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Terry Russo, MMSc, PA-CClinical CoordinatorDeSales University

Whatwere my own reservations when startingclinical rotations? H&Ps did not prepare me for assimilation intothe medical community Started didactic rotations (Friday morningrotations) in 1997 Has continued without any changes BECAUSEIT WORKS!

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Eachstudent goes to a different site weekly Includes both hospital and office settings Friday mornings from 8AM-12PM Schedule is posted for students on a Tuesday Currently have over 140 Friday morningrotation sites

Appliesclassroom learning to clinicalexperiences Break from the classroom - highpoint ofstudents’ week Acts as a bridge between first and second year PAs are increasingly hired in subspecialties Students begin to realize whether they aremedically or surgically oriented

Mucheasier to secure a Friday morningpreceptor than for a full clinical rotation Great way to transition preceptors to takestudents for full rotations Not a big commitment for the preceptor Preceptors look forward to students coming Teaching reinvigorates the preceptor Students often offered to return for elective,core rotation, or a job

WeekOne: Student completes a bio which is sent at beginning of yearwith class picture to all preceptors Students attend orientation at local hospitals as a groupregarding policies and procedures Week Two: Students, by groups, go to a surgical scrub course at a localhospital HIPAA and OSHA courses are completed Patient confidentiality form and honor code signed WeekThree: Friday Rotations begin

Studentsprovided with Friday morningrotation booklet Contains: Names of preceptors with directions to site Clinical Coordinators’ names, office and cell number Policies and procedures

Attendanceat the assigned site is mandatory Important to establish a policy for trackingstudents, otherwise they will be sleeping in Students encouraged to drive to site beforeFriday to prevent getting lost In case of illness, student must call programsecretary by 8am or considered unexcusedabsence

-“Students are to provide requests to be excused from a Friday MorningRotation in writing at least one week prior to the date in question. Thewritten request should be given to the Clinical Assistant to obtain approval. Acopy of the original request with approval or denial of request will beprovided to the student for their records.”-“In case of illness, the student is required to notify the PA Program ClinicalAssistant and the preceptor by 8:00 a.m. that day. The program reserves theright to require a written excuse from the student’s healthcare provider for anabsence. In case of emergency, please call the Clinical Assistant as soon asreasonably possible. If no notification of an absence is given, the program willconsider this an unexcused absence.”-“In the event that you are not able to locate your assigned preceptor within30 minutes of your assigned start time, please call the Clinical Assistant forreassignment. If the student fails to call for reassignment, it will result in anunexcused absence.”

DeSales University – Physician Assistant ProgramPreceptor Evaluation Form – P1 Clinical ExperienceNAME: DATE:SITE:ATTENDANCE:On TimeLateATTITUDE:ExcellentGoodFairINTEREST LEVEL:InterestedPoorNot InterestedCOMMENTS:PRECEPTOR NAME:PRECEPTOR SIGNATURE:Please complete and sign this form immediately so that the student may return theform to the PA Program. Thank you for taking the time to evaluate our student.P1 Clinical Experience Preceptor Evaluation Form - Rev. 3/1/12

DeSales University – Physician Assistant ProgramStudent Evaluation Form – P1 Clinical ExperienceSTUDENT NAME:SITE:Was the preceptor able to take time to explain/educate?If no, please explain:Was the site busy enough to be a good experience?If no, please explain:POSITIVES AT SITE(May continue on reverse)DATE:STUDENT #YESYESNONONEGATIVES AT SITEWere you able to do any history taking or PE (if applicable)?YESDo you consider this a good site for a 5-week rotation (if applicable)?NOIf applicable: # of SOAP Notes# of Pelvic ExamsNOYESTOTAL # HOURS SPENT AT SITEStart Time End TimeIf less than 3 hours spent at site, explain reason:P1 Clinical Experience Student Evaluation Form – Rev. 3/1/12

Studentsmust time stamp the studentevaluation and place in locked box Penalty is enforced if student submitsevaluation more than one week after rotation Any tardiness or absentees added toprofessionalism file and student counseled Failure to make up time or hand in the studentevaluation results in a 2 point reduction oftheir Clinical Medicine grade (inspiresattention to detail)

The patient’s illness? Occurrences in the patient’s personal life that may be related to their illness?The practitioner-patient relationship?The importance of spending enough time with the patient?The importance of engaged listening without interruption?What did I learn, not only about the patient, but from thepatient? What did the patient teach me?What did I learn about what it’s really like to be a healthcare provider?What did I learn about myself during this encounter?

