Download PHAS 6101Sub-syllabus EM 2016

THE UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER at SAN ANTONIO
School of Health Professions
Department of Physician Assistant Studies
2016-2017
PHAS Supervised Clinical Practice
EMERGENCY MEDICINE (EM) Sub-syllabus
As a student at The University of Texas Health Science Center at San Antonio, you
have a legal and ethical responsibility to safeguard the privacy of all patients and protect
confidentiality and security of all health information. Protecting the confidentiality of
patient information means protecting it from unauthorized use or disclosure in any
format— oral, verbal, fax, written, or electronic/computer. Patient confidentiality is a
central obligation of patient care. Any breaches in patient confidentiality or privacy may
result in disciplinary action, up to and including dismissal from this educational program.
Course Description: This is a four-week clinical practicum during which the student will
have the opportunity to gain practical experience in acute and emergent conditions under
the direct supervision of a licensed practitioner. Students will work primarily in emergency
medicine but may be required to take call and participate in hospital rounds. This
practicum is usually accomplished in a hospital emergency room.
Course Information:
1. This is a PA2 course.
2. Prerequisites include successful completion of the didactic year of studies.
3. This is a clinical course with learning done through direct observation, hands
on practice and reading.
4. The delivery method of this course is a hands-on four-week hospital-based
rotation. The emergency department experience is fast paced and
stressful. Students will evaluate and treat acute illnesses and injuries as well
as exacerbations of chronic illnesses of varying severity. There is usually an
opportunity to observe or participate in the resuscitation of trauma and
cardiac patients. Students often are able to perform procedures such as
suturing and splinting or casting. You will develop a working knowledge for
protocols in patient evaluation and management. Appropriate utilization of
ancillary services including laboratory, x-ray, and referral are
emphasized. Students learn limitations and appropriate indications for
immediate and delayed consultation. Students may also be exposed to triage
of patients when the patient load exceeds the immediate capability of the
facility. You should see patients of all ages, neonates to geriatrics. Expect to
work long hours – often 12-hour shifts, and 24-hour shifts at select sites. You
can also expect to work some weekends and nights as part of the shift
requirements. This will broaden your exposure to a wider variety of patient
problems.
5. Credit Hours: 4
Clock Hours: 180
Course Times: 4-week practicum. Students are expected to work a minimum of 14
shifts (16 shifts preferred) consisting of 12 hours and should include: at least three
nights, if available and at least one Saturday night.
Course Location:
As assigned by the Clinical Coordinator. Students will be given contact information for
the location and preceptor as soon as feasible. Generally, confirmed locations are
released at the end of one semester for rotation sites in the next semester.
Course Director:
Tiffani Burgin, MPAS, PA-C
Office: PA Faculty suite
Phone: 567-4240/Fax 567-4241
E-mail: [email protected]
Preferred contact: text or office phone
Email Policy: Email is responded to within 24 hours most weekdays. Every student is
issued a University e-mail address upon matriculation. As a standing University Policy,
only the student’s University e-mail address will be used for any electronic institutional
communications of an official nature.
Required Text:
Stone, C., Humphries, R., Current Diagnosis & Treatment, Emergency Medicine, 7e,
McGraw-Hill.
Papadakis, M., McPhee, S., Rabow, M., 2015 Current Medical Diagnosis & Treatment,
McGraw-Hill.
Tintinalli, J., Stapczynski, S., Cline, D., John Ma, O., Cline, R., Cydulka,G., Meckler, G.
Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 8e
*all three texts are Free online through access medicine (see web address below)*
http://www.accessmedicine.com.libproxy.uthscsa.edu/Index.aspx
Recommended Texts:
Sanford Guide to Antimicrobial Therapy –Yearly.
Maxwell Quick Medical Reference. (spiral bound) Maxwell Publishing Co.
ISBN: 0964519135.
Additional reading: As assigned by preceptor.
