Midwestern University College of Health Sciences Clinical Handbook

Midwestern University College of Health Sciences Physician Assistant Program

Clinical Handbook 2011 - 2012

This Handbook is published for the convenience of students enrolled in Midwestern University’s Physician Assistant Program, Downers Grove campus. It is intended to be effective as of June 1, 2011. The Midwestern University Physician Assistant Program reserves the right to make changes in any or all specifications contained herein. Midwestern University provides equality of opportunity in its educational programs for all persons, maintains nondiscriminatory admission policies, and considers for all admission all qualified students regardless of race, color, sex, sexual orientation, religion, national or ethnic origin, citizenship status, disability, status as a veteran, age, or marital status. Midwestern University is not responsible for loss or damage to a student’s personal property on premises owned or operated by the University, regardless of cause. May 2011 2

Mission Statement - Midwestern University Midwestern University’s historical and sustaining philosophy dedicates the institution and its resources to the highest standards of academic excellence to meet the educational needs of the health care community. Mission Statement - College of Health Sciences The College of Health Sciences is dedicated to the highest standards of excellence in the education of professionals who will meet the health care and service needs of the community in a wide range of academic and practice settings. This mission is expressed in the education, scholarship, and service objectives of the programs of the College of Health Sciences. Mission Statement - Physician Assistant Program

The mission of the Midwestern University Physician Assistant (PA) Program is to: Provide an educational environment that enables individuals to become competent and compassionate physician assistants who possess the clinical skills to make meaningful contributions to the evolving health care needs of the patients they will serve and to stimulate involvement in the physician assistant profession by encouraging participation and leadership in local, state, and national organizations. The goals of the PA Program are to: 1) provide a rigorous academic and clinical curriculum and achieve first-time PANCE percentage pass rates and mean Program scores above the national average, 2) cultivate an environment of professionalism to encourage the development of competent and compassionate providers, 3) prepare students to serve diverse populations in both primary care and specialty settings, and 4) demonstrate the application of evidence-based medicine and foster a continuous commitment to life-long learning and community involvement as a health care provider.

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Dear Midwestern University Physician Assistant Students and Preceptors: Progression to the clinical training phase of the Midwestern University Physician Assistant (PA) Program is an important milestone for our students. It is the culmination of hours of preparation in lectures, small group activities, and practical examinations, along with mastery of great quantities of didactic material in written examinations throughout the didactic year. Clinical rotations endeavor to build upon the academic knowledge gained in the first year through direct patient care in a variety of settings. Our ultimate collective goal is to prepare each of our PA students for excellence in professional practice. This Midwestern University PA Program Clinical Handbook is an adjunct to the first year PA Program Academic Policies, the Midwestern University Student Handbook, and the Midwestern University Catalog. The Clinical Handbook is intended to guide PA students and Preceptors through the objectives of training, and contains specific policies and procedures pertinent to the clinical portion of our Program. The Handbook is organized into four major sections: 1) 2) 3) 4)

General information Policies and procedures Rotation-specific syllabi and objectives Forms

Throughout the document you will find designations which demonstrate compliance with the Accreditation th Standards for Physician Assistant Education 4 Edition of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). These designations are noted in italics and parentheses, just prior to the relevant section or policy. We require both students and Preceptors to familiarize themselves with the content of the Clinical Handbook before the start of clinical rotations, and hope this Handbook serves as a useful resource during core and elective rotations. The PA Program faculty and staff enthusiastically support our Preceptors and students throughout the clinical phase of training and are dedicated to the development of exceptional clinical rotation experiences. Please feel free to contact the Clinical Coordinators or other members of the PA Program faculty or staff if you have any questions regarding the material in this Handbook or if you need assistance during clinical rotations. Sincerely,

A. Smith Alyson L. Smith, MS, PA-C Program Director & Associate Professor Midwestern University PA Program Downers Grove Campus

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Midwestern University College of Health Science Physician Assistant Program Faculty/Staff Contact List Program Phone: (630) 515-6034 Program Fax: (630) 971-6402 Clinical Team email: [email protected]

Clinical Team

David A. Luce, MMS, PA-C

Clinical Coordinator & Assistant Professor

[email protected]

Soonja L. Sawyer, MS, PA-C

Clinical Coordinator & Instructor

[email protected]

Barbara Mullin, BS

Clinical Data Coordinator

Susan Laurenzana

Administrative Assistant

[email protected]

[email protected]

Program Faculty and Staff

Alyson L. Smith, MS, PA-C

Program Director & Associate Professor

[email protected]

Kara N. Roman, MMS, PA-C

Associate Program Director & Assistant Professor

[email protected]

Lendell Richardson, MD

Medical Director & Assistant Professor

[email protected]

Sandhya Noronha, MD

Assistant Professor

[email protected]

James F. Gunn, MMS, PA-C

Instructor

[email protected]

Susan Blanchard

Senior Administrative Assistant

[email protected]

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Code of Ethics of the Physician Assistant Profession

The American Academy of Physician Assistants recognizes its responsibility to aid the profession in maintaining high standards in the provision of quality and accessible health care services. The following principles delineate the standards governing the conduct of physician assistants in their professional interactions with patients, colleagues, other health professionals and the general public. Realizing that no code can encompass all ethical responsibilities of the physician assistant, this enumeration of obligations in the Code of Ethics is not comprehensive and does not constitute a denial of the existence of other obligations, equally imperative, though not specifically mentioned. Physician Assistants shall be committed to providing competent medical care, assuming as their primary responsibility the health, safety, welfare, and dignity of all humans. Physician Assistants shall extend to each patient the full measure of their ability as dedicated, empathetic health care providers and shall assume all responsibility for the skillful and proficient transactions of their professional duties. Physician Assistants shall deliver necessary health care services to health consumers without regard to sex, age, race, creed, socio-economic or political status. Physician Assistants shall adhere to all state and federal laws governing informed consent concerning the patient’s health care. Physician Assistants shall seek consultation with their supervising physician, other health care providers, or qualified professionals having special skills, knowledge or experience whenever the welfare of the patient will be safeguarded or advanced by such consultation. Supervision should include ongoing communication between the physician and the physician assistant regarding the care of all patients. Physician Assistants shall take personal responsibility for being familiar with and adhering to all federal and state laws applicable to the practice of their profession. Physician Assistants shall provide only those services for which they are qualified via education and/or experiences and by pertinent legal regulatory process. Physician Assistants shall not represent in any manner, either directly or indirectly, their skills, training, professional credentials, identity or services. Physician Assistants shall uphold the doctrine of confidentiality regarding privileged patient information, unless required to release such information by law or such information becomes necessary to protect the welfare of the patient or the community. Physician Assistants shall strive to maintain and increase the quality of individual health care service through individual study and continuing education. Physician Assistants shall have the duty to respect the law, to uphold the dignity of the physician assistant profession, and to accept its ethical principles. The physician assistant shall not participate in or conceal any activity that will bring discredit or dishonor to the physician assistant profession and shall expose, without fear or favor, any illegal or unethical conduct in the medical profession. Physician Assistants, ever cognizant of the needs of the community, shall use the knowledge and experience acquired as professionals to contribute to an improved community. Physician Assistants shall place service before material gain and must carefully guard against conflicts of professional interest. Physician Assistants shall strive to maintain a spirit of cooperation with their professional organizations and the general public. - American Academy of Physician Assistants

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TABLE OF CONTENTS

Mission and Goal Statements ..................................... 3 Program Director Letter ............................................... 5 Faculty/Staff Contact List............................................. 7 Code of Ethics ............................................................. 8 Calendar .................................................................... 11 Abbreviations ............................................................. 12 Policies and Procedures Advanced Clinical Medicine Courses ........................ 13 Attendance ................................................................ 13 Boundaries ................................................................ 14 Clinical Assessment Days ......................................... 14 Clinical Rotation Grades ............................................ 14 Clinical Site Affiliation Agreement .............................. 15 Clinical Site Evaluations ............................................ 15 Communication with the PA Program ........................ 15 Core Rotations ........................................................... 15 Criminal History Background Checks ........................ 16 Dress Code ................................................................ 16 Elective Rotations ...................................................... 16 End-of-Rotation Exams ............................................. 17 Graduation Requirements ......................................... 17 Health Insurance ....................................................... 17 Health Insurance Portability and Accountability Act .. 18 Hours ......................................................................... 18 Immunization Requirements ...................................... 18 Independent Study in Capstone Project I -IV ............ 18 Leave of Absence ...................................................... 19 Legal .......................................................................... 19 Mid-Rotation Student Self-Evaluation........................ 19 Mid-Year Evaluation .................................................. 19 Needle Stick or Injury on Rotations ........................... 19 Patient Encounter Logs ............................................ 20 Physician Assistant Resources ................................. 21 Preceptor Evaluation ................................................. 21 Preceptor Resources ................................................. 21 Prescriptive Activities and Charting ........................... 21 Professional Curriculum in the First Year .................. 22 Professional Curriculum in the Second/Third Year .... 22 Professionalism ......................................................... 22 Professional Liability Insurance ................................. 23 Rotation Change Requests ....................................... 23 Rotation Prerequisites ............................................... 23 Safety ........................................................................ 23 Site Development ...................................................... 23 Student Performance Evaluation ............................... 23 Summative Exams ..................................................... 24 Supervision ................................................................ 24

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General Information General Learning Objectives ..................................... 25 Competencies for the Physician Assistant ............... 27 Required and Recommended Textbooks .................. 31 Elective I and Elective II Rotation Syllabi .................. 33 Rotation Syllabi and Objectives Behavioral Medicine .................................................. 37 Emergency Medicine ................................................. 41 Family Medicine ......................................................... 49 Geriatric Medicine ...................................................... 59 Internal Medicine ...................................................... 65 Pediatrics ................................................................... 73 General Surgery ........................................................ 81 Women’s Health ........................................................ 87 Forms Request for Rotation Absence .................................. 93 Mid-Rotation Student Self-Evaluation Form .............. 95 Student Performance Evaluation Form ..................... 99

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College of Health Sciences Physician Assistant Program CLINICAL YEAR CALENDAR 2011 - 2012 ACTIVITY

DATE

*Advanced Clinical Medicine I

6/6/11 - 6/17/11

Rotation #1

6/20/11 -7/31/11

*CAD #1

Friday, 7/29/11

Rotation #2

8/1/11 - 9/11/11

*CAD #2

Friday, 9/09/11

Rotation #3

9/12/11-10/23/11

*CAD #3

Friday, 10/21/11

Rotation #4

10/24/11-12/4/11

*CAD #4 *Advanced Clinical Medicine II *Mid-Year Evaluation (MYE)

Winter Break Rotation #5 *CAD #5 Rotation #6

Friday, 12/2/11 12/5/11 – 12/16/11 12/15/11 – 12/16/11 12/17/11 – 1/1/12 1/2/12 - 2/12/12 Friday, 2/10/12 2/13/12 - 3/25/12

*CAD #6

Friday, 3/23/12

Rotation #7

3/26/12 - 5/6/12

*CAD #7

Friday, 5/4/12

Rotation #8

5/7/12- 6/17/12

*CAD #8

Friday, 6/15/12

*Advanced Clinical Medicine III – PANCE Review

6/18/12 – 6/22/12

*End-of-Year Evaluation (EYE)

6/21/12 – 6/22/12

Elective I

6/25/12 – 7/22/12

Elective II

7/23/12 – 8/19/12

*Advanced Clinical Medicine III – Completion Week

8/20/12 – 8/24/12

*PA III Completion Date

8/24/12 *on campus 11

ABBREVIATIONS AAPA………………………………..……………. American Academy of Physician Assistants ARC-PA…Accreditation Review Commission on Education for the Physician Assistant, Inc. CAD……………………………………………..……………………....Clinical Assessment Day CDC………………………………………..….…..Centers for Disease Control and Prevention CHS……………………………………………..…...……………..…College of Health Sciences CPT………………………………………..……………………Current Procedural Terminology CSP…………………………………………..………………………………Clinical Skills Portion EOR…………………………….…………….…...……………….………………End-of-Rotation EYE…………………………….………………….………….…………..End-of-Year Evaluation HIPAA……………………………….……Health Insurance Portability and Accountability Act th

ICD-9…………………………………….. International Classification of Diseases, 9 edition LOA……………………………………….…………………………………….Leave of Absence MCQ…………….…………………………………………………..….Multiple Choice Question MWU……………………………….…………………………..…………..Midwestern University MYE……………………………….…………………………..…………..…Mid-Year Evaluation NCCPA……………………National Commission on Certification of the Physician Assistant OSCE……………………….………………………Objective Structured Clinical Examination PA..........................................................................................................Physician Assistant PA-ARC………….………………………..Physician Assistant Academic Review Committee PAEA………………………………….……………Physician Assistant Education Association PANCE……………………………….…Physician Assistant National Certifying Examination RMS......................................................................................Rotation Management System Typhon………………………...Typhon Group Physician Assistant Student Tracking System

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Advanced Clinical Medicine Courses Advanced Clinical Medicine I (ACM I): 6/6/11 – 6/17/11 This course is designed to build upon the student’s foundation of clinical medicine knowledge and to prepare him or her for clinical rotations. Lectures will provide advanced information and instruction covering a range of medical topics including interpretation of electrocardiograms, basic life support for health care providers and advance cardiovascular life support, and other topics that will facilitate the student’s continuing development of knowledge and therapeutic skills in patient assessment, medical decision-making, and clinical management. Instructions for using the Typhon Group Physician Assistant Tracking System (Typhon) will also be provided. Advanced Clinical Medicine II (ACM II): 12/5/11 – 12/16/11 This course is designed to build upon the student’s foundation of clinical medicine knowledge and to continue to develop critical thinking and medical decision making skills. Lectures will provide advanced information and instruction covering a range of medical topics, and students will build upon their physical examination skills in small group practical and discussion sessions. Advanced Clinical Medicine III (ACM III): 6/18/12 – 6/22/12 and 8/20/12 – 8/24/12 This course is designed to build upon the student’s foundation of clinical medicine knowledge. Guest lecturers with clinical expertise in a variety of fields will provide advanced information and instruction. In addition, students will receive updates on clinical practice issues. During the course, students will receive an intensive week of lecture topics to help them prepare for the Physician Assistant National Certifying Examination (PANCE). Students will also focus on professional issues in preparation for graduation and clinical practice. During this time students will also be engaged in presenting and evaluating final Capstone Projects.

Attendance (ARC-PA: A3.17) During the clinical portion of the Physician Assistant (PA) Program, students must attend all scheduled courses, exams, and rotation activities. If a rotation requires that a student participate in supervised call time, the student is expected to do so. The PA Program generally does not permit absences for any reason other than personal illness or a family emergency. Students are not permitted time off to study for exams or to seek employment, except as noted later in this section. An unexcused absence is grounds for failure of a rotation or didactic clinical phase course. Any unexcused absence will be reviewed by the PA Clinical Coordinators and the matter may be referred to the PA Academic Review Committee (PA-ARC) for further action. Habitual tardiness is also considered disruptive and unprofessional and may result in action by the Clinical Coordinators and referral to the PAARC. For Clinical Rotation absences due to: 1. Personal illness or family emergency: The student MUST call the PA Program AND the rotation site on the day the absence occurs. These calls must occur by 9:00 AM or the start of the assigned clinic time, whichever is earlier. The Clinical Coordinators will work with the Preceptor to determine how the missed time will be made up. Final approval for the make-up of missed time will be at the discretion of the Clinical Coordinators. Extended absence, even if excused, may require a Leave of Absence (LOA) from the Program, which will alter the student’s anticipated date of graduation. For additional information, please refer to the College of Health Science section of the Midwestern University (MWU) Catalog. 2. Conferences and Events: A University policy has been established for students to request an excused absence from classes/laboratories/rotations to attend approved off-campus functions, including medical conferences. Physician Assistant students must first complete a Request for Rotation Absence form in this Handbook, and the request must be approved by the Clinical Coordinators. For additional information, please refer to the Policies section of the MWU Student Handbook. 13

3. Personal Day - One (1): Students who have no unexcused absences during core rotations may request a single personal day for use during elective rotations. A personal day may not be requested for either the first or last working day of a rotation. Students should complete the Request for Rotation Absence form and submit it to the Clinical Coordinators via email [email protected] no later than 48 hours prior to the requested day off. Outside of unforeseen personal illness or family emergency, the student may not plan any absence unless the PA Clinical Coordinators grant approval in advance. The student should not, under any circumstances, directly ask a Preceptor for permission for an absence for any reason.

Boundaries Patients, providers, and staff must be treated with all due respect and courtesy. The PA Program expressly forbids dating patients or becoming “involved” with patients, Preceptors, or other staff. Good judgment and appropriate boundaries when dealing with patients and clinic/hospital personnel are imperative. Any student breach in the Physician Assistant Code of Ethics on patient-professional relationships will be referred to the PA-ARC as described in the MWU Student Handbook. (ARC PA: A3.11, A3.17) Midwestern University believes in the dignity and worth of its students, faculty, staff, interns and residents, and will not tolerate unacceptable conduct or behavior that has the effect of substantially interfering with the individual’s performance or creates an intimidating, hostile, or offensive learning/working environment. Members of the MWU community have a right to be free from sexual harassment. If an MWU student feels he or she is being subjected to sexual harassment, he or she should refer to the MWU Student Handbook for detailed policies and procedures and immediately contact the PA Program Director and/or the Dean of Student Services.

