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PHYSICIAN ASSISTANT MASTERS PROGRAM

School of Allied Health Professions


Loma Linda University
Course Syllabus
COURSE:

Clinical MedicineIII, PAST 543 5 units

COURSE DESCRIPTION:
A continuation of the study of common medical disorders encountered in primary care, and the
management of these disorders. Includes the clinical presentation, etiology, pathophysiology,
diagnostic work-up, and management of the conditions studied. Based upon NCCPA blueprint.
QUARTER:

Summer, 2015

COURSE COORDINATOR:

Frank Sirna, PA-C

CONTACT INFORMATION:

Office: 909-558-7295
Email: fsirna@llu.edu

Office hours: Monday-Friday by appointment. Friday is my usual clinical day, so I may not be
available on Fridays.
ALTERNATE CONTACT INFORMATION:
See Memo regarding the alternate contact list if you are having difficulty contacting the Course
Coordinator
COURSE LECTURERS:

See list of adjunct faculty on class schedule

LECTURE SCHEDULE:

Mondays:
1:00 4:50 p.m.
Thursdays:
1:00-3:50 PM
Additional times as scheduled and TBD (see attached calendar)
Dates and times vary to meet guest speaker needs

LOCATION:

Evans Hall Amphitheater, Room 216

ACADEMIC INTEGRITY:
Acts of dishonesty, including theft, plagiarism, giving or obtaining information during
examinations, or knowingly providing false information is unacceptable. Instructors and
students are charged with the responsibility of reporting instances of such behavior to the
department chairperson. The department chairperson is responsible for investigating such
reports. Substantiated violations will be brought before the dean for disciplinary action. Such
action may include, but is not limited to, academic probation or dismissal for the program.

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ACCOMMODATIONS:
If you are an individual with a disability and need reasonable accommodations to fully
participate in class, please obtain the Student Information and Requested Accommodation form
from Dr. Craig Jackson, Dean of the School of Allied Health Professions, Nichol Hall Room 1603.
REQUIRED TEXTS:
Each student must obtain a copy of the required texts within the first 2 weeks of the quarter, as
books not purchased by this time will be returned to the publisher.
Cecils Essential of Medicine, 8th Ed; Saunders/Elsevier. (2010)
Practical Radiology: A Symptom Based Approach. F.A. Davis, 2013
Dubin. Rapid Interpretation of EKGs. Cover Publishing. (Current edition)**
**This is a self-learning, programmed text, you will need your own copy
Note: These 3 texts are NOT available through the LLU Library as an on-line text. You
will need to purchase a hard copy or E-version for your own use
Current Medical Diagnoses and Treatment, 2015, McGraw-Hill/Lange Publishing*
Fitzpatrick et al. Color Atlas of Skin Diseases. McGraw-Hill. (Current edition)*
*Copies are available in the on-line LLU library. Check the main library Access
Medicine website. These are full access electronic copies of all chapters. You may use
the on-line version or purchase your own hardcopy version.
SUGGESTED RESOURCES:
Recommended for the Emergency Medicine Topics:
Current Emergency Diagnosis and Treatment 7e, 2011, McGraw-Hill/Lange (CEDT 7e)*
*Copies are available via the LLU library website Access Medicine
OTHER RESOURCES AND REQUIRED READING:
A large number of medical, pharmacology, and basic science texts are available via the LLU
Library Access Medicine website: http://www.accessmedicine.com/features.aspx
Please Note:
1. Selected sections of the current edition of ANY of the medical texts on the library Access
Medicine website or texts from concurrent courses may be listed as REQUIRED reading
during the quarter.

