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Preceptor Handbook Orientation and Guidance for Physician Assistant Preceptors
Preceptor Handbook Orientation and Guidance for Physician Assistant Preceptors
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Dear Preceptor:
Let me begin by expressing my gratitude to each of you who have accepted the role of
preceptor for those who are anxiously engaged in learning how to become competent physician
assistants (PA). Your contributions to this educational partnership are immense and
irreplaceable. Nothing that can be done in a campus-setting could ever equal the real-life
experiences you provide these eager learners. Being a preceptor can and should be richly
rewarding. It challenges us to think about why we do things the way we do. It motivates us to
do our best. It inspires us to stay at the top of our game.
Two of the most frequent concerns I hear about being a preceptor are that “it takes up too
much time” and that “I can’t see as many patients.” I would contend that neither of those
statements need be so. In fact, the opposite effect can be realized; productivity and patient
satisfaction can be enhanced while mentoring. It all depends upon how you utilize your PA
student. Make them part of your team and expect results and they suddenly become a valuable
resource; an “extra” pair of hands to meet the needs of your patients and enhance patient
satisfaction because of the extra time a student spends with them.
The University of Charleston Physician Assistant Program exists to help meet the ever
increasing need for rural primary health care providers. That is our focus, part of our mission
and a preeminent goal. Rural practice isn’t something most practitioners pursue yet the needs in
rural and medically underserved areas are great. You can help meet that need by partnering with
us to provide the clinical experiences physician assistant students need to prepare them to
provide health care services in these remote parts of the country. We invite you – we implore
you - to make a difference in the health care of the underserved. Be a Preceptor.
This is a partnership. If you mentor a PA student from this program, you do so with our
help. We don’t just abandon our students when they walk through your door. We stay in
constant contact with the student and remain available to you and your staff at all times.
Together we can make a difference in their professional development.
David Payne, PA-C, MPAS
University of Charleston
Physician Assistant Program Director
2300 MacCorkle Ave SE
Charleston, West Virginia 25304
(304) 357-4818
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Benefits of being a preceptor
Preceptors are the backbone of the most critical component of a future health care
provider’s education. Preceptors not only provide students with the invaluable exposure to the
“real world” of health care delivery, they also have a strong influence over the attitudes and
practices their students will develop and possibly carry throughout the remainder of their
professional career. Being a preceptor is your opportunity to influence and shape the health care
provided to this and future generations.
The ever increasing demand placed upon health care providers for improved productivity
often seems like a deterrent to being a preceptor. That need not be the case, however. There is a
brief initial period of orientation that occurs whenever a new student arrives on the scene; but,
that student can quickly become an asset in any busy practice if given the opportunity to excel
and do what they are there to do – obtain supervised clinical practice experience.
Studies2 have shown that preceptors do NOT necessarily have a longer day or spend more
time with patients just because they have a student. They have also shown that students do not
inevitably decrease productivity. In fact, they may actually increase productivity3.
Requirements for being a preceptor
First and foremost, prospective preceptors should enjoy teaching and sharing their
knowledge and experience with students and others who wish to learn.
Preceptors must be able to provide, directly or in collaboration with their practice
colleagues, a minimum of 40 hours each week of clinical practice experience for their Physician
Assistant student.
Board-certified physicians (MD or DO) and Certified Physician Assistants (PA-C)
supervised by board-certified physicians must precept the majority of each PA student’s clinical
practice experiences. However, other primary health care providers can act as preceptors for
some of the more specialized health care experiences students must obtain, such as women’s
health and psychiatry/behavorial medicine. Nurse practitioners and clinical psychologists often
act as preceptors for these important learning opportunities.
1 Physician Assistant Education Association. Preceptor Orientation Handbook: Tips, Tools, and Guidance for
Physician Assistant Preceptors. 2012 2 McKee, M., Steiner-Grossman, P., Burton, W., & Mulvihill, M. Quality of student learning and preceptor
productivity in urban community health centers. Family medicine 30;108-112 (1998). 3 Hildebrandt, E. Preceptors: A perspective of what works. Clinical Excellence for Nurse Practitioners 5;175-180
(2001).
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Mastering the preceptor role4
There are several important adult learner principles to remember in clinical teaching:
1. Learning is evolutionary. Expect your students to build upon previous experiences.
If they can’t do this – they have a problem.
2. Participation, repetition and reinforcement strengthen and enhance learning. Provide
opportunities and expect your students to stay busy. Mandate they see as many
patients as you feel they are capable of seeing. If you are on-call, require them to be
available too. If you are in surgery or called to the emergency department – so are
they (day or night).
3. A variety of learning activities increases interest. Don’t let students stay in their
comfort zone for too long. Frequently challenge them to perform new or different
tasks.
4. Immediate use of information or skills and readiness to learn enhances retention.
Expect students to be prepared for scheduled procedures or other activities and “test”
their readiness by questioning them as the skill is performed.
The following strategies are offered as guidelines for improving effectiveness as a
preceptor in juggling the roles of mentor/teacher and busy clinician:
1. Modeling. Demonstrate your approach to patient assessment.
2. Oral case presentations. This should reflect the student’s ability to obtain appropriate
histories, report pertinent physical findings, generate reasonable differential
diagnoses, and develop suitable management and follow-up plans.
3. Direct questioning. This can be useful in fostering your student’s critical thinking
skills. Don’t just drill them for trivia. Give them the opportunity for reflective
responses to questions such as “What do you think?” or “Why would you do that?”
4. Directed readings/literature searches. If your student fails to demonstrate the
knowledge base needed to be effective, require them to do additional research and
reading/studying to eliminate any perceived knowledge/skill deficit.
5. Coaching. This is the process of providing verbal cues to the student as he/she moves
through a procedure. This allows the student to master the steps of a skill.