Clinical Assessment Days Clinical Assessment Days (CAD) are designed to help the student integrate medical knowledge and clinical skills acquired during the didactic and clinical phase of training. Components of the CAD include an end-of-rotation exam, advanced clinical lectures, clinical learning and assessment activities using standardized patients, and a PA Program meeting. Students must satisfactorily participate in ALL components of each CAD. CADs are held at the completion of each core clinical rotation. Each day will typically begin at 8:00 AM and conclude by 5:30 PM. Attendance at the CAD is a requirement for each core rotation and is a prerequisite for graduation. CAD schedules and lectures will be posted on Blackboard at least 48 hours prior to the CAD. Once posted, individual student schedules for CAD activities cannot be changed.

Clinical Rotation Grades (ARC-PA: A3.17) For each core rotation, students are required to achieve a passing score in each of the following components: 1. End-of-rotation (EOR) exam – must attain a minimum score of 60% 2. Student Performance Evaluation - completed by the Preceptor(s) 3. CAD learning and assessment activities For each elective rotation, students must receive a passing grade, based upon the Student Performance Evaluation completed by rotation Preceptor(s) and satisfactory completion of all other rotation requirements. The Clinical Coordinators have the final determination as to whether a student has met all rotation requirements and will confer the final grade for each rotation. 14

Marginal or failing performance in any rotation will be reviewed by the PA Clinical Coordinators and typically referred to the PA-ARC for action. This committee has the right to adjust the final rotation grade. Failure of more than one rotation or didactic course during the clinical phase of training constitutes a significant problem and may result in dismissal from the Program. The following describes the usual course of action in the event of marginal or failing performance of a required rotation component: A. A student receiving an unsatisfactory score from a Preceptor will be referred directly to the PAARC. B. A student failing an EOR examination (score less than 60%) may be allowed a single re-test of that examination. If the re-test score is equal to or greater than 60%, the student will receive a passing score for the EOR exam. If the re-test score is less than 60%, the student will be referred to the PA-ARC. - For an EOR failure during a CAD, the re-test examination will be administered the next business day at 7:30 AM in the PA Program office. - For an EOR failure during ACM-II, the re-test examination will be administered within a similar time frame. C. Any student failing more than two EOR exams on the first attempt will be referred to the PA-ARC.

Clinical Site Affiliation Agreement (ARC-PA: A1.02, A3.03) A formal affiliation agreement or memoranda of understanding between the sponsoring institution and clinical sites is a required accreditation standard of the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA). The PA Program ensures that clinical sites are capable of providing clinical instruction and experiences requisite to PA education, and final site approval rests solely with the PA Program.

Clinical Site Evaluation (ARC-PA: C4.01) The Program engages in ongoing evaluations of all sites and Preceptors to ensure program-defined expectations for learning outcomes and performance evaluation measures are met. Midwestern University faculty perform site visits routinely throughout the clinical training period. In addition, site visits may be used to assess a student’s progress and to provide support to the Clinical Preceptor. These visits may be scheduled or unannounced.

Communication with the PA Program (ARC-PA: A3.10) Clinical phase students should feel free to contact any member of the PA Program faculty for help, counsel, or advice related to professional training as often as necessary. Any student experiencing significant personal stress during his or her training is encouraged to seek counseling and/or support by directly contacting the MWU Wellness Center Director of Counseling for a free and confidential appointment (630-515-7142). Midwestern University e-mail is the primary contact method used by the PA Program during the clinical phase of training. The Program will not respond to email sent from personal accounts. Students are required to check their MWU e-mail account daily for clinical phase information which may include rotation changes, immunization notifications, or other important correspondence.

Core Rotations (ARC-PA: B3.03, B3.04) The clinical phase of the program has eight 6-week core rotations. Core rotations include Behavioral Medicine, Emergency Medicine, Family Medicine, Geriatrics, Internal Medicine, Pediatrics, Surgery, and Women’s Health. The majority of core rotation sites are located within the greater Chicago area. There is limited availability for core rotations at select MWU clinical sites outside of the greater Chicago area and students are regularly assigned to these distant sites. Housing is provided for out-of-state core clinical rotations only. Students are expected to secure their own housing for local and elective rotations, and must provide their own transportation to all core and elective clinical rotations regardless of location. 15

(ARC-PA: A3.03) Students are never required to provide or solicit clinical sites or Preceptors. The Program maintains responsibility for the coordination of clinical sites and Preceptors for all rotations. The PA Program reserves the right to schedule student rotations based on, but not limited to, availability, location, and previous healthcare experience. The student’s academic performance may be used as a factor in assigning or changing clinical rotations. In addition, there are occasionally circumstances beyond the Program’s control which may require amendment to a student’s clinical rotation schedule.

Criminal History Background Checks All students are required to submit to a criminal background check at matriculation and immediately prior to participation in the clinical training phase of the program. In addition, students who remain enrolled must submit to a criminal background check as needed to remain eligible for continued participation. Refer to the Policies section of the MWU Student Handbook for further information.

Dress Code (ARC-PA: A1.03f, B3.01) During all rotations, and when returning to campus for scheduled didactic courses, evaluations, and CADs, students are expected to maintain a professional appearance. On rotations, students are required to wear a short white coat (not a long coat) with a Program-issued nametag and a PA Program patch (left arm). There may be some rotations where site policies dictate that white coats are not worn, but a nametag indicating physician assistant student status must be visible at all times. Failure to wear proper identification is a violation of state statutes for medical practice and may result in failure of the rotation and referral to the PA-ARC. As representatives of the PA Program, students must be well-groomed, clean, neat, and dressed to avoid extremes of hair and clothing styles. Students should be dressed modestly at all times during all seasons. For example, shorts, sandals, halters, sheer or revealing clothing, and open-toed shoes are never appropriate. Students are asked not to chew gum. Long fingernails, artificial nails, and colored fingernail polish are unacceptable for health providers caring for patients. If you have additional questions or desire clarification about appropriate professional attire or decorum, refer to the MWU Student Handbook or please feel free to contact the Clinical Coordinators for guidance.

Elective Rotations (ARC-PA: A3.03) Students must complete two 4-week elective rotations as part of their clinical training. When submitting preferences for elective clinical rotations, students are required to enter a lottery for existing MWU elective sites or may submit appropriate documentation to suggest a new elective site. Core rotation sites cannot be used for elective rotations, and students are not permitted to contact any existing MWU clinical site in an attempt to arrange their own electives. For a new elective site to be considered, the student must complete the following tasks: 1) initiate contact with the site/Preceptor and any hospital contacts and 2) complete the on-line Elective Rotation Preference Sheet with appropriate Preceptor/site contact information. In order for a new site to be considered, a current written affiliation agreement with MWU must already be in place, or the site must be willing to accept MWU’s standard affiliation agreement. A timeframe for submitting the above information will be announced to students during a regularlyscheduled Program meeting on a CAD. Student suggested sites, Preceptors, and affiliation agreements will be reviewed by the Program for educational suitability. Final approval for all elective sites rests with the PA Clinical Coordinators. In addition, there are occasionally circumstances beyond the Program’s control which may require changes in a student’s elective clinical rotation schedule.

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End-of-Rotation Exams An End-of-Rotation (EOR) exam must be successfully completed (score of 60% or higher) at the end of each core rotation during the CAD as scheduled. Questions on EOR exams are based upon the General Learning Objectives and the specific rotation objectives for each rotation as outlined in this Handbook. End-of-Rotation scores will be securely posted to the Midwestern University on-line system (https://online.midwestern.edu) by 5:00 PM on each CAD. In the event of an EOR exam failure, refer to the Clinical Rotation Grades section in this Handbook for details on the typical course of action. In order to be permitted to sit for the required EOR exam, each student must: - successfully complete the required rotation as scheduled; - complete all patient encounter logs by 12:00 PM on the day preceding the CAD; and - complete the on-line Preceptor evaluation by 12:00 PM on the day preceding the CAD.

Graduation Requirements (ARC-PA: A3.17) In order to be considered by the PA-ARC and the College of Health Sciences (CHS) Promotion and Graduation Committee for timely graduation, each student must satisfactorily meet all the following PA Program criteria for the clinical phase of training: Eight 6-week core rotations and two 4-week elective rotations; All components of each CAD; Advanced Clinical Medicine I, II & III; Independent Study in Capstone Project I-IV; Mid-Year Evaluation; End-of-Year Evaluation; Cumulative Grade Point Average (GPA) ≥ 2.75 ; Demonstrate professionalism throughout clinical training; and CHS Graduation Clearance Form (online).

Health Insurance The University requires that all full-time and part-time students enrolled in any University program be covered under a health insurance plan acceptable to the University. Midwestern University has made a Student Medical Health Care Plan available to students. Students may choose health care insurance through Midwestern University or may choose their own comparable plan. Evidence of acceptable non-University health insurance coverage must be provided prior to program matriculation and prior to registration for the fall quarter each succeeding year thereafter by completing an On-line Waiver Form that can be accessed through the on-line Midwestern web site (https://online.midwestern.edu). Non-University insurance plans must provide coverage comparable to that offered by the University. Short-term or catastrophic coverage is not deemed comparable and cannot be an acceptable health insurance plan. A student’s health insurance coverage may be randomly verified. Failure to maintain health insurance may result in immediate dismissal from the University. Details of benefit plan coverage and related premium costs are available by calling the MWU Department of Student Services at (630) 515-6470.

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Health Insurance Portability and Accountability Act (ARC-PA: B2.16) All MWU PA students are required to abide by the standards and policies of the Health Insurance Portability and Accountability Act (HIPAA). Violation of patient privacy is a serious offense and is grounds for dismissal from the Program. In addition to maintaining HIPPA standards within the clinical setting, students are expressly prohibited from taking photographs or video of patients without proper Preceptor and patient consent. Distribution of photographs, video, or discussion of patient encounters (even without patient identifying information) via email or on social websites is considered a significant violation of both HIPPA standards and Program policies and is grounds for referral to the PA-ARC and dismissal from the Program. Any student with questions regarding appropriate implementation of HIPAA standards or other matters of patient confidentiality must immediately contact the PA Clinical Coordinators for guidance.

Hours (ARC-PA: A3.17) It is PA Program policy that students are expected to actively participate in a minimum of 40 hours of supervised clinical practice experiences weekly. This time may include daytime business hours, evening hours, weekend hours and supervised call time. If a Preceptor unexpectedly needs to be away from the practice site for any period of time outside of his or her normal schedule, the student must immediately notify the PA Program so alternate arrangements for that student may be made. When a PA student is participating in a clinical rotation he or she must be adequately supervised at all times. A licensed and board-certified medical provider (MD, DO, or PA) must be on site and evaluate every patient seen by the student. See the Supervision section of this Handbook for additional information.

Immunizations, Titers, Tuberculosis, and Other Related Requirements (ARC-PA: A3.07) In order to meet Program accreditation standards, health screening and immunization of students must be in compliance with current Centers for Disease Control and Prevention (CDC) recommendations for health professionals. Current recommendations may be found at http://www.cdc.gov/vaccines/. Students are responsible for maintaining and updating their immunization status and proof of titers while on clinical rotations. The University is required by law to keep student immunization documentation on file. Students who are non-compliant with their required immunizations and/or testing will be suspended from their rotations immediately. Any student who misses a rotation because of incomplete immunizations or titers will receive a failing grade for the rotation and, if immunizations are not quickly obtained, is subject to dismissal from the Program. Immunizations must not be obtained at the student’s clinical training site. In accordance with University policy, documented laboratory proof of the absence of tuberculosis must include the following: date of placement, date of reading, result listed as number of millimeters, signature of an authorized medical professional, and contact information for the site where the testing was completed. For further information refer to MWU Student Handbook.

Independent Study in Capstone Project I - IV This course is designed to facilitate the completion of an independent medical research project (“Capstone Project”) as the culmination of the master’s degree for the physician assistant student. The project entails scholarly inquiry into a clinical medicine topic, application of evidence-based medicine techniques, creation of effective patient and community education materials, and a final presentation/dissemination of the materials collected. Specific details and deadlines for Project components are available on the Blackboard website. Satisfactory completion of all components of the Capstone Project is a requirement for graduation. 18

Leave of Absence (ARC-PA: A3.17) If any circumstances require a student’s absence for more than two days during clinical training, even if excused, a Leave of Absence (LOA) may be required. Requests for a LOA should be first made to the PA Program Director who will make a recommendation to the Dean of the College of Health Sciences. The Dean has the final authority to grant a LOA. Please refer to MWU Catalog for further information. Legal If a student believes a situation arising during a clinical rotation may have legal implications, the student must contact the PA Program Director, and/or the Dean of Student Services immediately.

Mid-Rotation Student Self-Evaluation The Mid-Rotation Student Self-Evaluation is designed to allow a student to thoughtfully reflect upon his or her performance at the mid-point of a clinical rotation, and to foster a conversation with his or her Preceptor regarding progress in the rotation. After completing the Mid-Rotation Student Self-Evaluation, the student must meet with the Preceptor to review and sign the form. Students are required to fax or scan/email the completed Mid-Rotation Student Self-Evaluation to the PA Program at the end of the third week of each core rotation. Mid-Year Evaluation (ARC-PA: A3.17) Successful completion of the Mid-Year Evaluation (MYE) is a prerequisite for continued progression in the Program and for graduation. All students are required to complete all components of the MYE as scheduled. The evaluation consists of: - a written, Multiple Choice Question (MCQ) test; - an Objective Structured Clinical Examination (OSCE); and - a Clinical Skills Portion (CSP). Mid-Year Evaluation failures will be referred to the PA-ARC. Failure of the MYE may require the Program to alter the student’s rotation schedule and may result in extension of the student’s curriculum.

Needle Stick or Injury on Rotations (ARC-PA: A3.08) Students are potentially exposed to blood/infectious body fluids via respiratory, percutaneous, or mucocutaneous exposures in hospital, clinic and doctors’ office environments, and are at risk to acquire infectious diseases during the course of clinical training. Prompt evaluation of accidental exposures and appropriate treatment and follow-up may reduce infection and associated risks. An exposure incident is defined by Midwestern University as specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that result from performing an assigned rotational task as a student. The bodily fluids considered potentially infectious for blood borne pathogen exposures include blood and blood products, any fluid contaminated with blood, semen, saliva, cerebrospinal fluid, amniotic fluid, vaginal secretions, pleural fluid, peritoneal fluid, pericardial fluid and synovial fluid. Procedure for Exposure Incident MWU students exposed to a patient via blood or potentially infectious body fluid should: 1. Seek immediate treatment and follow-up in accordance with appropriate medical standards; 2. Fill out injury and treatment forms following the protocol of the rotational facility or physician's office where they are assigned; 3. Go immediately to an emergency department; and 19

4. Immediately notify the Preceptor and Clinical Coordinators of the occurrence. 5. Students who incur expenses related to treatment of an accidental needle stick should seek reimbursement first through their health insurance company. Please note that expenses incurred due to a needle stick or injuries while on clinical rotations are not covered through Worker's Compensation. Any expenses that are not covered through a student's own health insurance company thereafter should be referred to Dean McLean, Director of Risk Management, at (630) 515-7232. Students shall within 5 days send a copy of the injury and treatment forms to their Preceptor and Clinical Coordinators. When making out an injury report for an exposure incident, the student and/or Preceptor must give the name of the source individual and medical record number, if known or feasible. If an exposure occurs, the following information should be recorded in the student's confidential medical record: 1. Date and time of exposure; 2. Job duty being performed by student; 3. Whether protective equipment (gowns, gloves, masks, protective eyewear) or engineering controls were used (i.e., recapping device or a needle disposal device or mechanical pipette); 4. Details of exposure, including amount and type of fluid or material, and severity (i.e. depth of percutaneous exposure and whether fluid was injected; extent and duration of skin or mucous membrane contract; 5. Description of source material, including HIV, HBV, HCV status if known. In the event the source individual is a dialysis patient, a current HBsAg report should be used. (ARC-PA: A3.09, A3.21) The above exposure incident policies and procedures are those prescribed by Midwestern University. Information in a student’s confidential medical record is never accessible to or reviewed by PA Program faculty or staff except for routine immunization records, and tuberculosis and drug screening results. The PA Program Director, Medical Director, and principal faculty do not participate as health care providers for students in the Program at any time, nor are they able to provide medical advice or treatment to any student following an exposure incident.