ARC-PA Standards: Please See the Supervised Clinical Practice Main Syllabus for
specific ARC-PA Standards pertinent to all rotations.
Competencies: Please See the Supervised Clinical Practice Main Syllabus for specific
Competencies pertinent to all rotations.
Course Goal: The Overall goal of this course is to expose the student to and provide a
hands-on experience for the student in the discipline of Emergency Medicine to include
the complex and minor illnesses as well as major and minor trauma common to this
discipline.
Course Objectives:
Performance Objectives:
The successful student will meet the performance expectations of their preceptor and
the general objectives for all rotations.
1. Take an age appropriate medical history; acute/emergent care and problemoriented.
2. Perform an age appropriate primary assessment; problem-oriented/emergent
and comprehensive as indicated, with secondary and tertiary assessments as
indicated.
3. Order or perform appropriate diagnostic tests based on history and physical
examination findings.
4. Recognize emergent conditions and execute appropriate emergent
management.
5. Formulate an appropriate differential diagnosis list.
6. Develop and execute the appropriate management plan for the patient’s
gender, age, diagnoses, and conditions; to include patient education and health
maintenance as appropriate.
7. Describe and explain the role of the PA and PA student to patients, providers,
and staff.
8. Prepare hospital admission orders and/or referral forms to move the patient to
another facility or specialist.
9. Write a complaint directed SOAP note for patients when possible. See the
Supervised Clinical Practice manual for the SOAP note submission requirement.
10. Log a patient visit for patients seen and/or procedures you have participated
in or observed using the patient logging system.
Recommended Procedures:
While in the Emergency Room, students are expected to seek opportunities to observe,
assist, or perform the following procedures, realizing they may not have the opportunity
to do so for all of those listed:
1. General
a. Administration of IV medication
b. Digital block
c. IV fluid resuscitation
d. Local anesthesia
e. Intravenous and central line placement
2. EENT
a. Anterior nasal packing
b.
c.
d.
e.
f.
g.
h.
i.
Control of epistaxis
Ear lavage
Eye irrigation
Fluorescein stain
Foreign body removal (ear/nose)
Indirect laryngoscopy
Removal of a corneal foreign body
Slit lamp examination
3. Dermatologic
a. Burn care (2nd /3rd degree)
b. Dressing change with/without packing
c. Foreign body removal (simple/skin)
d. Incise and drain an abscess
e. Suture a laceration
4. Pulmonary
a. Evaluate a chest X-Ray
b. Perform a tube thoracostomy
5. Cardiovascular
a. Interpret and EKG
b. Perform cardiac compressions
6. Gastrointestinal
a. Anoscopy
b. DRE with hemoccult test
c. Evaluate an abdominal X-Ray
d. Nasogastric tube placement
e. Perform peritoneal lavage
7. Genitourinary
a. Catheterize (female)
b. Catheterize (male)
c. Pelvic examination
d. Review Wet prep/KOH of vaginal secretions
8. Musculoskeletal
a. Apply an ace bandage
b. Apply a cast
c. Apply a shoulder immobilizer
d. Apply a sling
e. Apply a splint
f. Arthrocentesis
g. Bi-Valve a case
h. Evacuate a subungual hematoma
i. Evaluate an extremity X-ray
j. Inject a bursa or joint
k. Reduce a dislocation
l. Reduce a fracture
m. Remove a toenail/fingernail
9. Psychiatry
a. Apply psychiatric restraints
NOTE: the above list is not designed to be all inclusive. The successful student will
seek opportunities to participate in procedures of all kinds. You should include the
above list in your reading for the rotation. Both the PANCE Blueprint list above and the
procedure list above may be testable information.
COURSE REQUIREMENTS:
Patient encounter logging:
Students are expected to log 120 patients. Students should log those patients that they
are assigned as well as any patients their team is working on when the student is involved
in the care or decision making process. This includes patients rounded on or consulted
on. Note: If you are unable to log 25% of your patients the first week, notify the course
director or you will be expected to meet the logging requirements at end of the rotation.
