali.sanai@verizon.net 410-288-6226
OB/GYN
OB/GYN
OB/GYN
OB/GYN
GBMC Labor & Delivery 6701 N. Charles Street Towson, MD 21204 St. Agnes Hospital Department of OB/GYN 900 Caton Avenue Baltimore, MD 21229 Private Practice 106 Old Court Road, Suite 104 Pikesville, MD 21208 Baltimore City Health Dept. 1515 W. North Avenue, 2nd Floor Baltimore, MD 21217 Carroll Childrens Hospital 230 Washington Heights Westminster, MD 21157 Private Practice 413 Pulaski Highway, Suite 204 Joppa, MD 21085 Private Practice 4000 Old Court Road, Suite 205 Baltimore, MD 21208 Private Practice 202 Hospital Drive Glen Burnie, MD 21061 Pioneer Health Center 8341 Pioneer Drive Severn, MD 21144 Private Practice 7211 Park Heights Avenue Baltimore, MD 21208 Johns Hopkins @ White Marsh 4324 Campbell Boulevard Baltimore, MD 21236
Jenn Norris, PA-C jnorris@gbmc.org 443-849-4511 Rosemarie Sears, PA-C rsears@stagnes.org 410-368-2514 Beth Aronson, MD baronson@gbmc.org 410-486-6540 Jeanne Hoover Jeanne.hoover@baltimorecity.gov 410-396-0176 Cynthia Newton, PA-C cindynewt@comcast.net 410-848-4424 Balbir Chauhan, MD 410-679-2122 Alfred B. Rosenstein, MD alrosenstein@comcast.net 410-655-4600 Cristeta Gatdula, MD 410-760-2358 Marisa Garcia-Faust, PA-C Ms_garcia7@msn.com 410-467-6040 Sondra K. Heiligman, MD sondrakheiligman@yahoo.com 410-318-8550 Joe Hubicki Hubicki@comcast.net 443-442-2312
Pediatrics
Pediatrics
Pediatrics
Pediatrics
Pediatrics
Pediatrics
Pediatrics
Emergency Medicine
Union Memorial Hospital Department of Emer. Med. 201 E. University Parkway Baltimore, MD 21218 Doctors Community Hospital Department of Emer. Med. 8118 Good Luck Road Lanham, MD 20706 Mercy Medical Center Department of Emer. Med. 301 St. Paul Place Baltimore, MD 21202 St. Agnes Hospital Department of Emer. Med. 900 Caton Avenue Baltimore, MD 21229
Kathi Burroughs, PA-C kathipa@comcast.net 410-554-2107 Elena M. Castro, MD ecastrokaouk@gmail.com 301-552-8665 John Gilbert, PA-C jnrjilbert@verizon.net 301-552-8665 Keith Burgess, PA-C keithmusicman@comcast.net 410-332-9809 Carol Kniola, PA-C samster@verizon.net 410-368-2000 (ER) Tania Boyadjieva, PA-C Tania_zvet@hotmail.com 443-444-4040
Emergency Medicine
Emergency Medicine
Emergency Medicine
Emergency Medicine
Good Samaritan Hospital Department of Emer. Med. 5601 Loch Raven Boulevard Baltimore, MD 21239
Felicia Pryor, PA-C feliciatp@aol.com Yongwon Lee, PA-C Yongwon1376@gmail.com 410-952-3084 Eric Davison, PA-C Edavisonpac.72@verizon.net Gwendy McCoy Gwendy@comcast.net 410-332-9809 Darlene Leftwich, PA-C darerpac@hotmail.com 443-843-5500 Stephanie SingerNicole Kirk, PA-C nkirk21@gmail.com 443-777-7046
Emergency Medicine
Mercy Medical Center Department of Emer. Med. 301 St. Paul Place Baltimore, MD 21202
Emergency Medicine
Harford Memorial Hospital Department of Emer. Med. 102 Barton Court Abingdon, MD 21009 Franklin Square Hospital Department of Emer. Med. 9000 Franklin Square Drive Baltimore, MD 21237 8
Emergency Medicine
Emergency Medicine
Howard County Hospital Department of Emer. Med. 5755 Cedar Lane Columbia, MD 21045
Peter Wessels, PA-C pwessels@hcgh.org 410-740-7777
Surgery Surgery Good Samaritan Hospital Department of Surgery 5601 Loch Raven Boulevard Baltimore, MD 21239 St. Agnes Hospital Department of Surgery 900 Caton Avenue Baltimore, MD 21229 Mercy Medical Center Department of Surgery 301 St. Paul Place Baltimore, MD 21202 Holy Cross Hospital Department of Surgery 1500 Forest Glen Road Silver Spring, MD 209101484 Franklin Square Hospital Department of Surgery 9000 Franklin Square Drive Baltimore, MD 21237 Northwest Hospital Center Department of Surgery 5401 Old Court Road Randallstown, MD 21133 Sinai Hospital of Baltimore Department of Surgery 2401 W. Belvedere Avenue Baltimore, MD 21215 Maureen Cutting, PA-C Maureen.cutting@medstar.net 443-444-3731 Margaret Firko, PA-C mfirko@stagnes.org 410-368-2414 Ralph Garrett, PA-C Garrett63@hotmail.com 410-332-9827 Butch Jackson, PA-C jackbu@holycrosshealth.org 301-754-7258 Daniel Picard, MD Daniel.l.picard@medstar.net 443-777-7123 Jeff Stark, PA-C jstark@lifebridgehealth.org 410-521-2200, x. 55433, x. 52749 Roy Ruehle, PA-C Rruehle21286@yahoo.com 410-245-5000 Jean Sturdivant, B.S. jsturdiv@lifebridgehealth.org 410-601-6412
Surgery
Surgery
Surgery
Surgery
Surgery
Surgery

Clinical Practicum Syllabus Class of 2013 PAST 251, 252, 253, 254 Introduction
The clinical portion of the Physician Assistant Program begins in June of 2012 and extends through May of 2013. There are twelve months of clinical rotations divided among the clinical courses of PAST 251, 252, 253, and 254. 1. 2. 3. 4. 5. 6. 7. 8. Family Practice Internal Medicine Pediatrics Obstetrics and Gynecology Emergency Medicine Surgery Community Medicine Elective General Elective
All rotations (Family Practice, Emergency Medicine, Internal Medicine, and Surgery, OB/Gyn, Pediatrics, and Community Medicine) are approximately 6 weeks in duration and are scheduled and selected by the Clinical Coordinator. In addition, there is a General Elective Rotation which is 6 weeks in duration and a Final Preceptorship (PAST 255), which begins in June of 2013 and runs approximately two months in duration. Both the General Elective and PCP are planned by the Clinical Coordinator for scheduling, students are given the priveledge of site selection and set-up if they are in good standing with the program. "The subject matter in PA education can be of a very sensitive and sometimes disturbing nature. Students are reminded that the purpose of the educational sessions is to prepare students to provide physician supervised primary health care to all persons and in all environments without regard to the student's own personal beliefs and biases."
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Requirements for all Rotations and Student Responsibilities

1. Satisfactory Preceptor Evaluation Students must pass all rotations. Failure of a rotation will require repeating that rotation, delaying graduation, or dismissal from the Program depending on the circumstances surrounding the failure. The student is responsible for seeing that the evaluations are submitted on the first class day after the end of the rotation. A description of the Preceptor evaluation is found below under Course Grade Computation. 2. Fortnightly Evaluations (aka Mid-rotation Evaluation) These evaluations are designed to assure that students get timely feedback from clinical instructor so that deficiencies identified early on can be corrected by rotations end. The student has the responsibility to make an appointment with the preceptor to have the fortnightly evaluation completed. These evaluations are submitted to the clinical coordinator by the 3rd Friday of every rotation. At least one needs to be submitted for each rotation, more may be required for those having difficulty. Electronic (scanned) and paper copies will be accepted. 3. Patient Encounter Logs Students keep a record of each patient contact through Typhon logging system. Typhon should be logged for EVERY patient (there is a minimum, no maximum). 1) All typhon encounters need to be completed by the end of your rotation. If it is incomplete, you will receive an Incomplete grade (refer to student manual). a. Patient Encounter Logs i. All areas with red arrow are required information for EVERY clinical encounter. ii. I would like the remaining sections (sections without red arrow) completed for at least 3 encounters daily. iii. You should log encounters daily, try not to get behind! I will be checking routinely. b. Skills Log i. Skills performed during a rotation and their frequency is also maintained electronically---this will be assessed through your documentation of CPT codes. c. Time Log i. Under Other Logs and Reports, click on my time log, click on add/edit daily time log. Complete the entire log as it pertains to your clinical day. This should be completed daily. ii. If you attend any conferences, please indicate this under the My Clinical Conference Log iii. This should reflect the hours spent on site by the student and any absences during the rotation. 2) You all should print out the summary of patients encountered and time log during your rotation. Please ask your preceptor to sign off on all your logs. This information can be found in the following sections: a. Case log totals (graphical)--enter in the dates spent at the rotation. This should only be about 4-5 pages of information for your preceptor to sign. b. My Time Log--enter in the month for the summary of your time log. 11
Student Evaluation of the Clinical Rotation These evaluations, time and case logs must be turned in with other materials no later than the first campus day following the end of rotation. They are to include constructive criticism and may offer suggestions for solutions for issues raised. These forms are posted on Typhon (under My evaluations) and should be completed at the end of your rotation. These evaluations are summarized for preceptors at the end of each clinical year. Clinical Seminars and Psychiatry Seminars Clinical seminars are mandatory for students on required rotations. Students attending family medicine rotations attend a psychiatry seminar. See descriptions below. Site Visit Evaluation Faculty will evaluate student clinical performance during each rotation either in person, telecommunications, or by electronic means. On-site visits are conducted as a matter of routine. Post Rotation Examinations Students must perform satisfactorily on all post-rotation exams. These exams will be based upon general medicine and your clinical rotation specialty. If you fail a post-rotation exam, you have a one-time opportunity to retest. The retest grade will be averaged with your previous exam grade. For students on a two-month rotation, a mid-rotation exam will be administered as a courtesy. These mid-rotation exams will not count for grade however will be used as a counseling tool as to your progress. See description in sections to follow for grading information. Attendance Students are required to attend the clinical site a minimum of forty hours per week. Generally, attendance will be during the regular work week and day shifts: 8:30 to 4:30, 9:00 to 5:00, or 7:00 to 3:00. Rotations, particularly emergency medicine, general surgery and obstetrics, may require evening, night, weekend and on-call attendance. Students must notify the Clinical Coordinator if the schedule will be other than the routine Monday through Friday for eight hours per day. This can be done by email at the beginning of each rotation. In the event that a student is unable to attend the clinical site for an assigned day for any reason, or will be late she/he must notify the preceptor directly and Clinical Coordinator, no later than one hour before the scheduled arrival time. In emergencies, contact is to be made as soon as possible. If the preceptor is unavailable directly, the student must continue to call until contact is made. Following notification of the preceptor the student must contact the clinical coordinator. A voice mail message is satisfactory in this case, but must include student name, clinical site, preceptor and whether or not she/he has been notified, reason for absence or lateness, and plan for making up the time. The student must make up all missed time before the end of the rotation. A clinical absence form is required for each event of absence, this must be signed by the preceptor and faxed to the PA Program office (443) 8401405 on the first day back on clinical site. Due to the importance of attendance as part of a medical team, each absence will lead to a deduction of .5% from the final rotation grade. Exceptions may be made in certain circumstances as deemed appropriate by the Course Instructor.
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The Program takes these policies seriously. Breech of professional conduct or attendance policies will at the very least lower the students marking by one letter grade and may result in failure of the course and dismissal from the program.
Safety and Security Students, Faculty, and Clinical Faculty are responsible to ensure that appropriate security and personal safety measures are addressed in all locations where instruction occurs. It is everyones responsibility to read and observe policies on safety and security for each and every institution that you are assigned or enter. All sites used by the program are safe, should any site practices be concerning to the student, the program should be notified immediately.
Required Immunizations, Health Screenings and Health Insurance Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC): http://www.cdc.gov/mmwr/preview/mmwrhtml/00050577.htm Exposure to Blood: What Health Care personnel needs to know: http://www.cdc.gov/ncidod/dhqp/pdf/bbp/Exp_to_Blood.pdf Personal Health Insurance Coverage Students are required to carry some form of health care insurance while attending the Program and must provide the Program with verification of coverage by the start of the fall semester. Allowing health insurance coverage to lapse at any time while in the program will result in immediate removal of the student from clincial site or classes and may ultimately result in program dismissal. Neither CCBC nor the Essex PA programs clinical affiliates provide health services to students beyond routine first-aid care. Some health care services are available from the Towson University Dowell Health Center. Students may go to the health care provider of their choice. Students are responsible for all medical fees incurred while attending the Essex PA Program. This includes medical care for accidents or injuries which may occur on Campus or at any of the College's affiliated institutions Student Identification/Patient Introductions Physician assistant students must be clearly identified as such (see dress code). At minimum, students will introduce themselves to patients and hospital personnel as physician assistant students. Students must not represent themselves as anything other than a physician assistant student, regardless of former experience or title, while attending the clinical site. Outside Work in a Clinical Setting Students who elect to work in a health care capacity must dress appropriately so as not to confuse or misrepresent their work role with their PA student status (i.e., the name badge and program emblem may not be worn unless the student is completing a Program clinical assignment).
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Chart Entry Signature All clinical documents and chart entries must be signed with the students' full name followed by PA-SI (Year I) or PA-SII (Year II and Graduating students use the PA-SII designation). Students who fail to identify themselves appropriately will be dismissed from the program. Avoid Misrepresention It is imperative that students represent themselves accurately as physician assistant students while in the clinical setting, regardless of former titleRN, MD, PharmD, etc. Equally important is that students not represent themselves as Towson University CCBC Essex Physician Assistant student
Planning Rotations
Students in good standing with the program (see Student Policy Manual) may have the privilege of selecting their own general elective rotation and primary care preceptorships. Students on probation may have these rotations assigned. Locations may include affiliates with which the program already has an agreement (if available) or sites that the students identify on their own. Procedure for developing an individual site follows below. The general elective is generally not scheduled for the first clinical rotation, but may occur during any of the eleven remaining rotations. General Elective Students are encouraged to select sites for the general elective which can provide: 1. Clinical experience of particular interest to the studenta potential career path 2. Experience in a specialty which is not ordinarily offered by the Program 3. The opportunity to strengthen experience already gained in one of the standard rotations; Fianl Preceptorships Specific requirements are listed on pages 49-51. Student Responsibilities All materials related to the planning of the general elective and FP rotations must be submitted to the clinical coordinator by the following deadlines. For Electives during: Rotations 2 Rotations 3 Rotations 4 Rotations 5 Rotations 6 Rotations 7 Rotation 8 Final P receptorship
June 4, 2012 July 16, 2012 August 27, 2012 October 8, 2012 November 19, 2012 January 7, 2013 February 18, 2013 April 8, 2013
The responsibility for submitting all appropriate documentation and requirements listed below rests solely with the student. If all obligations are not met by the dates listed above in this syllabus, the 14
student will receive an F grade for the rotation and will have to repeat it at the end of the clinical year prior to the Final Preceptorship. Out of state PCPs will need to be requested 4 weeks prior to the above deadlines for the corresponding rotation. Letter of Intent: This is a signed letter from the prospective preceptor agreeing to accept the student for a specific type of rotation on specific dates. Rotation objectives: It is imperative that the student and preceptor reach an agreement about what is expected of each party in terms of clinical education during the rotation. Students negotiate with the preceptor in establishing personal objectives for the elective.
Affiliation Agreement: If a prospective preceptor or institution does not have an existing Affiliation Agreement with the College, the student is responsible for giving all pertinent information to the Clinical Coordinator (CC) so that the contracts can be properly prepared. Additionally, students may be responsible for hand delivering the contracts and returning them to the CC if it becomes necessary. *These contracts protect the institution and individual and students will not be permitted on any clinical site without written authorization from the CC. Violation of this policy will result in course failure and dismissal from the program. Site Selection: If the student selects a site that is one of the Programs standard sites, other students assigned for one of the required rotations will take first priority over the Elective, Community Medicine or Final Preceptorship requests. Contacting Other PA Programs for Sites: If the student requests a rotation out of the area, the program will initiate contact with the PA program in the requested destination. As the student, you will NOT initiate this communication. The initial contact to the other programs Clinical Coordinator will be done by our own Clinical Coordinator. Once a dialog is established, you may then continue it as long as the Clinical Coordinator from both programs are Copied on emails that pertain to site arrangements. Policies and procedures for processing student grievances are located in the following locations: PA Program Student Policy pg. 36-37, CCBC College Catalog pg. 336, School of Health Professions Honor Code pg. 5, Towson Graduate Catalog pg. 27.
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Course Grade Computation