Patient Encounter Logs Students are required to electronically log their patient encounters in all rotations, including elective th rotations, using Typhon and the International Classification of Diseases, 9 edition (ICD-9) codes and Current Procedural Technology (CPT) codes. For core rotations, students will not be allowed to take the End-of-Rotation (EOR) Exams if on-line activity logs for that rotation are not complete. Failure to take any End-of-Rotation exam as scheduled due to delinquent encounter logs is considered an unexcused absence and may result in a failing grade for the rotation. Each rotation’s activity logs must be completed by 12:00 PM on the day prior to each Clinical Assessment Day (CAD) and by 12:00 PM on the Friday before Advanced Clinical Medicine IIIb in August. Students must be timely, accurate, and complete when logging patient encounters in Typhon. Patient encounter logs are used by many state regulatory bodies and hospital boards requiring documentation after graduation of procedures, prescriptive experience, or exposure to patient populations. This documentation is required before final authority to practice or privileges are granted. In addition, the student builds a portfolio using Typhon to demonstrate his or her clinical experience to prospective employers. (ARC-PA: C1.01, C4.02) Timely, accurate, and complete logs are an expected component of professionalism and also enable the Clinical Coordinators to ensure that each rotation is providing high-quality clinical education that meets Program-defined expectations for clinical practice experiences.

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Physician Assistant Resources American Academy of Physician Assistants (AAPA) www.aapa.org/ Physician Assistant Education Association (PAEA) www.paeaonline.org/ National Commission on Certification of Physician Assistants (NCCPA) www.nccpa.net/ Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) www.arc-pa.org/ Preceptor Evaluation (ARC-PA: C4.01, C4.02) In order to meet Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) Standards and to permit ongoing Program self-study of student experiences at clinical training sites, the MWU PA Program requires each student to complete an evaluation of the Preceptor(s) and training site at the end of each core and elective clinical rotation. The PA program may share anonymous student evaluation scores and feedback in aggregate with Preceptor(s). Each student must complete the Preceptor evaluation by 12:00 PM on the day preceding each CAD or by 12:00 PM on the Friday before Advanced Clinical Medicine IIIb in August.

Preceptor Resources Precepting a student can be one of the most rewarding experiences of your career. As a Preceptor when you share your knowledge and experience with today’s students you are molding tomorrow’s health care providers. The Physician Assistant Education Association (PAEA) recognizes your efforts and offers the following link as a tool to assist you. Physician Assistant Education Association (PAEA) Resources on Precepting http://www.paeaonline.org/index.php?ht=d/sp/i/80183/pid/80183.

Prescriptive Activities and Charting (ARC-PA: B3.02, C4.02) Students may not independently 1) prescribe legend or non-legend medications, 2) authorize a prescription or refills, or 3) dispense medications. A student in violation of these guidelines on prescription writing or dispensing of medications will be immediately removed from the rotation and brought before the PA-ARC. All charting and orders (written or electronic) completed by students must be reviewed and countersigned by a supervising physician and/or physician assistant. Should a student or Preceptor have further questions or need clarification regarding these policies before or during a clinical rotation, he or she should call the PA Clinical Coordinators immediately for guidance.

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Professional Curriculum in the First Year (June 2010-May 2011) The didactic curriculum is taught by Midwestern University PA Program principal and instructional faculty and is comprised of the following courses: First Quarter: Biopsychosocial Issues Clinical Biochemistry/Nutrition Clinical Medicine I Human Anatomy I Professional Seminar I

Second Quarter: Clinical Medicine II Healthcare Issues Human Neurosciences Human Physiology Pharmacology I Physical Diagnosis Research Seminar I

Third Quarter: Clinical Medicine III Human Physiology II Immunology Pharmacology II Psychiatric Principles Research Seminar II

Fourth Quarter: Clinical Medicine IV Human Genetics Infectious Diseases Introduction to Capstone Project Pharmacology III Professional Seminar II

Professional Curriculum in the Second/Third Year (June 2011-August 2012) The clinical curriculum is taught by the Midwestern University PA Program principal and instructional faculty and is comprised of the following courses: Advanced Clinical Medicine I Advanced Clinical Medicine II Advanced Clinical Medicine III Independent Study in Capstone Project III & IV The remaining clinical curriculum includes the 8 six-week core rotations listed below and 2 four-week electives. Behavioral Medicine Family Medicine Surgery Internal Medicine Electives (I/II) (four-weeks each)

Emergency Medicine Pediatric Medicine Geriatrics Women’s Health

The MWU CHS Physician Assistant Program reserves the right to alter its curriculum as it deems appropriate. Professionalism (ARC-PA: B2.04) Student conduct is expected to be exemplary and professional at all times. Failure to exhibit professional demeanor jeopardizes a student’s continued participation in the PA Program. During clinical experiences, students are interacting with other medical professionals and should make every effort to establish and maintain professional working relationships. Attitude is one of the most important aspects of student clinical rotations. While every rotation may have challenges, a positive attitude can make a difference in how a student is perceived and accepted. Preceptors often solicit staff input regarding interpersonal skills when filling out student evaluations. Dependability, consistency, and professionalism are traits that patients, staff, and fellow providers appreciate. Regardless of how the day is going, students should be patient, consistent, and professional in their approach to all patients and professionals. 22

Professional Liability Insurance (ARC-PA: A1.03g) Each student is insured for malpractice under the Midwestern University’s student professional liability program. This insurance only covers students on Program-authorized and assigned clinical rotations. This does not cover personal medical or hospitalization insurance. Furthermore, the insurance does not cover the student during voluntary or paid clinical activities not assigned by the PA Program. Any student choosing to pursue outside clinical activities may not represent him or herself as a MWU PA student during these activities, and participates in these activities at his or her own legal risk.

Rotation Change Requests In the event of unusual extenuating circumstances, it may be appropriate for a student to request a change in rotation. To request a rotation change, the student must submit a request in writing that identifies the rotation type, dates, and reason for the requested change. This request must be submitted to the PA Clinical Coordinators a minimum of three months prior to the rotation start date. Final approval or denial for any requested rotation change rests with the PA Clinical Coordinators. Students may not request core or elective rotation assignment changes for matters of convenience or personal preference.

Rotation Prerequisites (ARC-PA: A1.02) Certain clinical sites require students to complete paperwork or on-line training applications prior to the rotation as part of the clinical affiliation agreement with the Program. Students are required to comply with all rotation prerequisites. Some sites require drug testing, respiratory mask fit testing, and/or fingerprinting. The Program will cover costs related to site-specific requirements for core rotations. If testing is required for elective rotations, this expense may fall to the student for payment.

Safety (ARC-PA: A1.03g) If a student finds himself or herself in any position that threatens his or her safety, he or she must contact the appropriate authorities immediately. Additionally, he or she must contact the PA Program Director, and/or the Dean of Students as soon as it is safe to do so.

Site Development (ARC-PA: A3.03) Midwestern University PA students are never required to provide or solicit clinical sites or Preceptors. Students wishing to suggest new clinical training sites or Preceptors should contact the PA Clinical Coordinators. Final approval or denial of any clinical site or Preceptor rests with the PA Clinical Coordinators. Students are not permitted to contact existing MWU clinical sites in an attempt to arrange a new clinical rotation. Students may not participate in rotations with persons who are or are about to become members of their immediate or extended family, or with a person considered to be a “significant other”. If a student finds him or herself in a position which may represent a conflict of interest relevant to this policy, he or she must immediately contact the Clinical Coordinators for guidance.

Student Performance Evaluation (ARC-PA: C4.02) The Student Performance Evaluation Form is completed by the Preceptor by the end of a rotation. It can be faxed, scanned/emailed, or mailed to the PA Program in the self-addressed prepaid envelope, or returned in person on the CAD. The Preceptor and the student must sign the completed evaluation form before it is submitted to the Program. 23

Summative Evaluation (ARC-PA: C3.04) Successful completion of the summative End-of-Year Evaluation (EYE) is a prerequisite for continuation in the Program and for graduation. All students are required to complete and pass all three components of the summative EYE as scheduled. - a Multiple Choice Question (MCQ) test; - an Objective Structured Clinical Examination (OSCE); and - a Clinical Skills Portion (CSP). The PA-ARC reviews all student scores following the EYE. Failure to pass the EYE may result in extension of the student’s curriculum and/or dismissal from the PA Program.

Supervision (ARC-PA: A2.16, A2.17) When a PA student is participating in a clinical rotation he or she must be adequately supervised at all times. A licensed and board-certified medical provider (MD, DO, or PA) must be on site and evaluate every patient seen by the student. Never, under any circumstances, should the student be the only provider to see a patient. This is a violation of Midwestern University policy as well as state statutes and regulations governing the practice of both physicians and physician assistants. Students have a moral and legal responsibility to immediately notify the PA Clinical Coordinators of any serious concerns they have about a clinical site or Preceptor, such as inadequate clinical supervision or significant problems with patient care. Any student who does so will not be penalized. If a student is removed from a clinical site due to problems with the setting, he or she will not be required to repeat the missed clinical time.

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GENERAL LEARNING OBJECTIVES During the clinical year, PA students learn to provide exceptional patient care via two major activities: 1) the evaluation and treatment of patients under the direct supervision of a Preceptor, and 2) the study of assigned medical diseases, disorders, and essential skills using required textbooks and other resources. All PA students are required to complete readings and meet objectives for each core rotation as outlined in this handbook. The listed disease and skill topics for core rotations are based upon those published in the National Commission on Certification for the Physician Assistant (NCCPA) Content Blueprint. Readings during elective rotations are self-directed and/or may be assigned by the Preceptor. In addition to rotation-specific objectives, these general objectives apply for every core and elective rotation: Medical History Takes and records focused histories on patients Associates patients’ complaints with their presented history Interprets history and formulates a differential diagnosis Knows and understands individual risk factors for each disease and related condition Recognizes and understands signs and symptoms associated with a specific diagnosis Physical Examination Knows and understands what constitutes an appropriate directed physical exam after eliciting a patient history Recognizes pertinent physical findings Interprets particular physical findings in order to differentiate one disorder from another Laboratory and Diagnostic Studies Selects appropriate routine or initial laboratory or diagnostic studies to help establish a diagnosis Interprets and applies results of diagnostic studies Knows and understands appropriate follow-up studies Knows and understands when diagnostic or laboratory studies are not indicated Differential Diagnosis Selects the most likely diagnosis; evaluates the differential diagnosis in light of history, physical exam, diagnostic test findings Understands the pathophysiology for the most likely diagnosis Recognizes associated disease conditions and complications Management Evaluates severity of the patient’s condition Prioritizes each patient’s conditions and makes appropriate referrals for further diagnostic assessment. Recognizes factors in the history that affect the patient’s treatment plan or prognosis Identifies and evaluates patients for whom a specific type of therapy is appropriate or inappropriate Health Maintenance and Disease Prevention Knows and understands risk factors for conditions amenable to prevention or detection in an asymptomatic individual Appreciates pertinent incidence statistics among patient groups at risk, including incidence of symptoms and identifiable disorders among various groups Selects appropriate treatment, which may include preventive measures, education and medication 25

Clinical Intervention The student demonstrates knowledge and understands: Priority in management, or medical intervention, specifically in emergency or acute cases Indications for hospital admission Appropriate discharge planning Components of a rehabilitation program Appropriate counseling of a patient or family regarding current and future problems, including risk factors related to the present encounter The importance of education for both the patient and family regarding self-care The relevant roles of allied health personnel Issues surrounding management of chronic pain, especially in terminally ill patients Recognizes and addresses the patient’s expression of fear of injury or death Clinical Therapeutics Recognizes indications for use of medications Knows and understands the appropriate follow-up schedule or monitoring approach regarding a therapeutic regimen Knows and understands the importance of patient compliance with a treatment regimen and techniques to increase compliance or understanding, specifically patient and family education Applies knowledge of drugs to the safe and effective selection and administration of drugs Knows and understands the risks, signs and symptoms of drug interactions resulting from polypharmacy in the therapeutic regimen Knows and understands the actions to take in response to acute, specific drug toxicity Modifies the therapeutic regimen within the context of continuing care Legal/Ethical and Health Care Systems Knows and understands informed consent Recognizes the patient’s right to refuse treatment or testing (patient autonomy) Knows and understands the guidelines for confidentiality of medical records Is aware of cost containment issues Recognizes practitioner error versus negligence Knows and understands the Good Samaritan Law Knows and understands the guidelines for reporting findings to proper authorities Recognizes the need for third-party permission for treatment in medical emergencies Assesses the degree of disclosure to terminally ill patients Knows and understands the definitions of, and legal issues regarding, brain death and organ donation

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Competencies for the Physician Assistant Profession Preamble In 2003, the National Commission on Certification of Physicians Assistants (NCCPA) initiated an effort to define PA competencies in response to similar efforts being conducted within other health care professions and growing demand for accountability and assessment in clinical practice. The following year, representatives from three other national PA organizations, each bringing a unique perspective and valuable insights, joined NCCPA in that effort. Those organizations were the Accreditation Review Commission for Education of the Physician Assistant (ARC-PA), the body that accredits PA educational programs; the Association of Physician Assistant Programs (APAP), the membership association for PA educators and program directors; and the American Academy of Physician Assistants (AAPA), the only national membership association representing all PAs. The resultant document, Competencies for the Physician Assistant Profession, is a foundation from which each of those four organizations, other physician assistant organizations and individual physician assistants themselves can chart a course for advancing the competencies of the PA profession.

Introduction The purpose of this document is to communicate to the PA profession and the public a set of competencies that all physician assistants regardless of specialty or setting are expected to acquire and maintain throughout their careers. This document serves as a map for the individual PA, the physician-PA team and organizations that are committed to promoting the development and maintenance of these professional competencies among physician assistants. The clinical role of PAs includes primary and specialty care in medical and surgical practice settings. 1

Professional competencies for physician assistants include the effective and appropriate application of medical knowledge, interpersonal and communication skills, patient care, professionalism, practice-based learning and improvement, systems-based practice, as well as an unwavering commitment to continual learning, professional growth and the physician-PA team, for the benefit of patients and the larger community being served. These competencies are demonstrated within the scope of practice, whether medical or surgical, for each individual physician assistant as that scope is defined by the supervising physician and appropriate to the practice setting. The PA profession defines the specific knowledge, skills, and attitudes required and provides educational experiences as needed in order for physician assistants to acquire and demonstrate these competencies.

MEDICAL KNOWLEDGE

Medical knowledge includes an understanding of pathophysiology, patient presentation, differential diagnosis, patient management, surgical principles, health promotion and disease prevention. Physician assistants must demonstrate core knowledge about established and evolving biomedical and clinical sciences and the application of this knowledge to patient care in their area of practice. In addition, physician assistants are expected to demonstrate an investigatory and analytic thinking approach to clinical situations. Physician assistants are expected to: • understand etiologies, risk factors, underlying pathologic process, and epidemiology for medical conditions • identify signs and symptoms of medical conditions • select and interpret appropriate diagnostic or lab studies • manage general medical and surgical conditions to include understanding the indications, contraindications, side effects, interactions and adverse reactions of pharmacologic agents and other relevant treatment modalities • identify the appropriate site of care for presenting conditions, including identifying emergent cases and those requiring referral or admission • identify appropriate interventions for prevention of conditions

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• identify the appropriate methods to detect conditions in an asymptomatic individual • differentiate between the normal and the abnormal in anatomic, physiological, laboratory findings and other diagnostic data • appropriately use history and physical findings and diagnostic studies to formulate a differential diagnosis • provide appropriate care to patients with chronic conditions

INTERPERSONAL & COMMUNICATION SKILLS

Interpersonal and communication skills encompass verbal, nonverbal and written exchange of information. Physician assistants must demonstrate interpersonal and communication skills that result in effective information exchange with patients, their patients’ families, physicians, professional associates, and the health care system. Physician assistants are expected to: • create and sustain a therapeutic and ethically sound relationship with patients • use effective listening, nonverbal, explanatory, questioning, and writing skills to elicit and provide information • appropriately adapt communication style and messages to the context of the individual patient interaction

• work effectively with physicians and other health care professionals as a member or leader of a health care team or other professional group • apply an understanding of human behavior • demonstrate emotional resilience and stability, adaptability, flexibility and tolerance of ambiguity and anxiety • accurately and adequately document and record information regarding the care process for medical, legal, quality and financial purposes

PATIENT CARE

Patient care includes age-appropriate assessment, evaluation and management. Physician assistants must demonstrate care that is effective, patient-centered, timely, efficient and equitable for the treatment of health problems and the promotion of wellness. Physician assistants are expected to: • work effectively with physicians and other health care professionals to provide patient-centered care • demonstrate caring and respectful behaviors when interacting with patients and their families • gather essential and accurate information about their patients • make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment • develop and carry out patient management plans • counsel and educate patients and their families • competently perform medical and surgical procedures considered essential in the area of practice • provide health care services and education aimed at preventing health problems or maintaining health

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PROFESSIONALISM

Professionalism is the expression of positive values and ideals as care is delivered. Foremost, it involves prioritizing the interests of those being served above one’s own. Physician assistants must know their professional and personal limitations. Professionalism also requires that PAs practice without impairment from substance abuse, cognitive deficiency or mental illness. Physician assistants must demonstrate a high level of responsibility, ethical practice, sensitivity to a diverse patient population and adherence to legal and regulatory requirements. Physician assistants are expected to demonstrate: • understanding of legal and regulatory requirements, as well as the appropriate role of the physician assistant • professional relationships with physician supervisors and other health care providers • respect, compassion, and integrity

• responsiveness to the needs of patients and society • accountability to patients, society, and the profession • commitment to excellence and on-going professional development • commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices • sensitivity and responsiveness to patients’ culture, age, gender, and disabilities • self-reflection, critical curiosity and initiative

