PA Student Medical Documentation

We are excited to announce effective March 2nd, PA students’ medical documentation can now be used by billing providers.  Please be sure to review the tip sheet and module to ensure compliance.

If you are a non-Duke employee, the module can be found here.   For Duke employees, click here, and use your NetID and password for instructions to enroll in the training.

If you have questions, please reach out to the program.

We believe this change will be beneficial to both students and preceptors, and we’re excited to support everyone in adopting this new policy!

The Clinical Year Team

Announcements

Welcome to the Clinical Year, Class of 2020!

The Duke PA Class of 2020 began their clinical rotations on July 22, 2019.  We hope you are finding that they are adjusting well to this new phase of their education.  Please keep us updated on anything you need from the Program, and thank you so much for your continued support of our students.

Duke PA Class of 2020

 

Best wishes to the Class of 2019!

The Class of 2019 made their debut as PAs and our colleagues on August 2, 2019 after a Certificate Ceremony at Duke Chapel.  We wish them the best as they take their national certifying exam and begin their careers as PAs!

Certificate ceremony for the Duke Physician Assistant program at the Duke Chapel on Friday, August 2, 2019.

 

Category I CME – Increase for PA Preceptors 

Beginning this clinical year (2019-2020), PAs who precept Duke PA students are eligible to receive two (2) CME I credits for every week of teaching!  This means that a standard four-week rotation for a single preceptor could be worth eight (8) CME I credits.  This is a substantial increase from previous years, and we do hope that our PA preceptors take advantage of this opportunity!

Here are the details:

  • A Request and Attestation is required to be completed each clinical year prior to earning CME credit.  Having this form on file for you is the first step of the process, and it is now an electronic process.  If you haven’t already, go here and complete your attestation.
  • PA preceptors will receive 2 AAPA Category 1 CME credit for each week of clinical teaching.  You have the potential to earn eight credits for a standard four-week rotation, and 16 credits for an eight-week rotation.
  • For purposes of credit calculation, a week is defined as 40 hours of precepting.  In instances of co-precepting, it will be necessary to keep up with the numbers of hours you taught a student.
  • After precepting, the Duke PA program must also receive a completed evaluation from the PA preceptor prior to awarding Category 1 CME credit.  We award credit at the end of each clinical year.
  • The evaluation is available online and will include a self‐report of the number of weeks the preceptor taught and reflection questions.  The evaluation must be completed and submitted to the PA Program by the preceptor requesting credit
  • A maximum of 20 Category 1 CME credits per calendar year may be awarded to each preceptor.
  • Not available for non-PA preceptors, but others may be able to earn Category 2 CME.

Faculty and Staff Profiles

Alicia R. Bolden, DMSc, MPH, PA-C

Clinical Team Faculty

I joined Duke PA Program as faculty in July 2019. I have worked clinically in internal medicine (IM) as a hospitalist for most of my career. I also have clinical experience in urgent care, occupational medicine, and GI. I have been in PA education for over 6 years and served as Academic Director and Associate Program Director at the Nova Southeastern University PA program in Fort Lauderdale. In my current role on the clinical team here at Duke PA program, some of my responsibilities will include coordinating the core rotation IM course, call-back-day activities, site visits, and supporting the evidence-based medicine course that runs throughout the clinical year. In addition to my clinical year responsibilities, I serve as faculty advisor, instructor in the physical assessment course, and participate in the admissions process. The most exciting part of my new role here at Duke will be getting to know all of the clinical preceptors and community partners that contribute to the knowledge of our PA students. I look forward to introducing myself to each and every one of you. Thank you for your service to our profession.

Teaching Tips

Guidelines for Orienting PA Students to Clinical Sites

Providing a student with a comprehensive orientation at the start of a rotation better ensures a positive experience for the student, preceptors, staff, and patients. The Duke PA Program is happy to provide you with a succinct checklist to adopt and adapt to orient a student effectively and efficiently. The checklist can be accessed here.