Be sure to include CPT codes for all procedures whether observed or as the
primary provider when logging. Also, make sure to log all ICD codes for the
patients. This is an ARC-PA requirement. You must prove that you have seen
patient’s off all ages and diagnosis codes when you are about to graduate. If you
have a patient that comes in for hyperlipidemia, DM and HTN follow-up but is also
found to have depression during the visit you need to record all four ICD codes.
Professionalism:
Students are expected to conduct themselves in a professional manner, not only in
interaction with patients, but also with peers, faculty, and staff of the Department, School,
Health Science Center, Social media and community in general. In addition to
conventional academic tests and measurement criteria for assessment, students will be
evaluated on issues related to their professional and personal conduct and judgment
according to the standards of the Department, School, and profession.
Professional and technical standards must both be passed to successfully complete each
rotation. Professionalism is an essential component of each and every rotation. The
School of Health Professions’ Professional Conduct guidelines can be found in the
UTHSCSA Catalog. It is every Student’s responsibility to familiarize themselves with
these items. See also Supervised Clinical Practice Manual.
Academic Integrity
Students in the School of Health Professions are expected to be above reproach in all
professional and academic activities. Policies on academic dishonesty and integrity will
be strictly enforced; students who fail to conform to standards of academic integrity and
scholastic honesty are subject to disciplinary actions. Academic dishonesty includes,
but is not limited to, cheating on examinations or assignments, plagiarism, falsifying
data or results, presenting another person’s work as one’s own without giving proper
credit or citation, etc. These forms of academic dishonesty are classified as
“disciplinary” issues and are investigated by the Associate Dean for Students. Violations
of academic integrity standards may result in severe penalties including suspension or
dismissal from the university. To avoid charges of academic dishonesty, consult with the
department chair or faculty member about expectations.
Participation: See Supervised Clinical Practice Manual.
Assignment Guidelines:
See Supervised Clinical Practice Manual for encounter logging, extra credit, and Student
Note requirements. Below are the unique assignments for Emergency Medicine rotation.
See Supervised Clinical Practice Manual.
ASSIGNMENTS
During your EM rotation, you are required to document one problem-focused encounter
in the form of a SOAP note that gathers the pertinent data on a patient. Additionally you
are required to submit one Procedure note. These items are required and will be a part
of your EOR grade. Not submitting these items prior to EOR could result in an incomplete
rotation or a repeat of that rotation. Review the SOAP note and procedure note elements
from Canvas.
The combined points form the ER encounter note and the Procedure Note will total a
maximum of 100 points.
The ER encounter note is worth 60 points toward your grade and is equally divide among:
1. Subjective
- (25%) = 15 points
2. Objective
- (25%) = 15 points
3. Assessment
- (25%) = 15 points
4. Plan
- (25%) = 15 points
Total points
= 60 points
The Procedure note is worth 40 points toward your grade and is equally divide among:
1. Name of the procedure, indication for the procedure
- (25%) = 10 points
2. Consent and anesthesia
- (25%) = 10 points
3. Details of the procedure, findings
- (25%) = 10 points
4. Complications/Estimated Blood Loss, F/U, signature
- (25%) = 10 points
Total points
= 40 points
The Procedure Note should contain:
1. Name of the procedure (Site and type of procedure)
2. Indication for the procedure
3. Consent (type of consent, include: risks, benefits, alternatives, potential
complications, name
and relationship of person giving consent)
4. Anesthesia (Type, amount, method of administration including needle size, route)
5. Details of the procedure (Site prep, instruments/ blade description, size and/or shape
of incision(s),
6. Findings (probing performed, drainage observed in characteristics and amount,
foreign bodies encountered, anatomic abnormalities, specimens taken, management of
the wound including irrigation, packing, closure methods and amounts)
7. Complications/Estimated Blood Loss (Vascular/nervous/tissue difficulties, amount in
metric units)
8. How patient reacted to the procedure. (Tolerated well, vital signs post-;procedure
are: XXX)