6. Feedback. This is a critically important and often overlooked step in adult learning.
Feedback should be descriptive of specific situations and provided as soon after the
preceptor’s observation of the event as possible. Feedback may be even more
beneficial if you provide the student an opportunity to verbalize their own self-
assessment of the event prior to hearing the preceptor’s comments.
4 Burns, C., Beauchesne, M., Ryan-Krause, P., & Sawin, K. Mastering the Preceptor Role: Challenges of Clinical
Teaching. J Pediatr Health Care 20(3):172-183 (2006). http://www.medscape.com/viewarticle/532189
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Taking the time to develop an optimal learning climate in a busy practice environment
will pay off. Students learn best when there is ongoing student assessment, close
communication, quick response to student’s stress, trusting relationships, mutual respect and
acceptance as part of the team. Having appropriate expectations and developing a strategy for
quickly incorporating the student into your busy practice routine will reduce the barriers to being
both an effective and efficient preceptor and clinician.
Preceptor-Student Relationship
Educational guidelines emphasize that students need the opportunity to practice the skills
they are attempting to master. That is, they must be able to interview and examine patients
independently, communicate with patients and colleagues, interpret clinical information, and
demonstrate the full spectrum of behaviors that constitute professionalism. Students who are
allowed these opportunities are generally more prepared to work in coordination with the
physician to become a useful part of the health care team. Because students arrive with different
levels of capability, responsibility for patient care may need to be graduated over time. It is very
important to give the student as much responsibility as they are willing and able to accept while
providing the supervision necessary to assure outstanding patient care and learning.
A preceptor’s main role is to facilitate a student’s encounter with patients, assuring the
student has meaningful, graduated responsibility. We would expect that students should be able
to conduct all tasks of a patient visit from the initial history and physical exam to the patient
education and treatment discussion. Depending on the stage of their clinical year, some students
may require upfront guidance on the patient encounter. We encourage you to allow the students
to ask questions and review the chart with you before the initial visit, particularly if it is early in
their clinical year.
After the visit, students should be able to present their findings orally, write and/or dictate
appropriate notes, check labs, and complete follow-up calls.
Many educators have found the Microskills Model very helpful when teaching within the
clinical environment. It includes the following components:
Get a Commitment: For every patient seen by the student, ask the student “what do you
think is going on?” This will help the preceptor identify a student’s ability to diagnose as
well as identify their learning needs.
Probe for Supporting Evidence: All students should be considering a differential
diagnosis in order to organize their H&P as well as establish a working diagnosis.
Preceptors can use a variety of questions to test the student’s reasoning abilities.
Examples include, “what else did you consider,” “what led you to that conclusion?”
Teach the General Rules: After you have determined the student’s level of
understanding and learning needs it is important to give them general rules to guide them
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in their diagnosis and treatment. General rules encompass guidelines the provider utilizes
to make medication changes and schedule follow-ups.
Reinforce what the student is doing right: Students are more likely to maintain good
habits and work harder if the preceptor is able to provide them with positive feedback and
praise for a job well done.
Correct Mistakes: Positive and negative feedback should be given as soon as possible to
the observed behavior. This will allow them the opportunity to incorporate suggestions
and improve their clinical performance during subsequent patient encounters.
Under no circumstances should students be allowed to manage, treat or discharge a patient
without direct personal involvement/supervision of the preceptor. Students must not be
used as substitutes for any other member of the facility’s health care team: administrative
or clinical.
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Mission, Vision and Goals
The mission of the University of Charleston Physician Assistant Program (UCPAP) is to
prepare competent physician assistants who value and provide comprehensive, patient-centered,
culturally sensitive primary care, and are committed to lifelong-learning, professional growth,
community health, and caring for underserved populations.
Our vision is to foster a culture of learning by employing innovative educational
strategies and a team-based approach within a supportive environment and to provide an
application-based curriculum centered on critical principles of health and disease.
Our goals are to prepare physician assistants who:
1. Practice primary care medicine,
2. Are committed to the medically underserved,
3. Actively participate as members of their community,
4. Assume leadership roles within the profession, and
5. Support and sustain the University of Charleston Physician Assistant Program.
Competencies
The National Commission on Certification of Physician Assistants (NCCPA), in
conjunction with the AAPA, PAEA and ARC-PA, has developed a document entitled
Competencies for the Physician Assistant Profession which states:
“The clinical role of PAs includes primary and specialty care in medical and surgical
practice settings. 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.”5
The University of Charleston PA Program has adopted this manuscript as a resource for
defining the basic knowledge, clinical skills, professional attitudes and behaviors individuals
enrolled in this program should strive to attain and demonstrate throughout their course of study.
UCPAP students must demonstrate competence in the following six categories:
5 National Commission on Certification of Physician Assistants. Competencies for the Physician Assistant
Profession. March 2005. http://www.nccpa.net/pdfs/Definition%20of%20PA%20Competencies%203.5%
20for%20Publication.pdf. Accessed 3/9/2012.
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1. Medical knowledge which includes an understanding of pathophysiology, patient
presentation, differential diagnosis, patient management, surgical principles, health
promotion and disease prevention.
2. Interpersonal and communication skills which encompasses verbal, nonverbal and written
exchange of information.
3. Patient care, including age-appropriate assessment, evaluation and management.
4. Professionalism manifested through:
a. The expression of positive values and ideals as care is delivered,
b. Prioritizing the interests of those being served above one’s own,
c. Knowing one’s professional and personal limitations,
d. Practicing without impairment from substance abuse, cognitive deficiency or
mental illness, and
e. Demonstrating a high level of responsibility, ethical practice, sensitivity to patient
diversity and adherence to legal and regulatory requirements.
5. Practice-based learning and improvement by engaging in critical analysis of one’s own
practice experience, the medical literature and other information resources for the
purpose of self-improvement in order to assess, evaluate and improve personal patient
care practices.
6. Systems-based practice demonstrates a provider’s awareness of, responsiveness toward
and work to improve the larger system of health care, encompassing the societal,
organizational and economic environments in which health care is delivered, to provide
patient care that is of optimal value.
