Primary Care Capstone Syllabus PHAS 7402.01 Fall 2017 Department of Physician Assistant The University of Texas Rio Grande Valley Lisa D. Longoria, MPAS, PA-C
Syllabus Welcome to your Capstone Rotations in Primary Care Medicine. This experience is designed to enable you to establish competencies in the comprehensive approach to the practice of medicine. The specialty of Primary Care Medicine is centered on lasting, caring relationships with patients and their families. Primary Care integrates the biological, clinical and behavioral sciences to provide continuing and comprehensive health care. The scope of practice encompasses all ages and genders, each organ system, and many disease entities. Instructor Lisa D. Longoria, MPAS, PA-C Clinical Assistant Professor EHABE 2.129 (956) 665-2298 Lisa.longoria@utrgv.edu Textbooks Andreoli, TE. Cecil Essentials of Medicine. 8 th ed. Philadelphia: Saunders; 2010. *Azimov MB, Esherick JS, Slater ED. Current Practice Guidelines in Primary Care 2017. United States of America: McGraw-Hill Education; 2017. *Chang, Anna, Williams, BA. Current Diagnosis & Treatment: Geriatrics. 2 nd Ed. United States of America: McGraw-Hill; 2014. *Fauci AS, Kasper DL, Jameson JL, Longo DL, Hauser SL, eds. Harrison's Principles of Internal Medicine. 19th ed. New York: McGraw- Hill; 2012. *Ginsburg S, Hafferty F, Levinson W, Lucey C. Understanding Medical Professionalism. New York: McGraw-Hill; 2014.
*e-books *Lewis, E, Matheny, S, South-Paul, J. Current Diagnosis & Treatment: Family Medicine. 4 th ed. United States of America: McGraw-Hill Education; 2015. *McPhee SJ, Papadakis MA, Rabow MW, eds. Current Medical Diagnosis & Treatment 2017. New York: McGraw-Hill Education; 2017. Responsibilities and Expectations It is expected that students will act professionally at all times. Students should carefully review and refer to the Policy Manual for details about such things as absence, dress code, behavior, etc. Course Description: PHAS 7401 Capstone Clinical Track I This is an advanced clinical course designed to augment and update the existing clinical skills and knowledge of the primary care Physician Assistant. Learning objectives will focus on increasing the core competencies for the PA profession with focus on the medical knowledge competency in the area of medical concentration track the student has chosen. Prerequisite: Completion of both Didactic and Clinical Year courses. Competencies I. Medical Knowledge Medical knowledge includes the synthesis 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 investigative and analytic thinking approach to clinical situations. Physician assistants are expected to understand, evaluate, and apply the following to clinical scenarios: 1. evidence-based medicine 2. scientific principles related to patient care 3. etiologies, risk factors, underlying pathologic process, and epidemiology for medical conditions 4. signs and symptoms of medical and surgical conditions 5. appropriate diagnostic studies 6. management of general medical and surgical conditions to include pharmacologic and other treatment modalities 7. interventions for prevention of disease and health promotion/maintenance 8. screening methods to detect conditions in an asymptomatic individual 9. history and physical findings and diagnostic studies to formulate differential diagnoses II. Interpersonal & Communication Skills Interpersonal and communication skills encompass the verbal, nonverbal, written, and electronic exchange of information. Physician assistants must demonstrate interpersonal and communication skills that result in effective information exchange with patients, patients families, physicians, professional associates, and other individuals within the health care system. Physician assistants are expected to: 2. use effective communication skills to elicit and provide information 4. work effectively with physicians and other health care professionals as a member or leader of a health care team or other professional group
6. accurately and adequately document information regarding care for medical, legal, quality, and financial purposes III. Patient Care Patient care includes patient- and setting-specific assessment, evaluation, and management. Physician assistants must demonstrate care that is effective, safe, high quality, and equitable. Physician assistants are expected to: 1. work effectively with physicians and other health care professionals to provide patient-centered care 2. demonstrate compassionate and respectful behaviors when interacting with patients and their families 3. obtain essential and accurate information about their patients 4. make decisions about diagnostic and therapeutic interventions based on patient information and preferences, current scientific evidence, and informed clinical judgment 5. develop and implement patient management plans 6. counsel and educate patients and their families 7. perform medical and surgical procedures essential to their area of practice 8. provide health care services and education aimed at disease prevention and health maintenance 9. use information technology to support patient care decisions and patient education IV. 