PRACTICE-BASED LEARNING AND IMPROVEMENT Practice-based learning and improvement includes the processes through which clinicians engage in critical analysis of their own practice experience, medical literature and other information resources for the purpose of selfimprovement. Physician assistants must be able to assess, evaluate and improve their patient care practices. Physician assistants are expected to:

• analyze practice experience and perform practice-based improvement activities using a systematic methodology in concert with other members of the health care delivery team • locate, appraise, and integrate evidence from scientific studies related to their patients’ health problems • obtain and apply information about their own population of patients and the larger population from which their patients are drawn • apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness • apply information technology to manage information, access on-line medical information, and support their own education • facilitate the learning of students and/or other health care professionals • recognize and appropriately address gender, cultural, cognitive, emotional and other biases; gaps in medical knowledge; and physical limitations in themselves and others

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SYSTEMS-BASED PRACTICE

Systems-based practice encompasses the societal, organizational and economic environments in which health care is delivered. Physician assistants must demonstrate an awareness of and responsiveness to the larger system of health care to provide patient care that is of optimal value. PAs should work to improve the larger health care system of which their practices are a part. Physician assistants are expected to: • use information technology to support patient care decisions and patient education • effectively interact with different types of medical practice and delivery systems • understand the funding sources and payment systems that provide coverage for patient care • practice cost-effective health care and resource allocation that does not compromise quality of care • advocate for quality patient care and assist patients in dealing with system complexities • partner with supervising physicians, health care managers and other health care providers to assess, coordinate, and improve the delivery of health care and patient outcomes • accept responsibility for promoting a safe environment for patient care and recognizing and correcting systems-based factors that negatively impact patient care • apply medical information and clinical data systems to provide more effective, efficient patient care • use the systems responsible for the appropriate payment of services

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In 1999, the Accreditation Council for Graduation Medical Education (ACGME) endorsed a list of general competencies for medical residents. NCCPA’s Eligibility Committee, with substantial input from representatives of AAPA, APAP and ARC-PA, has modified the ACGME’s list for physician assistant practice, drawing from several other resources, including the work of Drs. Epstein and Hundert; research conducted by AAPA’s EVP/CEO, Dr. Steve Crane; and NCCPA’s own examination content blueprint. Vers. 3.5 (3/22/05)

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Required and Recommended Textbooks for Clinical Rotations: 2011-2012 ALL ROTATIONS Required:

Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Any pocket (or PDA) drug reference of your choosing. BEHAVIORAL MEDICINE

Required:

Kaplan VA, Sadock, BJ. Kaplan and Sadock's Synopsis of Psychiatry. 10th Ed. Lippincott, Williams & Williams; 2008. ISBN-10: 078177327X American Psychiatric Association st Desk Reference to the Diagnostic Criteria from DSM-IV-TR. 1 Ed. American Psychiatric Publishing, Inc.; 2000 ISBN-10: 0890420270 EMERGENCY MEDICINE

Required:

Ma OJ, Cline DM, Tintinalli JE, Kelen GD, Stapczynski JS th Emergency Medicine Manual. 6 Ed. McGraw-Hill Professional; 2003. ISBN-10: 0071410252

Recommended:

Buttarovoli, P nd Minor Emergencies-Splinters to Fractures. 2 Ed. Mosby Elsevier; 2010. ISBN-10 0323083463 Tintinalli J, Stapczynski J, John Ma O, Cline D, Cydulka R, Meckler G. th Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 7 Ed. McGraw-Hill Professional; 2010 ISBN-10: 0071484809 Garmel, G.M., Mahadevran, S.V. nd An Introduction to Clinical Emergency Medicine, 2 Ed. Cambridge University Press. 2006. ISBN-10: 0521542596

FAMILY MEDICINE Required:

McPhee, SJ, Papadakis, MA th Current Medical Diagnosis and Treatment 2010. 49 Ed. McGraw-Hill Lange, 2009. ISBN-10: 9780071624442 Kliegman RM, Marcdante K, Jenson H. Behrman R. th Nelson Essentials of Pediatrics, 6 Ed. Saunders; 2011. ISBN-10: 1437706436 DeCherney A, Nathan L, Goodwin TM, Laufer N. th Current Diagnosis and Treatment – Obstetrics/Gynecology. 10 Ed. McGraw-Hill Lange; 2007. ISBN-10: 0071439005

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Recommended:

Mengel, MB, Schwiebert, LP th Family Medicine Ambulatory Care and Prevention. 5 Ed. McGraw-Hill Lange; 2009. ISBN-10: 9780071494564 Kahan, S, Ashar, BH. nd Medicine In a Page. 2 Ed. Blackwell Publishing; 2009. ISBN-10: 9780781770354

GERIATRICS Required:

Ham RJ, Sloane PD, Warshaw GA, Bernard MA, Flaherty E. th Primary Care Geriatrics, A Care-Based Approach. 5 Ed. Mosby; 2006 ISBN-10: 323039308

Recommended:

Reuben DB et al. th Geriatrics at Your Fingertips, 12 Edition. American Geriatrics Society; 2010. ISBN-10: 9781886775541

INTERNAL MEDICINE Required:

Andreoli, TE, Carpenter, CCJ, Griggs, RC, Benjamin, IJ. Cecil’s Essentials of Medicine. 8th Ed. W. B. Saunders; 2011 ISBN-10: 9781416061090

Recommended:

Fauci AS et al. th Harrison’s Principles of Internal Medicine. 17 Edition. McGraw-Hill; 2008. ISBN-10: 0071466339

PEDIATRICS Required:

Kliegman RM, Marcdante K, Jenson H, Behrman R. th Nelson Essentials of Pediatrics. 6 Ed. Saunders; 2011. ISBN-10: 1437706436

SURGERY Required:

Lawrence PF, Bell RM, Dayton MT. Essentials of General Surgery. 4th Ed. Lippincott, Williams and Wilkins; 2006. ISBN-10: 0781750032 Blackbourne, LH. th Surgical Recall. 5 Ed. Lippincott, Williams and Wilkins; 2008. ISBN-10: 0781770769

Recommended:

Lawrence PF, Bell RM, Dayton MT. rd Essentials of Surgical Subspecialties. 3 Edition. Lippincott, Williams and Wilkins; 2007. ISBN-10: 0781750040 WOMEN’S HEALTH

Required:

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DeCherney A, Nathan L, Goodwin TM, Laufer N. th Current Diagnosis and Treatment - Obstetrics/Gynecology. 10 Ed. McGraw-Hill; 2006. ISBN-10: 0071439005

Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS Elective I and Elective II Rotation PASS 0749, PASS 0750 Credit Hours 4.00 (each rotation) Total Required Hours: 8.00 COURSE PURPOSE The overall educational goal for Elective Rotation I and II is for students to explore areas of medical or surgical interest in more depth and to further develop skills and knowledge toward the goal of professional PA practice. Students remain responsible for following the General Learning Objectives of core rotations. In addition, students and Preceptors are encouraged to work together to develop a unique list of objectives based upon the elective specialty to focus the student’s learning efforts on the rotation. These specialty-specific lists should emphasize conditions listed in the NCCPA content Blueprint and those within the General Learning Objectives of the MWU Clinical Handbook. Students are also encouraged to frame their experiences within the context of the Competencies for the Physician Assistant Profession as they prepare for graduation and clinical practice. COURSE COORDINATORS Soonja L. Sawyer, MS, PA-C Instructor and Clinical Coordinator [email protected]

David A. Luce, MMS, PA-C Clinical Coordinator and Assistant Professor [email protected]

Affiliated clinical Preceptors will provide rotation experiences and will participate in student assessment. Students should direct all questions regarding course administration to the PA Clinical Coordinators. COURSE TIMES/LOCATION Elective rotation II and Elective rotation II follow successful completion of all aspects of the second year of training in the PA Program, including 8 six-week core rotations in Behavioral Medicine, Emergency Medicine, Family Medicine, Geriatrics, Internal Medicine, Pediatrics, Surgery, and Women’s Health. All students must complete 2 four-week elective rotations in sequence; the electives may occur at a single clinical training site. This rotation will take place in hospital, clinic, or private practice settings in urban, suburban, or rural communities. Students are required to take call, attend conferences, provide patient presentations, and complete required readings, whether assigned by the Program or the Preceptor. REQUIRED COURSE TEXTBOOKS Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing

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COURSE REQUIREMENTS AND POLICIES This is a 4-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and satisfactorily complete all learning activities in their entirety. Please see the Policies and Procedures section of this handbook for specific details on all expectations regarding clinical rotations. EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading for elective rotations. GENERAL KNOWLEDGE OBJECTIVES During the clinical year, PA students learn to provide exceptional patient care via two major activities: 1) the evaluation and treatment of patients under the direct supervision of a Preceptor, and 2) the study of assigned medical diseases, disorders, and essential skills using required textbooks and other resources. In addition to rotation-specific objectives, these general objectives apply for every core and elective rotation. The Preceptor and PA student are asked to work together to create a list of specialty-specific objectives relevant to those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants. In addition, Preceptors may assign specialty-specific reading and/or provide additional training in skills, tasks, or procedures relevant to PA practice in that specialty. Medical History Takes and records focused histories on patients Associates patients’ complaints with their presented history Interprets history and formulates a differential diagnosis Knows and understands individual risk factors for each disease and related condition Recognizes and understands signs and symptoms associated with a specific diagnosis Physical Examination Knows and understands what constitutes an appropriate directed physical exam after eliciting a patient history Recognizes pertinent physical findings Interprets particular physical findings in order to differentiate one disorder from another Laboratory and Diagnostic Studies Selects appropriate routine or initial laboratory or diagnostic studies to help establish a diagnosis Interprets and applies results of diagnostic studies Knows and understands appropriate follow-up studies Knows and understands when diagnostic or laboratory studies are not indicated Differential Diagnosis Selects the most likely diagnosis; evaluates the differential diagnosis in light of history, physical exam, diagnostic test findings Understands the pathophysiology for the most likely diagnosis Recognizes associated disease conditions and complications Management Evaluates severity of the patient’s condition Prioritizes each patient’s conditions and makes appropriate referrals for further diagnostic assessment. Recognizes factors in the history that affect the patient’s treatment plan or prognosis Identifies and evaluates patients for whom a specific type of therapy is appropriate or inappropriate 34

Health Maintenance and Disease Prevention Knows and understands risk factors for conditions amenable to prevention or detection in an asymptomatic individual Appreciates pertinent incidence statistics among patient groups at risk, including incidence of symptoms and identifiable disorders among various groups Selects appropriate treatment, which may include preventive measures, education and medication Clinical Intervention The student demonstrates knowledge and understands: Priority in management, or medical intervention, specifically in emergency or acute cases Indications for hospital admission Appropriate discharge planning Components of a rehabilitation program Appropriate counseling of a patient or family regarding current and future problems, including risk factors related to the present encounter The importance of education for both the patient and family regarding self-care The relevant roles of allied health personnel Issues surrounding management of chronic pain, especially in terminally ill patients Recognizes and addresses the patient’s expression of fear of injury or death

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Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS Behavioral Medicine Rotation PASS 0642 Credit Hours 6.00 COURSE PURPOSE The overall educational goal for the Behavioral Medicine Rotation is to train Physician Assistant students to become competent in both knowledge and skills while providing medical care to patients in a supervised Behavioral Medicine clinical setting. Students are expected to master each of the topics listed, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacological treatment (including surgical options), complications, health maintenance, prevention, patient education and counseling. COURSE COORDINATOR David A. Luce, MMS, PA-C Assistant Professor and Clinical Coordinator [email protected]

Sandhya Noronha, MD Assistant Professor [email protected]

Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day. COURSE TIMES/LOCATION This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are responsible for assigned reading material even if those topics are not experienced on the rotation. REQUIRED COURSE TEXTBOOKS Required for all clinical rotations: Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing Required for Behavioral Health rotation: Kaplan and Sadock's Synopsis of Psychiatry. 10th Ed. Lippincott, Williams & Williams; 2008. ISBN-10: 078177327X American Psychiatric Association st Desk Reference to the Diagnostic Criteria from DSM-IV-TR. 1 Ed. American Psychiatric Publishing, Inc.; 2000 ISBN-10: 0890420270

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COURSE REQUIREMENTS AND POLICIES This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and Procedures section of this handbook for expectations regarding clinical rotations.

EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading. GENERAL KNOWLEDGE OBJECTIVES Upon completion of this rotation, the student will be able to: 1. Understand the pathophysiology, diagnosis and treatment of common psychiatric problems. 2. Develop a problem-based approach to the diagnosis and management of a wide spectrum of common (and less common) psychiatric illnesses. 3. Obtain a medical history based on the patient’s chief complaint and clinical presentation. 4. Formulate a differential diagnosis based on chief complaint, history and physical exam. 5. Master each of the topics listed in the Diseases and Disorders section of the clinical handbook, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, patient education and counseling. 6. Order, perform (or assist in the performance of), explain and interpret the labs and diagnostic procedures outlined in the Skills Section of the clinical handbook. 7. Counsel patients and family members with regards to rehabilitation therapy and side effects of psychotropic drugs as well as psychodynamic psychotherapy, psychoanalysis, supportive psychotherapy, cognitive and behavioral therapies, group therapies, couples and family therapy, psychoeducational interventions and electroconvulsive therapy. Diseases and Disorders The topics listed below are those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants and others pertinent to Behavioral Medicine. Anxiety Disorders Panic Disorder Generalized Anxiety Disorder Posttraumatic Stress Disorder Phobias

Psychoses Delusional Disorder Schizophrenia Schizoaffective Disorder Medications

Somatoform Disorders

Substance Abuse Disorders Alcohol Abuse/Dependence Drug Abuse/Dependence Tobacco Abuse

Mood Disorders Adjustment Disorders Depression Dysthymia Bipolar Disorder Medications Personality Disorders Antisocial Avoidant Borderline 38

Eating Disorders Anorexia Nervosa Bulimia Obesity Other Behavioral and Emotional Disorders Acute Reaction to Stress Child/Elder Abuse Domestic Violence

Dependent Histrionic Narcissistic Obsessive-Compulsive Paranoid Schizoid Schizotypal

Uncomplicated Bereavement

Disorders of Infancy, Childhood & Adolescence Mental Retardation Autistic Spectrum Disorder Asperger Disorder Pervasive Developmental Disorder, NOS Attention Deficit/Hyperactivity Disorder Conduct Disorder Oppositional Defiant Disorder Tourette Disorder

Cognitive Disorders Delirium Dementia Alzheimer’s Amnesic Disorders Miscellaneous Psychiatry and the Law Psychopharmacology Continuity of Care SKILLS

This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation. It is desirable that the PA student reach a performance level commensurate with his or her peers. Labs/Diagnostics Perform and/or interpret the following: Liver function tests Renal function tests Toxicology screen Procedures Order, perform and/or assist, and/or explain to patients the following procedures and tests: Formulate DSM-IV diagnosis Perform mental status examination Screen for domestic violence, suicide, and depression with the appropriate tools Chemical and/or physical restraints Patient Education/Counseling Provide patient education and counseling in the following areas: Counsel patient and family members in regards to rehabilitation therapy Work with family members to facilitate and coordinate treatment Understand the common side effects, and drug interactions of each class of psychotropic medications and demonstrate the ability to select and use these agents to treat mental disorders State the characteristics and techniques of, and common indications and contraindications for, psychodynamic psychotherapy, psychoanalysis, supportive psychotherapy, cognitive and behavioral therapies, group therapies, couples and family therapy, psychoeducational interventions, and electroconvulsive therapy

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Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS Emergency Medicine Rotation PASS 0644 Credit Hours 6.00 COURSE PURPOSE The overall educational goal for the Emergency Medicine Rotation is to train physician assistant students in all aspects of care of the emergent patient. The rotation is designed to prepare the student for triaging patients presenting for emergent care, for evaluating, managing, and stabilizing patients with acutely presenting conditions, and for performing invasive and noninvasive procedures commonly performed in the Emergency Department. COURSE COORDINATION David A. Luce, MMS, PA-C Assistant Professor and Clinical Coordinator [email protected]

James F. Gunn, MMS, PA-C Instructor [email protected]

Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day. COURSE TIMES/LOCATION This rotation will take place in an emergency department setting for 6 weeks in the clinical year. Students are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are responsible for assigned reading material even if those topics are not experienced on the rotation. REQUIRED COURSE TEXTBOOKS Required for all clinical rotations: Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing Required for Emergency Medicine Rotation th

Emergency Medicine Manual. 6 Ed. Ma OJ, Cline DM, Tintinalli JE, Kelen GD, Stapczynski JS. McGraw-Hill Professional; 2003. ISBN-10: 0071410252

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Recommended for Emergency Medicine Rotation nd

Minor Emergencies-Splinters to Fractures. 2 Ed. Buttaravoli, P. Mosby Elsevier; 2010. ISBN-10: 0323083463 nd An Introduction to Clinical Emergency Medicine. 2 Ed. Mahadevan SV, Garmel GM. Cambridge University Press; 2006. ISBN-10: 0521542596 th

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 7 Ed. Tintinalli J, Stapczynski J, John Ma O, Cline D, Cydulka R, Meckler G. McGraw-Hill Professional; 2010. ISBN-10: 0071484809 COURSE REQUIREMENTS AND POLICIES This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and Procedures section of this handbook for expectations regarding clinical rotations. EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading. GENERAL KNOWLEDGE OBJECTIVES Upon completion of this rotation, the student will be able to: 1. Understand the pathophysiology, prevention, diagnosis and treatment of common clinical conditions requiring emergent evaluation and treatment. 2. Perform a complete and focused history and physical exam as it relates to the presenting condition. 3. Order the appropriate imaging and/or laboratory studies for clinical diseases and conditions requiring emergent evaluation. 4. Appropriately interpret laboratory and imaging abnormalities that indicate the necessity for emergent care and/or surgical intervention. 5. Demonstrate the skills and knowledge required for basic life support and advanced cardiac life support. 6. Master each of the topics listed in the Diseases and Disorders Section of the clinical handbook, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacological treatment (including surgical options), complications, patient education and counseling. 7. Perform or assist in the performance of and interpret and explain the labs, diagnostic procedures outlined in the Skills Section of the clinical handbook.