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Orientation
All members of the office staff have a key role in assuring that each student has a
successful rotation. It is critical to familiarize the student with office routines and the location of
critical resources. It is important that the student be functional and confident in the clinical
setting. Orientation is very helpful to assure the students feel welcome and become familiar with
staff. Students depend on these individuals for assistance during patient visits and patient
introductions. Orientation may include not only introductions to staff but a tour of the facility
and a description of office procedures, routines and scheduling. This can often be provided by
one of the office staff. Specific orientation topics that should be addressed, as applicable,
include:
1. Facility security/safety protocols
2. Site-specific HIPAA training, if needed
3. Computer use policies, access, username, password
4. Medical record/EMR access and patient encounter documentation policies
5. Attendance expectations including routine work schedule, call, weekends, etc. and
who to notify in case of sickness or other absence from their assigned schedule
6. Participation in facility activities (rounds, conferences, team meetings, etc)
7. Expectations and policies regarding participation in patient care: patient encounters,
procedures, etc.
8. Any additional site/preceptor-specific issues
We encourage preceptors to set aside some time at the start of a student’s rotation (or
prior to the rotation when possible) to formulate mutual goals in regards to what they hope to
achieve during that specific supervised clinical practice experience. Students have been
mandated by the program to perform self-assessment prior to each rotation to identify the
experiences they hope to have and to discuss these with the preceptor in formulating goals for the
rotation.
Make supervised clinical experiences available
Physician assistant students need exposure and experience in the entire spectrum of
clinical services. Where consistent with your practice, this should include:
Outpatient care
Inpatient care
Emergency room care
Operating room surgical care
Long-term care (nursing homes)
Home visits
In addition and in order to fulfill the program’s mission to prepare clinicians that will be
ready to function in remote, rural and medically underserved areas, we also strongly encourage
students to obtain clinical experience in performing the following:
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Office-based laboratory procedures
Imaging procedures
Preceptors, or their designated qualified alternate, must be available for supervision,
consultation and teaching whenever the student is scheduled for their clinical practice experience
work. It is important to clearly assign students to another MD, DO or PA who will serve as the
student’s preceptor for any given time interval that the program designated primary preceptor is
not available. A resident physician can serve as an alternate preceptor but not as the designated
primary preceptor. In those rare cases where a qualified preceptor is not available for a brief
period of time, students may be assigned to work with ancillary staff (lab, x-ray, physical
therapy, pharmacy, etc.). The program feels these opportunities can be valuable in preparing
future PA providers to work in medically underserved communities where it is not uncommon
for them to have to perform these ancillary functions.
Under no circumstances should students be expected or asked to substitute for paid
clinical, clerical or other facility employees. Students are not employees of the clinical site.
They are there solely for supervised experiential learning and must work entirely under the
preceptor’s supervision. The preceptor is expected to see all the patients seen by their PA
student and review all direct patient care performed by their PA student. The preceptor should
be aware of the student’s assigned activities at all times. The PA student must not be allowed to
assess, treat, or discharge a patient without evaluation by the preceptor.
Patient Notification of Student Involvement
Patients must be informed that a physician assistant student will be participating in their
care and be given the opportunity to decline student involvement. To that end, the program
mandates that students wear the UC Physician Assistant Program white clinic coat and their
name badge identifying them by name and “Physician Assistant Student,” unless otherwise
directed by the clinical site and/or preceptor. Students are also required to verbally introduce
themselves as a PA student. If the patient requests their provider only and refuses the PA
student’s services or participation in their care, the request must be honored.
Level of Supervision
Before PA students are allowed to begin even their first supervised clinical practice
experience rotation, they undergo a formal comprehensive pre-clinical assessment which
includes objective structured clinical evaluations (OSCEs) using standardized patients and a
comprehensive written examination to assess their biomedical and clinical knowledge base.
They are not allowed to begin clinical rotations unless they pass every component of this series
of assessments.
Therefore, PA students from the UC PA Program have demonstrated skills in detailed
history taking, performing comprehensive and problem-focused physical examinations,
providing oral presentation of findings, and medical-decision making before they begin their first
clinical rotation. As students progress through their 10 clinical practice rotations their level of
skill is expected to improve allowing for progressively increased supervised autonomy. It is each
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preceptor’s responsibility to assess the level of supervision a student requires during each
rotation. However, by the end of the first week in any rotation students should be able to
actively participate in the evaluation of patients and as a preceptor feels more comfortable with
the student’s skills and abilities, the student should be expected and encouraged to assume
increasing supervised autonomy during that specific rotation.
Student Documentation of Patient Care
If allowed by the preceptor and/or facility, PA students may enter information in the
medical record. However, preceptors must clearly understand how different payors view student
notes as related to documentation of services provided for reimbursement purposes. Any
questions regarding this issue should be directed to the facility’s billing department. All medical
record entries must be identified as a “student” note and must include the PA student’s signature
and the designation “PA-S.” The preceptor can not bill for services performed by a student.
Preceptors are required to document the services they provide as well as review and edit all
student documentation.
If facility policies do not allow students to make medical record or EMR entries, the
program encourages preceptors to still require their student’s to prepare appropriate succinct
hand-written patient care notes to evaluate the student’s documentation skills and provide
feedback.
Assess student performance
Assessment of student performance should be an ongoing process throughout each
supervised clinical practice rotation. Regular feedback about observed strengths and weaknesses
is a critical component of effective learning. The preceptor’s evaluation of the student is
tremendously important. At the end of this handbook, you will find an example of the program’s
standard form for Preceptor Evaluation of the Student/Program.
We ask preceptors to provide formal feedback twice during the four-week rotation: at the
end of week two and at the end of the rotation. The week two evaluation is formative in nature;
meaning, we do not use it to determine the student’s final rotation grade but rather as a means of
ensuring the student (and program faculty) receive some formal feedback about their progress
midway through each rotation. The end-of-rotation preceptor evaluation of student performance
along with the rotation-specific assignments students are required to submit to the designated
rotation course director (a program faculty member) are used to determine the rotation grade.