9. Follow-up and wound care instructions.
10. Signature of person performing procedure.
READING ASSIGNMENTS/TOPICS:
While in the Emergency Room, it is not possible to predict the types of patients you will
see nor when you will see them. While there is a recommended reading list of topics, it
is possible that you will see patients who do not fit into any of the reading topics. You
may never see a patient that fits each in every category listed. Examination questions
will come from the reading list. The successful student will read beyond the
assignments to help insure they understand disease processes and injuries not listed
but encountered while on rotation. Students may accomplish the reading assignments
in any order.
Reading lists are on Canvas, Modules, EOR Exam Reading Lists.
Expectations: At the end of this rotation students should have an appreciation for the
overall management of a patient from admission through dismissal from the emergency
department. Students will evaluate and treat acute illnesses and injuries as well as
exacerbations of chronic illnesses. Students will have varying levels of involvement as
they are exposed to different levels and kinds of trauma. This will typically include some
observation, but more often direct hands on activities, such as suturing, foreign body
removal, splinting/casting, toenail excision, wound care and bandaging, and I & D to
name a few. Students should be able to interact well with referral sources and ancillary
services. The most successful students will seek opportunities to participate in as well
as observe all types of patient care and procedures for all age groups (from newborn to
geriatric). While it is expected that you will have many opportunities to participate in a
number of procedures, students who aggressively pursue involvement, generally have
much more success. The ED is a very busy and active clinical setting and if you do not
push forward to take the opportunities given to you, you will not walk away with a wellrounded experience.
Examination:
There is one comprehensive examination at the end of the rotation. Examination topics
will come from the reading list. Additional grading criteria are listed below in Evaluation
Criteria.
Evaluation Criteria/Grading Scale:
See the Supervised Clinical Practice Manual for expanded grading details and copy of
the grading rubric for clinical rotations. The grading scale and rubric consists of:
1. Preceptor Bi-weekly evaluation - 50 points
2. Preceptor Final evaluation
- 50 points
3. Exam score
- 500 points
4. Patient logging
- 200 points
5. Participation
6. Documentation notes
Total points
- 100 points
- 100 points
- 1000 points
You may receive bonus points for submitting photos, EKG’s and Radiographic studies
with accompanying case history and interpretation.
You must earn a grade of “C” or better to pass Inpatient rotation. Also, remember that if
you fail to submit any portion of the required items or if your preceptor gives you a bad
evaluation, you may be required to present to the Student Progress Committee before
continuing to your next rotation.
Remediation:
Individual student remediation for any course or rotation is at the discretion of the
faculty. Remediation may include additional study assignments, Student Services’
counseling, one-on-one or group student sessions, and assignment to the selective option
during the 2nd year. Remediation is not limited to the activities listed and selection of a
remediation activity is a faculty prerogative.
Recording of Class Materials:
Recording of lectures and other learning activities in this course by any means e.g., video,
audio, etc., is not permitted unless approved by the instructor or required for compliance
with the Americans with Disabilities Act (ADA).
Americans with Disabilities Statement
Students who wish to request accommodations for disabilities should complete a
Student/Resident Request for Accommodations under the Americans with Disabilities
Act (ADA) form (Form ADA-100). The form and additional information may be obtained
at http://www.uthscsa.edu/eeo/request.html. The completed form should be submitted
to Dr. David Henzi, assistant Dean for Student Affairs and Enrollment Management
(Dean’s Office), and a copy should be submitted to Dr. Bonnie Blankmeyer, Executive
Director of the Equal Employment/Affirmative Action Office (Room 101F-02 in the
Medical School Building). Request accommodations as soon as you know you will
require them. Accommodations will not be made retroactively
.