Graduate Course Proposal Form Submission Detail - PAS6400
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Submission Type: New
Course Change Information (for course changes only):
Comments: to GC 1/14/13. for MA in P.A.; needs textbook; faculty emailed 1/25/13. Back to GC. Apprd. to USF Sys 2/20/13. to SCNS 2/28/13. Apprd eff 4/1/13. Nmbr 6866 apprd as 6400
- Department and Contact Information
Tracking Number Date & Time Submitted 3025 2012-11-29 Department College Budget Account Number Medicine MD HSC-10009-611600-000000-0000000 Contact Person Phone Larry Collins 813-396-9424 firstname.lastname@example.org
- Course Information
Prefix Number Full Title PAS 6400 Family Practice Clinical Rotation Is the course title variable? N Is a permit required for registration? N Are the credit hours variable? N Is this course repeatable? N If repeatable, how many times? 0 Credit Hours Section Type Grading Option 6 I - Internships (Including Practicum) R - Regular Abbreviated Title (30 characters maximum) FAMILY PRACTICE CLINICAL ROT Course Online? Percentage Online C - Face-to-face (0% online) 100
The twelve-week family practice clinical rotation provides students with experience refining their skills in performing history and physical exams, ordering and interpreting laboratory/diagnostic tests, synthesizing information in establishing diagnosis.
A. Please briefly explain why it is necessary and/or desirable to add this course.
Needed for program/concentration/certificate change
B. What is the need or demand for this course? (Indicate if this course is part of a required sequence in the major.) What other programs would this course service?
To be consistent with other Physician Assistant Degree Programs
C. Has this course been offered as Selected Topics/Experimental Topics course? If yes, how many times?
D. What qualifications for training and/or experience are necessary to teach this course? (List minimum qualifications for the instructor.)
MD, DO, PA, ARNP
- Other Course Information
Upon completion of the rotation, the student will be able to:
1. Describe the preventive care practices for men, women, and children according to age, including immunizations, disease screening, and accident prevention.
2. Identify risk factors, signs and symptoms, and pertinent historical and physical examination findings associated with normal growth/development and aging as it relates to each of the previous medical conditions.
3. Understand the clinical manifestations, anatomy, epidemiology, physiology, pathophysiology, and natural history associated with each of the previous medical conditions.
4. Distinguish normal from abnormal human anatomy and physiology to include growth and development across the lifespan.
5. Demonstrate knowledge of genetic mutations/disorders and chromosomal anomalies and make appropriate referral.
6. Understand the indications, contraindications, complications, and cost-effectiveness of various laboratory, radiological diagnostic studies, and procedures associated with each of the previous medical conditions.
7. Understand radiologist‟s interpretation of diagnostic studies including, but not limited to, upper GI series, barium enema, skull films, sinus series, CT with and without contrast, ultrasounds, and MRIs.
8. Explain normal and abnormal diagnostic results including, but not limited to, blood, urine, sputum, x-ray, CT, MRI, ultrasound, EKG, and PFTs associated with each of the previous medical conditions.
9. Explain the rational for the formulation of a differential diagnoses based on history and physical examination findings for each of the above medical conditions.
10. Synthesize history and physical examination findings and pertinent laboratory/diagnostic studies to develop a working/definitive diagnosis.
11. Understand therapeutic management plans for each of the previous medical conditions.
12. Understand diagnostic tests and follow-up needed for selected pharmacological treatment.
13. Explain modifiable risk factors and lifestyle modifications associated with each of the previous medical conditions.
14. State the elements essential to the process of patient counseling about the course of an illness, therapeutic program selection, and strategy for management compliance for each of the previous medical conditions.
1. Understand the clinical manifestations, anatomy, epidemiology, physiology, pathophysiology, and natural history associated with the previous medical conditions affecting women.
2. Understand the indications, contraindication, complications, and cost-effectiveness of various laboratory and radiologic diagnostic studies and procedures associated with the medical conditions affecting women.
3. Understand the therapeutic management plans for the previous conditions affecting women, including understanding the indications, contraindications, complications, and cost-effectiveness of pharmacological treatments.
4. Describe standard methods of prevention and early detection for conditions commonly encountered in gynecology through the use of osteoporosis screening, Papanicolaou testing, and breast/mammography examinations.
5. List the cytologic classification of PAP smears.
6. Describe normal and abnormal manifestations of menstruation.
7. Describe the human reproductive process in terms of normal physiology, infertility, ovulation, and pregnancy.
8. List and discuss the different methods of contraception, their effectiveness, contraindications, and side effects.
9. Outline the essentials of prenatal management, including, but not limited to:
a. establishing patient‟s estimated date of confinement
b. defining timing of laboratory and physical assessments
c. counseling in areas such as nutrition, exercise, rest, drugs/alcohol, over-the –counter/prescription medications, and breast vs. formula feeding.