The final grade for each clinical rotation, including the decision to pass or fail a student, is
ultimately made by the program.
Preceptors are encouraged to contact the program at any time during a student’s rotation
if concerns about student performance threaten patient safety, clinical site security or other
critical facility policies or operations.
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Providing student feedback
In the setting of clinical medical education, feedback refers to information describing a
student’s performance in a given activity. It is a key step in the acquisition of medical skills.
Feedback is formative not judgmental. As an integral part of the learning process, it allows the
student to remain on course and to reach their goals. Without feedback mistakes go uncorrected,
good performance is not reinforced, and clinical competence is achieved empirically or not at all.
Most students have an uncertainty when they begin their clinical rotations. Without feedback
their sense of going adrift in a strange environment will be amplified.
When used properly, feedback can be a powerful tool in clinical medical education. It
provides the trainee with vital information on his or her performance, thereby setting the stage
for improvement. It is important to convey an attitude of concern for the progress and
development of the student that is not restricted to grades and testing.
It is necessary to help the student see feedback as an informed, non-evaluative, objective
appraisal of performance intended to improve clinical skills – rather than as an attack on their
personal worth. Guidelines for giving feedback include:
Base it on first-hand data
Limit it to behaviors that are remediable
Make it specific not generalized
Refer to decision making and actions
The important thing to remember about feedback is that it is necessary and valuable to
facilitate the student in making the most of his or her clinical opportunities. Not only is feedback
helpful to the student but it is also necessary for the Program to assess their ability to prepare
students for the healthcare environment. It is our hope that students will reflect the maturity,
honesty, and commitment necessary to receive feedback and improve their clinical skills- traits
that are certainly worth cultivating in our future providers.
End-of-rotation student evaluation
An end-of-rotation student evaluation must be completed for each student. A
standardized program form is provided for this purpose (see Appendix 2). The completed form
should be sent/faxed to the program during the student’s final week at your facility. Please be as
candid as possible in your evaluation of each student you supervise. Do not evaluate the students
based upon some preconceived grade you feel they should receive. Evaluate them based upon
their performance and abilities. The program monitors and assesses each student’s progression
as they move from one clinical experience to another. Our ability to do that effectively requires
clear, concise and candid evaluations from all preceptors.
Preparing a formal performance evaluation is perhaps one of the most unpleasant tasks
any supervisor has to perform. Please remember, however, that a student’s performance
evaluation is a critical component of their education. Evaluations help assure everyone that these
future health care providers possess the knowledge, skills and professional manners/attitudes
necessary to effectively perform the responsibilities they will one day assume.
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Program evaluation
Included within the Preceptor Evaluation of the Student is a section of questions asking
you to evaluate the UC Physician Assistant Program. This is an especially important part of our
program’s self-assessment and improvement process. Your feedback about student preparedness,
knowledge and clinical skills, communication skills, etc. will help us evaluate our own
performance as educators and develop plans for program improvement. Please be candid.
Identify any concerns you have about our program or any suggestions you may have for
improvement in curriculum content or program administration.
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Preparations
All students in the clinical year are required to have current immunizations (per CDC
guidelines for healthcare workers) including a current TB test and will have completed a criminal
background check. These background checks are considered a condition of acceptance into the
clinical program. Our students will all have achieved current BLS, ACLS, and HIPPA
certification and have been trained in surgical technique and infection control (including
Standard Precautions and bloodborne pathogen exposure control policies and procedures).
The program does not supply nor mandate that students independently procure Worker’s
Compensation insurance; however, all students are required to maintain a personal health
insurance policy. UC maintains professional liability insurance coverage for each student in the
amounts of $1,000,000 per occurrence and $3,000,000 aggregate.
Travel/Living accommodations
Students are responsible for arranging and financing travel and living accommodations
associated with each of their clinical rotations.
Professional attire/appearance
Students are required to maintain a professional appearance in dress and hygiene.
Student should discuss appropriate dress code with the preceptor prior to the rotation or during
the orientation. Generally, men are to wear a dress shirt with collar and tie, non-jean slacks,
socks and closed-toe shoes. Women are to wear a dress or a combination shirt or blouse with
non-jean slacks or a skirt and appropriate hosing or socks with closed-toe shoes. In addition,
students are to wear a half-length white lab coat emblazoned with the UCPAP logo and their UC
Physician Assistant Student name tag during all assigned rotation activities unless the coat is
inappropriate based upon the activity being performed (e.g. operating room).
All students are prohibited from wearing any of the following items during a rotation:
denim jeans, excessive jewelry, visible body piercing jewelry except one pair of non-dangling
earrings, shorts or short-skirts, T-shirts or sweatshirts as an outer layer of clothing, sandals or any
open toed-shoes.
Students are to be appropriately groomed to present a professional appearance. Hair is to
be clean and long hair is to be neatly gathered behind the head. Nails are to be kept clean and
trimmed short. Strong colognes or perfumes are not to be used.
Any student infraction of the dress code should be noted in the professionalism section of
the student’s evaluation. Serious or recurrent infractions should be reported directly to the
program’s Director of Clinical Education by phone or email to initiate prompt corrective
counseling.
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Attendance/Participation
Students are expected to conduct themselves in each clinical practice rotation as if they
were an employee of the affiliate site. Punctuality is required. Any absence or recurring
episodes of tardiness (more than 2 times during a rotation) should be promptly reported to the
program’s Director of Clinical Education.
Professional conduct
We believe that a PA should possess professional attributes that will be a reflection of the
PA profession. These attributes are just as important as academic and clinical skills and will be
deemed as such. Professionalism is an important part of your evaluation of the student and
inadequacies will not be taken lightly. Students must observe confidentiality, integrity, and
professional behavior in the clinical environment. If at any time the preceptor determines that a
student’s behavior introduces concerns regarding the safety of patients, substandard care, or
unprofessional conduct, the program should be immediately notified.