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DISEASES AND DISORDERS The topics listed below are those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants and others pertinent to Emergency Medicine. The Eye, Ear, Nose & Throat Eye Disorders Acute-angle glaucoma Blowout fracture Chronic glaucoma Conjunctivitis Corneal Abrasion Dacryoaedenitis Diabetic Retinopathy Hypertensive Retinopathy Hyphema Iritis Orbital Cellulitis Retinal Detachment Retinal Vascular Occlusion Temporal Arteritis Chemical Eye Burns Red Eyes

Ear Disorders Barotrauma Presbycusis Tympanic Membrane Perforation Nose/Sinus Disorders Epistaxis Nasal Fractures Foreign Bodies Mouth/Throat Disorders Peritonsillar Abscesses Airway Management Dental Abscess Foreign Bodies

Dermatologic System Desquamation Stevens-Johnson syndrome Toxic epidermal necrolysis

Insects/Parasites Spider bites

Other Burns Urticaria Angioedema/Anaphylaxis The Pulmonary System Infectious Disorders Pneumonia Tuberculosis Pleural Diseases Acute Pulmonary Edema Pleural Effusion Pneumothorax

Obstructive Pulmonary Diseases Asthma Other Pulmonary Disease Foreign Body Aspiration Near Drowning

Pulmonary Circulation Pulmonary Embolism

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The Cardiovascular System Conduction Disorders Atrial Fibrillation and Flutter Atrioventricular Block Bradycardia Bundle Branch Block Paroxysmal Supra-Ventricular Tachycardia Premature Beats Ventricular Tachycardia Ventricular Fibrillation & Flutter

Ischemic Heart Disease Acute Myocardial Infarction

Congestive Heart Failure

Vascular Disease Aortic Aneurysm/Dissection Arterial Embolism/Thrombosis Chronic/Acute Arterial Occlusion Venous Thrombosis

Hypertension Malignant Hypotension Cardiogenic Shock

Angina Pectoris Stable Unstable Variant Cardiac Death (SCD) Acute Coronary Syndromes

Other Forms of Heart Disease Cardiac Tamponade Pericardial Effusion Pericarditis Syncope Endocarditis Anaphylaxis Chest Pain

The Gastrointestinal/Nutritional System Esophagus Mallory Weiss Tear Esophageal Varices

Small Intestine/Colon Appendicitis Diverticulosis Diverticulitis Obstruction Toxic Megacolon

Stomach Ulcer Disease Peptic Duodenal Pancreas Acute Pancreatitis Liver Hepatitis Acute Liver Failure Rectum Pilonidal disease Anorectal abscess/fistula

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Other Abdominal Pain Diarrhea Gall Bladder Disease Gastrointestinal Bleeding Splenic Rupture Ulcerative Colitis Vomiting/Diarrhea/Constipation

The Renal/Genitourinary System Renal Diseases Acute/Chronic Renal Failure Infectious/Inflammatory Conditions Pyelonephritis Urinary tract infections

Benign Conditions of the GU Tract Nephro/Urolithiasis Paraphimosis/phimosis Testicular Torsion

The Musculoskeletal System Disorders of the Shoulder Fractures/Dislocations/ Separations Rotator Cuff Disorders Sprain/Strain

Disorders of the Forearm/Wrist/Hand Fractures/Dislocations Boxer’s Colles’ Gamekeeper’s Thumb Humeral Nursemaid’s Elbow Scaphoid Sprains/Strains Tenosynovitis Carpal Tunnel Syndrome de Quervain’s Tenosynovitis Elbow tendonitis Epicondylitis

Disorders of the Back/Spine Spinal Cord Injuries Low Back Pain

Disorders of the Hip/Pelvis Aseptic Necrosis Fractures/Dislocations Disorders of the Knee Meniscal Injuries Fractures/Dislocations Knee trauma Disorders of the Ankle/Foot Fractures/Dislocations Sprains/Strains

Other Clavicular Fractures Salter-Harris classification

The Neurologic System Diseases of Peripheral Nerves Bell’s Palsy Headaches Cluster Migraine Tension

Infectious Disorders Encephalitis Meningitis

Seizure Disorders Status Epilepticus Generalized Convulsive Disorder Generalized Nonconvulsive Disorder Vascular Diseases Transient Ischemic Attack Cerebral Aneurysm Stroke Other Altered Mental Status Head Injury Concussions Intracerebral Hemorrhage Syncope Vertigo/Dizziness

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The Endocrine System Diseases of the Thyroid Gland Hyperthyroidism Hypothyroidism Adrenal Crisis Addisons

Diabetes Type I Type II Diabetic Ketoacidosis Hypoglycemia Hyperglycemia

Psychiatry/Behavioral Science Other Behavior/Emotional Disorders Child/Elder Abuse Domestic Violence Suicidal Ideation

Substance Use Disorders Alcohol abuse/dependence Drug Overdose/Toxicity Eating Disorders Anorexia nervosa Bulemia

Infectious Diseases Fungal Disease Pneumocystis

Parasitic Disease Amebiasis

Bacterial Disease Diphtheria Shigellosis Tetanus Salmonellosis Chlamydial Infection

Spirochetal Disease Syphilis Lyme Borreliosis Rocky Mountain Spotted Fever

Mycobacterial Disease Tuberculosis Atypical Mycobacterial Disease

Viral Diseases Rabies Condylomata Acuminata Rotavirus Human Immunodeficiency Virus

Other Sepsis Herpetic Whitlow Osteomyelitis The Hematologic System Anemias Sickle Cell Disease Iron Deficiency Coagulation Disorders Factor VIII Disorders Factor IX Disorders Factor XI Disorders Disseminated Intravascular Coagulopathy (DIC)

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Thrombocytopenia Von Willebrand’s Disease Idiopathic Thrombocytopenic Purpura Thrombotic Thrombocyotopenic Purpura

The Reproductive System Complicated Pregnancy Pregnancy Induced Hypertension Ectopic pregnancy Postpartum hemorrhage Abortion Abruptio placentae

Uterus Dysfunctional Uterine Bleeding Pelvic Inflammatory Disease

Miscellaneous Wound Management Basic suture techniques Anesthesia and regional blocks

Chemical Warfare Biotoxins Ricin Blister Agents Mustard Gas Blood Agents Cyanide Choking Agents Chlorine Phosgene Nerve Agents Sarin Tabun Organophosphate

Biological Warfare Anthrax Botulism Plague Smallpox Tularemia Viral Hemorrhagic Fevers Other Poisoning Anaphylaxis Bite Injury SKILLS

This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation. It is desirable that the PA student reach a performance level commensurate with his or her peers. Labs/Diagnostics Perform and/or interpret the following: Radiographs: limb, spine, KUB, etc. MRI and CT ECG Urinalysis – routine, microscopic Venipuncture for CBC, electrolytes, blood chemistries and cultures IV therapy indications for various IV fluids Procedures Order, perform and/or assist, and/or explain to patients the following procedures and tests: Cardioversion Cardiopulmonary resuscitation Endotracheal intubation Cricothyroidectomy Defibrillation Cardioversion ACLS protocols Gastric lavage Urinary bladder catheter Various intravenous catheters Central line placement – subclavian, internal jugular and femoral 47

Suture lacerations Venous and arterial blood samples Lumbar puncture Local anesthesia Short arm, long arm, long leg, and short leg splints Immobilization techniques Patient Education/Counseling Provide patient education and counseling in the following areas: medication compliance

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Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS Family Medicine Rotation PASS 0645 Credit Hours 6.00 COURSE PURPOSE The overall educational goal for the Family Medicine Rotation is to train physician assistant students in all aspects of continuing and comprehensive primary health care. The student learns to care for patients of both genders, all ages, and all diseases from many different cultural and economic backgrounds. More than any other specialty, family medicine is holistic and blends biological, clinical and behavioral sciences. COURSE COORDINATOR David A. Luce, MMS, PA-C Assistant Professor and Clinical Coordinator [email protected] Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day. COURSE TIMES/LOCATION This rotation will take place in clinic or private practice settings for 6 weeks in the clinical year. When the family practice setting includes the Preceptor making hospital rounds, students are required to participate. Students are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are responsible for assigned reading material even if those topics are not experienced on the rotation. REQUIRED COURSE TEXTBOOKS Required for all clinical rotations: Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing Required for Family Medicine Rotation: McPhee, SJ, Papadakis, MA th Current Medical Diagnosis and Treatment 2010. 49 Ed. McGraw-Hill Lange, 2009. ISBN: 978-0-07-162444-2 Marcdante K, Kliegman RM, Behrman R. th Nelson Essentials of Pediatrics, 6 Ed. Saunders; 2011. ISBN-13: 978-1-4377-0643-7 49

DeCherney A, Nathan L, Goodwin TM, Laufer N. th Current Diagnosis and Treatment – Obstetrics/Gynecology. 10 Ed. McGraw-Hill Lange; 2007. ISBN-10: 0071439005 Recommended for Family Medicine Rotation: Mengel, MB, Schwiebert, LP th Family Medicine Ambulatory Care and Prevention. 5 Ed. McGraw-Hill Lange; 2009. ISBN-13: 9780071494564 Kahan, S, Ashar, BH. nd Medicine In a Page. 2 Ed. Blackwell Publishing; 2009. ISBN: 9780781770354

COURSE REQUIREMENTS AND POLICIES This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and Procedures section of this handbook for expectations regarding clinical rotations. EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading.

GENERAL KNOWLEDGE OBJECTIVES Upon completion of this rotation, the student will be able to: 1.

2.

3. 4.

5. 6.

7.

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Recognize the importance of preventive care in family medicine and demonstrate counseling and the delivery of patient education in nutrition, exercise, smoking cessation, and participating in regular health-maintenance visits. Describe the pathophysiology, prevention, diagnosis and treatment of common medical problems in primary care including episodic illness and chronic disease management such as diabetes, hypertension, dyslipidemia, and global health issues. Perform and interpret routine screening evaluations and diagnostic tests for the common primary malignancies encountered in primary care. Recognize psycho-social issues that impact patients in primary care such as alcoholism, substance abuse, smoking, domestic violence, anxiety and depression, sedentary lifestyle, and personal and family stress. Demonstrate competence in clinical problem solving in the clinical care of children, women, and men of all ages from a variety of cultural and economic backgrounds. Demonstrate proficiency in each of the topics listed in the Disease and Disorders section of the clinical handbook. Particular attention should be given to the etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacologic treatment (including surgical intervention), complications, patient education and counseling. Perform or assist in the performance of and interpret and explain labs, diagnostic procedures outlined in the Skills Section of the clinical handbook.

Diseases and Disorders The topics listed below are those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants and others pertinent to Family Medicine. Dermatological System Eczematous Eruptions Dermatitis Atopic Contact Nummular eczematous Perioral Seborrheic Stasis Dyshidrosis Lichen simplex chronicus Acneiform Lesions Acne vulgaris Rosacea Folliculitis Papulosquamous Diseases Dermatophyte infections Tinea versicolor Tinea corporis/pedis Drug eruptions Lichen planus Pityriasis rosea Psoriasis Desquamation Stevens-Johnson syndrome Toxic epidermal necrolysis Erythema multiforme Verrucous Lesions Seborrheic keratosis Actinic keratosis

Neoplasms Basal cell carcinoma Melanoma Squamous cell carcinoma Hair and Nails Alopecia areata Androgenetic alopecia Onychomycoses Paronychia Bacterial Infections Cellulitis Erysipelas Impetigo Viral Diseases Exanthems Herpes simplex Molluscum contagiosum Verrucae Varicella-zoster virus infections Other Acanthosis nigricans Hidradenitis suppurativa Urticaria Vitiligo

Eye, Ear, Nose and Throat Eye Disorders Blepharitis Cataract Chalazion Conjunctivitis Ectropion Entropion Glaucoma Hordeolum Pterygium

Nose/Sinus Disorders

Acute/chronic sinusitis Rhinitis Ear Disorders Acute/chronic otitis media Hearing impairment Labyrinthitis Otitis externa Vertigo

Mouth/Throat Disorders Acute pharyngitis Laryngitis 51

Oral candidiasis Oral herpes simplex

Sialadenitis

The Pulmonary System Infectious Disorders Acute bronchitis Influenza Pneumonias

Obstructive Pulmonary Disease Asthma Restrictive Pulmonary Disease Idiopathic pulmonary fibrosis Pneumoconiosis Sarcoidosis

Cardiovascular System Hypertrophic cardiomyopathy Hypertension Essential Secondary Hypotension Orthostasis/postural

Valvular Disease Aortic stenosis/insufficiency Mitral stenosis/insufficiency Mitral valve prolapse Tricuspid stenosis/insufficiency Pulmonary stenosis/insufficiency

Conduction Disorders Atrial fibrillation/flutter Atrioventricular block Bundle branch block Paroxysmal supraventricular tachycardia PACs PVCs

Ischemic Heart Disease Angina pectoris Stable Unstable Prinzmetal’s/variant

Congestive Heart Failure

Other Conditions Acute pericarditis Acute rheumatic fever Giant cell arteritis

Peripheral vascular disease Acute/chronic arterial occlusion Venous insufficiency Phlebitis/thrombophlebitis Varicose veins Gastrointestinal System Liver Acute/chronic hepatitis Metabolic Disorders Lactose intolerance

Rectum Anal fissure Hemorrhoids Gallbladder Acute/chronic cholecystitis Cholelithiasis Cholangitis Small Intestine/Colon Constipation Diverticular disease Irritable bowel syndrome Infectious Diarrhea

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Upper GI Esophagitis Gastroesophageal reflux disease Gastritis Peptic ulcer disease

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Urinary/Renal System Conditions affecting Males Prostatitis Benign prostatic hyperplasia Erectile dysfunction Infertility Contraception options Epididymitis Orchitis Testicular torsion Hydrocele/varicocele Nephro/urolithiasis Infectious/Inflammatory Conditions Cystitis Pyelonephritis Urethritis Renal Diseases Glomerulonephritis Nephrotic syndrome Polycystic kidney disease Musculoskeletal System Osteoarthritis Osteoporosis Bursitis Disorders of the Back/Spine Back strain/sprain Cauda equina Herniated nucleus pulposus Kyphosis/scoliosis Low back pain Disorders of the Ankle/Foot Sprains/strains Disorders of the Knee Meniscal injuries Sprains/strains Disorders of the Shoulder Rotator cuff disorders Adhesive capsulitis/frozen shoulder Disorders of the Forearm/Wrist/Hand Tenosynovitis De Quervain’s tenosynovitis Elbow tendonitis Epicondylitis

Rheumatologic Conditions Ankylosing spondylitis

Fibromyalgia Gout/pseudogout Polyarteritis nodosa Polymyositis Polymyalgia rheumatica Reactive arthritis (Reiter's syndrome) Rheumatoid arthritis Systemic lupus erythematosus Scleroderma

Neurological System Diseases of Peripheral Nerves Bell's palsy Trigeminal neuralgia Carpal tunnel syndrome Tarsal tunnel syndrome Headaches Cluster headache Migraine Tension headache Seizure Disorders Generalized convulsive disorder Generalized nonconvulsive disorder Endocrine System Hyperthyroidism Hypothyroidism Thyroiditis Diabetes mellitus Type 2 Hypoglycemia Hypercholesterolemia Hypertriglyceridemia

Infectious Disease Candidiasis Botulism Chlamydia Cholera Diphtheria Gonococcal infections Salmonellosis Shigellosis Tetanus Tuberculosis Amebiasis Nematode infections/infestations

Toxoplasmosis Lyme borreliosis/disease Rocky Mountain spotted fever Syphilis Epstein-Barr virus infections Herpes simplex HIV infection Influenza Varicella-zoster virus infections Hepatitis A Malaria

