Graduate Studies Reports Access
Graduate Course Proposal Form Submission Detail - PAS6100
Tracking Number - 3027
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Current Status:
Approved by SCNS - 2013-07-01
Campus: Tampa
Submission Type: New
Course Change Information (for course changes only):
Comments: to GC 1/14/13. for MA in P.A.; needs text; faculty emailed 1/25/13. updated; approved. to USF Sys 2/20/13. to SCNS 2/28/13. Apprd eff 4/1/13. Nmbr 6840 apprd as 6100
Detail Information
- Date & Time Submitted: 2012-11-29
- Department: Medicine
- College: MD
- Budget Account Number: HSC-10009-611600-000000-0000000
- Contact Person: Larry Collins
- Phone: 813-396-9424
- Email: lcollins@health.usf.edu
- Prefix: PAS
- Number: 6100
- Full Title: Internal Medicine Clinical Rotation
- Credit Hours: 6
- Section Type: I -
Internships (Including Practicum)
- Is the course title variable?: N
- Is a permit required for registration?: N
- Are the credit hours variable?: N
- Is this course repeatable?:
- If repeatable, how many times?: 0
- Abbreviated Title (30 characters maximum): INTERNAL MED CLINICAL ROTATION
- Course Online?: C -
Face-to-face (0% online)
- Percentage Online: 100
- Grading Option:
R - Regular
- Prerequisites:
- Corequisites:
- Course Description: During the six-week internal medicine rotation, physician assistant students become a part of an internal medicine practice caring for adult and geriatric patients.
- Please briefly explain why it is necessary and/or desirable to add this course: Needed for program/concentration/certificate change
- 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
- Has this course been offered as Selected Topics/Experimental Topics course? If yes, how many times? No
- What qualifications for training and/or experience are necessary to teach this course? (List minimum qualifications for the instructor.) MD, DO, PA, ARNP
- Objectives: Upon completion of the rotation, the student will be able to:
1. Understand the clinical manifestations, anatomy, epidemiology, physiology, pathophysiology, and natural history associated with each of the previous medical conditions.
2. Appreciate the wide range of illnesses of varying complexity affecting the patient population admitted to the Internal Medicine hospital service and the frequent multiple co-morbidities that confound the severity of the presenting illness and provide challenges to treatment.
3. Define the social barriers to patient access to health care, adequate nutrition, and environmental safety which contributes to advanced disease/illness requiring inpatient management of the listed medical conditions.
4. Identify the unique health concerns of patients suffering from drug/alcohol abuse and behavioral/psychiatric conditions and available services after discharge on an outpatient basis to further promote long term health stabilization.
5. Differentiate the criteria for admitting a patient into the ICU, telemetry unit, and general medical unit.
6. Compare and contrast the preventive care practices for adults according to age, including immunizations, disease screening, and accident prevention.
7. Differentiate normal from abnormal human anatomy and physiology to include growth, development, and sexuality across the lifespan.
8. Identify the appropriate laboratory and imaging studies needed to accurately diagnose the above medical conditions, taking into consideration the indications, contraindications, complications and cost-effectiveness of each.
9. Differentiate normal and abnormal diagnostic results associated with each of the previous medical conditions, including but not limited:
a. blood
b. urine
c. sputum
d. cerebrospinal/pleural/peritoneal fluids
e. plain x-ray film
f. CT scan
g. MRI angiography
h. Ultrasound
i. EKG
j. PFTs
10. Generate differential diagnoses based on history and physical examination findings for each of the previous medical conditions as they relate to the adult patient requiring hospitalization.
11. Select the definitive diagnosis based on history, physical examination findings, and laboratory and imaging studies.
12. Construct an appropriate therapeutic management plan for each of the previous medical conditions.
13. Describe the appropriate pharmacological treatments for the previous medical conditions, taking into consideration indications, contraindications, complications and cost-effectiveness.
14. Define the appropriate diagnostic tests and follow-up needed for short-and long-term management of the previous medical conditions.
15. Describe modifiable risk factors and lifestyle modifications associated with each of the previous medical conditions, and educate the patients about these risk factors and recommended lifestyle modifications.
16. Evaluate the social, emotional, and physical manifestations of sexual abuse, sexual assault, elder abuse, and substance abuse along with the reporting requirements under state law.