10. Describe presumptive signs of pregnancy.
11. Describe positive signs of pregnancy.
12. Define factors that constitute a high-risk pregnancy.
13. Understand the criteria for clinical pelvimetry.
14. Discuss the potential problem and management of Rh-D negative incompatibility.
15. List methods for determining fetal well-being and gestational maturity in utero.
16. List the signs and symptoms that may indicate, to the patient, complications of her pregnancy that necessitate contacting the physician.
17. Outline common causes of first trimester and third trimester bleeding.
18. Define and contrast placenta previa and abruptio placenta.
19. Discuss the effects and management of diabetes mellitus in pregnancy.
20. List criteria for diagnosis of pre-eclampsia and eclampsia, and discuss management.
21. Discuss the management of a spontaneous abortion and missed abortion.
22. List the signs and symptoms of the onset of labor and indicate at what point the patient should contact her physician.
23. Compare the signs and symptoms of false labor and true labor.
24. Define and discuss potential hazards and management of premature rupture of membranes.
25. Define and contrast stripping vs. rupturing of membranes.
26. Define the three (3) stages of labor.
27. Outline the management of a patient in the labor.
28. Recognize a normal vs. an abnormal fetal monitoring strip.
29. Discuss methods for determining fetal stress (NST, OCT, estriol levels, fetal heart rate) and their indications.
30. List the desired effects and dosages during labor of the following medications:
31. List indications for Caesarean section and management of fetus born by Caesarean section.
32. Outline routine postpartum management to include requirements for hospital discharge and scheduling of follow-up visits.
33. Describe approximate gestational age of the newborn from physical assessment.
34. Recognize the clinical presentation of post-partum depression.
35. Describe the evolution and normal physiology of menopause.
36. Recognize the social, emotional, and physical manifestations of sexual abuse, sexual assault, elder abuse, and substance abuse along with the reporting requirements under state law.
37. Formulate a plan for the education of women and their partners regarding sex education, family planning, birth control, abnormal PAP smears, genetic testing for pre-conception risk assessment, pregnancy, and disease management.
Upon completion of the rotation, the student will be able to:
1. Assess the normal growth and development of individuals across the life span.
2. Accomplish a comprehensive initial medical interview and complete physical examination specific to the patient encounter.
3. Establish a list of problems following data synthesis according to the Problem Oriented Medical Record.
4. Accomplish a problem-specific medical interview and physical examination in an efficient manner emphasizing areas specific to the patient encounter.
5. Generate a differential diagnoses based on history and physical examination findings.
6. Select the appropriate laboratory and radiographic diagnostic studies pertinent to the further evaluation of an individual's health status and for each of the previous medical conditions.
7. Appropriately educate the patient and/or legal guardian regarding the indications, contraindications, risks, rationale, alternatives, and performance of medical tests and procedures.
8. Perform and interpret selected laboratory procedures including, but not limited to, venipuncture, rapid antigen strep testing, dipstick urinalysis, guiac stool testing, and fingerstick glucose testing.
9. Obtain specimen collections for culture and sensitivity of blood, urine, cervix/vagina, sputum, stool, urethra, and wound.
10. Perform urinary catheter insertion and specimen collection.
11. Perform IV insertion and initiate IV fluids.
12. Interpret normal and abnormal results of various laboratory and radiographic diagnostic studies for each of the above medical conditions including, but not limited to, the electrocardiogram, chest x-ray, orthopedic x-ray, complete blood count, blood chemistry profiles, microscopic urinalysis, thyroid function studies, and KUB.
13. Design a therapeutic plan for risk factor reduction and disease management in accordance with existing standards of practice for each of the previous medical conditions.
14. Demonstrate technical ability to initiate, prescribe, or perform excisional, punch, shave, and endometrial biopsies.
15. Perform pneumatic otoscopy.
16. Perform cerumen removal using curette and/or irrigation.
17. Perform cryotherapy.
18. Perform trephination of subungal hematoma.
19. Perform Fluorescein staining of cornea.
20. Perform peak flow meter assessment.
21. Perform incision and drainage (I&D) of abscess and paronychia.
22. Demonstrate technical ability to prescribe, assist, or perform intramuscular, subcutaneous, intradermal, and intravenous push injections.
23. Evaluate, cleanse, debride, and approximate wound edges (steri-strips, sutures, staples) and dress wounds of varying complexity under preceptor supervision.