Rotation grades are based on the preceptor evaluation, clinical seminar or report/literature review grade, faculty site-visit evaluation, post-rotation examination and professional behavior. Grades for each rotation will be calculated on a 100-point scale as follows:
Rotations Grades
Preceptor Evaluation Professional Behavior1 Clinical SeminarPsychiatry Seminar2 On-Site Faculty Evaluation Data Logging Post Rotation Exam* S = 86 U = 40 S= 0 N = -10 U = -20 A = +6 B = +2 C = 0 F = -10 S = 0 N = -5 U = -10 Complete = 0 Incomplete = -10 A = +8 B = 0 C = -8 F = -50
S-Satisfactory N-Needs Improvement (possible rotation failure) U-Unsatisfactory (for preceptor grade rotation failure, other categories probable rotation failure)
1
As noted by clinical coordinator, preceptor, faculty site visitor, Clinical Seminars Facilitator or other professionals at the clinical site. One infraction of professional behavior on the evaluation is rated as an N; two or more items will constitute a rating of U for the rotation.
2
For students attending both Clinical and Psychiatry Seminars an average of the two scores will be used for this component
Example: Application of Grading Criteria Rotation 1a Grade Score S 86 Preceptor Evaluation S 0 Professional Behavior A 6 Seminars/Project S 0 Site Visit Evaluation Complete 0 Data Logging B 0 Post Rotation Exam 92 Rotation Grade Average of Rotation 1 and 2: 92 + 82 = 174 / 2 = 87
Rotation 1b Grade Score S 86 S 0 A 6 S 0 In-Complete -10 B 0 82 PAST 251 Grade: B
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Description of Course Components and Requirements

Preceptor Evaluation The preceptor evaluation constitutes a majority of the student grade for the rotations. Preceptors complete a standard evaluation form, assesses whether or not the students performance was satisfactory or unsatisfactory, and indicates professional conduct which could be improved or were a problem during the rotation. These evaluation links are emailed to all preceptors during your rotation. It is the students responsibility to ensure that evaluations are submitted electronically or via paper copy. Professional Conduct Exemplary professional conduct is expected of all physician assistant students at all times. The only time that professional conduct plays a role in the students rotation evaluation is if it has been a problem. Therefore, points are deducted for overall behavior that needs improvement and additional points if unsatisfactory. A professionalism assignment will be assigned to all students with an infraction. The following individuals may also note problem professional conduct: clinical coordinator, faculty site visitor, or clinical seminar faculty. Responsibility for final assessment of professional conduct rests with the Clinical Coordinator. Clinical Seminars Students attending rotations will meet on the first day back on campus with an assigned faculty member per the senior schedule. Requirements for the seminar include: Review of your clinical database information (to include electronic patient logs), Clinical write-up: These should be SOAP notes, and submitted electronically once per month. This should be completed by the 15th of every month. Clinical case presentation or psychiatry seminar Case Discussion to include the following: Basis of diagnosis Review of diagnostic criterion Disease etiology Rationale for the plan chosen If the faculty has any concerns after this review, along with affecting your grade for the rotation, you may be required to give additional case presentations and/or clinical write-ups. The clinical case presentation is a mini grand rounds session. All students will submit their case presentation in the form of a clinical write-up along with pertinent associated work (i.e. CT, Labs, ECGs, etc.). The faculty will prepare questions on your submitted cases. The clinical database information must be complete and current by the end of each week. The clinical write-up is due to the assigned faculty member on the 15th of the month. All written work and case presentations must use The Student Guide to Recording Medical Data as a guide. See the senior schedule for times and dates seminar schedule is available on-line.
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Psychiatry/Behavioral Medicine Seminars The program does not require that physician assistant students attend a separate psychiatry rotation. The program however is committed to assuring and documenting sufficient clinical experience in psychiatry. While clinicians are exposed to psychiatric problems in almost any setting, the family medicine rotation is where students will see and manage the largest percentage of behavioral problems. Therefore clinical students attending family medicine attend a Psychiatry/Behavior Medicine Seminar scheduled on the first day back on campus with Psychiatry Faculty. PSYCHIATRY REQUIREMENTS FOR FAMILY MEDICINE ROTATIONS Students are required to submit TWO (2) cases of patients who present with a primary psychiatric condition (Mood Disorder, Anxiety Disorder, Substance-Use Disorder, etc), or psychosocial problem (divorce, unemployment, etc) REGARDLESS of the primary cause for the visit to the Family Practice office. The format for the submission of the 2 cases is below AND the write-up is to be emailed to the address listed below. Each student is required to complete and submit two (2) cases while on the Family Practice rotation. Students should plan to submit a write-up of a case on the 3rd Friday of their Family Practice rotation. Additionally, each student will make one (1) oral presentation of a case when he/she is back on campus for the end-of-rotation group sessions. The case used for the oral presentation SHOULD NOT be one of your write-up cases. Please use the written case presentation format as the template for your oral presentation. Finally, each week, the student is to send the Clinical Coordinator (CC) (via email) the following information: TOTAL # OF CASES SEEN IN LAST WEEK TOTAL # OF CASES SEEN FOR PSYCHIATRIC PROBLEM TOTAL # OF CASES SEEN FOR PSYCHOSOCIAL PROBLEM TOTAL # OF CASES SEEN FOR MEDICAL TREATMENT WITH PRIMARY PSYCHIATRIC DIAGNOSIS TOTAL # OF CASES SEEN FOR MEDICAL TREATMENT WITH PSYCHOSOCIAL PROBLEM LIST THE SPECIFIC PSYCHIATRIC DIAGNOSES SEEN IN THAT WEEK AND THE NUMBER OF CASES OF SEEN FOR EACH DIAGNOSIS: Alcohol Dependence Major Depression Schizophrenia 4 3 1
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Email address: mhelwig@ccbcmd.edu
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FAMILY PRACTICE MEDICINE ROTATION PSYCHIATRY CASE PATIENT CONTACT FORM
Please complete the following information for the two (2) case write-ups of the patient with a primary psychiatric disorder during the Family Practice rotation. PATIENT DATA o Gender o Age o Marital Status REASON FOR FAMILY PRACTICE VISIT HISTORY OF PRESENT PROBLEM: o (Nature of problem, onset, duration, history of prior treatment)
PRESENCE OF PSYCHOSOCIAL PROBLEM OR ISSUE? o (What is relationship of this problem to patients current physical functioning?)
HISTORY OF SUBSTANCE USE/ABUSE: o (Drug of choice, onset, duration, frequency of use, history of prior treatment) MENTAL STATUS EXAMINATION o (Performed yes/no; form short/long; results) o Delusions: Type o Hallucinations Type o Suicidal Ideation o Homicidal Ideation o Orientation X 4 (person, place, time, purpose) MEDICAL CONDITIONS (List all conditions for which patient is being treated) MEDICATIONS (List all conditions for which patient is being treated) DSM-IV-TR PROVISIONAL DIAGNOSIS(ES) o (All disorders, all 5 axes) DISPOSITION & TREATMENT
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On-Site Faculty Evaluation Site visits to rotations where PA students are assigned serve several purposes. The preceptor can be kept abreast of program changes or schedule modifications. The site and preceptor are evaluated against program standards. Student performance is evaluated. Site visits are also intended to keep the student in touch with the program over the course of the rotation. Student performance during an on-site evaluation may include any or all of the following: review of chart entries, case presentation, and observation of interaction with staff and / or patients. Post Rotation Exams Following completion of each of the required rotations students take a multiple-choice examination designed to measure knowledge and skill gained during a rotation in core knowledge and the specialty discipline. A schedule of exam times is listed on the Senior Schedule. The student must pass the exam in order to pass the rotation. Final Course Grade A point score is calculated for each rotation and an average of all rotations for the course becomes the final course grade using the following program parameters for letter grades: 90 - 100 80 89 70 79 Below 70 = = = = A B C F PAST 251 PAST 252 PAST 253 PAST 254 = Rotations 1a & 1b = Rotations 2a, 2b, 3a, & 3b = Rotations 4a & 4b = Rotations 5a, 5b, 6a, & 6b
Any student who receives an F on any given clinical rotation will receive an F for the course grade regardless of average score for all rotations. A failure in any program course may result in dismissal from the program. A student who fails a single rotation, has not previously failed any rotations, and is in good standing with the program may be allowed to repeat the rotation timing and scheduling at the discretion of the Clinical Coordinator. Regardless, if the opportunity for repeating the rotation is granted or not, the student will receive an F grade for the course. Once the student repeats the rotation and receives a passing grade, a repeat course grade will be entered as a C. A student may not earn any higher than a C for courses where a rotation was failed.
What to Expect From Your Clinical Rotations