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2. Accessible texts, websites, and handouts listed as required reading in the schedule are all
testable and may be used for test items on examinations.
3. Any standard, current edition of a text or selected, peer reviewed websites, may be used as
references when submitting written assignments and for in-class presentations.
4. See the reading column of the Clinical Medicine III schedule.
5. Electronic versions of handouts, Power Point presentations, PDF documents and slide sets,
hyperlinks, and videos will be made available on Canvas in lieu of hardcopy printouts for
the majority of our courses unless notified otherwise.
Learning Objectives, Test Items, Testable Material, and Study Guides:
1. Learning objectives specific for the lecture or series of lectures on specific topics will be
posted on Canvas.
2. These specific learning objectives will be used as a basis for constructing test items for the
written examinations.
3. These learning objectives should be used as a study guide when preparing for section or
final examinations in this course.
4. We get frequent requests for high yield notes, study guides or other helps to focus studying
for exams. The learning objectives for each speaker and topic or series are that material.
5. Unless specified otherwise, the primary text or texts are the final arbiter for any test items that
are contested or questioned
6. Test items may come from lecture material and/or assigned reading.
TESTS, GRADING and ACADEMIC PROGRESS:
The final grade is based upon total points attained through exams, assignments, and class
participation. Each student must attain 75% of total points available to pass course
Midterm
Final Comprehensive Exam
Workshops, Presentations, Papers
Professionalism
[Points are tentative for all of the above and may change]

50 points
100 points
10 (if any, may change)
multiplier (0.90-1.0)

The points for each item may be adjusted as needed. The class will be notified in advance of any
changes. Any papers will be treated as the equivalent of a section exam.

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The minimum score to pass this course is 75%. However, in order to remain in good standing in
the PA Program and the School of Allied Health Professions, a 3.0 GPA in required. See the PA
Program and LLU-SAHP student hand books for more information. Minimum passing score on
all examinations is 75%. Letter grades will be assigned as follows:
A
AB+

93-100%
90-92%
87-89%

B
BC+

83-86%
80-82%
77-79%

C
CD

75-76%
70-74%
65-69%

Quizzes, either in class or on-line, workshops, or short papers may be added to this course in
order to reinforce learning or as a part of interactive learning. Since these may be one-time
occurrences and not repeatable, points not earned due absence, even if excused, may not be able
to be made up.
Each examination must be passed in order to pass this course. This includes each section,
midterm, and final examination that may be given. Any failed section or midterm examination
will result in remediation and may result in disciplinary action including program academic
probation.
Class presentations or term papers will be counted as the equivalent of a section examination
unless indicated otherwise.
Failure of the comprehensive final examination will result in a FINAL COURSE GRADE OF Cas the highest possible grade, regardless of the total points earned in the course.
Failure of the comprehensive final examination will result in disciplinary action that may result
in registering for a tutorial, course failure, deceleration, dismissal from the program, or other
action as determined by the program faculty.
Failure of the comprehensive final examination may result in the student registering for a
tutorial the following quarter if all other academic and professional performance in the program has been
acceptable. Successful completion of the tutorial will require passing an examination that is the
equivalent of the Clinical Medicine III comprehensive examination. Per SAHP policy, the grade
for the tutorial will be a C which will replace the original failing course grade.
NOTE: Each of the Clinical Medicine series of courses must be passed with a grade of C+ or higher
in order to progress to the Clinical Year without restrictions or Program Academic Probation.
REMEDIATION:
See the Student Handbook for details on the remediation process for failed examinations or
courses. There will be no re-takes of examinations granted. If a student misses an exam for an
excused absence, he or she will be given a different exam than the one given to the rest of the
class.

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EXAMINATION POLICIES AND PROCEDURES


All tests and examinations are serious occasions. Therefore, we ask that the following behaviors
be observed in order to minimize distraction and anxiety during testing.

1. All tests will begin on time. Please plan to arrive early enough to stow your coat, books and
other gear outside of the classroom. Sharpen your pencils before the test begins.
2. Please be certain to keep your eyes on your own paper.
3. Talking between students or other forms of communication is not allowed during testing.
4. Any corrections to a test will be posted on the whiteboard at the front of the classroom. Check
for any changes before turning in your test.
5. Scantron/computer scored examinations are frequently used. However, certain errors can
occur when these answer sheets are filled in. Please check the following prior to turning your
answer sheet:
Your ID number is correct
All bars/bubbles have been appropriately filled in-no blank items
Only one bar/bubble is filled in per test item unless instructed otherwise
No test items have been skipped
Your answer marks line up correctly with the test item (i.e., #20 correctly lines up
with #20 as intended, not 19 or 21, etc.)
Review your test and answer sheet prior to turning these in to be sure you have
no skips, alignment errors, or other problems
6. When you have finished testing, exit the classroom quietly and move away from the
classroom before engaging in conversation.
7. NOTE: Once you have turned in your examination and answer sheet and have exited the
examination room, you will NOT be allowed to make any changes to your answer sheet
under any circumstances.
8. Lost points due to alignment errors, skips, double marking, or filling in the wrong bubble
will not be credited back under any circumstances unless the respective test item(s) has/have
been nullified or otherwise adjusted for the class as a whole.
9. If the scanner is unable to read your answer sheet, we will contact you.