Hematological System Iron deficiency anemia Thalassemia Sickle cell anemia 55

Malignancies (clinical features, diagnosis) Acute/chronic lymphocytic leukemia Acute/chronic myelogenous leukemia Lymphoma Multiple myeloma Psychiatric/Behavioral Conditions Anxiety disorders Depressive disorders Substance abuse/addiction Domestic/intimate partner/child/elder abuse/violence Uncomplicated bereavement SKILLS This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation. It is desirable that the PA student reach a performance level commensurate with his or her peers. Lab/Diagnostics Perform and interpret the following: ECG KOH and mineral oil skin preps Cervical cancer screening Wet mount/pH assessment of vaginal fluids Throat culture and rapid strep testing TB testing (skin, blood, sputum, urine) Stool testing-ova and parasites Stool hemoccult Urinalysis Venipuncture Joint fluid analysis Wound cultures Peak flow assessments Tests for STIs Order and evaluate reported findings: Radiographs – chest, KUB, GI, head, C-spine, L-S spine, hip, extremities and contrast studies Mammogram and breast ultrasound Ultrasound studies – GI, GU, MS, CV (including Echocardiography) DEXA scan Nuclear medicine reports CT (CTA) MRI (MRA) Pulmonary function tests Audiometry Procedures Order, perform and/or assist, and/or explain to patients the following procedures and tests: Anoscopy, proctoscopy, sigmoidoscopy, colonoscopy Assessment of urinary problems, bladder aspiration, catheterization, tests for urinary incontinence Dermatologic procedures: skin biopsies, cryotherapy, tissue destruction, use of Wood’s lamp Ear irrigation Visual acuity assessments Fluorescein eye staining and irrigation Injections: intramuscular, subcutaneous, and intradermal Arthrocenteses/joint injection Nebulizer treatments 56

Splinting extremities Tonometry Tympanography Audiometry Patient Education/Counseling Provide patient education and counseling in the following areas: Nutrition evaluation and initial diet recommendations Physical activity/exercise recommendations Substance abuse, safety counseling Intimate partner/domestic/child and elder abuse End-of-life issues Family history and interpretation of the pedigree Immunization schedules Desensitization to allergens Preconception care/Family Planning

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Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS Geriatric Medicine Rotation PASS 0646 Credit Hours 6.00 COURSE PURPOSE The overall educational goal for the Geriatric Medicine Rotation is to train physician assistant students in all aspects of health care as it relates to the geriatric population. The rotation is designed to prepare students to identify the physiological, behavioral, psychological, and social changes associated with aging, manage acute medical illnesses, recognize common chronic disease processes specific to the elderly, and to perform exams and procedures with proficiency and skill. COURSE COORDINATOR Soonja L. Sawyer, MS, PA-C Instructor and Clinical Coordinator [email protected] Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day. COURSE TIMES/LOCATION This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are responsible for assigned reading material even if those topics are not experienced on the rotation. REQUIRED COURSE TEXTBOOKS Required for all clinical rotations: Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing Required for Geriatrics Rotation: th

Primary Care Geriatrics, A Care-Based Approach. 5 Ed. Ham RJ, Sloane PD, Warshaw GA, Bernard MA, Flaherty E. Mosby; 2006 ISBN-10: 323039308 Recommended: th

Geriatrics At Your Fingertips. 12 Edition. Reuben DB, Herr KA, Pacala JT, Pollack BG, Potter JF, Semla TP. American Geriatric Society; 2010 ISBN-10: 9781886775541 59

COURSE REQUIREMENTS AND POLICIES This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and Procedures section of this handbook for expectations regarding clinical rotations. EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading. GENERAL KNOWLEDGE OBJECTIVES Upon completion of this rotation, the student will be able to: 1. Understand the physiological, behavioral, and psychological changes associated with aging. 2. Recognize the common chronic medical conditions affecting older persons including diseases affecting cognition and mood. 3. Recognize the importance of preventive care, health maintenance, recommended immunizations, and patient education and counseling in older persons. 4. Understand the effects of medication dosing regimens in older persons with respect to nutritional status and organ function. 5. Recognize psycho-social issues that impact older persons, such as living conditions, sources of social support, disability, and loss of independence. 6. Understand the appropriate management of a terminally ill patient including hospice care, pain control, and symptom management. 7. Understand the importance of advance directives and medical power of attorney. 8. Master each of the topics listed in the Diseases and Disorders Section of the clinical handbook, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacological treatment (including surgical options), complications, patient education and counseling. 9. Perform or assist in the performance of and interpret and explain the labs, diagnostic procedures outlined in the Skills Section of the clinical handbook.

Diseases and Disorders The topics listed below are those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants and others pertinent to Geriatric Medicine. The Dermatological System Verrucous Lesions Actinic Keratosis Seborrheic Keratosis Viral Diseases Zoster/Varicella

Neoplasms Basal Cell Melanoma Squamous Cell 60

Hair and Nails Onychomycosis Paronychia

Bacterial Infections Cellulitis/Vasculitis

Decubitus Ulcers/Leg Ulcers Vesicular Bullae Bullous Pemphigoid

The Eye, Ear, Nose & Throat Eye Disorders Cataracts Acute-angle glaucoma Chronic glaucoma Diabetic Retinopathy Macular Degeneration

Ear Disorders Cerumen Impaction Hearing Impairment Presbycusis Vertigo

The Pulmonary System Infectious Disorders Acute Bronchitis Influenza Pneumonias Aspiration Bacterial Viral

Obstructive Pulmonary Disease Asthma Chronic Bronchitis Emphysema Pulmonary Embolism

The Cardiovascular System Cardiomyopathy Dilated Hypertrophic Restrictive

Hypotension Orthostatic/Postural

Ischemic Heart Disease Acute Myocardial Infarction Angina Pectoris Stable Unstable Variant

Congestive Heart Failure

Conduction Disorders Atrial Fibrillation and Flutter Paroxysmal Supraventricular Tachycardia

Peripheral Vascular Disease Carotid Stenosis Giant Cell Arteritis

Hypertension Essential Secondary Malignant

The Gastrointestinal/Nutritional System Esophagus Esophagitis GERD Stomach Gastritis Neoplasm Peptic Ulcer Disease

Nutritional deficiencies Niacin Thiamine Vitamin A All B Vitamins Vitamin C Vitamin D Vitamin K

Pancreas Neoplasm Small Intestine/Colon Constipation Diverticular Disease Neoplasm Ischemic Bowel Disease

Gallbladder Cholelithiasis Cholecystitis

Rectum Fecal Impaction Hemorrhoids 61

The Genitourinary System Benign Conditions-GU Tract Benign Prostatic Hypertrophy Incontinence Nephrolithiasis Urethrolithiasis Renal Diseases Acute/Chronic Renal Failure Neoplasm

Infectious/Inflammatory Conditions Cystitis Prostatitis Pyelonephritis Urethritis Prostate Cancer Bladder Cancer

The Musculoskeletal System Disorders of the Shoulder Fractures/Dislocations Rotator Cuff Disorders Separations Sprain/Strain Frozen Shoulder

Disorders of the Back/Spine Back Strain/Sprain Low Back Pain (Lumbago) Spinal Stenosis Kyphosis

Rheumatologic Conditions Fibromyalgia Gout/Pseudogout Paget’s Disease Polymyalgia Rheumatica Rheumatoid Arthritis Systemic Lupus Erythematosus Disorders of the Hip Fractures/Dislocations Disorders of the Knee Sprains/Strains Bursitis

Osteoporosis Osteoarthritis

The Neurologic System Dementias Alzheimer’s Disease Vascular Dementia Dementia of Lewy Body Type Pick’s Disease Normal Pressure Hydrocephalus

Vascular Diseases Cerebral Aneurysm Stroke Transient Ischemic Attacks (TIA)

Delirium

Movement Disorders Essential Tremor Parkinson’s Disease

Seizure Disorders Generalized Convulsive Generalized Non-convulsive Status Epilepticus Syncope The Endocrine System Diabetes Mellitus Type 1 Type 2

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Hypothyroidism Hypoglycemia

The Hematologic System Anemias Iron Deficiency B12 Deficiency Folate Deficiency Hemolytic Anemia

Malignancies Acute/Chronic Myeloid Leukemia Acute/Chronic Lymphoid Leukemia Lymphoma Multiple Myeloma

The Reproductive System Breast Cancer

Menopause

Psychiatry Anxiety Depression Other Behavioral/Emotional Disorders Acute Reaction to Stress Elder Abuse Domestic Violence Uncomplicated Bereavement Infectious Diseases Bacterial Diseases Community-Acquired Pneumonia Nosocomial Pneumonia

Viral Diseases HIV Influenza

Mycobacterial Diseases Atypical Mycobacterium Tuberculosis Skills This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation. It is desirable that the PA student reach a performance level commensurate with his or her peers. Order, perform, and/or interpret the following labs and diagnostic tests: Arterial puncture for arterial blood gases ECG Mental status examination Nutritional assessment PPD Rapid strep testing Sputum cultures Stool testing – ova & parasites, hemoccult Urinalysis, routine and microscopic Venipuncture for CBC, electrolytes, blood serum chemistries and cultures Wound cultures IV therapy–indications for various IV fluids (D5, Ringer’s lactate, D5W, NS, hypotonic/hypertonic saline) Routine radiographs – chest, KUB, GI, back, C-spine and extremity, including contrast studies Nuclear medicine read outs – CT, MRI, PET Pulmonary function tests Order, perform and assist, and/or explain to patients the following procedures: Anoscopy, proctoscopy, sigmoidoscopy, colonoscopy Bladder catheter insertion/removal 63

Bone marrow biopsy Cardioversion Cardiopulmonary resuscitation Central Line placement – subclavian, femoral, internal jugular Dermatologic procedures - shave and punch biopsies, cryotherapy, and application of podophyllin or bi/trichloroacetic acid Snellen eye chart Fluorescein staining of eye and irrigation Intravenous line insertion Joint injection/aspiration Lumbar puncture Nutritional support Nasogastric tube insertion Paracentesis Thoracocentesis Tonometry – Schiotz Tracheostomy Tympanogram Patient Education/Counseling Exercise/physical activity recommendations Nutrition – low fat, low cholesterol, weight reduction, diabetic and low salt diet Preparation for x-ray studies/special testing General age-associated changes in physiology in geriatrics Drug therapies unique for the geriatric patient Evaluation and prevention of falls Hazards of hospitalization of the elderly Problems associated with immobility Nursing home care and home care of the elderly patient

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Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS Internal Medicine Rotation PASS 0641 Credit Hours 6.00 COURSE PURPOSE The overall educational goal for the Internal Medicine Rotation is to train physician assistant students in all aspects of care for the adult patient and to guide them in their evolution into respectful and professional health care providers in the setting of a general medical practice. The rotation is designed to prepare students to care for adults with common clinical problems in the ambulatory and/or hospital setting, to do so with respect and sensitivity, and to perform necessary exams and procedures with proficiency and skill. COURSE COORDINATOR Soonja L. Sawyer, MS, PA-C Instructor and Clinical Coordinator [email protected]

Lendell Richardson, MD Medical Director and Assistant Professor [email protected]

Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day. COURSE TIMES/LOCATION This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are responsible for assigned reading material even if those topics are not experienced on the rotation. REQUIRED COURSE TEXTBOOKS Required for all clinical rotations: Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing Required for Internal Medicine Rotation: th

Cecil Essentials of Medicine, 8 Ed. Andreoli, TE, Carpenter, CCJ, Griggs, RC, Benjamin, IJ. Saunders, 2011 ISBN-10: 9781416061090 Recommended for Internal Medicine Rotation: th

Harrison’s Principles of Internal Medicine, 17 Edition Fauci, AS, et al McGraw-Hill, 2008 ISBN-10: 9780071466332 65

COURSE REQUIREMENTS AND POLICIES This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and Procedures section of this handbook for expectations regarding clinical rotations. EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading. GENERAL KNOWLEDGE OBJECTIVES Upon completion of this rotation, the student will be able to: 1. Recognize the importance of preventive care in the health of the adult patient. 2. Demonstrate the ability to counsel and educate patients in order to promote health and prevent disease (or better manage disease, once established). 3. Understand the pathophysiology, prevention, diagnosis and treatment of common medical problems in the care of the adult patient. 4. Develop a problem-based approach to the diagnosis and management of a wide spectrum of common (and less common) acute and chronic adult illnesses. 5. Obtain a focused, relevant medical history and perform a focused physical examination based on the patient’s chief complaint and clinical presentation. 6. Formulate a differential diagnosis based on chief complaint, history and physical exam. 7. Master each of the topics listed in the Diseases and Disorders section of the clinical handbook, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacologic treatment (including surgical options), complications, patient education and counseling. 8. Order, perform (or assist in the performance of), explain and interpret the labs and diagnostic procedures outlined in the Skills Section of the clinical handbook. Diseases and Disorders The topics listed below are those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants and other topics pertinent to Internal Medicine.

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The Eye, Ear, Nose & Throat Eye Disorders Retinopathy Diabetic Hypertensive Macular degeneration Iritis Keratitis

Ear Disorders Mastoiditis Ménière’s Disease Vertigo Mouth/Throat Disorders Oral leukoplakia

The Pulmonary System Infectious Diseases Pneumonias Tuberculosis

Pulmonary Circulation Cor pulmonale Pulmonary Embolism Pulmonary Hypertension

The Pulmonary System (cont) Pleural Diseases Pleural Effusion

Neoplastic Disease Bronchogenic Carcinoid Tumors Metastatic Tumors Pulmonary Nodules

Restrictive Pulmonary Disease Idiopathic Pulmonary Fibrosis Sarcoidosis Obstructive Pulmonary Disease Bronchiectasis Chronic Bronchitis Emphysema

Other Pulmonary Disease ARDS

The Dermatologic System Vesicular Bullae Bullous pemphigoid Pemphigus vulgaris The Cardiovascular System Cardiomyopathy Dilated Hypertrophic Restrictive Peripheral Vascular Disease Phlebitis and Thrombophlebitis Venous Thrombosis Varicose Veins

Angina Pectoris Stable Unstable Variant Ischemic Heart Disease Acute Myocardial Infarction Acute Coronary Syndrome Hypotension Orthostatic/Postural

Hypertension Essential Secondary Malignant

Valvular Disease Tricuspid Stenosis/Insufficiency Pulmonary Stenosis/Insufficiency 67

Congestive Heart Failure

Aortic Stenosis/Insufficiency Mitral Stenosis/Insufficiency Mitral Valve Prolapse

Other Forms of Heart Disease Endocarditis Myocarditis Conduction Disorders Atrial Fib./Flutter Atrioventricular Block Bundle Branch Block Supraventricular Tachycardia V. fib/V. tach

Vascular Disease Arterial Embolism and Thrombosis Chronic/Acute Arterial Occlusion Giant Cell Arteritis

The Gastrointestinal/Nutritional System Esophagus Esophagitis Motility Disorders Mallory-Weiss Tear Neoplasms Strictures Varices

Small Intestine/Colon Inflammatory Bowel Disease Irritable Bowel Syndrome Neoplasms Polyps Obstruction Toxic Megacolon

Stomach Gastritis Neoplasms Peptic Ulcer Disease GERD

Infectious Diarrhea

Liver Acute/Chronic Hepatitis Cirrhosis Neoplasms

Nutritional Deficiencies Niacin Thiamine Vitamin A All B vitamins Vitamin C Vitamin D Vitamin K

Pancreas Acute/Chronic Pancreatitis Neoplasms

Metabolic Disorders Lactose Intolerance Celiac Sprue

Gallbladder

The Genitourinary System Renal Disease Acute Renal Failure Chronic Renal Failure Nephrotic Syndrome Polycystic Kidney Disease

Benign Conditions of the GU Tract Benign Prostatic Hyperplasia Erectile Dysfunction Incontinence

Electrolyte and Acid/Base Disorders Hypo/hypernatremia Hypo/hyperkalemia Hypo/hypercalcemia Hypomagnesemia Metabolic alkalosis/acidosis Respiratory alkalosis/acidosis Volume depletion Volume excess SIADH

The Musculoskeletal System Disorders of Back/Spine Ankylosing Spondylitis Back Strain/Sprain 68

Osteoporosis Rheumatologic Conditions

Cauda Equina Herniated Disc Pulposus Low Back Pain (Lumbago) Spinal Stenosis

Fibromyalgia Gout/Pseudogout Polyarteritis Nodosa Polymyositis Polymyalgia Rheumatica Reiter’s Syndrome

The Musculoskeletal System (cont) Infectious Acute/Chronic Osteomyelitis Septic Arthritis Osteoarthritis

Rheumatologic Conditions (cont) Rheumatoid Arthritis Systemic Lupus Erythematosus Scleroderma Sjogren’s Syndrome

The Neurologic System Alzheimer’s Disease Movement Disorders Essential Tremor Huntington’s Chorea Parkinson’s Disease Multiple Sclerosis

Diseases of Peripheral Nerves Diabetic Peripheral Neuropathy Guillian-Barré Syndrome Myasthenia Gravis Trigeminal Neuralgia Vascular Diseases Cerebral Vascular Accident Transient Ischemic Attacks Cerebral Aneurysm

The Endocrine System Thyroid Disease Hyperparathyroidism Hypoparathyroidism Hyperthyroidism Graves’ Disease Thyroid Storm Hypothyroidism Thyroiditis Hashimoto’s Thyroiditis Thyroid Neoplasm

Lipid Disorders Hypercholesterolemia Hypertriglyceridemia

Pituitary Gland Disease Acromegaly/Gigantism Dwarfism

Diseases of the Adrenal Glands Cushing’s Syndrome Adrenocortical Insufficiency

Diabetes Insipidus Diabetes Mellitus Type 1 Type 2 Hypoglycemia

Infectious Diseases Fungal Disease Candidiasis Cryptococcosis Histoplasmosis Pneumocystis Carinii Gram Positive Bacteria Botulism Gram Negative Bacteria Cholera

Parasitic Disease Amebiasis Hookworms Malaria Toxoplasmosis

Spirochetal Disease Lyme Borreliosis Rocky Mountain Spotted Fever Syphilis 69

Chlamydial Infection Gonococcal Infections Gram Negative Bacteria (cont) Salmonellosis Shigellosis Mycobacterial Disease Tuberculosis Atypical Disease

Viral Diseases CMV Infections Epstein-Barr Infections Human Immunodeficiency Virus Epstein-Barr Infections Human Papilloma Virus Influenza Varicella-Zoster Infections

The Hematologic System Anemias Aplastic Anemia B12 Deficiency Folate Deficiency Iron Deficiency Thalassemia G6PD Deficiency Hemolytic Coagulation Disorders Factor V Leiden Factor VII Deficiency Factor VIII Deficiency Factor IX Deficiency Factor XI Deficiency Factor XII Deficiency Factor XIII Deficiency Disseminated Intravascular Coagulation

Disorders of Platelet Number or Function Idiopathic Thrombocytopenic Purpura Thrombotic Thrombocytopenic Purpura Von Willebrand’s Disease Thrombocytopenia Malignancies Acute Lymphoblastic Leukemia Chronic Lymphocytic Leukemia Acute/Chronic Myelogenous Leukemia Multiple Myeloma Lymphoma

SKILLS It is desirable that the PA student reaches a performance level in primary care/family medicine commensurate with his/her peers. This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation.