Documentation of participation
Students are required to maintain complete and accurate internet-based records of ALL
patient encounters (without any patient identifying information). These logs are a critical
component of the program’s evaluation of each a student’s clinical rotation. These records are
also used to evaluate equivalency of experiences obtained by program students assigned to
different locations for similar clinical rotations.
Evaluate preceptors and clinical rotation experiences
Students are required to prepare a formal clinical rotation and preceptor evaluation at the
conclusion of each rotation experience. Data from these surveys will be aggregated and
analyzed annually and a copy will be made available to the preceptor.
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The UCPAP has adopted a blend of traditional, active and collaborative learning methods
designed to enhance both academic learning and clinical skills development throughout the
comprehensive didactic curriculum. The four full-time semesters students spend on-campus
preparing for their supervised clinical experiential learning includes the following courses of
study:
First Semester
MPAS 501 Professional Development I (1 credit)
The professional development sequence of courses spans the entire program curriculum and is intended to
introduce and integrate principles of professionalism, ethics, and the business of medicine with the practice
of medicine. This first semester focuses on the history of the profession, professionalism, medical ethics,
and working as part of a health care delivery team.
MPAS 691 Patient-Centered Care I (2 credits)
The patient-centered care (PCC) sequence of courses spans the didactic component of the curriculum and is
designed to challenge students to develop clinical reasoning skills, think critically, enhance interpersonal
and communication skills, apply evidence-based resources, and problem-solve as clinicians and as
members of an interdisciplinary health care team. The first PCC course focuses on several fundamental
concepts: team approach to care, patient-centered medical home (PCMH), roles and responsibilities of
various health professions, core epidemiology and biostatistics principles, evidence-based medicine, and
health information literacy. Tailoring care to individual patients will also be discussed, including principles
related to treating patients with chronic disease so that students may subsequently consider disease
processes of organ-systems in the context of patients with underlying comorbidities.
MPAS 550 Mechanisms of Disease (3 credits)
This course is an introduction to general pathology covering the basic principles of cell biology, histology,
embryology, immunology, molecular genetics, infectious processes, nutrition, and environmental effects on
health necessary for an understanding of human disease processes and the molecular mechanisms
underlying disease development. The pathophysiology of diseases affecting specific body regions is
presented in the individual organ system courses.
MPAS 560 Clinical Pharmacology (2 credits)
This course covers fundamental pharmacology principles to provide a foundation for students to learn more
about and subsequently utilize pharmacotherapeutics in the practice of patient-centered care. Topics include
but are not limited to: pharmacokinetics, pharmacodynamics, drug interactions, adverse drug reactions,
autonomic nervous system pharmacology, and analgesia. Emphasis will be placed on individualization of
drug therapy.
MPAS 570 Applied Anatomy (3 credits)
This course in human anatomy is intended to stress the clinical applications of topographic, radiographic
and gross anatomy in the day to day practice of medicine. Recognizing normal anatomic structures,
common anatomic variations, and anatomic pathology as well as the application of that knowledge toward
effective diagnostic evaluation and therapeutic intervention is emphasized.
MPAS 580 Medical Physiology (3 credits)
This course covers fundamental physiologic principles that must be understood in order to fully appreciate
health and disease. Alterations of normal function will be highlighted throughout. Students will also be
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introduced to common laboratory medicine practices used to evaluate for disruption of the normal health
state.
MPAS 590 History and Physical Examination Skills (3 credits)
This course begins to develop effective interviewing skills necessary to perform a comprehensive health
history as well as a problem-specific history. Students will be taught the principles of physical examination,
including inspection, auscultation, percussion, and palpation. The initial focus will be on normal physical
exam findings, with a latter emphasis on abnormal findings, so that students can identify normal findings
and later differentiate between them. Instruction and practice in recording the comprehensive health history
and physical exam will be included in this course. This course focuses on the history and physical
examination specific to adults. History and physical exam skills specific to the pediatric and geriatric
population are taught in other courses.
Second Semester
MPAS 502 Professional Development II (1 credit)
This second course in the series focuses on the health care provider’s roles and responsibilities in the area
of public health and the practice of preventive medicine.
MPAS 692 Patient-Centered Care II (2 credits)
The patient-centered care (PCC) sequence of courses spans the didactic component of the curriculum and is
designed to challenge students to develop clinical reasoning skills, think critically, enhance interpersonal
and communication skills, apply evidence-based resources, and problem-solve as clinicians and as
members of an interdisciplinary health care team. The second PCC course introduces students to simulated
cases where they will act as clinicians to evaluate standardized patients. Cases will be acute care in nature
and emphasis will be placed on the following: developing differential diagnoses, developing assessments
and plans, the medical chart, medical documentation, informed consent, oral case presentation, and
integration of preventive care and public health principles in the context of acute care.
MPAS 601 Behavioral Dynamics (3 credits)
This foundational course will emphasize psychosocial aspects of medicine. Students will be challenged to
develop interpersonal and communication skills applicable to connecting with patients and other healthcare
professionals. Treatment will be discussed from a biopsychological perspective with reference to
psychotherapies, psychopharmacology, and environmental intervention. Recognition and management of
common psychiatric and psychosocial problems encountered in primary care will be highlighted.
Indications for referral and hospitalization will be discussed. Topics covered will include, but not be limited
to, anxiety disorders, mood disorders, psychosis, substance use disorders, personality disorders, eating
disorders, and psychiatric emergencies and crises.
MPAS 602 Hematology/Oncology (2 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the hematopoietic and
lymphoid organs and processes of hemostasis are examined. The clinical presentation, epidemiology,
pathology, patient assessment, diagnosis, therapeutic interventions, management, and clinical course of
these conditions will be explored. An introduction to oncology is also included which focuses on the
clinical aspects of cancer screening, diagnosis, staging, and therapeutic intervention. Organ specific cancers
are primarily discussed in their corresponding clinical science courses.