At the core of a physician assistant education are the clinical rotationswhere students become adept at interacting with patients, didactic learning is applied and new skills are practiced. After passing through a few sites, it will become apparent that there is no such thing as a typical rotation or a standard approach. Not everything goes as planned. Schedules change and personality conflicts arise. The student must develop a high degree of flexibility and initiative to benefit fully from each rotation. Description of Rotations The clinical practicum focuses on the assessment and overall management of patients presenting to the clinical site. Students participate in all aspects of patient care including the assessment of clinical
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findings, developing differential diagnoses and implementing treatment plans, in collaboration with the preceptor. Students will be exposed to both outpatient and inpatient settings. Every clinical site is different. Each has its own inherent assets and liabilities. Clinical sites within the same specialty vary. Some sites are highly structured with a heavy patient load and limited student/preceptor conference time, while others may have a low patient turnover rate with a lot of time for one-on-one instruction from the preceptor. Due to these variations, it will be up to the student to glean the maximum from each rotation and to supplement what cannot be met clinically with readings based on the objectives for that rotation. There are no perfect rotations. Objectives Each rotation specialty has a directed set of objectives, which are met through observation and participation at the clinical site and by attending conferences and seminars with the preceptor. Students are responsible for independent reading and study for any topic area that cannot be covered on the clinical site. Students are referred to the PA Program required text list for independent reading and study. Preceptors There is one preceptor listed on the evaluation form who is responsible for evaluating the students performance during the rotation. That person may be an administrative person who is in charge of Physician Assistant student rotations and will obtain input from other Physician Assistants, preceptors, clinicians, etc. regarding the students performance to arrive at a final grade. The instruction style of the preceptor is, quite possibly, the most variable feature of the clinical rotation. Some preceptors have precious little time to spend with students one-on-one. They may expect students to rapidly find their niche as a member of the medical team, assign students to other preceptors or expect students to identify individuals with whom they chose to spend their time. It is clear that some individuals are better instructors for certain students than others. The student is encouraged, where allowed, to work with, if possible, those people with whom they are the most comfortable. Schedule When the student was accepted into this program, it was emphasized that the demands of the program would require the students full attention during its 26 months. That means that personal, financial or any other considerations should have been as well organized as possible to allow the student to focus on the necessities of the program. With the numerous aspects of scheduling clinical rotations, which must be taken into consideration, it is not possible for the student to choose which clinical site he or she wants. Preferences may be accommodated where possible. The final decision on student placement rests with the clinical coordinator.
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How to Manage
When starting a new rotation, it is best to take a day to observe the style of patient care and learn the routine of that particular site. How are patient write-ups done? Who co-signs notes and orders? Who is in charge? How are patients followed in the system? Some rotations will have very specific requirements, while others may not be as structured or have a predictable routine. Should a situation arise in which the student is requested to do something that he or she is uncomfortable doing, without direct supervision, the student must inform the preceptor and not perform the task until supervision is provided. Attitude The amount of knowledge and expertise gained from each rotation is largely determined by the students attitude and behavior. If a student chooses a passive role, the learning experience will be minimal. If, however, a politely assertive stance is taken, the opportunity for learning is limitless. Therefore, it is imperative that students take the initiative in each rotation. Preceptors and staff will evaluate how eagerly you approach tasks on rotation. Do you stand back and wait to be told what to do or do you ask and volunteer for tasks? There are always things to learn from different people in different professions. This is especially true in the medical field, whether a student or a practicing professional. The student must make the preceptor and other colleagues aware of whom they are and that they are willing to learn from every situation. It is not only necessary, but also extremely beneficial to make every attempt to maintain an attitude of mutual respect for all colleagues and accept all they have to offer. Attendance Minimum attendance requirements are described earlier in the syllabus. However, you will be assessed on your willingness to work, to stay until all patients are seen and all documentation complete. Preceptors do note behaviors such as avoiding an assignment at the end of the shift versus demonstration of willingness to go beyond what is required. Prompt attendance is also noted. Preceptors may not mention lateness, but note it and it will appear as part of your evaluation. Religious Holidays Absences will be approved, provided that the preceptor and Clinical Coordinator are notified in advance and clinical time is made up. Inclement Weather Policy Students are not required to attend the clinical site on days when the college is closed due to inclement weather. However, it is strongly recommended that students attend the clinical site, if the commute can be made safely. Call the preceptor early in the morning to assess the clinical situation. Students who do not report to the site must notify the preceptor and CC. Students who feel that they are unable to reach the site safely due to inclement weather when the college is not officially closed will be excused provided that the absence procedure is followed. However, all missed hours must be made up.
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Problems Invariably, problems will arise during rotations. It is up to the student to clarify with the preceptor at the outset of the rotation what the expectations are, eliminating unexpected surprises at the end of the rotation. The mid-rotation evaluation is another tool used to measure progress. Personality conflicts do occur and students may feel awkward if one arises, particularly with the person responsible for their grade. It is crucial to identify difficulties as early as possible so they dont interfere with the students ability to learn or jeopardize a fair assessment of the students performance. The student should contact the Clinical Coordinator, their Faculty Advisor or their Faculty Session Advisor as soon as a problem develops in an attempt to lessen, if not solve the difficulty. All efforts will be made to reach a conclusion that is mutually satisfactory to both the student and the preceptor. Please Note The Program expects all students to adhere to standards of professional conduct and patient safety. Students failing to do so, at any time, will be removed from the clinical site and are subject to Program dismissal. Behaviors, which will lead to immediate dismissal, include, but are not limited to: Performing at an unsafe level as assessed by the clinical staff or Program Faculty. Unprofessional conduct (see the PA Program Student Handbook for expansion on professional conduct). Failure to recognize ones clinical limitations. Falsification of medical information. Misrepresentation of the students status.
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Clinical Practicum Seminar 2012-2013

Students will meet in Clinical Seminars on first campus day after rotation and perform case presentations to the following faculty.
Physician Assistant Program
Towson University CCBC Essex
Faculty SOAP Note Session Assignments Faculty Member Melecia Helwig Office Room N327 mhelwig@ccbcmd.edu 443 840-1885 Class of 2013 Advisees
Abdelkarim, Susanna Bonsal, Lauren Duncan, Juliet Fuhr, Shannon Hanssen, Jamie Leigh, Jennifer Molina, Elvin Prada, Michael Shinaberry, Kristina Barrett, Lydia Burgess, Lance Greenway, Melanie Haroun, Lydia Li, Qing Muffoletto, Kara Richardson, Brooke Skellan, Mackenzie Bergmann, Adina Felton, Brittany Griffin, Stephen Manthripragada, Lacie Payea, Thomas Saville, Kun Steen, Laurel Xuan, Xiaqing Bishop, Abigail Doyle, Stephen Fonfara, Brittany Hamilton, Kerin Hergenhahn, Sarah Mikula, Edward Peng, Xinqi Schaffer, Kimberly Winter, Lauren Zager, Laura
Shawn McNamara Office Room N322 smcnamara@ccbcmd.edu 443 840-1807
Jack Goble Office Room N325 jgoblejr@ccbcmd.edu 443-840-1159
Robert Solomon rsolomon@ccbcmd.edu Office Room N326 443 840-1930
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** SOAP Notes are due by the Friday of the 3rd week of each rotation to the respective group leader
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Emergency Medicine Rotation
Description
The Emergency Medicine Clinical Practicum focuses on recognition and management of problems common to the emergency medicine clinical setting and on prevention of accidents and preventable illness. Much emphasis is placed on collection and accurate recording of medical histories and physical findings. Students will complete the objectives for the rotation through supervised clinical practice, participation in planned Emergency Medicine Seminars, independent reading and study, and attendance at grand rounds and other lectures or presentations available at the clinical site.
Reading and Study

Students will utilize Blueprints Emergency Medicine (latest edition) as the primary source for reading and independent study. It is also imperative that students explore other texts on the programs textbook list and sources of reference recommended by individual clinical instructors; and that they avail themselves of the current medical literature. Review of the programs handbook Recording Medical Information will provide guidance for recording histories, physical exams, discharge summaries and presenting cases.
Goal
With the recognition that one cannot master all of Emergency Medicine in a 6 week rotation, the programs philosophy includes an emphasis on collection and analyses of medical data using critical thinking skills in a systematic approach to presenting problems and complaints. Students are expected to gain mastery of a substantial fund of knowledge to function effectively with the wide spectrum of problems in the medicinal practice. Minimum objectives are listed here to guide student learning and instructor facilitation of student learning. Referring to Emergency Medicine lecture outlines, objectives and reading assignments will provide the student with additional direction for learning. While only limited objectives are listed here it is important that students take advantage of all learning opportunities that arise in the clinical setting.
Objectives
At the conclusion of the rotation the student will: 1. Be introduced to the principles of proper patient triage in a hospital emergency department. 2. Collect and record, with accuracy, a focused history and physical exam. 3. Accurately and concisely present case summaries in accordance with program and/or institutional guidelines. 4. Accurately develop a plan of investigation and order the appropriate laboratory and diagnostic tests for complaints presenting to the emergency medicine in a cost-effective manner and within applicable reimbursement guidelines and regulations. 27
5. Promote lifestyle changes through patient education for prevention of disease: a. Diet, Exercise, Smoking Cessation, Weight Management, Sun Exposure, Safety Practices
Emergency Medicine Rotation Continued

6. Perform Medication Reconciliation with guidance from the institutions medical team. Through a process of identifying the most accurate list of all medications a patient is taking including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patients current list of medications against the physicians admission, transfer, and/or discharge orders. 7. Demonstrate knowledge of the symptoms, physical findings, appropriate diagnostic tests, and necessary therapeutic intervention for management of acute and emergent situations: Diabetic emergencies Blood dyscrasias Altered mental status, altered Respiratory distress consciousness and seizure Chest pain Psychiatric emergencies Respiratory and cardiac arrest Cardiac rate and rhythm Stroke/Other cerebral vascular events abnormalities, EKG Alterations of blood pressure abnormalities, syncope Fever and sepsis Eye emergencies Headache Substance abuse Abdominal pain/Acute abdomen Poisoning Foreign body Drug and alcohol toxicity Common pediatric emergencies Allergic disorders Dermatology emergencies Bacterial/Viral and other Orthopedic emergencies/joint pain and infectious processes limitation of motion Common male and female Visual changes/Common eye problems genitourinary complaints 8. Competently perform skills common to the emergency medicine practice: Venipuncute EKG recording and initial assessment Administration of oral, topical Use of sterile technique and parenteral medications Catheterization Intradermal skin testing Initial assessment of radiographs, MRI Suturing and CT scans Burn dressing Casting/Splinting 9. Recognize and initiate therapy, awaiting the arrival of a physician: Cardiac arrest or failure Acute chest pain/myocardial infarction Respiratory arrest or failure Acute endocrine imbalances Hypertensive crisis Ingestion of poisonous/toxic substances Seizures Shock : hypovolemic & cardiogenic 10. Recognize the need and make appropriate referrals for management of medical problems beyond the scope the Emergency Medicine and for follow-up of problems identified in the Emergency Medicine setting. 28
11. Discuss the psychological effects of emergency room care on patients and their families and demonstrate the ability to counsel these individuals Psychiatric Objectives: 12. For each of the common medical conditions listed, identify each item in the differential diagnosis in terms of etiology/pathophysiology, course of the disease, presenting signs and symptoms, mental status exam,
initial laboratory tests and imaging studies, and plan for initial management: Anxiety Suicidal Ideation Bipolar Disorder Substance related disorders Borderline Personality Mood Disorders/Depression
Conversion reaction Schizophrenia and Psychotic Disorders Eating Disorders
Psychiatric emergencies (Delirium) Sleep Disorders Geriatric Psychiatry (Abuse/Neglect)
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Family Practice and Ambulatory Medicine Rotation
Description
The Family Medicine Clinical Practicum focuses on prevention of disease and recognition and management of problems common to the family medicine clinical setting. Much emphasis is placed on collection and accurate recording of medical histories and physical findings. Students will complete the objectives for the rotation through supervised clinical practice, participation in planned Family/Internal Medicine Seminars, independent reading and study, and attendance at grand rounds and other lectures or presentations available at the clinical site.
Reading and Study

Students will utilize Blueprints Family Medicine (latest edition) and Rakel: Essential of Family Medicine (latest edition) and Ferris Clinical Advisor, latest edition as the primary source for reading and independent study. It is also imperative that students explore other texts on the programs textbook list and sources of reference recommended by individual clinical instructors; and that they avail themselves of the current medical literature. Review of the programs handbook Recording Medical Information will provide guidance for recording histories, physical exams, discharge summaries and presenting cases.
Goal
With the recognition that one cannot master all of Family Practice and Ambulatory Medicine in a 1.5 month rotation, the programs philosophy includes an emphasis on collection and analyses of medical data using critical thinking skills in a systematic approach to presenting problems and complaints. Students are expected to gain mastery of a substantial fund of knowledge to function effectively with the wide spectrum of problems in the medicinal practice. Minimum objectives are listed here to guide student learning and instructor facilitation of student learning. Referring to Family Practice/Ambulatory Medicine lecture outlines, objectives and reading assignments will provide the student with additional direction for learning. While only limited objectives are listed here it is important that students take advantage of all learning opportunities that arise in the clinical setting.
Objectives
At the conclusion of the rotation the student will: 1. Collect and record, with accuracy, a complete medical history and physical exam; and interim or episodic history and physical examination. 2. Accurately and concisely present case summaries in accordance with program guidelines. 30
3. Collect and record, with accuracy and in the appropriate format, an admission history and physical examination, prepare admission orders, document patient course in progress notes and complete discharge summaries appropriate with the clinical sites policies. 4. Accurately develop a plan of investigation and order the appropriate laboratory and diagnostic tests for presenting medical complaints in a cost-effective manner and within applicable reimbursement guidelines and regulations.
Family Practice and Ambulatory Medicine Rotation Cont