PSYCHOMOTOR
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. Perform a thorough focused, problem-oriented history and physical examination on a patient with non-urgent, urgent, and emergent health concerns requiring hospitalization.
3. Synthesize the initial assessment in the formulation of a differential diagnosis.
4. Select, order, and interpret the appropriate laboratory and radiographic diagnostic studies in the evaluation of the patient with an established differential diagnosis.
5. Perform selected laboratory procedures including but not limited to: venipuncture, bladder catheterization, lumbar punctures, nasogastric tube placement, and arterial blood gases.
6. Interpret pulmonary function tests.
7. Participate in the airway management of patients on mechanical ventilation.
8. Participate in wound management.
9. Interpret normal and abnormal results of various laboratory and radiographic diagnostic studies as related to the problem(s) encountered.
10. Generate a problem list from the patient encounter.
11. Design a therapeutic plan for risk factor reduction and disease management in accordance with existing standards of practice for each of the medical conditions previously listed.
12. Participate in or perform clinical procedures required for the care and management of the patient in collaboration with the Preceptor, including, but not limited to:
a. Intubation
b. Central line placement
c. Thoracentesis
d. Paracentesis
e. Chest tube placement
f. Pericardialcetesis
g. Lumbar puncture
h. Bronchoscopy
i. Endoscopy
13. Write clear, concise, and relevant progress notes including diagnostic, therapeutic, and patient education plans utilizing the SOAP format or electronic medical record.
14. Participate as a member of an Internal Medicine hospital team comprised of attending physicians, medical residents, and interns in a collaborative approach to the care of the patient.
15. Write clear and comprehensive admission orders and interval orders based on close monitoring and assessment of the hospitalized patient.
16. Administer intravenous infusions utilizing appropriate equipment including scalp vein needle, butterfly needle, intravenous catheter, heparin lock, and infusion pumps
17. Administer injections by a variety of routes including intradermal, subcutaneous, intramuscular, and intravenous.
18. Catheterize the urinary bladder of both male and female patients.
19. Insert nasogastric tube.
20. Change tracheostomy tube.
21. Recognize signs of impending deterioration of a patient‟s clinical condition throughout their hospitalization and intervene in an expeditious fashion as warranted.
22. Be familiar with the technique of venous cut-down.
23. Be familiar with medications commonly added to IV solution and compatibility concerns.
24. Be familiar with composition of fluids that are frequently lost from the vascular system or body including blood, urine, gastric secretions, diarrhea, and sequestered fluids in third spaces.
25. Be familiar with the types of and indications for the various electrolyte solutions including D5, Ringer‟s lactate, D5W, NS, hypotonic, and hypertonic saline solutions.
26. Calculate the rate of infusion of IV fluid replacement.
27. Be familiar with relationships between serum electrolytes and IV therapy and the need to adjust therapy based on lab results and physical symptoms and signs.
28. Be familiar with the problems of hypervolemia and hypovolemia.
29. Be familiar with blood and blood products utilized in IV therapy and the indications and complications of their use including transfusion reactions and transmission of infectious agents.
30. Be familiar with peritoneal dialysis.
31. Demonstrate familiarity with normal nutritional requirements.
32. Be familiar with the complications of obesity.
33. Be familiar with dietary treatment of health problems including weight reduction, diabetic, low fat, low cholesterol, and low sodium diets.
34. Be familiar with the drugs used most frequently in treatment of health problems including basic modes of action, indications, contraindications, and complications.
35. Be familiar with the management of common health problems.
36. Monitor a patient's progress through continuous physical examination, data collection and analysis.
37. Develop understanding in completing medical records (including reimbursement, coding and billing).
38. Communicate information in a clear, concise and complete manner to physicians, other members of the healthcare team, and to patients.
39. Assess and recognize their limitations and utilize proper referral (i.e.: physician, hospital, social agency) for treatment.
40. Utilize and integrate evidence-based research in medical decision making and problem solving.
41. Demonstrate cultural sensitivity and appreciation for cultural differences on patient-provider interactions.
42. Educate the patient and their family regarding available resources for the terminally ill that will provide emotional, physical, and spiritual support.
AFFECTIVE
At all times throughout the rotation, the student will demonstrate:
1. Compliance with HIPAA regulations regarding patient confidentiality.
2. Sensitivity and responsiveness to the culture, age, gender, socioeconomic status, and disabilities of patients and their caregivers/families.