24. Perform staple and suture removal.
25. Apply elastic and /or plaster/fiberglass casts with necessary modifications (monovalve, bivalve, windows).
26. Under direct supervision of Preceptor, participate in performing advanced procedures, including, but not limited to:
a. Joint aspiration and injection
b. Toenail removal and nail matrix ablation when applicable
c. Trigger point injections
27. Develop understanding and participate in completing medical records (including reimbursement, coding and billing) utilizing traditional charting and/or electronic medical record charting methods.
28. Communicate information in a clear, concise and complete manner to the physician, other members of the healthcare team, and to the patient.
29. Assess and recognize limitations and utilize proper referral (i.e., physician, hospital, social agency) for treatment.
30. Utilize and integrate evidence-based research in medical decision making and problem solving.
31. Demonstrate cultural sensitivity and appreciation for cultural differences during patient-provider interactions.
1. Perform an integrated and systematic history and physical examination of an ovulating, pregnant, menopausal and post-menopausal woman.
2. Select and interpret the appropriate laboratory and radiographic diagnostic studies pertinent to further evaluate pre-conception health risks, pregnancy, and intra-uterine fetal health.
3. Perform acquisition of and interpret selected laboratory procedures including, but not limited to, urine pregnancy testing, KOH/wet mount, PAP smear, and sexually transmitted infection (STI) sampling.
4. Recognize microscopic findings consistent with vaginal candidiasis, trichomoniasis, and bacterial vaginosis.
5. Describe protocols for treating common gynecologic problems, including sexually transmitted diseases.
6. Perform and document findings on pelvic and bimanual examination.
7. Perform fetal heart tone assessment.
8. Assess intrauterine growth and development using gestation wheels, Leopold‟s maneuvers, and results from pelvic ultrasound.
9. Under direct supervision of Preceptor, observe or participate in performing advanced procedures, including, but not limited to:
a. IUD insertion
b. Diaphragm fitting
c. Endometrial and cervical biopsies
d. Colposcopic exam
e. Bartholin cyst drainage
f. Dilation and curettage
g. Normal vaginal delivery with or without episiotomy
h. Cesarean delivery
10. Advise women on the types, contraindications, and side effects of the various forms of contraception.
11. Instruct patients on self-breast examination.
12. Educate the pregnant woman on prenatal care recommendations, including the schedule of visits, what tests are routinely performed at what intervals, and how nutrition in the pregnant woman is managed.
13. Identify standards in the growth and development of the fetus.
14. Identify ectopic pregnancy and initiate appropriate management.
15. Describe common prenatal complications including gestational diabetes, preeclampsia, toxemia of pregnancy, and third trimester bleeding with management options.
16. Obtain and document a complete and problem oriented obstetric exam.
17. Educate the patient on the impact of alcohol, drugs, and folic acid deficiency on the fetus.
At all times throughout the rotation, the student will demonstrate:
1. Compliance with HIPAA regulations regarding patient confidentiality.
2. Sensitivity regarding the emotional, cultural, and socioeconomic aspects of the patient and his/her illness.
3. Professional interactions with all other members of the healthcare team.
4. Willingness to seek help from others when appropriate.
5. Concern for a patient's care and confidentiality through appropriate record keeping.
6. Openness to receiving, considering, and appropriately acting upon constructive criticism.
7. A genuine and earnestly constructive, self-critical manner consistent with lifelong learning.
8. Respect for patients and preceptors by performing assigned duties promptly, thoroughly, and carefully.
9. Appreciate and recognize the ethical and legal concepts as they relate to health care and the role of the physician assistant.
10. Recognize the importance and spend time reviewing these objectives before starting the rotation as they will be used to develop the measures for evaluating the student's clinical performance.
B. Learning Outcomes
Course Learning Outcomes:
Upon successful completion of the supervised clinical rotation, the student will demonstrate they have developed the ability to:
1. Obtain and document a comprehensive initial, male/female annual, well child, and obstetrical history and physical examination on patients across the age continuum in the outpatient setting.
2. Demonstrate familiarity with the clinical manifestation, anatomy, epidemiology physiology, pathophysiology, and natural history associated with conditions commonly addressed in the family practice setting.
3. Obtain and document pertinent historical information and perform an appropriate physical examination in the context of managing common chronic disease processes encountered in Family Practice.
4. Obtain and document an accurate problem-focused, age appropriate, history and physical examination, on a patient presenting with an acute condition.
5. Differentiate normal developmental milestones and normal aging changes from abnormal findings in the care of the Family Practice patient.