Orienting the student to the clinical setting: On the first day of the student’s clinical rotation have a dedicated time and place to:

  • Supervisors: Let the student know who on the team they should report to each day, which person (or persons) will evaluate the student upon completion of the rotation, and who is their point of contact for any questions that arise
  • Schedule: Review the student schedule of clinical and other learning activities (lectures, assignments, etc.)
  • Workflow: Explain the patient workflow process and how the student will be involved in patient care throughout the supervised clinical experience
  • Introductions: Introduce the student to the staff and other health care providers
  • Tour: Give the student a tour of the clinical settings in which learning will take place
  • Site Specific Access: Provide the student with a practice-specific ID badge if needed, computer access, electronic health record training, and the office policies and procedures.
  • Protocol for Urgent/Emergency Issues: Let the student know what to do in the case of an emergency in the office/hospital

Overview of the rotation/preceptor expectations: Within the first day or two of the student’s clinical rotation, find time to discuss the following aspects of the rotation and your expectations of the student:

  • Provide tips on how the student can optimize their learning in the clinical setting
  • Discuss student’s goals for the rotation (Help them to prioritize these) and required course competencies
  • Describe the roles and responsibilities of the student
  • Review your expectations for medical documentation, oral presentations, and additional assignments/projects
  • Inform about expected attire, medical equipment, and recommended texts/readings/guidelines/resources
  • Discuss how student can learn from other members of the health care team
  • Explain your approach to assessment (direct observation, etc.), provision of feedback through the rotation, and review of performance evaluation at the conclusion of the rotation
  • Schedule a weekly or bi-weekly meeting to discuss student performance and revisit expectations
  • Review who at the clinical site will complete the student evaluation at the conclusion of the rotation

Preparing your staff to have a student: The staff of an office/hospital setting play a key role in ensuring that each student has a successful rotation. The preceptor should inform the staff about how the student will interact with them and with patients. Consider having a meeting or creating a memo with/ for staff in advance of the student’s arrival to discuss:

  • Student’s name and schedule
  • Student’s expected role in patient care
  • Expected effect of the student on office operations

Preparing your patients to have a student: There are several ways for sites to notify patients that students will be participating in patient care:

  • Post a sign at the check-in desk
  • Preceptor identifies patients on the daily schedule that would be good cases for student participation
  • Nursing staff or preceptor query if patients consents for student to be involved in their visit and in what capacity; do not query in front of the student

Orienting the student to your community: Discuss with the student early in the rotation characteristics of your local community or patient population that affect patient care as well as available community resources that your practice uses on a regular basis.

Announcements

The Class of 2019 is excited celebrate their graduation on Sunday May 12th and look forward to official program completion in early August. To ensure students’ full participation in commencement activities, PA students are on holiday from Friday, May 10th, beginning at 5:00pm through Sunday, May 12th. Beginning this year, students may also take one Graduation Discretionary Day on either Friday, May 10th OR Monday, May 13th. Students have been instructed to notify their preceptor if they plan to take a Graduation Discretionary Day; they are not required to submit a time away form per usual procedures. Time away for this Discretionary Day and the graduation holiday do not need to be made up. If students take a Graduation Discretionary Day, they are not permitted to take an additional discretionary day during the rotation period from April 29th-May 24th. Please contact Melinda.Blazar@duke.edu if you have any questions.

Preceptor Pearls

Nadia Pasha, MD

Inpatient Medicine Physician, Duke Raleigh Hospital

Why did/do you decide to precept Duke PA students?

I have been involved in PA teaching at Duke Raleigh Hospital for over 6 years and I truly enjoy it! I took on a leadership teaching role 4 years ago because I have a passion for teaching and find it extremely rewarding. It’s an amazing feeling to see how you can positively impact young brains and mentor them to become great clinicians. You have the ability to mold them and teach them what you feel could have been done better when you were a learner. It’s a great way to pay forward and educate those who will probably be taking care of us and our loved ones.

How do you orient students to your practice setting?

Typically 2 weeks prior to their rotation, students receive an email with FAQs and details on student & preceptor expectations. These have also been shared with the preceptors so there is role clarity. I also orient students in person whenever possible. I always give them my cell phone number and they know they can reach out to me anytime. Recently I am working on a short orientation video so I can further improve this process and students can have something to refer back to, whenever needed.