Labs/Diagnostics Perform and interpret the following: Arterial puncture for arterial blood gases ECG KOH preps PPD Rapid strep testing Sputum cultures Stool testing – ova & parasites, hemoccult Urinalysis, routine and microscopic Venipuncture for CBC, electrolytes, blood serum chemistries and cultures Wet mount Labs/Diagnostics (cont) Wound cultures 70

IV therapy-indications for various IV fluids (D5, Ringer’s lactate, D5W, NS, hypotonic and hypertonic saline) Routine X-ray studies-chest, KUB, GI, back, C-spine, and extremity, including contrast studies Nuclear medicine read outs-CT, MRI Pulmonary function tests Procedures Order, perform (and/or assist), explain to patients, and interpret the following procedures and tests: Anoscopy, proctoscopy, sigmoidoscopy, colonoscopy Bladder catheter insertion/removal Bone marrow biopsy Cardioversion Cardiopulmonary resuscitation Central line placement-subclavian, internal jugular and femoral Dermatologic procedures: shave and punch biopsies, cryotherapy, application of podophyllin or bi/trichloroacetic acid Ear irrigation Endotracheal tube insertion Snellen eye chart reading Eye staining and irrigation Injections: intramuscular and subcutaneous Intravenous line insertion Joint injection/aspiration Lumbar puncture Nasogastric tube insertion Paracentesis Thoracocentesis Tonometry-Schiotz Tracheostomy Tympanogram Patient Education/Counseling Provide patient education and counseling in the following areas: Exercise program Medication Common primary-care medical conditions (acute & chronic): Diabetes Hypertension Hypercholesterolemia Family planning/Contraception Infection prevention Nutrition: low fat, low cholesterol, weight reduction, diabetic and low salt Preparation for x-ray studies/special testing

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Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS Pediatric Medicine Rotation PASS 0648 Credit Hours 6.00 COURSE PURPOSE The overall educational goal for the Pediatrics Rotation is to train physician assistant students in all aspects of medical care for children and adolescents and to guide the student in developing the medical, technical, and interpersonal skills needed to provide competent, respectful, and professional care for the pediatric patient and his or her parent(s) or guardian(s). COURSE COORDINATORS Soonja L. Sawyer, MS, PA-C Instructor and Clinical Coordinator [email protected]

Alyson L. Smith, MS, PA-C Program Director and Associate Professor [email protected]

Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day. COURSE TIMES/LOCATION This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are responsible for assigned reading material even if those topics are not experienced on the rotation. REQUIRED COURSE TEXTBOOKS Required for all clinical rotations: Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing Required for Pediatrics Rotation: th

Nelson Essentials of Pediatrics, 6 Edition Kliegman RM, Marcdante K, Jenson H, Behrman R. Saunders, 2011 ISBN-13: 978-1-4377-0643-7 COURSE REQUIREMENTS AND POLICIES This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and Procedures section of this handbook for expectations regarding clinical rotations. 73

EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading. GENERAL KNOWLEDGE OBJECTIVES Upon completion of this rotation, the student will be able to: 1. Understand the role of the pediatrician and the physician assistant in the practice of pediatrics in both outpatient and inpatient settings. 2. Describe the appropriate use of consultants in pediatric care, including but not limited to obstetrician/gynecologists, perinatologists, neonatologists, and pediatric subspecialists. 3. Discuss the importance of the medical home and cost-effective care for pediatric patients. 4. Understand the normal process of growth and development in children and adolescents. 5. Perform a complete age-appropriate history and physical examination in children of all ages. 6. Provide age-appropriate anticipatory guidance and prevention education. 7. Detail the recommended routine vaccinations across the pediatric age span, and understand the issues and controversies surrounding pediatric vaccination. 8. Complete and interpret routine pediatric screening tools, including newborn assessment, Denver Development scale, CDC growth charts, and the calculation of body mass index. 9. Communicate respectfully, compassionately, and effectively with the pediatric and adolescent patient as well as with the patient’s parent(s) and/or guardian(s). 10. Demonstrate respect for the privacy of pediatric patients and for their dignity as persons. 11. Master each of the topics listed in the Diseases and Disorders Section of the clinical handbook, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacological treatment (including surgical options), complications, patient education, anticipatory guidance, and counseling. 12. Perform or assist in the performance of and interpret and explain the labs, diagnostic procedures outlined in the Skills Section of the clinical handbook. Diseases and Disorders The topics listed below are those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants and others pertinent to Pediatric medicine. The Dermatological System Eczematous Eruptions Dermatitis Atopic Contact Diaper Papulosquamous Diseases Dermatophyte Infections Tinea Versicolor Tinea Corporis, Pedis Drug Eruptions Pityriasis Rosea Desquamation Stevens-Johnson Syndrome Erythema Multiforme

Acneiform Lesions Acne Vulgaris Insect/Parasites Lice Scabies Viral Diseases Exanthems Herpes Simplex Molluscum Contagiosum Verrucae Bacterial Infections Impetigo Other Acanthosis Nigricans

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Birthmarks/Hemangiomas Harlequin change Henoch-Schönlein purpura Mongolian spots Urticaria The Eye, Ear, Nose and Throat Eye Disorders Amblyopia Congenital cataracts Conjunctivitis Orbital cellulitis Retinoblastoma Strabismus Mouth/Throat Disorders Acute Pharyngitis Parotitis Acute Tonsillitis Oral Herpes Simplex Aphthous Ulcers

Nose/Sinus Disorders Acute/Chronic Sinusitis Allergic Rhinitis Nasal Polyps

Epiglottitis Laryngitis Obstructive Sleep Apnea Oral Candidiasis

Retropharyngeal Abscess Peritonsillar Abscess

Ear Disorders Acute/Chronic Otitis Media Cerumen Impaction Hearing Impairment Otitis Externa Tympanic Membrane Perforation The Pulmonary System Infectious Disorders Acute Bronchitis Acute Bronchiolitis Croup Pertussis Pneumonias Tuberculosis

Obstructive Pulmonary Disease Asthma Cystic Fibrosis Other Pulmonary Disease Foreign Body Aspiration Respiratory Distress Syndrome

The Cardiovascular System Conduction Disorders Paroxysmal Supraventricular Tachycardia (PSVT) Innocent/Still murmur

Other forms of heart disease Acute Rheumatic Fever Endocarditis Hypertrophic Cardiomyopathy Long QT syndrome SLE-related heart block

Congenital Heart Disease Atrial Septal Defect Coarctation of Aorta Hypoplastic left heart Patent Ductus Arteriosus Tetralogy of Fallot Ventricular Septal Defect The Gastrointestinal/Nutritional System Stomach

Infectious diarrhea 75

Gastroesophageal Reflux Pyloric stenosis Vomiting Tracheoesophageal Fistula

Hernia Inguinal Umbilical Anal fissure

Chronic diarrhea Metabolic Disorders Phenylketonuria

Small Intestine/Colon Appendicitis Constipation Intussusception Hirschprung’s disease Inflammatory Bowel Disease Necrotizing enterocolitis

Childhood obesity Failure to thrive Vitamin deficiencies Genitourinary System Benign Conditions of GU Tract Paraphimosis/Phimosis Cryptorchidism Vesicoureteral Reflux Hydrocele/Varicocele Infectious/Inflammatory Conditions Cystitis Pyelonephritis

Neoplastic Diseases Wilms’ Tumor Testicular carcinoma

Renal Diseases Glomerulonephritis Nephrotic syndrome

The Musculoskeletal System Disorders of the Forearm/ Wrist/Hand Nursemaid’s Elbow Boxer’s fracture

Infectious Diseases Osteomyelitis Septic Arthritis Transient (Toxic) Synovitis

Disorders of the Hip Developmental Dysplasia of the Hip (DDH) Slipped Capital Femoral Epiphysis (SCFE) Legg-Calvé-Perthes Disease

Rheumatologic Conditions Juvenile Arthritis

Disorders of the Knee Osgood-Schlatter Disease Tibial torsion Talipes equinovarus Other Bowing deformity Clavicle fracture Greenstick fracture Monteggia fracture

Disorders of the Back/Spine Scoliosis Spina bifida

Toddler fracture Torus fracture Growing pain

The Neurologic System Cerebral Palsy Headache Cluster Migraine Tension Meningitis 76

Neurocutaneous Neurofibromatosis Tuberous Sclerosis Sturge-Weber Generalized Convulsive Disorders Generalized Nonconvulsive Disorders

Hypotonia Muscular Dystrophy Neuroblastoma Syncope

Pseudoseizure Status Epilepticus

The Endocrine System Diseases of the Pituitary Acromegaly/Gigantism Dwarfism Diseases of the Thyroid Congenital hypothyroidism

Diabetes mellitus Type 1 Type 2 Infant of diabetic mother Congenital Adrenal Hyperplasia

Infectious Diseases Parasitic Disease Pinworms Spirochetal Disease Lyme Disease Kawasaki Disease Reye Syndrome

Viral Diseases Cytomegalovirus infections Epstein-Barr infections Erythema Infectiosum Herpes Simplex Virus Influenza Measles Mumps Roseola Rubella Rubeola Varicella-Zoster infections

The Hematologic System Anemias Iron deficiency Sickle Cell Thalassemia

Malignancies Bone Tumors CNS Tumors Acute Lymphocytic Leukemia Lymphoma

Coagulation Disorders Hemophilia Thrombocytopenia Idiopathic Thrombocytopenic Purpura (ITP) Jaundice Lead Poisoning Occult bacteremia The Psychiatric/Behavioral System Attention Deficit Hyperactivity Disorder (ADHD) Autistic Spectrum Disorder Child abuse/neglect Tics Tourette syndrome Eating disorders Anorexia Bulimia

Common Problems Colic Discipline Enuresis Encopresis School avoidance Sleep disorders Toilet training

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The Adolescent Reproductive System Vaginitis Sexually Transmitted Infections Pelvic Inflammatory Disease

Contraceptive Methods Pubertal development Amenorrhea

Pediatric emergencies Neonatal fever/sepsis Pediatric head trauma Poisoning/ingestions Shaken baby syndrome Sudden Infant Death Syndrome (SIDS) Shock

Acetaminophen toxicity Adverse drug reactions Burns-body surface area Dehydration Drug reactions SKILLS

This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation. It is desirable that the PA student reach a performance level commensurate with his or her peers. Labs/Diagnostics Perform and/or interpret the following: Arterial puncture for arterial blood gases ECG PPD or TB Tine Test Rapid strep testing Sputum cultures Stool testing-ova & parasites, hemoccult Urinalysis, routine and microscopic Venipuncture for CBC, electrolytes, blood serum chemistries and cultures Wound cultures Order, make preliminary assessment; and/or evaluate reported findings: IV therapy: indications for various IV fluids Routine X-ray studies-chest, KUB, GI, back, C-spine and extremity; contrast studies incl. CT, MRI Pulmonary function tests Procedures Order, perform and/or assist, and/or explain to patients the following procedures and tests: Bladder catheter insertion/removal Cardiopulmonary resuscitation Debride and dress minor wounds Dermatologic procedures: cryotherapy, shave & punch biopsies, application, tissue destruction Ear irrigation Endotracheal intubation Eye staining and irrigation Fracture reduction Injections: intramuscular and subcutaneous Intravenous line insertion Lumbar puncture Nasogastric tube insertion Nebulizer therapy Suture lacerations Tympanogram Vision and hearing screening Obtain specimens to detect sexually transmitted infections Patient Education/Counseling Provide patient education and counseling in the following areas: 78

Behavioral expectations and discipline Immunizations Importance of routine well visits Normal and abnormal development Proper nutrition: breast feeding, infant diet, failure to thrive, obesity, hypercholesterolemia Knowledge of chromosomal abnormalities and evaluation of an infant with dysmorphic features Safety and accident prevention Treatment plan for acutely ill child

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Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS General Surgery Rotation PASS 0643 Credit Hours 6.00 COURSE PURPOSE The overall educational goal for the General Surgery Rotation is to train physician assistant students in all aspects of care of the surgical patient. The rotation is designed to prepare the student for providing preoperative and postoperative care for patients, for being effective first assistants in the operating room, for performing exams and minor surgical procedures, and for caring for patients with respect and sensitivity. COURSE COORDINATION David A. Luce, MMS, PA-C Assistant Professor and Clinical Coordinator [email protected]

James F. Gunn, MMS, PA-C Instructor [email protected]

Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day. COURSE TIMES/LOCATION This rotation will take place in hospital, surgical center, and outpatient clinic settings for 6 weeks in the clinical year. Students are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are responsible for assigned reading material even if those topics are not experienced on the rotation. REQUIRED COURSE TEXTBOOKS Required for all clinical rotations: Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing Required for Surgery Rotation th

Essentials of General Surgery. 4 Ed. Lawrence PF, Bell RM, Dayton MT. Lippincott, Williams and Wilkins; 2006. ISBN-10: 0781750032 th

Surgical Recall. 5 Ed. Blackbourne, LH. Lippincott, Williams and Wilkins; 2008. ISBN-10: 0781770769 81

Recommended for Surgery Rotation: rd

Essentials of Surgical Subspecialties. 3 Ed. Lawrence PF, Bell RM, Dayton MT. Lippincott, Williams and Wilkins 2007. ISBN-100781750040 COURSE REQUIREMENTS AND POLICIES This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and learning activities in their entirety. EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading. GENERAL KNOWLEDGE OBJECTIVES Upon completion of this rotation, the student will be able to: 1. Understand the pathophysiology, prevention, diagnosis and treatment of common clinical problems that require surgical intervention. 2. Perform a complete and focused pre-surgical history and physical exam as it relates to the presenting surgical condition. 3. Provide postoperative assessment and care of surgical patients. 4. Appropriately interpret laboratory and imaging abnormalities that indicate the necessity for surgical intervention. 5. Demonstrate the principles of sterile technique. 6. Identify basic anatomical structures related to the surgical cases and their neurovascular relationships. 7. Understand the principles of perioperative hemodynamic monitoring and fluid management. 8. Master each of the topics listed in the Diseases and Disorders Section of the clinical handbook, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacological treatment (including surgical options), complications, patient education and counseling. 9. Perform or assist in the performance of and interpret and explain the labs, diagnostic procedures outlined in the Skills Section of the clinical handbook. DISEASES AND DISORDERS The topics listed below are those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants and others pertinent to Surgery. Pulmonary System Neoplastic Disease Bronchogenic carcinoma Carcinoid tumors Metastatic tumors Pulmonary nodules Mesothelioma Trauma Penetrating Blunt

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Pleural Diseases Pleural Effusion Pneumothorax Empyema Pulmonary circulation Pulmonary Emboli Other Lymphoma-staging

Cardiovascular System Cardiac Disease Pacemaker/AICD Coronary artery disease Catheterization Vascular Disease Carotid Stenosis Aortic Aneurysm/Dissection Arterial Embolism/Thrombosis Peripheral Vascular Ulcer Ischemia Venous Thrombosis Varicose Veins Congenital Heart Disease Atrial Septal Defect Coarctation of the Aorta Ventricular Septal Defect Patent Ductus Arteriosus Tetralogy of Fallot

Valvular disease Aortic stenosis/insufficiency Mitral stenosis/insufficiency Tricuspid stenosis/insufficiency Pulmonary stenosis/insufficiency Mitral valve prolapse