6. Identify and counsel patients on the need for health maintenance, injury avoidance, and disease prevention through patient education on safety measures and recommendations for specific age appropriate medical screening examinations.
7. Understand the indications, limitations and costs of various laboratory tests, diagnostic studies, and procedures used in the evaluation of acute illnesses, disease risk factors, and preventative health measures.
8. Interpret the findings of laboratory tests, diagnostic studies, and procedures commonly obtained in the evaluation of the Family Practice patient.
9. Develop an initial comprehensive differential diagnosis and subsequently formulate definitive diagnosis based on the history and physical examination and available laboratory/diagnostic imaging data.
10. Formulate and implement an appropriate treatment plan in collaboration with the supervising preceptor, provide patient education, and define follow-up recommendations.
11. Identify potential therapeutic limitations, complications, and costs associated with the established treatment regimen that may affect patient compliance.
12. Demonstrate familiarity in recognizing situations where referral to other healthcare providers is necessary and to identify the appropriate referral resource.
13. Understand the components in performing a pre-operative clearance evaluation.
14. Participate in or perform necessary clinical procedures.
C. Major Topics
Recognize the clinical manifestations, assessment, and treatment of the following conditions:
I. CARDIOVASCULAR SYSTEM
1. Conduction Disorders
a. Bundle Branch Block
b. Premature beats
3. Ischemic Heart Disease
4. Vascular Disease
a. Giant cell arteritis
c. Varicose veins
5. Valvular Disease
a. Mitral valve prolapsed
6. Other Forms of Heart Disease
a. Acute pericarditis
II. PULMONARY SYSTEM
1. Infectious Disorders
a. Acute bronchitis
2. Neoplastic Disease
a. Carcinoid tumors
b. Pulmonary nodules
3. Obstructive Pulmonary Disease
c. Chronic bronchitis
4. Restrictive Pulmonary Disease
III. ENDOCRINE SYSTEM
1. Diseases of the Thyroid Gland
2. Diseases of the Pituitary Gland
3. Diabetes Mellitus
a. Type 2
4. Lipid Disorders
1. Eye Disorders
d. Corneal abrasion
2. Ear Disorders
b. Hearing impairment
c. Meniere‟s disease
e. Tympanic membrane perforation
3. Nose/Sinus Disorder
a. Acute/chronic sinusitis
b. Allergic rhinitis
d. Nasal polyps
4. Mouth/Throat Disorders
a. Acute pharyngitis
b. Acute tonsillitis
c. Aphthous ulcers
d. Dental abscess
f. Oral herpes simplex
V. GASTROINTESTINAL SYSTEM/NUTRITION
b. Motor disorders
c. Mallory-Weiss tear
a. Gastroesophageal reflux
c. Peptic ulcer disease
a. Chronic cholelithiasis
a. Acute/chronic hepatitis
5. Small Intestine/Colon
b. Inflammatory bowel disease
c. Irritable bowel syndrome
a. Anal fissure
b. Fecal impaction
d. Pilonidal disease
8. Infectious Diarrhea
9. Nutritional Deficiencies
c. Vitamin A
e. Vitamin C
f. Vitamin D
g. Vitamin K
10. Metabolic Disorders
a. Lactose intolerance
VI. GENITOURINARY SYSTEM
1. Benign Conditions of the GU Tract
a. Benign prostatic hyperplasia
b. Erectile dysfunction
2. Infectious/Inflammatory Conditions
VII. MUSCULOSKELETAL SYSTEM
1. Disorders of the Shoulder
a. Rotator cuff disorders
2. Disorders of the Forearm/Wrist/Hand
b. Carpel tunnel syndrome
c. De Quervain‟s tenosynovitis
d. Elbow tendonitis
3. Disorders of the Back/Spine
a. Ankylosing spondylitis
b. Back strain/sprain
d. Low back pain
e. Spinal stenosis
4. Disorders of the Hip
a. Aseptic necrosis
5. Disorders of the Knee
b. Meniscal injuries
6. Disorders of the Ankle/Foot
7. Neoplastic Disease
a. Ganglion cyst
10. Rheumatologic Conditions
c. Polyarteritis nodosa
e. Reiter‟s syndrome
f. Rheumatoid arthritis
g. Systemic lupus erythematous
VIII. REPRODUCTIVE SYSTEM
a. Dysfunctional uterine bleeding
5. Menstrual Disorders
c. Premenstrual syndrome
c. Fibrocystic disease
8. Pelvic Inflammatory Disease
9. Contraceptive Methods
11. Uncomplicated Pregnancy
a. Prenatal diagnosis/care
b. Normal labor /delivery
12. Complicated Pregnancy
b. Fetal distress
c. Gestational diabetes
d. Gestational trophoblastic disease
e. Molar pregnancy
f. Multiple gestation
g. Postpartum hemorrhage