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10. Examination by demonstration requires extra concentration on the part of the examiner and
the examinee. Feedback will be provided only after completion of the examination. Hinting
by body language during physical exams may result in scoring penalties for the patient.
11. We believe in the confidentiality of test scores and will distribute all test results to individual
students in a confidential manner, as soon as possible, usually via Canvas.
12. Test scores graded by Scantron may be available within 24 hours. However, due to technical
problems beyond our control, this may not always be feasible, but grades will be posted as
soon as possible. Examinations with essay, SOAPE notes, or other hand written sections will
take longer to grade and post.
13. Dishonesty such as cheating is unacceptable behavior. Inappropriate testing behavior
reflects unsatisfactory professional development and therefore leads to academic review
of the student and possible dismissal. Do not provide or receive unauthorized assistance on
exams. Do not remove exams from designated review areas or obtain exam material prior to
distribution by faculty. Irregularities you observe in test-taking should be referred to the
proctor or course instructor. See the heading labeled Academic Integrity under the section
Student Life in the LLU Catalog and in the Student Handbook in University Policies section
under the Academic Integrity Policy heading.
a. In an examination setting the department chair and the exam proctor will meet with
the student privately, immediately or at an appointed time, to discuss the details of the
unsatisfactory behavior. A written report will be placed in the students file. The
student will be referred to the dean of the School of Allied Health Professions for further
action.
b. In a non-examination setting the department chair will meet privately with the student
to discuss the details of the behavior. A written report will be placed in the students file.
The department faculty will decide on further disciplinary action.
14. It is expected that students will take examinations (and quizzes) at the regularly scheduled
time. To take an examination at a time other than when it is scheduled, the student must
secure the consent of the instructor and the department chair and must file with the instructor
a permit obtained from the Physician Assistant Program Office. A fee of $50 is charged for a
special examination.
15. During examinations, a qualified staff or faculty member will be in the room monitoring the
exam for any inappropriate testing behavior. Students may also be monitored electronically
at the discretion of the faculty.
16. Computer based examinations may have special instructions and limitations that you must
follow. This may include:
A limited amount of time to complete a section or an entire section
The inability to return to a section once you have indicated it is completed.

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17. Written assignments, essays, and short answer questions must use correct Standard English
grammar and spelling in order to receive full credit.
18. Examination dates may be moved by faculty from the original date and time indicated in
the respective quarter schedule as needed.
19. Students may request a scheduled Physician Assistant program examination to be moved
from the original date and time if ALL of the following requirements are met:
All students agree (a unanimous decision)
The vote to change the examination date and/or time was secret/anonymous
The request is made in writing to the respective faculty/course coordinator via email by the class president in a timely manner (at least 24 hours prior)
The program faculty are able to accommodate the change
EXAMINATION REVIEW POLICIES
1. The Loma Linda University Master of Physician Assistant Program utilizes a variety of
written and practical examinations to determine student progress as well as to evaluate
program effectiveness.
2. Current Program Policy: Keys will not be posted in order to preserve examination
integrity and security.
3. Program faculty may schedule a review of an examination for the entire class if possible.
4. Any student that has questions regarding any specific test item, the scoring of an
examination, or feels that he/she did not perform well on the examination should make an
appointment with the respective course director to review that examination.
5. Requests to re-evaluate a specific test item may be sent to the course coordinator or primary
instructor via e-mail, but must include documentation supporting the request to change the
keyed test item answer.
6. Students requesting to evaluate a specific examination should email the course director
within 7 calendar days of the examination date to make an appointment to review the
examination. Examination reviews requested after 7 calendar days are scheduled at the
discretion of the course instructor and may be denied without explanation.
7.

Students that achieve a score of 80% or less will be given priority when requesting to
review an examination. Students that achieve a score of 90% or greater on an examination
may request to review the examination, but will be accommodated at the discretion of the
course director.