5. Perform Medication Reconciliation with guidance from the institutions medical team. Through a process of identifying the most accurate list of all medications a patient is taking including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patients current list of medications against the physicians admission, transfer, and/or discharge orders.
6. Psychiatric Objectives: For each of the common medical conditions listed, identify each item in the differential diagnosis in terms of etiology/pathophysiology, course of the disease, presenting signs and symptoms, mental status exam, initial laboratory tests and imaging studies, and plan for initial management: Anxiety Suicidal Ideation Bipolar Disorder Substance related disorders Borderline Personality Mood Disorders/Depression
Conversion reaction Schizophrenia and Psychotic Disorders Eating Disorders
Psychiatric emergencies (Delirium) Sleep Disorders Geriatric Psychiatry (Abuse/Neglect)
7. Identify the symptoms, physical findings, appropriate diagnostic tests, and necessary therapeutic intervention for management of acute and emergent situations: Diabetic emergencies Respiratory distress Altered mental status, altered Chest pain consciousness and seizure Respiratory and cardiac arrest Cardiac rate and rhythm Stroke/Other cerebral vascular abnormalities, EKG abnormalities, events syncope Alterations of blood pressure Eye emergencies Fever and sepsis Substance abuse Headache Abdominal pain 8. With supervision and using appropriate consultation and referral will recognize, assess and implement initial management for problems and disorders common to the practice of internal medicine: Altered mental status/Seizure Hypertension Disorders Diabetes/other common endocrine disorders Parestesias Shortness of breath Joint pain and limitation of motion 31
Allergic disorders Common skin problems Chest pain Acute abdominal pain Common gastrointestinal problems Disorders of the immune system
Fever Bacterial/Viral and other infectious processes Blood dyscrasias Visual changes/Common eye problems Common male/female genitourinary complaints Common pediatric problems
9. Perform screening for and initiate preventive management and patient education for the following problems and possible sequelae: Type II diabetes Colon/Rectal cancer Cardiovascular disease Breast cancer Injuries Testicular and prostate cancer Domestic violence Skin cancers Sexually transmitted infectious diseases Cervical cancer and other preventable adult infections Bone and joint disorders Childhood infectious diseases Alcohol/substance abuse Undesired pregnancy
10. Promote lifestyle changes through patient education for prevention of disease: Diet Weight management Exercise Limitation of sun exposure Smoking cessation Safety Practices 11. Competently perform skills common to the family medicine practice: Venipuncute EKG recording and initial assessment Administration of oral, topical and parenteral medications Use of sterile technique Intradermal skin testing Catheterization Suturing Initial assessment of radiographs Casting/Splinting 12. Recognize the need and make appropriate referrals for management of medical problems beyond the scope of routine Family Medicine.
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Internal Medicine Rotation
Description
The 1.5 month Internal Medicine Clinical Practicum provides the student with the opportunity to further develop the attitudes, habits, knowledge and skill required of the physician assistant. It focuses on the assessment and management of acute and chronic problems common to the practice of internal medicine. Emphasis is given to patient education and prevention of injuries and illness. Students will demonstrate the ability to collect and communicate medical histories and physical findings as well as application of knowledge gained and critical thinking skills acquired in the classroom. Each student must spend sufficient time in a long-term care facility while on this rotation to complete the long-term care objectives described below. Students will complete the objectives for the rotation through supervised clinical practice in the internal medicine setting and long-term care unit; participation in planned Internal Medicine Seminars, independent reading and study, and attendance at grand rounds and other lectures or presentations available at the clinical site.
Reading and Study

Students will utilize Lange: Current Medical Diagnosis and Treatment (latest edition) and Blueprints Medicine (latest edition) as the primary sources for reading and independent study. It is also imperative that students explore other texts on the programs textbook list and sources of reference recommended by individual clinical instructors; and that they avail themselves of the current medical literature. Review of the programs handbook Recording Medical Information will provide guidance for recording histories, physical exams, discharge summaries and presenting cases.
Goal
With the recognition that one cannot master all of Internal Medicine in a two-month rotation, the programs philosophy includes an emphasis on collection and analyses of medical data using critical thinking skills in a systematic approach to presenting problems and complaints. Students are expected to gain mastery of a substantial fund of knowledge to function effectively with the wide spectrum of problems in the medicinal practice. Minimum objectives are listed here to guide student learning and instructor facilitation of student learning. Referring to Internal Medicine lecture outlines, objectives and reading assignments will provide the student with additional direction for learning. While only limited objectives are listed here it is important that students take advantage of all learning opportunities that arise in the clinical setting.
Objectives
At the conclusion of the rotation the student will: 1. Collect and record a complete medical history and physical exam; and an interim or episodic history and physical examination.
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Internal Medicine Rotation Continued

2. Collect and record, with accuracy and in the appropriate format, an admission history and physical examination, prepare admission orders, document patient course in progress notes and complete discharge summaries. 3. Give a concise verbal presentation of the history, physical examination, initial laboratory results, problems, probable disease mechanisms, plans for further assessment and management of an assigned patient in accordance with program guidelines for case presentations. 4. Perform Medication Reconciliation with guidance from the institutions medical team. Through a process of identifying the most accurate list of all medications a patient is taking including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patients current list of medications against the physicians admission, transfer, and/or discharge orders. 5. Accurately develop a plan of investigation and order the appropriate laboratory and diagnostic tests for presenting medical complaints in a cost-effective manner and within applicable reimbursement guidelines and regulations. 6. Promote age appropriate positive lifestyle changes through patient education for health maintenance and prevention of disease including: Diet/Exercise/Weight management Limiting sun exposure Smoking cessation Safety Practices 7. Competently manage long-term care patients to include the following: Admission to the facility: initial evaluation and management plan. Patient progress reports tailored to specific needs of the long-term patient to include: o Special history taking requirements with attention to mental status issues o Physical exam with special attention to patient disabilities o Medication reconciliation o Management planning with particular attention to: activities of daily living patient safety patients need for social services family and other personal social history o End-of-life issues o Discharge planning
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Internal Medicine Rotation Continued

8. For each of the common medical conditions listed, identify each item in the differential diagnosis in terms of etiology/pathophysiology, course of the disease, presenting signs and symptoms, initial laboratory tests and imaging studies, and plan for initial management: Cough Dysuria/other urinary complaints Back pain/joint pain Chest pain Abdominal pain Anemia Hypertension COPD/obstructive airway disease HIV infection Congestive heart failure Liver disease Diabetes mellitus Dyslipidemias Substance abuse Depression Common cancers Acute renal failure Pneumonia Dyspnea Infectious Disease, including HIV Myocardial infarction Venous thromboembolism Fluid, electrolyte, and acid-base disorders Altered mental status/ Seizure Disorders
9. Perform screening for and initiate preventive management and patient education for the following problems and possible sequelae: Type II diabetes Breast cancer Cardiovascular disease/dyslipidemia Gynecologic cancers Domestic violence Testicular and prostate cancer Sexually transmitted infectious diseases Skin cancers and other preventable infections Bone and joint disorders Colon/Rectal cancer Alcohol/substance abuse 10. Competently perform skills common to the internal medicine practice: Venipuncture/ABGs EKG recording and initial assessment Administration of oral, topical and Use of sterile technique parenteral medications Catheterization Intradermal skin testing Initial assessment of radiographs Central lines Lumbar puncture 11. Make appropriate referrals for management of medical problems beyond the scope of routine internal medicine practice.
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Obstetrics/Gynecology Rotation
Description
The 1.5 month Obstetrics and Gynecology Clinical Practicum focuses on (1) the assessment and management of reproductive problems for women from adolescent to adult years, (2) family planning, care of the pregnant women from preconception through the post-partum period, and maintains of reproductive health for men and women. There is also an emphasis on patient education and prevention of sexually transmitted diseases. Much emphasis is placed on collection and accurate recording of medical histories and physical findings; and on application of knowledge gained and critical thinking skills presented in the classroom. Students will complete the objectives for the rotation through supervised clinical practice; participation in planned OB/GYN Seminars, independent reading and study, and attendance at grand rounds and other lectures or presentations available at the clinical site.
Reading and Study

Students will utilize Blueprints Obstetric and Gynecology (latest edition) and Hacker - Moore: Essentials of Obstetrics and Gynecology (latest edition) as the primary source for reading and independent study. It is also imperative that students explore other texts on the programs textbook list and sources of reference recommended by individual clinical instructors; and that they avail themselves of the current medical literature. Review of the programs handbook Recording Medical Information will provide guidance for recording histories, physical exams, discharge summaries and presenting cases.
Goal
With the recognition that one cannot master all of Obstetrics and Gynecology in a 1.5 month rotation, the programs philosophy includes an emphasis on collection and analyses of medical data using critical thinking skills in a systematic approach to presenting problems and complaints. Students are expected to gain mastery of a substantial fund of knowledge to function effectively with the wide spectrum of problems in the medicinal practice. Minimum objectives are listed here to direct student learning and instructor facilitation of student learning. Referring to Obstetrics and Gynecology lecture outlines and objectives will provide the student with additional direction for student learning. While only limited objectives are listed here it is important that students take advantage of all learning opportunities that arise in the clinical setting.
Objectives
At the conclusion of this rotation the student will be able to: 1. Perform and document, with accuracy, a complete gynecologic and obstetrical history and physical exam.
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2. Perform and document with accuracy interim or episodic gynecologic and obstetrical history and physical examination.
Obstetrics/Gynecology Rotation - Continued

3. Perform and document with accuracy complete and appropriate labor and delivery assessment. 4. Accurately and concisely present case summaries. 5. Perform Medication Reconciliation with guidance from the institutions medical team. Through a process of identifying the most accurate list of all medications a patient is taking including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patients current list of medications against the physicians admission, transfer, and/or discharge orders.
6. Accurately develop a plan of investigation and order the appropriate laboratory and diagnostic tests for gynecologic and obstetric presenting complaints in a cost-effective manner and in accordance with appropriate reimbursement guidelines and regulations. 7. Assess and implement initial management for issues, problems and disorders common to the practice of gynecology: Vulvovaginitis Menstrual irregularities/Menstrual pain Candida, Trichomoniasis, Bacteria Vaginosis, Chemical-allergic-foreign Urinary complaints body vaginitis Menopause Infertility Hirsutism Urinary incontinence Infertility Uterine myomas, endometriosis Breast mass/malignancies Amenorrhea / Dysfunctional uterine Pelvic Malignancies bleeding/Menstrual pain Sexually transmitted diseases 8. Identify symptoms, physical findings, appropriate diagnostic tests, and necessary therapeutic intervention for management of acute and emergent gynecologic situations: Pelvic Pain Severe vaginal bleeding Lower abdominal pain Dysuria/Hematuria Leg/calf pain Dyspareunia Sexual abuse Domestic abuse Breast mass/discharge 9. Provide family planning services, education, and management of complications Family planning Intrauterine devices Progestin only agents: oral; injection; Male and female sterilization implants 37
Obstetrics/Gynecology Rotation - Continued

10. Competently perform clinical skills common to the OB/Gyn setting: 1. Breast exam 2. Pelvic exam, uterine sizing 3. Pelvimetry 4. Venipuncture 5. Administration of oral, topical and parenteral medications (including immunizations) 6. Pap smear and visual cervical assessment 7. Wet prep/KOH prep 8. Urinalysis 9. Vaginal and cervical cultures 10. Forms of contraception 11. Endometrial biopsy 12. Use of sterile technique 13. Testing stool for blood 11. Be able to discuss and propose management for obstetric issues. Antepartum care Medical complications of pregnancy Monitoring labor and delivery Identification of the high risk Fetal monitoring/fetal distress patient Prolonged pregnancy Premature labor Substance abuse during pregnancy Prenatal diagnosis and ultrasound Antepartum bleeding 12. Educate patients and partners about: Normal menstrual function Pregnancy Labor and delivery Peurperium Lactation Sexually transmitted diseases Safe sexual practices Maintenance of normal weight/exercise
Preventive measures such as selfbreast exam, mammography, and Pap smears basic behavior modification techniques Smoking cessation Basic nutritional needs for women from menarche through the postmenopausal years
13. Recognize the need and make appropriate referrals for major medical and psychiatric problems, and other problems beyond the scope of routine outpatient obstetrics and gynecology.
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Pediatric Clinical Practicum
Description
The 1.5 month Pediatric Clinical Practicum provides the student with the opportunity to further develop the attitudes, habits, knowledge and skill required of the physician assistant. It focuses on the assessment and management of the infant, child, and adolescent presenting with acute or chronic problems, and for routine well-child care with emphasis on parent/patient education and prevention of injuries and illness. Students will demonstrate the ability to collect and communicate medical histories and physical findings as well as application of knowledge gained and critical thinking skills acquired in the classroom. Students will complete the objectives for the rotation through supervised clinical practice; participation in planned Pediatric Medicine Seminars, independent reading and study, and attendance at grand rounds and other lectures or presentations available at the clinical site.
Reading and Study

Students will utilize Blueprints Pediatrics (latest edition), Nelson: Textbook of Pediatrics 17th edition and Harriet Lane Handbook: A Manual for Pediatric House Officers 16th edition as the primary sources for reading and independent study. It is also imperative that students explore other texts on the programs textbook list and sources of reference recommended by individual clinical instructors; and that they avail themselves of the current medical literature. Review of the programs handbook Recording Medical Information will provide guidance for recording histories, physical exams, discharge summaries and presenting cases.
Goal
With the recognition that one cannot master all of Pediatric Medicine in a one-month rotation, the programs philosophy includes an emphasis on collection and analyses of medical data using critical thinking skills in a systematic approach to presenting problems and complaints. Students are expected to gain mastery of a substantial fund of knowledge to function effectively with the wide spectrum of problems in pediatric medicine. Minimum objectives are listed here to guide student learning and instructor facilitation of student learning. Referring to Pediatric Medicine lecture outlines, objectives and reading assignments will provide the student with additional direction for learning. While only limited objectives are listed here it is important that students take advantage of all learning opportunities that arise in the clinical setting.
Objectives
At the conclusion of the rotation the student will: 1. Obtain and document a complete and episodic pediatric medical history and physical exam and patient progress, and record medical orders for signature of the clinical supervisor. 2. Obtain and document complete and appropriate newborn, well-baby, and well-child checks and developmental assessment. 40
Pediatric Clinical Practicum Continued