3. Professional interactions with all members of the healthcare team.
4. Willingness to seek help from others when appropriate.
5. Respect for patients and preceptors by performing assigned duties promptly, thoroughly and carefully.
6. Appreciate and recognize the ethical and legal concepts as they relate to health care and the role of the physician assistant.
7. Openness to receiving, considering, and appropriately acting upon constructive criticism.
8. A genuine and earnestly constructive, self-critical manner consistent with lifelong learning.
- 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.
- 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
2. Hypertension
a. Essential
b. Secondary
3. Ischemic Heart Disease
a. Stable
4. Vascular Disease
a. Giant cell arteritis
b. Phlebitis/thrombophlebitis
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
b. Influenza
c. Pneumonias
i. Bacterial
ii. Viral
2. Neoplastic Disease
a. Carcinoid tumors
b. Pulmonary nodules
3. Obstructive Pulmonary Disease
a. Asthma
b. Bronchiectasis
c. Chronic bronchitis
d. Emphysema
4. Restrictive Pulmonary Disease
a. Pneumoconiosis
III. ENDOCRINE SYSTEM
1. Diseases of the Thyroid Gland
a. Hyperthyroidism
b. Hypothyroidism
2. Diseases of the Pituitary Gland
3. Diabetes Mellitus
a. Type 2
b. Hypoglycemia
c. Hyperglycemia
4. Lipid Disorders
a. Hypercholesterolemia
b. Hypertriglyceridemia
IV. EENT
1. Eye Disorders
a. Blepharitis
b. Cataract
c. Chalazion
d. Corneal abrasion
e. Dacryoadenitis
f. Ectropion
g. Entropion
h. Hordeolum
i. Pterygium
2. Ear Disorders
a. Barotrauma
b. Hearing impairment
c. Meniere‟s disease
d. Labyrinthitis
e. Tympanic membrane perforation
f. Vertigo
3. Nose/Sinus Disorder
a. Acute/chronic sinusitis
b. Allergic rhinitis
c. Epistaxis
d. Nasal polyps
4. Mouth/Throat Disorders
a. Acute pharyngitis
b. Acute tonsillitis
c. Aphthous ulcers
d. Dental abscess
e. Laryngitis
f. Oral herpes simplex
g. Parotitis
h. Sialadenitis
V. GASTROINTESTINAL SYSTEM/NUTRITION
1. Esophagus
a. Esophagitis
b. Motor disorders
c. Mallory-Weiss tear
2. Stomach
a. Gastroesophageal reflux
b. Gastritis
c. Peptic ulcer disease
3. Gallbladder
a. Chronic cholelithiasis
b. Cholelithiasis
4. Liver
a. Acute/chronic hepatitis
b. Cirrhosis
5. Small Intestine/Colon
a. Constipation
b. Inflammatory bowel disease
c. Irritable bowel syndrome
6. Rectum
a. Anal fissure
b. Fecal impaction
c. Hemorrhoids
d. Pilonidal disease
e. Polyps
7. Hernia
a. Hiatal
8. Infectious Diarrhea
9. Nutritional Deficiencies
a. Niacin
b. Thiamine
c. Vitamin A
d. Riboflavin
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
c. Hydrocele/varicocele
d. Incontinence
e. Paraphimosis/phimosis
2. Infectious/Inflammatory Conditions
a. Cystitis
b. Epididymitis
c. Prostatitis
VII. MUSCULOSKELETAL SYSTEM
1. Disorders of the Shoulder
a. Rotator cuff disorders
b. Sprain/strain
2. Disorders of the Forearm/Wrist/Hand
a. Sprains/strains
b. Carpel tunnel syndrome
c. De Quervain‟s tenosynovitis
d. Elbow tendonitis
e. Epicondylitis
3. Disorders of the Back/Spine
a. Ankylosing spondylitis
b. Back strain/sprain
c. Kyphosis/scoliosis
d. Low back pain
e. Spinal stenosis
4. Disorders of the Hip
a. Aseptic necrosis
5. Disorders of the Knee
a. Bursitis
b. Meniscal injuries
c. Sprains/strains
6. Disorders of the Ankle/Foot
a. Sprains/strains
7. Neoplastic Disease
a. Ganglion cyst
8. Osteoarthritis
9. Osteoporosis
10. Rheumatologic Conditions
a. Fibromyalgia
b. Gout/pseudogout