MPAS 603 Infectious Disease (2 credits)
This is one of the foundational courses for study of the clinical sciences. This course uses a generalized
approach to study infectious diseases by examining the mechanisms of disease transmission and
pathogenicity, methods of diagnosis, antimicrobial pharmacotherapy, common and systemic clinical
presentations, and methods for infection control and prevention. Common bacterial, viral, fungal, and
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parasitic pathogens are explored. Organ system specific infections are primarily discussed in their
corresponding clinical science courses.
MPAS 604 Endocrinology (3 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting metabolism and
organs of the endocrine system are examined. The clinical presentation, epidemiology, pathology, patient
assessment, diagnosis, therapeutic interventions, management, and clinical course of these conditions will
be explored.
MPAS 605 EENT (2 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the eyes, ears, nose
and throat (EENT) are examined. The clinical presentation, epidemiology, pathology, patient assessment,
diagnosis, therapeutic interventions, management, and clinical course of these conditions will be explored.
Third Semester
MPAS 503 Professional Development III (1 credit)
The third in this seven course sequence surveys health care delivery systems, health care disparities, and
provider sensitivity to cultural diversity, socioeconomic differences, and their impact on health and
wellness. Alternative, integrative and preventive approaches to health care are examined.
MPAS 693 Patient-Centered Care III (2 credits)
The patient-centered care (PCC) sequence of courses spans the didactic component of the curriculum and is
designed to challenge students to develop clinical reasoning skills, think critically, enhance interpersonal
and communication skills, apply evidence-based resources, and problem-solve as clinicians and as
members of an interdisciplinary health care team. The third PCC course again utilizes simulated cases
where students will evaluate standardized patients. Emphasis will be placed on the following:
comprehensive patient management, longitudinal management of established patients, admission orders,
inpatient management, progress notes, discharge summaries, rehabilitative care, palliative care and end-of-
life issues, and utilization of an electronic health care record.
MPAS 606 Gastroenterology (2 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the gastrointestinal
system are examined. The clinical presentation, epidemiology, pathology, patient assessment, diagnosis,
therapeutic interventions, management, and clinical course of these conditions will be explored.
MPAS 607 Cardiovascular (4 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the cardiovascular
system are examined. The clinical presentation, epidemiology, pathology, patient assessment, diagnosis,
therapeutic interventions, management, and clinical course of these conditions will be explored. Students
will also be challenged to learn the fundamentals of interpreting an electrocardiogram (EKG) with an
emphasis on identifying common abnormal EKG patterns and differentiating these patterns from normal
and normal variant EKG tracings.
MPAS 608 Pulmonology (2 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the pulmonary system
are examined. The clinical presentation, epidemiology, pathology, patient assessment, diagnosis,
therapeutic interventions, management, and clinical course of these conditions will be explored.
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MPAS 609 Genitourinary (2 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the genitourinary
system are examined. The clinical presentation, epidemiology, pathology, patient assessment, diagnosis,
therapeutic interventions, management, and clinical course of these conditions will be explored.
MPAS 610 Neurology (2 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the neurologic system
are examined. The clinical presentation, epidemiology, pathology, patient assessment, diagnosis,
therapeutic interventions, management, and clinical course of these conditions will be explored.
MPAS 611 Geriatrics (2 credits)
This course is designed to provide the foundation to address changes that occur with aging and medical
problems commonly seen in the elderly. In addition, there is focus on the impact of aging on a patient’s
quality of life, limitations in mobility and communication, access to health care, therapeutic interventions,
and issues related to death and dying.
Fourth Semester
MPAS 504 Professional Development IV (1 credit)
Offered during the final semester of the didactic curriculum, this course focuses on preparation for clinical
practice looking at many of the legal and practice-based issues including: electronic data management,
coding, billing, reimbursement, rules and regulations, confidentiality, certification and licensure, and
safety.
MPAS 694 Patient-Centered Care IV (2 credits)
The patient-centered care (PCC) sequence of courses spans the didactic component of the curriculum and is
designed to challenge students to develop clinical reasoning skills, think critically, enhance interpersonal
and communication skills, apply evidence-based resources, and problem-solve as clinicians and as
members of an interdisciplinary health care team. The fourth PCC course will prepare students to work in
teams with students from other health professions on campus. Case-based scenarios and cases utilizing
mannikin simulators will facilitate a team approach to patient centered care. Students will be challenged to
rely on the strengths of students from other disciplines to solve complex medical cases. Emphasis will also
be placed on further developing interpersonal and communication skills.
MPAS 612 Women’s Health (3 credits)
This course addresses important aspects of women’s health with an emphasis on obstetrical, gynecologic,
and preventive care. Content will include a thorough exploration of physiology, pathophysiology, disease
states, management options, and screening guidelines for women’s health issues. Obstetrics focuses on the
principles of prenatal care, complications that arise in pregnancy, and management of the more common
emergent problems that can occur in pregnancy.
MPAS 613 Pediatrics (3 credits)
This course examines important aspects of primary care pediatrics including assessment of the child
patient, preventive health, and pediatric diseases and conditions. Specific issues of the newborn and older
child will be presented in such areas as perinatal care, child development & behavior, congenital & genetic
disorders, pediatric pharmacotherapy, pediatric infectious disease, and parenting. The student will also
learn assessment techniques specific to the pediatric population.
MPAS 614 Dermatology (2 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the dermatology
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system are examined. The clinical presentation, epidemiology, pathology, patient assessment, diagnosis,
therapeutic interventions, management, and clinical course of these conditions will be explored.
MPAS 615 Musculoskeletal (3 credits)
This is one of the series of courses using an organ systems approach for study of the clinical sciences.
During this course, the commonly encountered medical problems primarily affecting the musculoskeletal
system are examined. The clinical presentation, epidemiology, pathology, patient assessment, diagnosis,
therapeutic interventions, management, and clinical course of these conditions will be explored.