3. Give a concise verbal presentation of the history, physical examination, initial laboratory results, problems, probable disease mechanisms, plans for further assessment and management of an assigned patient in accordance with program guidelines for case presentations. 4. Perform Medication Reconciliation with guidance from the institutions medical team. Through a process of identifying the most accurate list of all medications a patient is taking including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patients current list of medications against the physicians admission, transfer, and/or discharge orders. 5. Develop and record an initial plan of investigation and order the appropriate laboratory and diagnostic tests for pediatric presenting complaints in a cost-effective manner and in accordance with appropriate reimbursement guidelines and regulations. 6. Child/Adolescent Psychiatry Objectives: For each of the common medical conditions listed, identify each
item in the differential diagnosis in terms of etiology/pathophysiology, course of the disease, presenting signs and symptoms, mental status exam, initial laboratory tests and imaging studies, and plan for initial management: Abuse and Neglect Suicidal Ideation/Risk Substance related disorders ADD and ADHD Mood Disorders/Depression Conversion reaction
Schizophrenia and Psychotic Disorders Eating Disorders Autism
Psychiatric emergencies Sleep Disorders Bipolar Disorder
7. For each of the common pediatric conditions listed, identify each item in the differential diagnosis in terms of etiology/pathophysiology, course of the disease, presenting signs and symptoms, initial laboratory tests and imaging studies, and plan for initial management: Fever Seizure Cough, wheeze Poor vision/hearing loss Sore throat/pharyngeal inflammation Traumabites, burns, head injury, sprain/strain/fracture, unexplained injuries/child Ear pain abuse and neglect URIviral and bacterial Joint or limb painlimp, joint swelling GI problemsabdominal pain, tenderness diarrhea, hemocult positive stool, Heart murmur abdominal mass, tenderness hepatomegaly, splenomegaly Abnormal eye examinationstrabismus GU problemsdysuria, frequency, Anemia, leukocytosis, thrombocytopenia hematuria, proteinurea, WBCs in urine, Chest radiographic abnormalitiesinfiltrate, dipstick abnormalities hyperaeration, atelectasis Headache Rashes Bruising/petechiae 41
8. Accurately and appropriately list key factors and identify importance, presentation, and/or management of the following issues: Immunization schedules Issues unique to adolescencesexual problems/concerns, risk taking behaviors Developmental disorders/behavior problems Medical genetics and congenital malformationprenatal diagnostics, Growth and nutrition problems effects of teratogenic agents Prevention of illness and injury Pediatric pharmacological therapeutics Physical and sexual child abuse Poisoning prevention and treatment Fluid and electrolyte management
9. Competently perform clinical skills common to the pediatric setting: Venipuncture Administration of oral, topical and parenteral medications (including immunizations) Intradermal skin testing Developmental screening Use of sterile technique 10. Educate parents and pediatric patients, where appropriate, on normal child development, importance of immunizations, prevention of injuries, and recognition of medical emergencies, basic behavior modification techniques, and basic nutritional needs for children from birth through adolescence, sex education and prevention of unwanted pregnancy and sexually transmitted infections. 11. Make appropriate referrals for major medical, psychiatric, learning problems, and other problems beyond the scope of routine outpatient pediatrics. 12. Child/Adolescent Psychiatry Objectives: For each of the common medical conditions listed, identify each item in the differential diagnosis in terms of etiology/pathophysiology, course of the disease, presenting signs and symptoms, mental status exam, initial laboratory tests and imaging studies, and plan for initial management: Abuse and Neglect Suicidal Ideation/Risk ADD and ADHD Substance related disorders Conversion reaction Mood Disorders/Depression Schizophrenia and Psychotic Disorders Psychiatric emergencies Eating Disorders Sleep Disorders Autism Bipolar Disorder
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General Surgery Rotation
Description
This rotation will familiarize the student with operating room techniques, various surgical procedures, pre-operative and post-operative patient management, health services and personnel affiliated with surgery.
Reading and Study

Students will utilize Blueprints Surgery (latest edition) and Lange: Current Surgical Diagnosis & Treatment latest edition as the primary source for reading and independent study. It is also imperative that students explore other texts on the programs textbook list and sources of reference recommended by individual clinical instructors; and that they avail themselves of the current medical literature. Review of the programs handbook Recording Medical Information will provide guidance for recording histories, physical exams, discharge summaries and presenting cases.
Goal
With the recognition that one cannot master all of Surgical Medicine in a 1.5 month rotation, the programs philosophy includes an emphasis on collection and analyses of medical data using critical thinking skills in a systematic approach to presenting problems and complaints. Students are expected to gain mastery of a substantial fund of knowledge to function effectively with the wide spectrum of problems in pediatric medicine. Minimum objectives are listed here to guide student learning and instructor facilitation of student learning. Referring to Surgical Medicine lecture outlines, objectives and reading assignments will provide the student with additional direction for learning. While only limited objectives are listed here it is important that students take advantage of all learning opportunities that arise in the clinical setting.
Objectives
At the conclusion of the rotation the student will: 1. Accurately collect and record the appropriate history and physical examination for surgical admission and pre-admission testing. 2. Assess post-surgical patient status and accurately record findings 3. Develop a differential diagnosis, a plan of investigation and order the appropriate laboratory and diagnostic tests for patients presenting to the surgical setting. 4. Demonstrate operating room protocol and the practice of aseptic techniques. 5. Write admission, post-operative and discharge orders.
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6. Efficiently and accurately present cases.
General Surgery Rotation Continued

7. Perform Medication Reconciliation with guidance from the institutions medical team. Through a process of identifying the most accurate list of all medications a patient is taking including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patients current list of medications against the physicians admission, transfer, and/or discharge orders. 8. Demonstrate the ability to accurately perform clinical surgical procedures commonly performed by Physician Assistants Surgical gowning and gloving Surgical Assisting Sterile and aseptic technique Wound closure (sutures and staples) Venipuncture Collect arterial blood specimens Administration of oral topical EKG recording and initial assessment and parenteral medications Catheterization Nasogastric tube placement Initial assessment of radiographs, MRI and CT scans Wound dressing 9. Assess and recommend a course of action for management of surgical emergencies Acute abdomen and Eye, ear, nose and throat injury abdominal injuries Chest injury Blunt trauma Urinary tract injury Airway obstruction Cardiac/Respiratory Arrest Head injury 10. Discuss the indications, contraindications and possible complications of common surgical procedures: Cholecystectomy Colon resection Mastectomy Total joint replacements Wound debridement Appendectomy Colonoscopy Sigmoidoscopy Endoscopy Thoracotomy Laparoscopy Laparotomy 11. Describe the indications, benefits, risks, monitoring needs, and potential complications for the use of anesthesia and sedation in the operative patient: General Intravenous induction agents Local Inhalation agents Regional Muscle relaxants Spinal Nerve blocks Conscious sedation 44
12. Select and monitor appropriate agents for post-operative pain management: Psychological Interventions Epidural/Spinal Anesthesia Systemic Opiates Nonsteroidal anti-inflammatory Drugs Cryoanalgesia Patient-Controlled analgesia (PCA) Peripheral Neural Blocks
General Surgery Rotation Continued

13. Evaluate, prevent and implement management of patients with post-operative problems and complications: Infection Renal Dysfunction Venous Stasis and circulatory Bleeding complications Hypothermia Pulmonary complications 14. Promote lifestyle changes through patient education for prevention of disease: Diet Weight management Exercise Limitation of sun exposure Smoking cessation Safety Practices
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Community Medicine Rotation
Description
The community medicine practicum is designed to provide the student with an opportunity to experience patient care within a community service agency or another setting which serves disadvantaged or special populations. Generally, these will be primary care settings.
Reading and Study

Students will utilize Current Medical Diagnoses and Treatment, latest edition and Bates: Guide to Physical Examination and History Taking latest edition as the primary source for reading and independent study. It is also imperative that students explore other texts on the programs textbook list and sources of reference recommended by individual clinical instructors; and that they avail themselves of the current medical literature. Review of the programs handbook Recording Medical Information will provide guidance for recording histories, physical exams, discharge summaries and presenting cases.
Goal
With the recognition that one cannot master all of Community Medicine in a 1.5-month rotation, the programs philosophy includes an emphasis on collection and analyses of medical data using critical thinking skills in a systematic approach to presenting problems and complaints. Students are expected to gain mastery of a substantial fund of knowledge to function effectively with the wide spectrum of problems in pediatric medicine. Minimum objectives are listed here to guide student learning and instructor facilitation of student learning. Referring to Community Medicine lecture outlines, objectives and reading assignments will provide the student with additional direction for learning. While only limited objectives are listed here it is important that students take advantage of all learning opportunities that arise in the clinical setting.
Objectives
At the conclusion of the rotation the student will: 1. Outline potential solutions to core issues for the community or special population. 2. Describe the special needs of patients served by this clinical site and obstacles meeting those needs to include genetics and Healthy People 2010 standards. 3. Demonstrate to the program faculty and preceptor, mastery of material related to the sites particular specialty. 4. Outline cases; including collection of diagnostic data, initial care plans, counseling, case management, interdisciplinary, and referrals needs. 5. Give accurate and concise verbal case presentations with the special circumstance/need of the clinical site in mind. 6. Perform Medication Reconciliation with guidance from the institutions medical team. Through a process of identifying the most accurate list of all medications a patient is taking including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patients current list of medications against the physicians admission, transfer, and/or discharge orders. 7. Implement management plans after discussion and approval by the preceptor. 8. Become increasingly competent with charting interim notes and/or focused history and physical examinations.
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Special Requirement for Community Medicine

In lieu of write-up and post rotation exam, students will: Complete a service project utilizing the plan-do-study-act model below which is mutually agreed upon with the sponsoring agency and the student and approved by the programs project director; Demonstrate an awareness of economic and social issues that influence the delivery of health care in the community; Demonstrate an awareness of cultural influences that effect health beliefs and practices within the community; and Submit a paper discussing the service project, using the model below as your guide. Max. 1500 words, 12 font, Times New Roman, 1 margins. Present overview of project during the clinical seminar
Setting Aims Improvement requires setting aims. The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected. Establishing Measures Use quantitative measures to determine if a specific change actually leads to an improvement. Selecting Changes All improvement requires making changes, but not all changes result in improvement. Organizations therefore must identify the changes that are most likely to result in improvement.
Testing Changes The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.
Plan Do
Develop a plan for improving quality at a process Execute the plan, first on a small scale
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Study Evaluate feedback to confirm or to adjust the plan Act Make the plan permanent or study the adjustments

General Elective Rotation
Description
The elective rotation is designed to provide the student with an opportunity to gain additional experience in one of the traditional settings such as family practice, internal medicine, psychiatry, surgery, OB/GYN, or emergency medicine. Students may decide to choose a setting not usually provided by the program with approval of the Clinical Coordinator.
Reading and Study

Students will utilize Blueprints Medicine (latest edition), Lange: Current Medical Diagnosis & Treatment latest edition and Bates: Guide to Physical Examination and History Taking larest edition as the primary source for reading and independent study. It is also imperative that students explore other texts on the programs textbook list and sources of reference recommended by individual clinical instructors; and that they avail themselves of the current medical literature. Review of the programs handbook Recording Medical Information will provide guidance for recording histories, physical exams, discharge summaries and presenting cases.
Objective
With the recognition that one cannot master all of the elected clinical practicum in a five-week rotation, the programs philosophy includes an emphasis on collection and analyses of medical data using critical thinking skills in a systematic approach to presenting problems and complaints. Students are expected to gain mastery of a substantial fund of knowledge to function effectively with the wide spectrum of problems in the medicinal practice. Minimum objectives are listed here to guide student learning and instructor facilitation of student learning. Referring to lecture outlines, objectives and reading assignments will provide the student with additional direction for learning. While only limited objectives are listed here it is important that students take advantage of all learning opportunities that arise in the clinical setting.
Goals
At the conclusion of the rotation the student will: 1. Accurately perform and record a complete, interim and/or focused history and physical examination. 2. Develop differential diagnoses for each case. 3. Outline management of cases, including collection of lab data, initial care plans, counseling and referrals. 49
4. Present case summaries to the preceptor emphasizing the significant medical and psychosocial aspects, significant negative and positive findings and problem lists.
General Elective Rotation - Continued