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 acknowledge 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: 1. understanding of legal and regulatory requirements, as well as the appropriate role of the physician assistant 3. accountability to patients, society, and the profession 4. commitment to excellence and on-going professional development 7. self-reflection, critical curiosity, and initiative V. Practice-based Learning & Improvement Practice-based learning and improvement includes the processes through which physician assistants engage in critical analysis of their own practice experience, the medical literature, and other information resources for the purposes of self- and practiceimprovement. Physician assistants must be able to assess, evaluate, and improve their patient care practices. Physician assistants are expected to: 2. locate, appraise, and integrate evidence from scientific studies related to their patients health VI. 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 balances quality and cost, while maintaining the primacy of the individual patient. PAs should work to improve the health care system of which their practices are a part. Physician assistants are expected to: 1. effectively interact with different types of medical practice and delivery systems
4. advocate for quality patient care and assist patients in dealing with system complexities 6. accept responsibility for promoting a safe environment for patient care and recognizing and correcting systems-based factors that negatively impact patient care Goals and Objectives Goal 1: Professionalism: Caring, Character and Clinical Competence Objectives: 1. Treat all patients, staff, and colleagues with respect. This includes the following: Displaying good manners Displaying sensitivity to cultural differences Adhering to the dress code Avoiding confrontations Avoid being offensive to the status quo 2. Display honesty, which includes the following: Showing discernment while avoiding deception when communicating with patients and their families Not passing others work off as your own Adhering to the Honor Code 3. Demonstrate caring towards patients and their families, colleagues, faculty, and all members of the health care team (including staff), which includes the following: Effectively communicates empathy Puts patients needs above own (altruism) 4. Demonstrate a good work ethic, which includes the following: Showing intellectual curiosity
Accepting responsibility for your patients Being prepared and on-time Being accountable Being dependable Reliable attendance and participation 5. Strive for excellence Actively seek to help Actively seek to broaden education and experience beyond clerkship requirements Avoid complaining 6. Accurately self-assess Actively seek and apply feedback Give feedback (including filling out course and teaching evaluations in a timely manner) Convey humility Goal 2: Patient Care: Objectives: Evaluate and manage patients in clinical settings with acute or chronic illness. 1. Obtain and record a patient s history in a logical, organized, and thorough manner. 2. Perform and record a complete physical examination in a logical, organized, and thorough manner for new patients and an appropriately focused physical examination for follow-up patients. 3. Be able to recognize normal from abnormal physical findings. 4. Interpret important supplemental information, including CBC, serum chemistries, ECG, chest x-ray, and urinalysis. 5. Use clinical reasoning to synthesize data into a prioritized differential diagnosis, working diagnosis, to guide initial diagnostic evaluation and disease management.
Goal 3: Medical Knowledge: Demonstrate understanding of the clinical presentation, basic pathophysiology, evaluation and management of diseases frequently encountered in a clinical setting. Objectives: 1. Review the pathophysiology and be able to recognize and initiate evaluation and management plans for complex clinical cases. 2. Use Bloom s Taxonomy to understand and interpret educational objectives written for clinical knowledge. 3. Using medical and clinical knowledge, complete case studies that are directly related to educational objectives. 4. Perform OSCE evaluations as assigned during each Capstone rotation. Goal 4: Interpersonal & Communication Skills: Establish effective communication so as to identify and respond to each patient s emotional needs and their personal desires regarding their medical treatment. Communicates effectively with team members to enhance team dynamics and patient care. Objectives: 1. Establish effective rapport with patients and their families. 2. Speak clearly to patients and their families using language they can understand. 3. Convey empathy to patients from a variety of cultures and backgrounds. 4. Keep team informed of patients progress and communicate with other healthcare members outside the team as needed.
