21.1. Clerkship Descriptions
The second year of the PA Program will engage students in a variety of experiential learning that consists of nine five-week clerkships of clinical training. The required disciplines include: Family Medicine, Internal Medicine, Emergency Medicine, General Surgery, Psychiatry, Pediatrics, and Women’s Health. These core clerkships will ensure each student gains the experiences expected in the accreditation Standards and will prepare them in the best possible way for practice as a generalist. There will be two elective clerkships. Students have the opportunity to identify preferences in elective disciplines. Placements are made in consultation with the clinical faculty and based on availability.
Most of the clinical year will be spent learning and refining patient care skills in clinical care settings with the supervision of a licensed preceptor. Each clerkship will be different, but the following guidelines are common to all experiences:
1) Students will be permitted to see patients with the supervision of their preceptors. The number of patients that the student will see is determined by each preceptor. The expectation is that by the end of the clinical year students should be progressively seeing more or more complex patients than when they began the year.
2) Most patient interactions will consist of the students introducing themselves, receiving the consent of the patient to interact with them and their family, soliciting the medical history and conducting a physical examination as appropriate.
3) Typically, students will present their findings, interpretation(s) and recommendations to the preceptor and they will then see the patient together to conclude the visit. Whether or not the preceptor repeats any or the entire interview or physical examination may depend on the gravity of the findings, the stage of the student’s training and previous preceptor-patient relationship. Students must refrain from discussing any findings, suspected diagnoses, next steps, or recommended treatments with the patient until after discussing their findings and conclusions with the preceptor.
4) In some settings the student will be shadowing the preceptor or working with a multidisciplinary team for periods of time. In this case, patient interactions may be indirect, where you will learn from observation, rather than doing. This style of learning is a key component of the clinical education process. Do not underestimate the importance of observation and team learning. That said, this type of learning experience should be minimized as this year is designed to allow for hands-on experiences. If a student finds they are being restricted from direct patient contact on most days of any clinical experience, they should discuss this with their primary preceptor and contact the Director of Clinical Education or their faculty advisor immediately.
5) Students should expect to work with other learners. Interprofessional education and practice are key to comprehensive and competent patient care. In consultation with their primary preceptor, we strongly encourage each student when appropriate to seek collaborative opportunities with students from other professions, such as medicine, nursing, dentistry, psychology, physical therapy, occupational therapy, pharmacy, and communication disorders.
6) Students are required to document each visit according to their site’s standards. Please follow the directions provided by each specific site. There may be paper charts, electronic medical records, or dictation systems. Sometimes special forms are used, such as for health maintenance exams or checklists for well-child and prenatal visits. Some sites may not allow students to document in the chart. In this instance, it would be best to develop a way to document the encounter and ask for an occasional review of the documentation by the preceptor. It is absolutely forbidden to dictate or document under the name or login of your preceptor.
7) When signing your name on any clinical document, always include your title: PA Student or PA-S and do not include any other credentials.
8) All notes, prescriptions and orders should be written in black ink. Do not use felt-tip pens when you write in the medical record.
9) Medical records or any document with patient identification must never be taken from the medical facility. Students must refrain from posting any clinical or patient information on social media sites. Students found to be discussing clinical experiences in any public forum (virtual and in–person) will be subject to disciplinary action, which may include dismissal from the Program.
10) Students must read and observe the rule set forth by the Committee for Medicare and Medicaid Services (CMS) as it pertains to student documentation. The CMS guidelines are used to teach physicians how to document for Medicare reimbursement. These guidelines have had a major impact upon medical education, with academic medical centers receiving large fines for non-compliance. The MGH IHP PA Program has studied the guidelines and recommends that the guidelines be applied to all Medicare and Medicaid patient visits, to avoid creating different standards of care and documentation between patients. Our current understanding of the guidelines is that:
- PA student notes may not be used to support a billable service.
- It is strongly recommended that the teaching preceptor refer to the PA student note only for past family history, social history and/or review of systems.
- The preceptor responsible for the patient must document personal involvement in a personally dictated or written note that includes all of the relevant key information necessary for billing.
- Most preceptors allow students to document the patient’s visit and then the preceptor will edit or write an addendum and co-sign. These rules do not mean the student cannot write/dictate a note. However, it does mean that the preceptor also needs to personally document the billable aspects of the history and physical.
11)Clinical schedules will be determined by the primary preceptor and may include evenings, nights, weekends, and holidays. Students are expected to be available to participate in learning opportunities during the times requested by the preceptors/site, for a minimum of 32-40 hours per week. If the Institute is closed due to inclement weather and the clinical site is open, the student is expected to communicate with their primary preceptor and make every effort, within reason, to participate in clerkship that day.