5. Perform Medication Reconciliation with guidance from the institutions medical team. Through a process of identifying the most accurate list of all medications a patient is taking including name, dosage, frequency, and route and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patients current list of medications against the physicians admission, transfer, and/or discharge orders. 6. Implement management after discussion and approval by the preceptor.
Site Selection
Students are encouraged to select sites which: 1. Will provide additional experience in the students area of interest, 2. Provides the opportunity to round out the students clinical education in a setting or specialty not usually provided by the program, 3. Provides the opportunity to augment the students previous experience in a standard operation, and 4. Has the potential for employment as a graduate. Students must be in good standing to be eligible to participate in the elective rotation. The Clinical Coordinator may assign students not in good standing to rotation sites that will fulfill weak areas of clinical knowledge.
Student Responsibilities
1. 2. 3. 4. Obtain preliminary approval from the Clinical Coordinator before approaching a prospective preceptor. Make initial contact with the potential preceptor to determine feasibility, appropriateness of facility and interest on the part of the preceptor. Have the Letter of Intent form signed by the prospective preceptor and turn it into the clinical coordinator by the established due date. Negotiate and define specific personal rotation objectives with the preceptor and have the preceptor sign the form. It is imperative that the student and preceptor reach an agreement about what is expected of each party in terms of clinical education during this rotation. If the site selected offers experience in one of the nine required rotations, the student may use the programs objectives for the experience. However, it is to the students benefit to come to an understanding with the preceptor regarding personally identified learning needs. If the prospective preceptor or institution does not have an existing affiliation agreement with the College, the student is responsible for giving all pertinent information (name, title, 50
5.
institution, address, phone numbers, etc.) to the Clinical Coordinator so that the contracts can be properly prepared. The Clinical Coordinator will manage the affiliation agreement. Students may be responsible for hand delivering the contracts and returning them to the College if it becomes necessary.
General Goals
At the end of this rotation, the student will be able to: 1. Present case summaries to the preceptor emphasizing significant medical and psychosocial aspects, significant negative and positive findings and problems lists. 2. Develop differential diagnoses for each case. 3. Use the problem oriented medical record system. 4. Outline management of cases, including collection of lab data, initial care plans, counseling and referrals. 5. Implement management after discussion and approval by the preceptor. 6. Perform and record a complete, interim and/or focused history and physical examination.
Specific Goals
(Negotiated and agreed upon by the student and preceptor) At the end of the rotation, the student will: 1. 2. 3. 4. 5. 6.
We both agree to the objectives listed above.
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___________________________ Student Signature/Date
___________________________ Preceptor Signature/Date
(May remove page to use when agreeing on a site turn in with Letter of Intent)
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Essex Campus PAST 254: Final Preceptorship Summer 2013 (June-July) Instructor: Melecia Helwig, MS, PAC Room N327 Office phone: 443-840-1885 /Mobile: 44-652-2128 Email: mhelwig@ccbcmd.edu Office hours: M/W 9-10 am; T 10:00-11:00 am; Th 2:30-3:30pm Prerequisites: matriculation of all previous PA courses. Course Goals and Rationale The primary care preceptorship, the final clinical experience of the program, allows the student an opportunity to integrate didactic and clinical experience in preparation for practicing as a Physician Assistant. The student will be exposed to the many health services provided in the primary care clinical setting and learn how to work closely with individuals providing these services. The student will also be exposed to the health promotion and disease prevention aspects involved in total patient care. Guidelines for finding a Primary Care/Final Preceptorship Letter of Intent Due: Mar. 15,2013 1. Students are expected to find their preceptors with physicians or organizations that are not currently clinical affiliates of the program. There will be no exceptions to this rule. This is done much the same way you find a job. It is recommended that you find a placement which may lead to employment. Through networking and using contacts already established among faculty and clinical instructors, students should identify sites where they would like to complete this preceptorship. Sending a resume with a cover letter explaining that you are looking for primary care placement site for your final clinical experience is an excellent way to introduce yourself. 2. Primary care is care provided by clinicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern not limited by problem origin, organ system or diagnosis. The four essential characteristics which must be met in order to be considered primary care sites are: Ambulatory care is provided First line care is providedpatient point of access into the health care system Comprehensive care is provided within the settingmore specialized care coordinated by primary care provider Longitudinal care is providedthe patient is managed over time even if additional consultants are needed 3. Primary care sites traditionally include Family Practice, Pediatrics, OB/GYN, and Ambulatory Medicine, Internal Medicine Outpatient Practice. Emergency departments, fast-track clinics, specialized outpatient care limited to industrial or occupational medicine, and inpatient departments do not meet qualifications for primary care. 4. The goal of the PCP is for the student to find a site outside existing program sites in a primary care that will round out the students clinical experience as a medical team member which allows continuity of care and/or has the potential for employment. School of Health Professions
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5. Students must complete the preceptorship at a single location. Attendance may not for any reason be split between two different sites. 6. Students may have a site which does not meet the above definition approved (by the clinical coordinator and the program director) for two situations only: The site is located in a Health Resources Shortage Area or other designation underserved area or, A position is open at the site for which the student is under serious consideration (must be verified in writing from the individual at the site responsible for hiring) 7. Approval of the clinical coordinator must be received before the student contacts the potential preceptor. 8. After receiving clinical coordinator approval, students will write a cover letter which will be sent to prospective preceptors with a CV and the objectives for the rotation. 9. Cover letter content: Reason for selecting the site and how it will meet students personal goals Student past experience before or during the program that will be an asset to the practice Statement that 40hr/week is the minimum requirement This is the last rotation before graduation Response from preceptor needed no later than April 1 (the sooner the better) An affiliation agreement will be necessary and will be forthcoming from the clinical coordinator if the answer is yes Program will provide letter of insurance, coordination with other programs, and confirmation of student status in the program, and verification of vaccinations and health requirements Dates of the preceptorship 10. Once the site is approved and preceptor agrees, the following packet of information must be sent by the student to the preceptor: Affiliation Agreement Objectives Letter of Intent General Course Objectives: At the conclusion of the course the student will: 1. Be familiar with, understand and perform clinical skills commonly performed by Physician Assistants 2. Identify abnormal findings on physical examination 3. Accurately develop a plan of investigation, ordering appropriate laboratory and diagnostic tests 4. Develop a differential diagnosis and/or problem list 5. Collect a complete, interim and/or focused history and physical examination 6. Recognize and/or initiate therapy, until the arrival of a physician, for the following, but not limited to, emergent conditions: Chest pain/Myocardial infarction, Respiratory distress, Endocrine emergencies, Seizures, Acute abdomen, Drug overdose 7. Understand hospital protocol, including roles of the attending physician, house staff physician, physician assistant, nurse, and paramedical staff 8. Recognize and implement management of patients with approval by the preceptor with the following, but not limited to conditions:
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Cardiac disease, Respiratory disease, Endocrine disease, Gastrointestinal illnesses, Genitourological illness, Neurological Conditions, Musculoskeletal Conditions, Geriatric Conditions
Methods of Evaluation Satisfactory Preceptor Evaluation Students must pass all rotations. Failure of a rotation will require repeating that rotation, delaying graduation, or dismissal from the Program depending on the circumstances surrounding the failure. The student is responsible for seeing that the evaluations are submitted on the first class day after the end of the rotation. Fortnightly Evaluations These evaluations are designed to assure that students get timely feedback from clinical instructor so that deficiencies identified early on can be corrected by rotations end. The student has the responsibility to make an appointment with the preceptor to have the fortnightly evaluation completed. These evaluations are submitted to the clinical coordinator by the 15th of every month. We will accept both paper and paperless evaluation forms. Patient Encounter Logs Students keep a record of each patient contact through typhoon logging system. Typhon should be logged for EVERY patient (no minimum, no maximum). 3) All typhon encounters need to be completed by the end of your rotation. If it is incomplete, you will receive an Incomplete grade (refer to student manual). a. Patient Encounter Logs i. All areas with red arrow are required information for EVERY clinical encounter. ii. I would like the remaining sections (sections without red arrow) completed for at least 3 encounters daily. iii. You should log encounters daily, try not to get behind! I will be checking routinely. b. Skills Log i. Skills performed during a rotation and their frequency is also maintained electronically--this will be assessed through your documentation of CPT codes. c. Time Log i. Under Other Logs and Reports, click on my time log, click on add/edit daily time log. Complete the entire log as it pertains to your clinical day. This should be completed daily. ii. If you attend any conferences, please indicate this under the My Clinical Conference Log iii. This should reflect the hours spent on site by the student and any absences during the rotation. Student Evaluation of the Clinical Rotation These evaluations must be turned in with other materials no later than the first campus day following the end of rotation. They are to include constructive criticism and may offer suggestions for solutions for issues raised. These forms are posted on Typhon (under My evaluations) and should be completed at the end of your rotation. These evaluations are summarized for preceptors at the end of each clinical year. Site Visit Evaluation Faculty will evaluate student clinical performance during each rotation either in person, telecommunications, or by electronic means. On-site visits are conducted as a matter of routine. Required Texts Students will utilize Lange: Current Medical Diagnosis and Treatment (latest edition) and Harrisons: Principles of Internal Medicine (latest edition) as the primary sources for reading and independent study.
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Out-of-State Rotation Request and Approval
Students may request out-of-state placement for the Community Medicine, Elective and Primary Care Preceptorship rotations only.
Requirements
*A minimum of two rotations must have been completed successfully before a student will be allowed to leave the state for Community Medicine or Elective rotations. All rotations must have been completed successfully before a student will be allowed to leave the state for the Primary Care Preceptorship. All students requesting out-of-state rotations must be in Good Standing GPA > 3.0 *No grades of C in any course. No formal notification of behavioral problems Adequate Program faculty available to evaluate the site and monitor the students performance A completed request form must be submitted to the Clinical Coordinator along with the Letter of Intent, signed by the Preceptor who will be supervising the student. Before approving the request, the Clinical coordinator will verify the interest of the Preceptor and the capability of the site to accommodate a student. If approved, the student must submit an agreement with the Program that includes, but not limited to, the following: Dates of Rotation Method of monitoring the students progress Method of evaluating the site Agreement to return to campus for all scheduled classes and activities or arrangement to submit assignments. Any special requirements or assignments
* Or approval by clinical coordinator and program director after review of students academic progress and site requested.
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RELEASE OF LIABILITY, WAIVER,

DISCHARGE AND COVENANT NOT TO SUE
COMMUNITY COLLEGE OF BALTIMORE COUNTY

INTERNATIONAL STUDIES PROGRAM
THIS IS A RELEASE OF LEGAL RIGHTS

READ AND UNDERSTAND BEFORE SIGNING
Name of Student:_____________________
Activity:______________________________
I, ________________________________________________________ will be participating in cross cultural study abroad in_________________________ (the Activity) for the period of [INSERT DATES OF ACTIVITY]. I hereby agree as follows: 1. I understand that participation in the Activity involves risk not found in study at the Community College of Baltimore County (the College). These include risks involved in traveling to and within and returning from one or more foreign countries; foreign political, legal, social and economic conditions; different standards of design, safety and maintenance of buildings, public places and conveniences. I understand that each foreign country has its own laws and standards of acceptable conduct, including dress, manners, morals, politics, drug use and behavior. I recognize that behavior which violates those laws or standards could harm the Colleges relations with those countries and the institutions therein, as well as my own health and safety. I will become informed of, and will abide by, all such laws and standards for each country to or through which I will travel during the Activity. I will comply with all rules and regulations issued by the College or any coordinating institution. It is within the sole discretion of the College, through its identified representative (the Representative), to determine that my behavior violates any such rules and regulations and warrants my termination from the Activity. I agree that the College has the right to enforce the rules and regulations, through the Representative, in its sole discretion, and that it will impose sanctions, up to and including termination of my participation in the Activity, for violating the rules and regulations or for any behavior detrimental to or incompatible with the interests, harmony and welfare of the College, the Activity or the other participants in the Activity. I recognize that due to the circumstances of foreign study programs, procedures for notice, hearing and appeal applicable to student rights at the College do not apply. If I am asked to terminate my participation, I consent to being sent home at my own expense with no refund of fees. I also agree that I will (a) not buy, sell or use illegal drugs at any time, (b) not engage in abusive use of
2.
3.
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alcohol, (c) participate in all classes and scheduled activities unless ill, and (d) abide by dress and cultural codes suitable in the countries visited. 4. The College, in its sole discretion, determines that circumstances within a foreign country may require the cancellation of the Activity within that country. The College will provide me with as much advance notice as possible of its intention to cancel all or a portion of the Activity. I also understand the College, an overseas institution or a foreign government may prematurely terminate all or a portion of the Activity. In consideration of being permitted to participate in the Activity, I do release, waive, forever discharge and covenant not to sue the College, the Board of Trustees of the College, officers, officials, employees or agents of the College (the Releasees) from and against any and all liability from any harm, injury, damage, claims, demands, action, causes of action, costs, including reasonable attorneys fees, and expenses of any nature which I may have or which may hereafter accrue to me, arising out of or related to any loss, damage, or injury, including but not limited to suffering and death, that may be sustained by me or by any property belonging to me which there caused by the negligence or carelessness of the Releasees, or otherwise, while I am engaged in the Activity, or in transit to or from the premises where the Activity or any adjunct to the Activity, occurs or is being conducted. I understand and agree that the Realeasees are hereby granted permission to authorize emergency medical treatment for me, if necessary, and that Releasees assume no responsibility for any injury or damage which might arise out of or in connection with such authorized medical treatment. I am aware that travel insurance may be available through [INSERT THE NAME OF THE TRAVEL AGENT] (the Travel Agent). If available, the Travel Agent will inform me of the specific terms and coverage of any such insurance. It is my express intent that, with respect to the Releasees, this Release shall bind the members of my family and my spouse, if I am alive, and my family, estate, heirs, administrators, personal representatives, or assigns, if I am deceased. I further agree to save and hold harmless, indemnify, and defend Releasees from any claim by my family, or me arising out of my participation in the Activity. I agree that the Releasees are not representatives or agent for the Travel Agent, transportation carriers, hotels and other suppliers of services connected with the Activity and that the Releasees are not responsible for the actions of these entities. In signing this Release, I, acknowledge and represent that I have fully read this Release and that I understand what it means and that I sign this Release as my act and deed. No oral representations, statements, or inducements, apart from the foregoing written statement have been made. I further represent that there are no health related reasons or problems which preclude or restrict my participation in all or part of this Activity, and that I have currently in effect health insurance as required by the College to provide for and pay any medical costs that may be attendant as a result of my participation in the Activity. 58
5.
6.
7.
8.
9.
10.
11.
I further agree that this Release shall be construed in accordance with the laws of the State of Maryland. If any term or provision of this Release shall be held illegal, unenforceable, or in conflict with any law governing this Release, the validity of the remaining portion shall not be affected thereby. I hereby represent that I am at least 18 years of age as of the date of this Release, or if I am younger than 18 years my legal guardian has read and signed (or will read and sign prior to the Activity) this Release in the space designated below. I am fully competent to sign this Agreement and I have executed this Release for full, adequate and complete consideration fully intending for me and for my family, estate, heirs, administrators, personal representatives or assigns to be bound by the same. This Release shall be effective on the date it has been signed by me, and if applicable, my legal Guardian.
12.
DATE:_________________________
___________________________________ Student/Participant
I: (a) am the parent or legal guardian of the above participant/student; (b) have read the foregoing Release (including such parts as may subject me to personal financial responsibility); (c) am and will be legally responsible for the obligations and acts of the student/participant as described in this Release, and (d) agree for myself and for the student/participant to be bound by its terms.
DATE:_________________________
c:\bwh\mydocs\release of liability for student travel 5/17/00
____________________________________ Parent/Guardian
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MEDICAL COLLEGE TRAVEL PROGRAM