5. Orally present a patient s history, physical examination, lab data, assessment and plan clearly, concisely, yet with appropriate detail. 6. Write cogent, clear progress notes that are up to date and document working diagnoses and status of diagnostic evaluation and therapeutic plans. Goal 5: Practice-based Learning & Improvement: Develop skills that foster life-long learning habits. Objectives: 1. Based on self-assessment and the Capstone objectives, create a set of personal SMART goals for the clerkship and reflect on your progress, modifying as necessary. 2. Actively seek feedback and perform reflection and self-assessment routinely. 3. Apply evidence-based medicine skills to patient care 4. Prepare and present an educational talk on a medical topic Goal 6: Systems-based Practice: Work effectively as part of a team. Develop an understanding of resources needed by patients and the resources and limitations of the current health care system. 1. Work as an effective member of the patient care team, demonstrating reliability, initiative, organization, and helpfulness. 2. Gain an understanding of interprofessional coordination and planning required when providing patient care. 3. Act as your patients advocate.
Evaluation & Assessment Preceptor Evaluation (30%) Your preceptor(s) will assess your clinical abilities as they pertain to your performance while on off campus learning opportunities. The Capstone Evaluation Form will be used to assign 30% of your grade for each capstone rotation. Assignments (30%) Course goals are achieved in each of the Capstone Rotations through a variety of experiences such as case studies, self-evaluations, reflections, write up notes, presentations, and the continued refining of education and skills. Students receive ongoing feedback on assignments and learning goals. OSCE Evaluation (30%) The Objective Structured Clinical Examination (OSCE) is a multipurpose evaluative tool that can be utilized to assess students in a (mock) clinical setting. It assesses competency, based on objective testing through direct observation. It is precise, objective, and reproducible allowing uniform testing of students for a wide range of clinical skills. The interaction with the patient includes taking a history, performing physical examination, ordering laboratory testing, interpreting findings, reaching a diagnosis, and prescribing treatment according to the medical model. Educational Portfolio (10%) An educational (or professional) portfolio is a collection of evidence that demonstrates the progressive acquisition of knowledge, skills, and attitudes. It also gives a picture of your individual experience in a learning situation. Portfolios were first developed in the 1940 s as an alternative to testing. They have become the primary means for evaluation of professional competence in fields like architecture, writing, most fine arts, and education. This is because they allow flexibility for an individual to give a representative view of their accomplishments and competence. Medicine, being both a science and an art, is very suitable for
the use of portfolios. Portfolios also promote reflective thinking and encourage you to be self-directed in determining the direction of your future learning. Development of life-long learning skills is critical to your future success as a physician assistant. But, this must be coupled with an accurate self-assessment to direct your future education. In order to encourage these skills, you will compile an educational portfolio during your three capstone rotations. This portfolio is an opportunity for you to demonstrate both your growth in the acquisition of the knowledge, skills, and attitudes required in the field of medicine and your level of competency in the six core competencies mentioned in this syllabus. In summary, the educational portfolio is designed to promote the following goals: 1. Increase self-directed learning among students and promote habits that foster life-long learning. 2. Encourage reflection on your own level of competence, your educational needs, and the medical and psychosocial needs of your patients. 3. Allow the student more flexibility and creativity to demonstrate the achievement of knowledge, skills, and attitudes necessary in medicine. Course Grades PHAS 7402 Capstone Evaluation Form (preceptor)* 30% Assignments 30% OSCE Evaluation 30% Educational Portfolio 10% * Students obtaining a failing grade on the Capstone Evaluation Form must refer to the Policy Manual for instructions.