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8. Open door or Walk-in examination review requests are not recommended or


encouraged and are at the discretion of the course instructor.
9. Examinations or posted keys may not be copied, photographed or used for extensive note
taking.
10. Examination reviews are not intended as study sessions for final examinations. End of quarter
reviews of previous examinations will not be allowed.

ATTENDANCE:
1. Attendance is required for all classes. Tardiness is not acceptable. Excessive absences may
result in a reduction of course grade.
2. Inform the office of any absence by calling (909) 558-7295. The student will be responsible
for obtaining all missed course information.
3. The course coordinator/instructor may also be notified by e-mail if you will be late or absent
from class or laboratory sessions.
4. We are now required to document the presence of each student in each course he/she
registered for. This is a Federal Government requirement that the University must comply
with.
5. Unless there is an examination or other documentation, each student is required to sign
in at the start of each class or laboratory session to document his/her attendance.
6. It is EACH students responsibility to sign in at the start of each class.
7. Please DO NOT sign in for other students.
8. In addition to the sign in sheet, faculty may take roll call or otherwise verify the presence of
each student in the classroom or laboratory session, regardless of location on or off campus.

PHONE AND COMPUTER USE:


1. Each student is required to have a laptop, notebook, or similar electronic device that allows
access to Canvas, the Internet, and the LLU e-mail system.
2. Electronic versions of handouts, Power Point presentations, PDF documents and slide sets,
hyperlinks, and videos will be made available to each student in lieu of hardcopy printouts
for the majority of our courses. You will need to access these for note taking during class.

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3. Our primary classroom has a 110-120 volt, 60 cycle AC electrical outlet and a data port at
each seat. Please notify the course instructor/coordinator if you find any of these not
functioning.
4. Both of our classrooms have LLU Wi-Fi system access.
5. Please feel free to use your computer to take notes or annotate any presentation to which
you have been given access electronically. All sounds must be turned off, including
keyboard and restart sounds.
6. Please restrict your computer use to note-taking and/or viewing class presentations.
7. DO NOT use your computer to check e-mail, surf the web, or other activities not related to
the class. This is distracting for you and for others around you. If you are using the
computer inappropriately, you may be asked to leave the class.
8. Turn all cell phones to quiet mode without vibration during all classes and laboratory
sessions.
9. Do not engage in texting or in conversations during classes or laboratories or you may be
asked to leave the classroom. If you exit the classroom to take a call, you may be asked not
to return for the remainder of the class period.
10. Inappropriate computer and/or cell phone use may lead to a lower grade in any course and
may place a student at risk for probation, suspension or dismissal from the program.
PROFESSIONALISM:
While there is a subjective nature to the measurement of professional behaviors, we emphasize
objective observation of each students behaviors and compare them to the desired outcomes for
our students. Various evaluation tools may be utilized to incorporate professionalism into the
final course grade. These will be included in the grading matrix of this class at the discretion of
the course instructor in consultation with the Physician Assistant Department Chair and Program
Director. Please see the Didactic Student Handbook (p. 12-13) for more information regarding
professional behaviors.
For this course, a professional demeanor multiplier (PDM) will be used to determine your final
grade for the course. Your objective grade will be initially calculated using the calculated average
of your examinations and laboratory grade. The subjective portion using the multiplier will be
based on your professional demeanor, including those benchmark behaviors listed in your
Didactic Student Handbook such as punctuality, attendance, positive attitude, preparation,
appropriate language and respectfulness. The following rubric will be used to determine your
PDM for the course. Please note that not all bullet points must be satisfied for a student to receive
a lower multiplier.

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Multiplier

Description of Behaviors

x 1.00

x 0.95

x 0.90

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Is punctual for class and never tardy