h. Pregnancy-induced hypertension
i. Premature rupture of membranes
j. Rh incompatibility
IX. NEUROLOGIC SYSTEM
1. Alzheimer‟s Disease
2. Cerebral Palsy
3. Diseases of Peripheral Nerves
a. Bell‟s palsy
b. Diabetic peripheral neuropathy
c. Myasthenia gravis
a. Cluster headache
c. Tension headache
5. Movement Disorders
a. Essential tremor
b. Huntington‟s disease
c. Parkinson‟s disease
6. Multiple Sclerosis
7. Seizure Disorders
a. Generalized convulsive disorder
b. Generalized nonconvulsive disorder
X. PSYCHIATRY/BEHAVIORAL SCIENCE
1. Anxiety Disorders
a. Panic disorder
b. Generalized anxiety disorder
c. Posttraumatic stress disorder
2. Attention-Deficit Disorder
3. Eating Disorders
a. Anorexia nervosa
b. Bulimia nervosa
4. Mood Disorders
5. Personality Disorders
b. Somatoform Disorders
7. Substance Use Disorder
a. Alcohol abuse/dependence
b. Drug abuse/dependence
c. Tobacco use/dependence
8. Other Behavior/Emotional Disorders
a. Uncomplicated bereavement
XI. DERMATOLOGIC SYSTEM
1. Eczematous Eruptions
iii. Nummular eczematous
viii. Lichen simplex chronicus
2. Papulosquamous Diseases
a. Dermatophyte infections
i. Tinea versicolor
ii. Tinea corporis/pedis
b. Drug eruptions
c. Lichen planus
d. Pityriasis rosea
a. Erythema multiforme
4. Acneiform Lesions
a. Acne vulgaris
5. Verrucous Lesions
a. Seborrheic keratosis
b. Actinic keratosis
c. Spider bites
7. Hair and Nails
a. Alopecia areata
b. Androgenetic alopecia
8. Viral Diseases
a. Condyloma accuminatum
c. Herpes simplex
e. Zoster virus
a. Acanthosis nigricans
b. Hidradenitis suppurativa
c. Lipoma/epithelial inclusion cysts
XII. HEMATOLOGIC SYSTEM
a. Vitamin B12
b. Folate deficiency
c. Iron deficiency
d. G6PD deficiency
e. Sickle cell anemia
XIII. INFECTIOUS DISEASES
1. Fungal Disease
2. Bacterial Disease
d. Gonococcal infections
3. Parasitic Disease
4. Spirochetal Disease
a. Lyme borreliosis
i. Lyme disease
b. Rocky Mountain spotted fever
5. Viral Disease
a. Cytomegalovirus infections
b. Epstein-Barr virus infections
c. Herpes simplex
d. Human papillomavirus infections 96
Essentials of Family Medicine (5th ed.). Sloane, P. Philadelphia: Lippincott Williams & Wilkins.
E. Course Readings, Online Resources, and Other Purchases
F. Student Expectations/Requirements and Grading Policy
Students are required to keep a complete record of all clinical encounters (both procedures & diagnoses) throughout the rotation. The primary tool for entering, maintaining, and tracking accurate records will be evaluated. In order for the clerkship director to monitor and facilitate clinical experiences, it will be necessary for students to keep logbooks up to date. At a minimum, students are required to update their logbooks at least once a week. A portion of the grade grade will be determined by keeping timely records. By not sufficiently documenting achievements in the required clinical experiences, students who fail to maintain timely, complete, and accurate records of their patient encounters may fail the rotation.
G. Assignments, Exams and Tests
End of Rotation Exam
H. Attendance Policy
During the clinical years, the student’s responsibilities lie within the individual clerkship. Attendance within the clerkship is a demonstration of attitude and professional behavior. This behavior impacts all members of the healthcare team including fellow students and patients. Any absence from the clerkship may have a direct impact on student performance, the broad-spectrum clinical experience, evaluation of professionalism, overall grade and the successful completion of the clerkship.
I. Policy on Make-up Work
Delinquencies will accumulate only if the student does not have a legitimate explanation such as illness or major personal difficulty. Thus, students will be given an opportunity to explain before a penalty is assessed. The Rotation Director would render a final determination. The above delineated process describes the minimum action to be taken across clerkships. Additional requirements and consequences as determined by each clinical rotation director may apply. Failure to complete the logbook can result in grade reduction.
J. Program This Course Supports
- Course Concurrence Information