OPTIONAL MEDICAL EMERGENCY INFORMATION
THE PURPOSE OF THIS FORM IS TO PROVIDE NECESSARY MEDICAL INFORMATION IN THE EVENT A MEDICAL EMERGENCY OCCURS DURING YOUR STUDY ABROAD IN [INSERT NAME OF TRIP OR PROGRAM AND THE DATES]. COMPLETION OF THIS FORM IS OPTIONAL, HOWEVER, ALL PARTICIPANTS ARE RESPONSIBLE FOR THE COST OF ANY MEDICAL CARE THAT MAY BE REQUIRED.
Date _________________ I (we) do hereby grant permission for _____________________________________________ to authorize necessary medical treatment and/or medication for: _________________________________ in case of an emergency. (Name of Participant Please Print) I further agree to release The Community College of Baltimore County, its Academic Escorts, instructors and travel agencies from any financial or other liabilities which may result from authorizing necessary medical treatment and/or medication for the above named participant. ADDRESS____________________________DATE OF BIRTH ______________________ Month Day Year ____________________________ BLOOD TYPE (if known)________________ PHONE NUMBER_____________________ SOCIAL SECURITY NO.________________ 1. a. Do you have any known reactions to: YES NO YES NO MEDICATIONS ___ ___ FOOD ___ ___ INSECT BITES ___ ___ PLANTS ___ ___ b. Are there any other health conditions the ___ ___ director should be aware of? If yes, please indicate known reaction or health conditions: _____________________________________________________________________ 2. Will you be taking any medication during the travel study course: ____YES ____NO If yes, please indicate the nature of the medication and reason for medication: _____________________________________________________________________
Please list the name, address, and telephone number of a person to be contacted in case of an emergency: EMERGENCY CONTACT: Name ____________________Relationship________________ ___________________________________________________________________________ (Street Address) (City) (State) (Zip Code) 60
Phone Number_______________________________________________________________ (Area Code) (Home) (Business) The health information printed above is, to the best of my knowledge, true and correct. I acknowledge that this form is incorporated into and becomes a part of the Release of Liability, Waiver, Discharge and Covenant Not To Sue Community College of Baltimore County, International Studies Program which I signed on [Insert Date of Release]. Any conflict regarding the terms of this form shall be resolved in accordance with the laws of the State of Maryland. Your Name______________________________ (Please Print) Signature of Participant______________________________ Signature of Parent (s)*______________________________ TITLE & DATE OF TRIP______________________________________________________ The Community College of Baltimore County does not provide health and accident insurance as part of its Travel Study Program. If you have your own insurance, please provide us with the information requested below. Name of health and accident company______________________________________ Policy or enrollment number______________________________________________ * For those tour members under the age of 21 .
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CCBC INTERNATIONAL TRAVEL STUDIES

GUIDELINES FOR APPROVAL AND OPERATION
The following guidelines and policies of operation are to be followed for the implementation of an international travel studies trip sponsored by The Community College of Baltimore County. 1. Program Approval. The attached approval form is to be completed by the appropriate faculty member, signed by the campus International Education Travel Studies Coordinator, and again signed by the system Director for International Education. 2. Academic Policy. International travel studies programs are to be offered for CCBC academic credit. The number of credits and title of the travel studies course is to be indicated on the Approval Form. Registering students may choose to audit the course. The campus Office of Student Life, Alumni, or Foundation Office may sponsor travel programs not requiring college credit, or they may be offered with special permission granted by the CCBC Director of International Education. A minimum of 12 CCBC students are to be enrolled in the designated travel studies course. Faculty may teach the course on load, or overload at the adjunct rate. This is to be negotiated with the appropriate academic dean. Following MHEC instructional guidelines, hours of instruction are to be calculated as follows: One semester hour of credit may be awarded for: a. Direct Instruction. A minimum of 15 hours of 50 minutes each of actual class time in direct instruction, whether in a classroom or in some other appropriate instructional location. Direct instruction would include lecturing, presenting instructional material, hosting a guest lecturer, leading class discussion or other activities in which the instructor is present and the entire time is devoted to conducting teaching/learning activities. Direct instruction might take place in a classroom or alternatively, in a museum or gallery, a geological or archeological site, a botanical garden, an historical or architectural site, wildlife or wetland sanctuary, or other location appropriate for directs instruction. b. Supervised Laboratory, Studio, or Field Trips. A minimum of 30 hours of 50 minutes each, in which students engaged in learning activities under the personal direction and supervision of the instructor. The instructor would be present throughout these meetings, actively guiding the students activities. c. Practica, Internships, and Cooperative Education Placements. A minimum of 45 hours, 50 minutes each, of student learning experiences without personal direction by the instructor. These learning activities would be determined in advance, and the 63
learning documented by the instructor. However, during the activity time itself, the students would be self-guided or supervised by someone other than the instructor, who need not be present. A log sheet for documenting hours of instruction during a travel studies course will be completed by the instructor. 3. Budget and Finance. The campus International Education Travel Studies Coordinator is responsible for determining the cost of the course. Expenses for the instructor and percent of overhead for the college are to be built into the overall budget in addition to all trip costs. This budget is to be shared with the CCBC Director of International Education for review. The coordinator is responsible for overseeing the finances of each international studies program on their respective campus. 4. Waiver and Health Form. The Waiver and Health Form, approved by the CCBC attorney will be completed by each participating student. 5. Cancellation. CCBC will reserve the right with all international travel studies programs to cancel all arrangements and agreements with a travel agency at any time if, in the opinion of the College, the agency is not adequately fulfilling the obligations and commitments outlined in the agreement. In the event CCBC decides to cancel an agreement with an agency concerning a proposed trip, the agency must agree to refund CCBC, within two weeks, all funds paid to the agency for the trip minus any verifiable cancellation fees or penalties imposed by airlines, hotels, ground transportation companies and/or organizations to whom admissions fees have been paid. CCBC will reserve the right to demand certified proof of any cancellation penalties. 6. International Exchange Programs. International exchange programs between CCBC and foreign institutions, which do not involve academic credit, should be sent through the designated approval process involving the campus international education coordinator, the appropriate academic dean, and CCBC director of international education. B. Ebersole 5.23.00
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CCBC INTERNATIONAL STUDIES APPROVAL FORM International Destination (s) -_____________________________________________
Title of College Course and Number of Credits - ____________________________ ____________________________________________________________________ (Please attach course syllabus and outline)
Objectives of the Travel Experience - _____________________________________ ____________________________________________________________________
Estimated Cost of the Travel Course - _____________________________________
Dates of the Travel Course - _____________________________________________
Signature of Participating Faculty and Staff ________________________________ (Date)
Signature of Campus International Education Coordinator _____________________ (Date)
Signature of Academic Dean ____________________________________________ (Date)
Signature of CCBC Director of International Education _______________________ (Date)
5.23.00
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Clinical Coordinator - Request for Approval

Out-of-State Clinical Rotations
Student Name________________________________________________________________ Rotation Dates________________________________________________________________ Preceptor Name_______________________________________________________________ Address______________________________________________________________________ ______________________________________________________________________ Phone________________________________Fax_______________________ Email__________________________________________________________________ Specialty____________________________________________________________ Estimated number of hours per day/week at facility ______. Estimated number of patients seen on an average day _____. Any other facilities the student will working at and/or other supervising preceptors ____________________________________________________________________________________ ____________________________________________________________________________________ __________________________________________________________________ --------------------------------------------------------------------------------------------------------------------Date_________________________ Student in Good Standing Yes No
Contact Person________________________Phone number/email___________________ Approved Yes No Clinical Coordinator___________________
Revised 6/4/10 MKH
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Full Faculty Approval Form Out of State Rotations
Student Name: _______________________ Class of _____ Date of Request: _______________ Rotation or Preceptorship for which out of state placement is requested (please check): __ Rotation # _____ __Community Medicine __Elective __ Primary Care Preceptorship
Dates of Rotation: From___________________ to ___________________________ Individual Responsible for student supervision, teaching and evaluation: Name: ________________________________________________________ Address: _____________________________________________ Phone:___________ Fax Number: ________________________ Email Address: ______________________
Clinical Coordinator Approval

The site and preceptor have been contacted and I have found: ____ Supervision is adequate. ____ There is ample space and patient population for student instruction/meeting objectives. ____ The Preceptor has interest and experience in teaching students. I have reviewed the student academic record and have found: ____ The student has a GPA of _____ (must be > 3.0) ____ There are no formal notification of problem behaviors in the student file. ____ The student will have completed minimum number of rotations prior to this out-of-state placement (two for Elective or Community Medicine--all for the PCP ____ The signed letter of intent is attached to this request. Method(s) of monitoring student progress and evaluating the site will be (check all that apply) ____ Weekly telephone conversations initiated by the student. Day______ Time___ ____ Site visit ____ Phone conferences with the preceptor. Approximate Date(s)_______________ ____ Regular email correspondence. Day ________ Time_________ ________________________________________________________________________ Clinical Coordinator signature Date
Program Director Approval

I have reviewed the request and checked with appropriate faculty to see that there are no objections and have 68
_____ Approved. _____ Denied Reason: ________________________________________________________________________ Program Director Signature Date

Underserved Populations Community Medicine and Cross-Cultural Clinical Project
The Physician Assistant Program has made limited stipends available through the Division of Allied Health and Human Performance to fund student Community Medicine Rotations to underserved populations in the United States and internationally. The goal of the project is to promote PA student awareness of cross-cultural health issues, stimulate student interest in delivery of health care services to domestic and international health professional shortage areas and allow students to be of service to communities from which they receive clinical learning opportunities. Sites must be located in officially designated underserved areas. Objectives
In addition to traditional student clinical/community medicine experience objectives of: Practicing cost-effective medical care; Performing and recording complete, interim and/or focused history and physical examination;
Giving accurate, concise verbal case presentations; Determining differential diagnoses for each case presented and giving logical, orderly explanations for the diagnosis; Outlining the management of cases, including collection of lab data, initial care plans, counseling and referrals; and Implementing management after discussion and approval by the preceptor/clinical instructor.
Students approved to participate and receive college support will: Complete a service project which is mutually agreed upon with the sponsoring agency and the student and approved by the programs project director; Demonstrate an awareness of economic and social issues that influence the delivery of health care in the community; Demonstrate an awareness of cultural influences that effect health beliefs and practices within the community; and Submit an article (after approval by the project director) to a physician assistant journal and or the PAXI newsletter, which demonstrates completion of the previous four objectives. Student Eligibility Requirements All prior rotations must have been completed successfully. Good Standing with a GPA of > 3.0, no "C" grades in any course, and no formal notification of any problem behaviors. 69
Completion and approval of the project application. Applications for participation in this project must be received no later than September 15, of the clinical year. Also see program Out-of-State Rotation requirements and guidelines.
70
Physician Assistant Program LETTER OF INTENT

Elective Rotation
Date___________________
Melecia K. Helwig, MS, PA-C Clinical Coordinator/Assistant Professor Towson University/CCBC-Essex Physician Assistant Program (443) 840-1885 (443) 840-1405 Fax
Dear Clinical Coordinator: I will be acting as preceptor for ______________________. She or he will work under my direction during her or his Elective rotation from ___________________ through _____________________. I understand that the student will attend the clinical site a minimum of 40 hours per week. The student and I have discussed the objectives for this rotation and a copy is attached. At the end of the rotation, I will complete and sign the student evaluation form. I also agree to complete a formal affiliation agreement with CCBC Essex, if necessary. Sincerely, ____________________________ Preceptor ____________________________ Preceptor (Print) ____________________________ E-Mail Address ____________________________ Fax ****Please attach a copy of the agreed upon objectives ___________________________ Organization (Print) ___________________________ Address (Print) ___________________________ ___________________________ Telephone Number
Clinical Coordinator: ____________________ Approval________ Date_____________
71
Physician Assistant Program LETTER OF INTENT

Final Preceptorship
Date___________________
Melecia K. Helwig, MS, PA-C Clinical Coordinator/Assistant Professor Towson University/CCBC-Essex Physician Assistant Program (443) 840-1885 (443) 840-1405 Fax
Dear Clinical Coordinator: I will be acting as preceptor for ______________________. She or he will work under my direction during her or his Primary Care Preceptorship rotation from ___________________ through _____________________. I understand that I am not displacing incoming 2nd year students by accepting this student. I understand that the student will attend the clinical site a minimum of 40 hours per week. At the end of the rotation, I will complete and sign the student evaluation form. I also agree to complete a formal affiliation agreement with CCBC Essex, if necessary.
Sincerely, ____________________________ Preceptor ____________________________ Preceptor (Print) ____________________________ E-Mail Address ___________________________ Organization (Print) ___________________________ Address (Print) ___________________________ ___________________________ Telephone Number
****Please attach a copy of the agreed upon objectives Clinical Coordinator: ____________________ Approval________ Date_____________
72
Class of 2013 Physician Assistant Program Clinical Evaluation