Has no unexcused absences; always makes arrangements with instructor
when absence is necessary
Follows rules and policies consistently and accepts responsibility for
personally following them (e.g. appearance, behavior, attendance,
language, etc.)
Pays attention in class and is not distracted and/or distracting to others
Actively participates in class discussions; appears interested in and
engages in educational activities
Effectively resolves his/her conflicts or disagreements with faculty, staff,
or students
Collegial and respectful relationships with faculty, staff and students
Is usually punctual for class but with one instance of unexcused tardiness
Attends class with one instance of an unexcused absence; did not make
arrangements with the instructor
Usually follows rules and policies; when reminded about breaches of
rules or policies, accepts them and does not attempt to circumvent them
Usually pays attention in class, occasionally distracted and/or distracting
to others
Rarely participates in class discussions; engages in educational activities
if called upon; appears disinterested at times
Has occasional difficulty with disagreements or conflict resolution with
faculty, staff, or students
Occasionally displays less than ideal respect or collegiality
Is frequently late to class with more than one instance of unexcused
tardiness
Has more than one instance of an unexcused absence; does not make
arrangements with the instructor
Sometimes disregards known rules and policies; sometimes wants
exceptions to be made for him or her; sometimes tries to circumvent
established rules (e.g. appearance, behavior, attendance, language, etc.)
Rarely pays attention in class, often distracted and/or distracting to others
Appears to avoid participation in class discussions or other educational
activities; usually appears disinterested
Argumentative, displays difficulty with resolving his/her disagreements
with faculty, staff, or students.
Lack of respect, uncooperative with faculty, staff, students
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PHYSICIAN ASSISTANT MASTERS PROGRAM


School of Allied Health Professions
Loma Linda University
PAST 542
Clinical Medicine II
Spring Quarter, 2015
Course Learning Objectives
This course is the second of a three quarter series of lectures and other classroom activities. The
course presents accepted methods of evaluating, diagnosing, and treating conditions discussed
in the class or in assignments. It focuses on the clinical relevance of data obtained from the history
and physical examination and diagnostic studies. In addition, it emphasizes the process of
synthesizing collected information to determine diagnoses and formulate management plans.
This series of courses builds upon and correlates information from previous and concurrent
courses including, but not limited to, Pharmacology, Anatomy, Pathophysiology, Physical
Diagnosis, Diagnostic Methods, and other PA Program courses throughout the Didactic Year.
You may need to go back and review material from other courses in order to get the most benefit
from the material presented in this course.
We use a variety of guest speakers that are content experts to present the highlights of the
respective diseases.
Due to time constraints, we cover common conditions and presentations and a basic core of
knowledge to enable you to pass board exams. However, students must expect to do significant
self-study to build upon and expand this knowledge in order to become effective clinicians.
Course Goals:
The above information and the following general course learning objectives are intended to help
explain the structure, goals, and nature of this course.
Please read and refer to this information if you have any questions. The intent is to state
plainly how information is presented and tested to ensure that each student may successfully
complete this course.
1. Our overall goal is for each to student to become a competent and compassionate Physician
Assistant in harmony with the mission, vision, and goals of Loma Linda University.
2. Present the core of medical knowledge needed to successfully pass the National Boards.

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3. Provide content experts that can explain pertinent diagnostic and treatment modalities for
diseases encountered commonly in primary care practice.
4. Provide each student the opportunity to interact with content experts to ensure that the
presented material is understood.
5. Provide students with a variety of speakers and learning activities as preparation for
supervised clinical practice.
Course Learning Objectives:
Students will demonstrate mastery of the course material by passing the examinations at or above
the 75% mastery level. At the completion of this course, for the organ systems, body regions, and
diseases discussed, the Physician Assistant student will be able to:
1. Explain the significance of each organ system in the disease process, the effects on the patient,
including typical signs, symptoms, and physical findings
2. Indicate what other systems would be affected by a disease in addition to the primary system
3. Discuss the natural progress and outcomes of the respective diseases if not treated.
4. Recognize a disease based upon history, physical findings, and diagnostic study results.
5. Discuss the role of the physician assistant in the practice of medicine, including participation in
the diagnosis and treatment of the indicated diseases.
6. Indicate the diagnostic studies that would confirm or rule out a suspected diagnosis, including
common laboratory and imaging studies.
7. Determine how the etiology and epidemiology of each disease process contributes to morbidity
and mortality in the general population.
8. Recommend first line treatments, preventive measures, and patient education in the
management of these diseases.
9. Correlate treatment outcomes with prognoses or expected outcomes for the indicated diseases.
10.
Distinguish between emergent and non-emergent medical condition and make
recommendations for appropriate treatment and referral.
11.
Relate a patients culture, race, and ethnic background to his/her healthcare needs and
include this information when formulating diagnostic, treatment, and education plans.

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