c. Polyarteritis nodosa
d. Polymyositis
e. Reiter‟s syndrome
f. Rheumatoid arthritis
g. Systemic lupus erythematous
VIII. REPRODUCTIVE SYSTEM
1. Uterus
a. Dysfunctional uterine bleeding
b. Endometriosis/adenomyosis
c. Leiomyoma
d. Metritis
e. Prolapse
2. Ovary
a. Cysts
3. Cervix
a. Cervicitis
b. Dysplasia
c. Incompetent
4. Vagina/Vulva
a. Cystocele
b. Prolapse
c. Rectocele
d. Vaginitis
5. Menstrual Disorders
a. Amenorrhea
b. Dysmenorrhea
c. Premenstrual syndrome
6. Menopause
7. Breast
a. Abscess
b. Fibroadenoma
c. Fibrocystic disease
d. Mastitis
8. Pelvic Inflammatory Disease
9. Contraceptive Methods
10. Infertility
11. Uncomplicated Pregnancy
a. Prenatal diagnosis/care
b. Normal labor /delivery
12. Complicated Pregnancy
a. Dystocia
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
4. Headaches
a. Cluster headache
b. Migraine
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
d. Phobias
2. Attention-Deficit Disorder
3. Eating Disorders
a. Anorexia nervosa
b. Bulimia nervosa
c. Obesity
4. Mood Disorders
a. Adjustment
b. Depressive
c. Dysthymic
d. Bipolar
5. Personality Disorders
a. Antisocial
b. Avoidant
c. Borderline
d. Histrionic
e. Narcissistic
f. Obsessive-compulsive
g. Paranoid
h. Schizoid
i. Schizotypal
6. Psychoses
a. Schizophrenia
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
a. Dermatitis
i. Atopic
ii. Contact
iii. Nummular eczematous
iv. Perioral
v. Seborrheic
vi. Stasis
vii. Dyshidrosis
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
e. Psoriasis
3. Desquamation
a. Erythema multiforme
4. Acneiform Lesions
a. Acne vulgaris
b. Rosacea
c. Folliculitis
5. Verrucous Lesions
a. Seborrheic keratosis
b. Actinic keratosis
6. Insects/Parasites
a. Lice
b. Scabies
c. Spider bites
7. Hair and Nails
a. Alopecia areata
b. Androgenetic alopecia
c. Onycomycosis
d. Paronychia
8. Viral Diseases
a. Condyloma accuminatum
b. Exanthems
c. Herpes simplex
d. Verrucae
e. Zoster virus
9. Other
a. Acanthosis nigricans
b. Hidradenitis suppurativa
c. Lipoma/epithelial inclusion cysts
d. Melasma
e. Urticaria
f. Vitiligo
XII. HEMATOLOGIC SYSTEM
1. Anemia
a. Vitamin B12
b. Folate deficiency
c. Iron deficiency
d. G6PD deficiency
e. Sickle cell anemia
f. Thalassemia
XIII. INFECTIOUS DISEASES
1. Fungal Disease
a. Candidiasis
2. Bacterial Disease
a. Chlamydia
b. Cholera
c. Diphtheria
d. Gonococcal infections
e. Salmonellosis
f. Shigellosis
3. Parasitic Disease
a. Amebiasis
b. Hookworms
c. Toxoplasmosis
4. Spirochetal Disease
a. Lyme borreliosis
i. Lyme disease
b. Rocky Mountain spotted fever
c. Syphilis
5. Viral Disease
a. Cytomegalovirus infections
b. Epstein-Barr virus infections
c. Herpes simplex
d. Human papillomavirus infections 96
e. Influenza
- Textbooks: CURRENT Medical Diagnosis And Treatment 2013. Stephen McPhee, Maxine Papadakis, Stephen J. McPhee, Michael W. Rabow. McGraw-Hill
Practical Guide To The Care Of The Medical Patient. (7th ed.). Ferri, F. Mosby Books.
- Course Readings, Online Resources, and Other Purchases:
- 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 Evalue. 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.
- Assignments, Exams and Tests: End of Rotation Exam
- 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.
- 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.
- Program This Course Supports: Physician Assistant
- Course Concurrence Information:
- if you have questions about any of these fields, please contact chinescobb@grad.usf.edu or joe@grad.usf.edu.