How do you integrate students into your clinical workflow of seeing patients?

Hospital Medicine can be a very busy & fast paced service with acutely sick patient. Each student meets with their provider and continues to work at their own pace depending on where they are in their rotation. They may see anywhere between 2-4 patients and help in managing the patients including placing orders in a supervised environment. They are encouraged to take ownership of their patients as they will be providers within the next year. They sometimes present their patients at Multi D rounds. We have also successfully advocated for a slightly lesser work load for the teaching service. This provides students with extra one on one time with their preceptor and they are able to discuss cases they saw in details. I teach students small tips and learning points as we go along and round.We provide students with IPE experience as they spend one day with each service- DPT/ ICU rounding RN and IR. Students also observe procedures on their patients including EGD, Cath and Bronch. We are working on innovative ways to add more to this experience.

How do you make time to assess students’ knowledge and observe clinical skills?

Students meet with their preceptor in the morning and are assigned patient. They go and see their patients and meet with their preceptor later in the day to discuss the case with special emphasis to their assessment and plan. I have found that this is the part students struggle with the most. Preceptors ask questions which helps them identify and assess the learner so they can build on the student’s knowledge base. They give them feedback in real time and students are expected to read up on what they learned. They are encouraged to ask questions. To help our preceptors become better educators, we constantly work on tips ,techniques , lectures and workshops to help them improve. As mentioned previously, our precepting provider has a decreased work load which gives them extra time to teach.

 What is your approach to providing constructive feedback to students?

In my experience the best way to give feedback is to first ask the students on what they feel is going well and what is work in progress. Students are usually very critical of themselves. I always encourage them and compliment them on what they are doing good. This boosts their moral and motivates them to work harder. Ask them how they think they can do better and then add recommendation to their ideas. Set some clear goals for the upcoming week and then circle back. I always ask them how we can support them and make this rotation better for them and for others. This creates an environment of collegiality and helps us improve as well. They walk away with a positive experience.

In very rare cases, if you feel a student is not engaging or lacking in their basic knowledge, I recommend reaching out to the PA program and letting them know ASAP so everyone can work towards the same common goal- helping the students become better clinicians.

What advice would you give a clinician new to precepting?

Just like different learners have different learning styles, different educators might have a different teaching style and that’s ok. Identify what works for you and how you can use this to teach your students. Ask your students for feedback and it is empirical that this is done in a safe environment and the students don’t feel intimidated. Make sure you let them know that your goal is to help them and support them. They can help you by telling you what works and what doesn’t. Self-reflect and stay open minded. Over time you will become more confident and understand what are good teaching techniques for you and your learners.

Is there anything else you would like to share about your experience as a preceptor?

Teaching can be great experience if we continue to evolve and change according to the needs of our students and patients. Students feel that they fit in if they are given tasks during their rotation. Do not hesitate to tell them to call and co-ordinate care with other health professionals for their patients or have them update and teach their patients. This gives them a sense of fulfillment. Be sure to support them I they have any questions during this process.

It gives me great pleasure to write LORs for my students and see how they grew in their professions. It will feel very rewarding to you too.

Faculty and Staff Profiles

Melinda Blazar, MHS, PA-C

Director of Clinical Education, Duke PA Program

Melinda Blazar

I am a graduate of the Duke PA Program in 2007 and have worked clinically in family medicine and women’s health for most of my clinical career.  After precepting Duke PA students for several years at Duke Family Medicine, I joined the PA Program faculty in 2011 as a clinical coordinator & became Director of Clinical Education in July 2018.  In this role, I am responsible for oversight of the clinical year curriculum, the overall assessment and evaluation of our clinical sites & preceptors, student assessment and adherence to accreditation standards.  I also advise students in both years of the program, teach in the didactic year, participate in admissions and work clinically 1 day/week, doing primarily low-risk obstetrics.  As Director of Clinical Education, I enjoy the ability to establish long-term relationships with preceptors and clinical sites, and see second year students growth and develop into clinicians as they move through their clinical training.    Our program is so grateful for the strong institutional and community partnerships we have, and for the significant effort that each of our preceptors contribute to sharing the future generations of Duke PA students!