Year II Rotations ___ month Rotation
Student:_______________________________ Rotation ______ Month(s)/Year___________ Site __________________________________ Rotation Type: Emergency Family Medicine Community Med OB/Gyn Pediatrics Elective Surgery Internal Medicine Preceptor _____________________________ Contributing Evaluators _________________ _____________________________________
Rotation
____
Return to PA Program, Clinical Coordinator fax No. (443) 840-1405
EVALUATION AND GRADING Evaluation is based on the degree of achievement of each of the learning objectives and the general amount and quality of change and growth. How well the student took advantage of learning opportunities, attitudes toward learning and developing, the quality and content of the supervisory meetings, motivation and development of professional attitude are criteria that will be included. The final grade, however, may or may not parallel the evaluation comments. It is theoretically possible to have an excellent evaluation but only a S grade if, for example, the student made extraordinary progress but started from a below par position. The final performance may only be minimally competent and passing, while the evaluation reflects the enormous change and progress that was made. The reverse could also be true. The grade, in other words, ties into professional standards, while the evaluation is individualized. The preceptor grade is a recommended grade. The Clinical Coordinator will review the preceptor recommendation and comments as well as the faculty evaluation, the students performance in faculty sessions, and the students overall professional behavior before assigning the final clinical grade. SUGGESTIONS FOR PREPARING THE FINAL STUDENT EVALUATION Set a date, time and meeting place for review of the evaluation with the student. Remind yourself and your student that it is the work and learning that are being evaluated, not the person. Consider whether or not this particular evaluation should include additional staff members, and if so, inform your student of this with an explanation. Involve the student in discussion and interaction as much as possible. Be as detailed and specific as possible, backing up your evaluative comments with illustrations. 73
Check type of observation and appropriate description for each of the following skill categories.
HISTORY TAKING SKILLS Type of Observation: History is incomplete; fails to include pertinent information. Direct Observation Indirect Observation History is complete & accurate; important/ relevant information is included. Not Observed History is consistently comprehensive, accurate, thorough and precise.
History is generally complete & accurate, but occasionally important information has been omitted.
REMARKS:
PHYSICAL EXAMINATION SKILLS Type of Observation: Direct Observation P.E. inadequate for the following reasons: critical portions of exam omitted fails to follow any logical sequence; misses obvious finding REMARKS: P.E. is generally complete. Occasionally: fails to follow a logical sequence misses important findings
Indirect Observation Exam is thorough. Follows logical sequences. Technically reliable & appropriate to presenting complaint
Not Observed Exam is thorough and precise. Follows logical sequences even in difficult cases. Always technically proficient
ORAL SKILLS Type of Observation: Case presentations are disorganized, poorly integrated & confusing.
Direct Observation Case presentations are generally organized but sometimes verbose, incomplete or confusing.
Indirect Observation Case presentations are organized & complete. Able to explain and summarize data effectively.
Not Observed Polished communication skills. Able to explain & summarize data completely & concisely. Presentation of information is orderly and succinct.
REMARKS:
WRITTEN SKILLS Type of Observation: Poorly prepared writeups Includes irrelevant information. Fails to provide relevant data.
Direct Observation Write-ups need improvement. Sometimes excludes relevant data, includes extraneous information.
Indirect Observation Write-ups concise, orderly & complete. Relevant information included. Important problems and progress noted.
Not Observed Write-ups outstanding (well written, precise, thorough). Articulate, concise statements of problems & progress included.
REMARKS:
74
INTERACTION WITH PATIENTS Type of Observation: Direct Observation Lacks communication skills. Cannot adequately explain information to patients. Fails to listen to patients. REMARKS: Attempts to explain information to patients, but occasionally has difficulty. Usually listens to patients.
Indirect Observation Communicates effectively. Offers appropriate explanations. Listens attentively to patients.
Not Observed Communicates effectively, shows empathy & is conscientious if offering explanations, relates well even to difficult patients.
APPLICATION OF BASIC MEDICAL KNOWLEDGE TO PATIENT MANAGEMENT Type of Observation: Direct Observation Indirect Observation Has difficulty recalling & applying basic knowledge. REMARKS: Occasionally unable to apply basic knowledge & relate it to cases. Is able to relate basic knowledge to cases.
Not Observed Recalls broad base of knowledge & is readily able to relate it to cases.
INTEGRATIVE SKILLS/PROBLEM SOLVING Type of Observation: Direct Observation Fails to integrate data. Unable to identify problems & priorities leading to incomplete differential diagnosis. Has some difficulty integrating data, identifying & assessing problems & priorities.
Indirect Observation Evaluates available data effectively. Understands & identifies problems & priorities.
Not Observed Effectively analyzes data, synthesizes information to arrive at a concise assessment. Consistently establishes appropriate priorities.
REMARKS:
CLINICAL MANAGEMENT SKILLS Type of Observation: Direct Observation Therapeutic program is incomplete or inaccurate. Fails to address patient needs. Fails to adequately interpret and/ or utilize lab data. Therapeutic program usually complete & accurate, but frequently fails to recognize constraints of setting and/or address patient needs. Occasionally fails to adequately interpret and/or utilize lab data.
Indirect Observation Therapeutic program is complete & accurate; addresses issues of clinical problem. Interprets & utilizes lab data adequately.
Not Observed Therapeutic program is comprehensive; plans are precise; can suggest a variety of plans (i.e. Can creatively problem solve & individualize treatment plans). Consistently interprets & utilizes lab data accurately.
75
REMARKS:
TECHNICAL/PROCEDURAL SKILLS Type of Observation: Direct Observation Has great difficulty learning/mastering new skills. (ie: ________________) REMARKS: Has some difficulty learning/mastering new skills. (ie: ___________________)
Indirect Observation Learns/masters new skills easily.
Not Observed Learns/masters new skills exceptionally easily.
LEARNING BEHAVIOR Type of Observation: Rarely interacts or participates in discussion. No independent study.
Direct Observation Sometimes participates or initiates discussion. Little evidence of independent study.
Indirect Observation Often initiates and/or participates in discussion. Some evidence of independent study.
Not Observed Often initiates and/or participates in discussion. Shows strong evidence of independent study.
REMARKS:
CHECK ANY BEHAVIORS YOU THINK ARE OR MAY BECOME A PROBLEM OR MAY IMPACT OVERALL GRADE Incomplete or sloppy work: unfinished chart work, assignments not done. Student did not contact preceptor within reasonable time before rotation began (usually two weeks prior). Absenteeism: repeated absence from activities, lateness, not available for rounds, conferences. Poor attitude: negativism, chronic complaining, lack of enjoyment in work. Unresponsive to correction: when deficiencies pointed out, does not correct them, makes same errors repeatedly. Impracticality: impractical plans and suggestions, dangerous orders, off on tangents. Does not take initiative: needs constant directions. Insecure: performance may be affected by lack of self-confidence. Does not know own limitations: not cautious enough, proceeds on own without checking with appropriate person, overestimates abilities. Does not always appreciate role of other health professionals. Appearance not always appropriate for site. Professional manner needs refinement. Preceptors Signature ___________________________________ Date _____________________________
76
OVERALL PERFORMANCE (Circle One) S Satisfactory Performance Has met goals and objectives as established by the program and the clinical site; performs safely and competently; and has made significant progress over the course of the rotation. U Unsatisfactory Performance 1) Has not fully met goals and objectives; 2) Has performed incompetently on one or more of the defined skills areas; 3) Has performed in a manner which was dangerous to patient or staff; 4) Has not shown satisfactory improvement in clinical skill over the course of the rotation. The preceptor will award the U if any one of the above is true. The preceptor will indicate with a check all of the factor s which apply to the awarding of the U grade.
PRECEPTOR COMMENTS:
Date:___________________ Signature: __________________________________________ (Preceptor) STUDENT COMMENTS:
Date: __________________ Signature: ___________________________________________ (Student) PROGRAM FACULTY COMMENTS:
77
Towson University - CCBC Essex Physician Assistant Program
Fortnightly Evaluation C2013

PA student________________________ Rotation #_______ Clinical Site________________
Indicate his/her strengths and weaknesses in the categories below. If you have not observed the student in any of these situations, please leave the section blank or indicate no comment. Please feel free to put comments on line supplied. Scoring Codes: Requires no supervision and/or prompting 5 Requires little supervision and/or prompting 4 Able to perform with routine supervision and/or 3 prompting Requires frequent supervision and/or prompting 2 Requires complete supervision and/or prompting 1 Dangerous to patient even with supervision and/or 0 prompting
Basic Fund of general medical knowledge Medical Interview (consider organization, appropriate questions) Physical Examination (consider ability to discern normal and abnormal) Procedural Skills (consider ability to learn, safety, judgment) Professionalism (consider demeanor, responsibility, relationship to medical team) Evaluators Overall Comments:
Score____ Score____ Score____ Score____ Score____
Evaluator's signature____________________________ Date_______________________ Students Comments: Students Signature__________________________Date ___________________

You may fax this form back to Melecia Helwig @ (443) 840-1405
78

2012-13 Student Evaluation of Clinical Experience
Preceptor(s)_________________________ Rotation Discipline__________________________ Site______________________________ Rotation Number ________________
Please fill out the following evaluation as objectively as possible be open and honest, but be professional in your comments. This form is provided in an effort to continually evaluate the clinical experiences provided. These forms will also be used and shared with the new students as they select their clinical sites in the future. Please note: Your completion of this evaluation will not be individually shared with site or affect your grade. Evaluations at the end of the year are reviewed and summarized before we share that information with the site and new students. 1. Describe briefly the physical setting of your rotation (Hospital, Office, Clinic, etc) and what condition the facility was in.
2. Did you work with your primary preceptor or many? Please describe how you were supervised.
3. What were the hours of your shift? (7-3:30pm, 12 hours rotating shifts, nights only, etc)
4. What other office / support staff with whom did you work? How were you received by them?
5. Please describe the parking, meals, and other amenities available at your site?
79
6. Please describe what procedures / skills you were allowed to perform at this rotation (write orders, write prescriptions, suture, order labs, perform biopsies, perform venipuncture, etc.)
7. Please describe how this rotation prepared you in accordance with the goals and objectives.
8. Please describe how this rotation could be better improved to prepare you as a PA.
9. Please describe how the didactic sessions in the first year prepared or did not prepare you for this rotation.
10.
Any other comments about this site or rotation.
Enjoyed Rate how you personally liked this discipline of medicine 5 4
OK 3 2
Disliked 1
Overall Evaluation of this site to others 80
81

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Student Clinical Practicum Handbook

Towson University CCBC Essex Physician Assistant Program

Towson University CCBC Essex Physician Assistant Program

Shawn McNamara Interim, Program Director

Steven J Schwartz, MD Medical Director 443-840-2854 Sschwa27@jhmi.edu

Robert J. Solomon, MS, PA-C Clinical Assistant Professor 443-840-1930 Rsolomon@ccbcmd.edu

Susan Landry Adjunct Faculty, Program Director Mental Health Slandry@ccbcmd.edu

University CCBC Essex Physician Assistant Program

Franklin Square Hospital 9000 Franklin Square Drive Baltimore, MD 21237

Bruce Lewis, PA-C blewis@totalurgentcare.com 410-612-0374

Jeanne Hoover Jeanne.hoover@baltimorecity.gov 410-396-0176 Marisa Garcia-Faust, PA-C Ms_garcia7@msn.com 410-467-6040

Community Medicine Family Medicine Family Medicine

Peter Wessels, PA-C pwessels@hcgh.org 410-740-7777

Towson University CCBC Essex Physician Assistant Program

Requirements for all Rotations and Student Responsibilities

Course Grade Computation

Rotation 1b Grade Score S 86 S 0 A 6 S 0 In-Complete -10 B 0 82 PAST 251 Grade: B

Description of Course Components and Requirements

Email address: mhelwig@ccbcmd.edu

FAMILY PRACTICE MEDICINE ROTATION PSYCHIATRY CASE PATIENT CONTACT FORM

What to Expect From Your Clinical Rotations

Clinical Practicum Seminar 2012-2013

Physician Assistant Program

Towson University CCBC Essex

Shawn McNamara Office Room N322 smcnamara@ccbcmd.edu 443 840-1807

Jack Goble Office Room N325 jgoblejr@ccbcmd.edu 443-840-1159

Robert Solomon rsolomon@ccbcmd.edu Office Room N326 443 840-1930

Towson University CCBC Essex Physician Assistant Program

Reading and Study

Emergency Medicine Rotation Continued

Conversion reaction Schizophrenia and Psychotic Disorders Eating Disorders

Psychiatric emergencies (Delirium) Sleep Disorders Geriatric Psychiatry (Abuse/Neglect)

Towson University CCBC Essex Physician Assistant Program

Reading and Study

Family Practice and Ambulatory Medicine Rotation Cont

Conversion reaction Schizophrenia and Psychotic Disorders Eating Disorders

Psychiatric emergencies (Delirium) Sleep Disorders Geriatric Psychiatry (Abuse/Neglect)

Towson University CCBC Essex Physician Assistant Program

Reading and Study

Internal Medicine Rotation Continued

Internal Medicine Rotation Continued

Towson University CCBC Essex Physician Assistant Program

Reading and Study

Obstetrics/Gynecology Rotation - Continued

Obstetrics/Gynecology Rotation - Continued

Towson University CCBC Essex Physician Assistant Program

Reading and Study

Pediatric Clinical Practicum Continued

Schizophrenia and Psychotic Disorders Eating Disorders Autism

Psychiatric emergencies Sleep Disorders Bipolar Disorder

Towson University CCBC Essex Physician Assistant Program

Reading and Study

6. Efficiently and accurately present cases.

General Surgery Rotation Continued

General Surgery Rotation Continued

Towson University CCBC Essex Physician Assistant Program

Reading and Study

Special Requirement for Community Medicine

Towson University CCBC Essex Physician Assistant Program

Reading and Study

General Elective Rotation - Continued

We both agree to the objectives listed above.

___________________________ Student Signature/Date

___________________________ Preceptor Signature/Date

Objectives of the Travel Experience - _ ________________________________

Contact Person______________Phone number/email_ Approved Yes No Clinical Coordinator___________

Clinical Coordinator: ________ Approval Date_

Date:_ Signature: ________________________ (Preceptor) STUDENT COMMENTS:

Date: Signature: _________________________ (Student) PROGRAM FACULTY COMMENTS:

Score Score Score Score Score

Evaluator's signature________________ Date_ Students Comments: Students SignatureDate ___