MPAS 616 Emergency Medicine (3 credits)
This course is designed to prepare students to recognize, rapidly assess, and effectively manage an
emergent illness or injury. Problem-based case studies and team-based activities are utilized extensively in
this course to encourage the development of team-work, collaboration, and interdisciplinary value. BLS
and ACLS certification is part of this course.
MPAS 617 Surgery (1 credit)
This course focuses on the surgical management of health care problems emphasizing the principles and
practices involved in aseptic and surgical technique, wound management, anesthesia, and preoperative,
perioperative and postoperative evaluation and management of patients.
Upon completion of the entire didactic curriculum, students are required to successfully
demonstrate a broad knowledge base of the basic biomedical and clinical sciences as well as
essential technical skills before they can proceed into the clinical practice rotations. The
program administers a pre-clinical comprehensive assessment to evaluate each student’s
readiness for supervised clinical practice experience. This assessment includes a comprehensive
written examination and multiple objective standardized clinical evaluations (OSCEs) to assess a
variety of technical skills including patient interviewing, physical examination, oral case
presentation, medical documentation, appropriate use and interpretation of diagnostic studies,
differential diagnosis formulation and development of treatment plans. Students are not allowed
to begin clinical rotations unless they pass this assessment.
Clinical Curriculum
The supervised clinical practice experience (SCPE) rotations are the culminating learning
activities of the physician assistant education. SCPE consist of nine (9) core or mandatory
rotations and one elective rotation in any of the medical or surgical specialties or subspecialties,
or in medical research or medical academia. Each rotation is four (4) weeks in length and there
is no defined order in which these rotations are scheduled. The nine core rotations include:
MPAS 701 Family Medicine Rotation
This core clinical practice rotation provides an opportunity to learn, understand and gain supervised
experience in practicing the principles of Family Medicine. The focus of this preceptorship is evaluation
and management of commonly encountered conditions in the outpatient setting and in patients of all ages.
MPAS 702 Internal Medicine Rotation
This four-week core clinical practice rotation provides an opportunity to learn, understand and gain
supervised experience in practicing the principles of Internal Medicine. The focus of this preceptorship is
providing longitudinal health care for chronic health problems.
MPAS 703 Pediatrics Rotation
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This core clinical practice rotation provides an opportunity to learn, understand and gain supervised
experience in practicing the principles of Pediatrics. The focus of this preceptorship is acute and preventive
health care for pediatric patients.
MPAS 704 Obstetrics/Gynecology Rotation
This core clinical practice rotation provides an opportunity to learn, understand, and gain supervised
experience in the principles and practice of Obstetrics and Gynecology. The overall focus of this
preceptorship is obstetrical, gynecologic, and women’s preventive care.
MPAS 705 Emergency Medicine Rotation
This four-week core clinical practice rotation provides an opportunity to learn, understand and gain
supervised experience in practicing the principles of Emergency Medicine. The overall focus of this
preceptorship is providing emergency medical services.
MPAS 706 General Surgery Rotation
This core clinical practice rotation provides an opportunity to learn, understand, and gain supervised
experience in the principles and practice of General Surgery, especially in the operating room setting. The
overall focus of this preceptorship is evaluation and care of patients with commonly encountered conditions
requiring surgical management.
MPAS 707 Psychiatry Rotation
This core clinical practice rotation provides an opportunity to learn, understand and gain supervised
experience in practicing the principles of Psychiatry. The focus of this preceptorship is behavioral and
psychiatric health care.
MPAS 708 Hospitalist Rotation
This four-week core clinical practice rotation provides an opportunity to learn, understand and gain
supervised experience in practicing the principles of Hospital Medicine. The focus of this preceptorship is
providing care for patients in the inpatient setting.
MPAS 709 Primary Care Rotation
This core clinical practice rotation provides an opportunity to learn, understand and gain supervised
experience in practicing the principles of Primary Care Medicine. The focus of this preceptorship is
evaluation and management of commonly encountered conditions in a medically underserved and/or rural
setting for patients of all ages and cultural backgrounds.
Concomitantly, students are enrolled in the following three courses which are administered
online, one each semester, by program faculty:
MPAS 505 Professional Development V
This fifth course in the series is taken at the onset of the student’s supervised clinical practice experiential
learning. The focus during this transitional phase is the development of skills needed to become a lifelong
learner through practice based learning/self-improvement and developing awareness of health care systems,
health policy, and current trends/issues. There is a continued emphasis on the display and development of
professionalism as it applies to clinical practice.
MPAS 506 Professional Development VI
During this sixth semester of professional development the organizational and economic elements of a
systems-based practice are examined focusing on cost-effective and efficient health care, case management,
risk management, error prevention, patient safety, and quality improvement.
MPAS 507 Professional Development VII
The focus of this final course in the series will be the professional expectations and responsibilities facing
the new physician assistant graduate and cultivation of the skills necessary for career development and
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growth. Topics will include such things as curriculum vitae/resume development, job searching,
interviewing, employment contracts, credentialing, privileging, mentoring, leadership development and
sustaining the profession.