Grading Scales The following grading scale is used to assign FINAL grades to this course: A 90 100 B 80 <90 C 70 <80 F < 70 Remediation is required for all clinical rotations and capstone rotations in which the student has not achieved competency in either or both the clinical evaluation and/or end of rotation written exam. Refer to the Clinical Remediation Policy found on page 29-30 of the Policy Manual for the Department of Physician Assistant. Missed Clinical Examination Policy Make up examination are permitted for excused absences only (see criteria and definition of departmental excused absences under section titled Punctuality and Absences). Make-up examination must be completed the day of the student s return; otherwise a grade of 0 will be assigned. STUDENTS WITH DISABILITIES If you have a documented disability (physical, psychological, learning, or other disability which affects your academic performance) and would like to receive academic accommodations, please inform your instructor and contact Student Accessibility Services to schedule an appointment to initiate services. It is recommended that you schedule an appointment with Student Accessibility Services before classes start. However, accommodations can be provided at any time. Brownsville Campus: Student Accessibility Services is located in Cortez Hall Room 129 and can be contacted by phone at (956) 882-7374 (Voice) or via email at ability@utrgv.edu. Edinburg Campus: Student Accessibility Services is located in 108 University Center and can be contacted by phone at (956) 665-7005 (Voice), (956) 665-3840 (Fax), or via email at ability@utrgv.edu. MANDATORY COURSE EVALUATION PERIOD Students are required to complete an ONLINE evaluation of this course, accessed through your UTRGV account (http://my.utrgv.edu); you will be contacted through email with further instructions. Students who complete their evaluations will have priority access to their grades. Online evaluations will be available:
Fall 2017 Module 1 Oct. 5 Oct. 11 Fall 2017 Module 2 Nov. 29 Dec. 5 Fall 2017 (full semester) Nov. 15 Dec. 6 ATTENDANCE Students are expected to attend all scheduled classes and may be dropped from the course for excessive absences. UTRGV s attendance policy excuses students from attending class if they are participating in officially sponsored university activities, such as athletics; for observance of religious holy days; or for military service. Students should contact the instructor in advance of the excused absence and arrange to make up missed work or examinations. SCHOLASTIC INTEGRITY As members of a community dedicated to Honesty, Integrity and Respect, students are reminded that those who engage in scholastic dishonesty are subject to disciplinary penalties, including the possibility of failure in the course and expulsion from the University. Scholastic dishonesty includes but is not limited to: cheating, plagiarism, and collusion; submission for credit of any work or materials that are attributable in whole or in part to another person; taking an examination for another person; any act designed to give unfair advantage to a student; or the attempt to commit such acts. Since scholastic dishonesty harms the individual, all students and the integrity of the University, policies on scholastic dishonesty will be strictly enforced (Board of Regents Rules and Regulations and UTRGV Academic Integrity Guidelines). All scholastic dishonesty incidents will be reported to the Dean of Students. SEXUAL HARASSMENT, DISCRIMINATION, and VIOLENCE In accordance with UT System regulations, your instructor is a responsible employee for reporting purposes under Title IX regulations and so must report any instance, occurring during a student s time in college, of sexual assault, stalking, dating violence, domestic violence, or sexual harassment about which she/he becomes aware during this course through writing, discussion, or
personal disclosure. More information can be found at www.utrgv.edu/equity, including confidential resources available on campus. The faculty and staff of UTRGV actively strive to provide a learning, working, and living environment that promotes personal integrity, civility, and mutual respect in an environment free from sexual misconduct and discrimination. CALENDAR OF ACTIVITIES August 28 First day of classes August 31 Last day to add a course or register for fall 2017 September 4 Labor Day NO classes November 15 Last day to drop a course; will count toward the 6- drop rule November 23 26 Thanksgiving Holiday NO classes December 6 Last day of classes December 7 Study Day NO class December 8-14 Fall 2017 Final Exams December 15-16 Commencement Ceremonies