Spreadsheet: Preceptor practices and contact information Start time Special instructions (call Tuesday for start time) Usedas a template to track where studentshave already rotated Records of preceptor comments compiled

Somesites prefer a confirmation call early inthe week from the student – the onus is onthe student Always have 2-3 backup sites; we use vascularlab or trauma ICU Some sites are mandatory for all students:hospice and the DeSales Free Clinic Some sites have required reading for studentsprior to rotation

Hospice:experiencing death and the processof dying is very different than reading about it Autopsies: students call the night before - ifnone, students given a back up site HIV clinic Endocrine Skilled nursing homes

Psychiatry:mental status exams Ophthalmology: retina visualization Pediatrics: newborn exam skills Neurology and Neurosurgery: neuro exams Burn unit and Trauma Hematology/Oncology, Infectious Disease,Radiology Reading Room Cardiology & CT surgery

Dermatology:view rashes ENT: ear exams ER: learn bullet presentations Surgery: gowning, gloving, maintain sterilefield - student knows what to expect duringclinical year OB/GYN: breast exams

CardiacCatheterization Radiology Reading Room Interventional Radiology EKG Reading Room with Cardiology Fellows Instills empathy When student is a practicing PA, they will have theability to explain these complex procedures to patients

MedicalKnowledge Interpersonal and Communication Skills Patient Care Professionalism Practice-Based Learning and Improvement Systems-Based Practice* Above is addressed by evaluation forms andduring quarterly academic and professionalismadvising

Studentsvote yearly for award given to“Educator of the Year” from Friday morningphysicians A plaque is awarded to physician at the annualPreceptor Dinner Preceptors’ hours are compiled and acertificate for CME Category II is sent topreceptors at the end of each school year

“Pleasehave student return here for her ERrotation” “Would love to have her back” “Would welcome her to do her rotation here” “Invited John to do his elective with us” “Would love to hire her when she graduates” “Student totally disengaged”* Records of preceptor comments compiled andkept on common drive for faculty access

“Inever thought I would enjoy surgery so much” “I didn’t faint” “Made me rethink what I thought I wanted to do” “Learned to suture a laceration - preceptor walkedme through and the patient survived!” “Would love to do my elective here in pedshem/onc”

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Manystudents have gone into subspecialtiesbecause of their Friday morning experiences Students are much more polished duringclinical year Students are more prepared for the OR andsurgery Know the ‘lay of the land’ of hospitals Opens their eyes to parts of medicine they didnot know existed Increased respect level for what PAs do

Timespent with case managers is an eyeopener Helps guide students towards elective choices Increased understanding of pecking orderfrom attending to medical student First exposure to real life billing As the year progresses, students able to writeup SOAP notes and submit them for grading

Promotesprofessionalism Promotes reflective learning Students begin relating to patients as individualsrather than as a disease state Students begin to develop empathy Students begin to understand their roles Students learn to deal with their emotions Insight gained on organization and problems ofhealth care Competencies for the PA professional reinforced

Wayto keep subspecialty preceptors involvedwith the program Gives Clinical Coordinators insight into studentbehaviors - red flags can appear before clinicalrotations begin Professionalism problems are identified early Assists in developing clinical schedule Perspective is no longer just from a classroom Way to assess preceptors for full clinicalrotations

Feel free to contact me with further questions atterry.russo@desales.edu

1. Helmich E, Bolhuis S, Laan R, Koopmans R. Early Clinical Experience: Do Students Learn What We Expect?Med Educ. 2011; 45(7): 731-741doi: 10.1111/j.1365-2923.2011.03932.x.2. Accreditation Review Commission on Education for the Physician Assistant, Inc.Accreditation Standards for Physician Assistant Education. 4th ed. 2011: withclarifyignchanges10.2011fnl.pdf. Accessed May 15,2013.3. O’Brien B, PhD, Poncelet AN, MD. Transition to Clerkship Courses: Preparing Students to Enter theWorkplace. Acad Med. 2010; 85(12): 1862-1869doi: 10.1097/ACM.0b013e3181fa2353.4. Poncele A, MD, O’Brien B, PhD. Preparing Medical Students for Clerkships: A Descriptive Analysis ofTransition Courses. Acad Med. 2008: 83(5): 444-451doi: 10.1097/ACM.0b013e31816be675.5. Christianson CE, MD, McBride RB, PhD, Vari RC, PhD, Olson L, EdD, Wilson HD, MD. From Traditional toPatient-Centered Learning: Curriculum Changes as an Intervention for Changing Institutional Culture andPromoting Professionalism in Undergraduate Medical Education. Acad Med. 2007; 82(11): 1079-1088doi: 10.1097/ACM.0b013e3181574a62.

Mar 01, 2012 · -In case of illness, the student is required to notify the PA Program Clinical Assistant and the preceptor by 8:00 a.m. that day. The program reserves the right to require a written excuse from the student [s healthcare provider for an absence. In case of emergency, please call the Clinical Assistant as soon as reasonably possible.