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AAAppppppeeennndddiiiccceeesss
1. Preceptor Development
A. Integrating the Student into a Busy Practice
B. Integrating the Learner into the Busy Office Practice
C. Providing Effective Feedback
D. Managing Difficult Learning Situations
E. Developing Expectations
F. Conflict Resolution
2. Preceptor Evaluation of the Student and Program
3. Student Evaluation of the Clinical Site and Preceptor
24 | P a g e
AAAppppppeeennndddiiixxx 111::: PPPrrreeeccceeeppptttooorrr DDDeeevvveeelllooopppmmmeeennnttt
A. Integrating the Student into a Busy Practice
The Model “Wave” Schedule1
This resource provides an actual time schedule for a preceptor and student to follow; it
allows the student to see a sufficient number of patients while also allowing the preceptor
to stay on schedule and not fall behind.
http://medicine.yale.edu/intmed/Images/preceptor_handbook_tcm309-40876.pdf (See
page 13)
– Adapted from Yale Medical School Ambulatory Clerkship Handbook
Integrating the Learner into the Busy Office Practice2
This article outlines five strategies for effectively integrating a student into a busy practice;
it helps answer preceptor questions, including “What do I do if I get behind?” and “What
measures can help prevent me from getting behind?”
http://www.oucom.ohiou.edu/fd/monographs/busyoffice.htm
Time-Efficient Preceptors in Ambulatory Care Settings3
This case-based article gives the reader time-saving and educationally effective strategies
for teaching students in the clinical setting.
http://www.paeaonline.org/index.php?ht=a/GetDocument
Action/i/80706
B. Evaluation and Teaching Strategies
Evaluation Using the GRADE Strategy4
This easy-to-use tool provides five simple tips on how to effectively evaluate PA students.
http://www.stfm.org/fmhub/Fullpdf/march01/ftobt.pdf
The One-Minute Preceptor5
This resource outlines five “microskills” essential to clinical teaching.
http://stfm.org/fmhub/fm2003/jun03/stevens.pdf
http://www.paeaonline.org/index.php?ht=d/sp/i/80183/pid/80183
Feedback and Reflection: Teaching Methods for Clinical Settings6
This article describes how to use these two clinical teaching methods effectively.
http://www.uthscsa.edu/gme/documents/FeedbackandReflection.pdf
Characteristics of Effective Clinical Teachers7
This study looks at what residents and faculty consider to be the most effective
characteristics of clinical preceptors. http://stfm.org/fmhub/fm2005/january/tamara30.pdf
P a g e | 25
C. Providing Effective Feedback
Getting Beyond “Good Job”: How to Give Effective Feedback8
This article outlines why feedback is important, barriers to feedback, and how to give
constructive feedback. http://pediatrics.aappublications.org/cgi/reprint/127/2/205
Feedback in Clinical Medical Education9
This article provides effective guidelines for giving feedback. http://jama.ama-
assn.org/content/
250/6/777.full.pdf+html
Feedback: An Educational Model for Community-Based Teachers10
This document provides insightful tips on giving feedback, describes differences between
feedback and evaluation, addresses barriers to giving feedback, and gives the reader case-
based practice scenarios. http://www.snhahec.org/feedback.cfm
D. Managing Difficult Learning Situations
Dealing with the Difficult Learning Situation: An Educational Monograph for
Community-Based Teachers11
These documents outline strategies for both preventing and managing difficult learning
situations. http://www.snhahec.org/diffman.cfm
Providing Difficult Feedback: TIPS for the Problem Learner12
This article provides an easy-to-use “TIPS” strategy to address difficult learners or learning
situations. http://www.uthscsa.edu/gme/documents/ProvidingDifficultFeedback.pdf
E. Developing Expectations
Setting Expectations: An Educational Monograph for Community-Based Teachers13
This document outlines both a timeline and comprehensive ways to develop expectations
for both the learner and teacher. http://www.snhahec.org/expectations.cfm
F. Conflict Resolution
Aspects of Conflict Resolution14
This article discusses the causes of conflict, approaches to conflict resolution, and
techniques/strategies to resolve conflict effectively.
http://www.traqprogram.ca/index.php/en/resources/traq-library/item/303-aspects-of-
conflict-resolution
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Appendix 1 References
1. Kernan WN. Preceptor’s Handbook. http://medicine.yale.edu/intmed/
Images/preceptor_handbook_tcm309-40876.pdf. Revised 1/30/04. V1.2011. Accessed May
15, 2011.
2. MAHEC Office of Regional Primary Care Education. Integrating the Learner into the Busy
Office Practice. MAHEC, Ashville, NC. http://www.oucom.ohiou.edu/fd/
monographs/busyoffice.htm. Accessed September 16, 2011.
3. Usatine R, Tremoulet, PT, and Irby, D. Time-efficient preceptors in ambulatory care settings.
Academic Medicine. June 2000;75:639-642.
4. Langlois J, Thach S. Evaluation using the GRADE strategy. Family Medicine. March
2001;33(3):158-160.
5. Neher J, Stevens N. The one-minute preceptor: shaping the teaching conversation. Family
Medicine. 2003;35(6):391-393.
6. Branch W, Paranjape A. Feedback and reflection: teaching methods for clinical settings.
Academic Medicine. December 2002;77(12, Part 1):1185-1188, December 2002.
7. Buchel T, Edwards FD. Characteristics of effective clinical teachers. Family Medicine.
January 2005;37(1):30-35.
8. Gigante J, Dell M, Sharkey A. Getting beyond "good job": how to give effective feedback.
Pediatrics. 2011;127(2):205-207.
9. Ende J. Feedback in clinical medical education. JAMA. 1983;250(6):777-781.
10. Southern New Hampshire Area Health Education Center. Feedback, An Educational Model
for Community-Based Teachers. http://www.snhahec.org/feedback.cfm. Accessed June 22,
2010.
11. Southern New Hampshire Area Health Education Center. Dealing with the Difficult Learning
Situation: An Educational Monograph for Community-Based Teachers.
http://www.snhahec.org/diffman.cfm. Accessed May 5, 2010
12. Lucas J, Stallworth J. Providing difficult feedback: TIPS for the problem learner. Family
Medicine. 2003;35(8):544-546.
13. Southern New Hampshire Area Health Education Center. Setting Expectations: An
Educational Monograph for Community-Based Teachers.
http://www.snhahec.org/expectations.cfm. Accessed June 22, 2010.
14. Letendre P. Aspects of conflict resolution. TraQ Program of the British Columbia Provincial
Blood Coordinating Office. 2002-2009.
http://www.traqprogram.ca/index.php/en/resources/traq-library/item/303-aspects-of-conflict-
resolution. Accessed October 8, 2011.