Trauma Penetrating Blunt

Other Pericardial effusion Cardiac tamponade Cardiac neoplasm Cardiogenic shock

Breast Disorders Abscess Carcinoma Fibroadenoma Fibrocystic disease Mastitis Gastrointestinal System/Nutritional Esophagus Barrett’s esophagus Neoplasm Mallory-Weiss tear Stricture Varices Stomach Neoplasms Ulcer Disease gastric/duodenal Pyloric stenosis Gallbladder Acute/Chronic Cholecystitis Cholelithiasis Biliary obstruction Hernia Femoral Hiatal Incisional Inguinal Umbilical Ventral

Liver Neoplasm Portal hypertension Rectum Anal Fissure Anorectal Abscess/Fistula Fecal impaction Hemorrhoids Neoplasms Pilondial disease Small Intestine/Colon Appendicitis Diverticulosis/Diverticulitis Inflammatory Bowel Disease Intussusception Ischemic Bowel Disease Neoplasms Obstruction Meckels diverticulum

Pancreas 83

Acute/Chronic pancreatitis Neoplasm

Trauma Penetrating & Blunt Spleen

Trauma Splenomegaly Endocrine System Thyroid Nodules Neoplastic disease Parathyroid Hyper/Hypoparathyroidism Genital/Urinary System Neoplastic Diseases Bladder carcinoma Prostate carcinoma Renal cell carcinoma Testicular carcinoma Wilms tumor Benign Conditions Incontinence Benign Prostatic Hyperplasia Hydrocele/Varicocele Testicular torsion Calculi

Electrolyte/AcidBase Disorders Metabolic Alkalosis/Acidosis Respiratory Alkalosis/Acidosis Hypo/Hypercalcemia Hypo/Hyperkalemia Hypo/Hypernatremia Hypomagnesemia Volume depletion/Excess

Musculoskeletal System Disorders upper extremities Fractures/Dislocations Disorders lower extremities Disorders lower extremities Fractures/Dislocations Aseptic Necrosis

Neoplastic Disease Bone cysts and tumors Ganglion Cysts Osteosarcoma

Trauma Soft tissue Compartment syndrome Disorders spine Herniated disc Dermatologic System Neoplasms Basal cell carcinoma Squamous cell carcinoma Melanoma Viral Diseases Condyloma Accuminata

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Other Burns Ulcers Decubitus and Leg Hidradenitis suppurative Lipomas Epithelial inclusion cysts

SKILLS It is desirable that the PA students reach a performance level in primary care commensurate with his/her peers. This list of skills is intended to serve as a guide for both the student and Preceptor during the clinical rotation.

Lab/Diagnostics Perform and/or interpret the following: Administer IV therapy for perioperative fluid management Blood typing and cross-matching Bleeding and coagulation studies ECG Radiographic imaging, CT, MRI: Head and Neck Chest Abdomen and Pelvis Spine Extremities Radiographic imaging - KUB Urinalysis, routine and microscopic Venipuncture for CBC, electrolytes, blood serum chemistries and cultures Wound culture Procedures Order, perform and/or assist, and/or explain to patients the following procedures and tests: Assist in major and minor procedures, learning the responsibility and skill of a surgical first assistant Demonstrate knowledge of surgical procedure prior to start of case Pre-op and post-op rounds and patient management Scrub, gown, glove and set up sterile field Understands and practices surgical aseptic technique Suturing techniques (indications for choice suture, type of closure). Clean and debride wounds; care of burns and lacerations; control bleeding/hemorrhage; infection control Remove and apply wound dressings Insert and remove drains Perform I&D- localized abscess, paronychia, etc. Assist with proctoscopy/colonoscopy/anoscopy Assist/perform treatment of abrasions, lacerations, foreign body removal Discuss fluid replacement, transfusion indication and mode of administration (needles, intracaths, butterflies). Insertion of IVs Placement of urethral catheters (male and female) Remove sutures Administer digital block anesthesia and topical local anesthesia Biopsy/excise superficial skin lesions/tumors Apply dry, and wet to dry dressings Remove ingrown toenail Assist in chest tube insertion Assist in central line placement Patient Education/Counseling Provide patient education and counseling in the following areas: Initial surgical evaluation, workup and diagnostic interventions Surgical procedures indicated to specific diseases Post-operative recovery, including follow-up and/or chemotherapy plans Utilization of support networks Genetic counseling 85

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Midwestern University College of Health Sciences PHYSICIAN ASSISTANT PROGRAM COURSE SYLLABUS Women’s Health Rotation PASS 0647 Credit Hours 6.00 COURSE PURPOSE The overall educational goal for the Women’s Health Rotation is to train physician assistant students in all aspects of care for women and to guide them in their evolution into respectful and professional health care providers to women. The rotation is designed to prepare students to care for women with common clinical problems in the ambulatory setting, to care for women with respect and sensitivity, and to perform exams and procedures common in women’s health with proficiency and skill. COURSE COORDINATOR Soonja L. Sawyer, MS, PA-C Instructor and Clinical Coordinator [email protected]

Kara N. Roman, MMS, PA-C Associate Director and Assistant Professor [email protected]

Affiliated clinical Preceptors will provide clinical rotation experiences and will participate in student assessment. Principal and instructional faculty will provide content for the Clinical Assessment Day. COURSE TIMES/LOCATION This rotation will take place in hospital, clinic, or private practice settings for 6 weeks in the clinical year. Students are required to take call, attend conferences, provide patient presentations, and read required textbooks. Students are responsible for assigned reading material even if those topics are not experienced on the rotation. REQUIRED COURSE TEXTBOOKS Required for all clinical rotations: Gilbert D, Moellering R, Eliopoulos G, Sande M, Chambers H. Stanford Guide to Antimicrobial Therapy 2010 (Pocket Edition) Antimicrobial Therapy. ISBN-10: 1930808526 Pagana KD, Pagana TJ. rd Mosby’s Manual of Diagnostic and Laboratory Tests. 3 Ed. Mosby; 2005. ISBN-10: 0323039030 Drug reference of the student’s choosing Required for Women’s Health Rotation: th

Current Diagnosis and Treatment – Obstetrics/Gynecology, 10 Ed. DeCherney A, Nathan L, Goodwin TM, Laufer N McGraw-Hill, 2006 ISBN-10: 0071439005 COURSE REQUIREMENTS AND POLICIES This is a 6-credit clinical rotation. To receive course credit, the student is required to attend all clinic sessions and satisfactorily complete all learning activities, including CAD days, in their entirety. Please see the Policies and Procedures section of this handbook for expectations regarding clinical rotations. 87

EVALUATION AND GRADING The student will be evaluated in his or her medical knowledge, technical skills, and professionalism for this rotation. Clinical Preceptors, instructional faculty, and principal faculty will all participate in the evaluation of the student for each rotation. Please see the Policies and Procedures section of the Clinical Handbook 2011-2012 for all policies and procedures which govern evaluation and grading. GENERAL KNOWLEDGE OBJECTIVES Upon completion of this rotation, the student will be able to: 1. Recognize the importance of preventive care in women’s health and demonstrate counseling and the delivery of patient education regarding nutrition, exercise, smoking cessation, pre-conceptual counseling, sexually transmitted infections and pregnancy prevention. 2. Understand the pathophysiology, prevention, diagnosis and treatment of common clinic problems in women’s health including breast, gynecologic, urinary, obstetric, and global health issues. 3. Perform and interpret Pap smear results and understand the triage of patients with abnormal Pap smears. 4. Perform a complete breast exam and appropriately evaluate and manage a breast mass. 5. Recognize psycho-social issues that impact women’s health, such as cultural issues, sexuality, body image, fertility, child care issues, domestic violence, and sexual abuse. 6. Employ shared problem solving in the clinical care of women of varying ages from varying cultural and economic backgrounds. 7. Master each of the topics listed in the Diseases and Disorders Section of the clinical handbook, focusing on the following areas: etiology, epidemiology, prognosis, physiology/pathophysiology, symptoms, signs, laboratory testing, diagnostic testing, interpretation of findings, medical management, non-pharmacological treatment (including surgical options), complications, patient education and counseling. 8. Perform or assist in the performance of and interpret and explain the labs, diagnostic procedures outlined in the Skills Section of the clinical handbook.

Diseases and Disorders The topics listed below are those included on the Content Blueprint prepared by the National Commission on Certification of Physician Assistants and others pertinent to Women’s Health. The Reproductive System Menstruation Physiology, Disorders, and Conditions Reproductive cycle Puberty/Tanner stages Menstrual cycle Normal and abnormal Dysmenorrhea Premenstrual conditions Perimenopause Menopause/Osteoporosis Ovary Functional cysts Neoplasms Benign and malignant Polycystic ovary syndrome (PCOS) Premature ovarian failure Vagina/Vulva Urethral disorders Vulvitis/Vaginitis 88

Bartholin’s gland disorders Cystocele and prolapse Rectocele and prolapse Neoplasms Cervix Cervicitis Abnormal Pap Smear/Cervical Cancer Uterus Abnormal/Dysfunctional Uterine Bleeding Endometrial cancer Endometriosis Leiomyomas Endometritis Uterine prolapse Sexually Transmitted Infections Pelvic Conditions PID Chronic pelvic pain Pelvic relaxation Genitourinary Conditions Urinary incontinence Urinary tract infection Contraceptive Methods/Surveillance Sexual Function and Dysfunction Intimate Partner Violence Breast Fibrocystic changes Adenoma Lactation Mastitis Abscess Intraductal papilloma Carcinoma

Infertility (male and female) Evaluation of the Pregnant Patient Uncomplicated Pregnancy Prenatal care Labor and delivery Postpartum care Complications in Pregnancy, Labor and Delivery, and Postpartum Period Ectopic pregnancy Infectious diseases – UTI, TORCH, HIV Hypertension Preeclampsia Eclampsia Gestational Diabetes 89

Thyroid disorders Hematologic disorders Neural tube defects Gestational trophoblastic disease Abortion Chorioamnionitis Rh incompatibility Fetal growth abnormalities Placenta previa Abruptio placenta Preterm labor PROM Abnormal fetal lie Umbilical cord prolapse Labor induction and augmentation Surgical delivery Post-term pregnancy Multiple gestations Shoulder dystocia Melasma Postpartum depression Uterine atony Postpartum hemorrhage Skills Order, perform, and/or interpret the following labs and diagnostic tests: Thyroid function Pregnancy Group B Strep Pap smear Wet mount STI evaluation Rh, typing, antibody screening Rubella titer HIV Hepatitis B Antenatal screening – triple or quad screen DEXA scan Order, perform and assist, and/or explain to patients the following procedures: Pelvic examination of the female patient Clinical breast exam Physical examination of the pregnant patient Fetal auscultation Estimate gestational age/EDD Determine fetal lie, presenting part, station Fetal and pelvic ultrasound Biophysical profile Electronic fetal monitoring Amniocentesis Labor and vaginal delivery Surgical delivery Induction and augmentation of labor Forceps and vacuum-assisted deliveries Colposcopy and biopsy Vulvar biopsy and/or destruction of vulvar lesions Endometrial biopsy Bartholin gland I & D Contraceptive fitting/insertion 90

Endometrial ablation Dilation and curettage Hysteroscopy Laparoscopy Hysterectomy Tubal ligation Sexual assault examination Immunizations appropriate across the female life cycle

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Request for Rotation Absence Name: ________________________________ Date of Request: ___________________ Requested Absence Date(s): ______________________________ Reason for desired absence: ___

Personal Day

___

Professional Conference

___

Other: Describe reason for desired absence: ____________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________

The student should submit the request to [email protected] as soon as he or she is aware of the need for the absence. The Clinical Coordinators will consider the request. If approved, the Clinical Coordinators will communicate with the Preceptor to determine how the missed clinical hours will be reassigned. The student will be notified of the decision. The student may not plan any absence unless the Clinical Coordinators grant approval in advance. The student should not, under any circumstances, ask a Preceptor for permission for an absence. (for PA Program use only)

PA PROGRAM: APPROVED________NOT APPROVED________DATE: ________________

PRECEPTOR:

APPROVED________NOT APPROVED________DATE: ________________

NOTES:

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Mid-Rotation Student Self-Evaluation Form MIDWESTERN UNIVERSITY-PHYSICIAN ASSISTANT PROGRAM 555 31st Street Downers Grove, IL 60515 Phone: (630) 515-6034 Fax: (630) 971-6402

STUDENT:________________________________ ADVISOR:______________________________ ROTATION: _______________________________ PRECEPTOR:___________________________ ROTATION DATES:________________________________________________________________ Instructions to Student: Please complete this form at the end of the middle week of each rotation. Evaluate your performance in each of the following areas thus far in your rotation. Review it with your primary Preceptor and obtain their signature. Fax the form to the PA Program Office. 4 = Excellent 3 = High Achievement 2 = Satisfactory 1 = Unsatisfactory

NA* *Not applicable

I. ACADEMIC PERFORMANCE 1. Skill in obtaining an appropriate focused medical history.

4

3

2

1 NA

2. Skill in performing an appropriate focused physical examination.

4

3

2

1 NA

3. Demonstrates the ability to formulate appropriate differential diagnoses.

4

3

2

1 NA

4. Skill in appropriate use of laboratory and diagnostic tests.

4

3

2

1 NA

5. Demonstrates the ability to develop the appropriate treatment plans.

4

3

2

1 NA

6. Selects appropriate preventative measures and/or education.

4

3

2

1 NA

7. Skill in performance of technical procedures.

4

3

2

1 NA

8. Utilizes resources appropriately in medical decision making.

4

3

2

1 NA

9. Demonstrates overall clinical knowledge and competence.

4

3

2

1 NA

1. Demonstrates a professional demeanor at all times.

4

3

2

1 NA

2. Dedicated to providing the highest quality of care to patients.

4

3

2

1 NA

3. Punctual and prepared for all obligations.

4

3

2

1 NA

4. Able to effectively relate to patients, peers and colleagues.

4

3

2

1 NA

II. PROFESSIONAL BEHAVIOR

95

96

III. COMMENTS Please describe your strengths in this rotation: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Please describe areas needing improvement and your goals for improving them during the remainder of your rotation: ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________

Instructions for Preceptor: Please briefly review this self-evaluation form with the student and then complete the following statement(s): 1. I agree with the student’s self-assessment. Yes_________ No__________ If no, please explain below. 2. I would like to see this student work on the following issues during the remainder of this rotation (please list specific goals):

3. I consider this student’s progress so far in this rotation to be: 4 = Excellent

3 = High Achievement

4. Preceptor’s Signature:_______________________ Date:_______________________

2 = Satisfactory

1 = Unsatisfactory

Student’s Signature:_____________________ Date:_______________________

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STUDENT PERFORMANCE EVALUATION FORM Midwestern University-Physician Assistant Program 555 31st Street Downers Grove, IL 60515 Phone: (630) 515-6034 Fax: (630) 971-6402

STUDENT:________________________________ ADVISOR:______________________________ ROTATION:_______________________________ PRECEPTOR:___________________________ ROTATION DATES:________________________________________________________________ Please complete the following assessment for the student that you supervised during this rotation. We ask that you complete the form and if possible, take time to review it with the student on the last day of their rotation. Thank you for your help in training our students. 4 = Excellent 3 = High Achievement 2 = Satisfactory 1 = Unsatisfactory

NA*

*Not applicable or not observed

I. ACADEMIC PERFORMANCE 1. Skill in obtaining an appropriate focused medical history.

4

3

2

1 NA

2. Skill in performing an appropriate focused physical examination.

4

3

2

1 NA

3. Demonstrates the ability to formulate appropriate differential diagnoses.

4

3

2

1 NA

4. Skill in appropriate use of laboratory and diagnostic tests.

4

3

2

1 NA

5. Demonstrates the ability to develop the appropriate treatment plans.

4

3

2

1 NA

6. Selects appropriate preventative measures and/or education.

4

3

2

1 NA

7. Skill in performance of technical procedures.

4

3

2

1 NA

8. Utilizes resources appropriately in medical decision making.

4

3

2

1 NA

9. Demonstrates overall clinical knowledge and competence.

4

3

2

1 NA

1. Demonstrates a professional demeanor at all times.

4

3

2

1 NA

2. Dedicated to providing the highest quality of care to patients.

4

3

2

1 NA

3. Punctual and prepared for all obligations.

4

3

2

1 NA

4. Able to effectively relate to patients, peers and colleagues.

4

3

2

1 NA

II. PROFESSIONAL BEHAVIOR

99

100

III. ATTENDANCE Total number of days that the student arrived late during this rotation:___________. Total number of days that the student was absent during this rotation:___________. Total number of requests for special scheduling for personal reasons:___________. IV. COMMENTS Please describe the student’s strengths in this rotation: _____________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Please describe areas needing improvement for this student: _____________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

V. OVERALL EVALUATION FOR THE ROTATION: (Required – Circle one)

4 = Excellent 3 = High Achievement 2 = Satisfactory 1 = Unsatisfactory Preceptor’s Signature:_______________________ Date:_______________________

Student’s Signature:_____________________ Date:_______________________

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