Policies & Procedures

Discretionary Day Policy

1) Each student is allotted 3 discretionary days of absence, which may be used during the clinical year.

2) No more than one discretionary day may be taken in a 4-week rotation block, and a discretionary day may not be taken on a Call Back Day or days during other required program activities.

3) If a discretionary day is taken on a Friday (not a Call Back Day) on which a clinical rotation exam is administered, the student must arrange to take the exam in advance in coordination with the assigned clinical coordinator.

4) All discretionary days must be approved by assigned clinical coordinators at least five days in advance by completing the Student Time Away Form.

Policies and Procedures

Maximizing Students’ Learning Experiences 

Preceptors have a critical role to ensure PA students are maximizing clinical learning activities with reference to program attendance policy. The intent of this policy to support achievement of these programmatic goals while allowing students sufficient time for self-care including physical rest, management of obligations outside of school, and recreation in order for them to be optimally effective as learners and healthy as people. In addition to ensuring students do not exceed with upper limit of works hours, preceptors should also make sure students have every opportunity to participate in patient throughout the entire course of the rotation. Strategies to ensure optimal learning include having colleagues supervise students when you are out of the office, connecting students with other members of the health care throughout the rotation, and not giving students “study days” near the end of the rotation.

I. Attendance Policy

1) Attendance is mandatory for dates students are assigned to a clinical rotation site as stipulated in the Work Hours Policy. In general, the student should be participating in supervised clinical experiences if the clinic is open and the preceptor and/or team is providing care to patients. Students are expected to be on time for clinic, conferences, rounds and other learning events throughout the course of the rotation. Preceptors are asked to notify the PA Program with concerns regarding tardiness or absences and document attendance issues on the student evaluation form under professionalism.

2) If the preceptor is on vacation, sick, or away from the clinical site, every effort should be made to have the student work with another provider in order to meet required work hours and maximize clinical learning opportunities. If this is not possible, the student or preceptor should notify the assigned clinical coordinator at the PA Program.

3) Students must notify the preceptor and the assigned clinical coordinator at the PA Program regarding time missed for any reason. Absences of greater than a half day or half shift require completion of the Student Time Away Form, which will be signed by (1) the preceptor and (2) the student’s assigned clinical coordinator. Clinical preceptors cannot approve time away without the permission of PA Program faculty. Any absences for reasons other than illness, family emergency, or a PA Program approved holiday require prior approval by the PA Program. Students are responsible for submitting Student Time Away Forms by email, fax, or in-person to the assigned clinical coordinator.

4) Students are allowed to miss up to one day/shift from a rotation for an excused absence (illness or family emergency, including funerals) without the need to make up the clinical hours. Any absence(s) greater than one day/shift due to these circumstances will require arrangements to make up the clinical hours, which will be coordinated with the preceptor and assigned clinical coordinator.

5) Official approved PA Program holidays are noted in the Clinical Year Manual. On some clinical services, students may be asked to work on the specified holiday. If this is the case, the student should be given a day off during the week of the holiday to compensate for time worked on that day.

6) All time away from rotations (illness, discretionary day, holiday, inclement weather, clinic closure) should be accurately reflected in the E*Value Time Log completed by students for faculty review. Any questions about adequacy of logged time should be directed to the clinical coordinator during the rotation, particularly if related to unexpected clinic closure or preceptor absence. An inadequate time or patient log may result in changes to a student’s clinical year schedule or require additional clinical time during weekends, EBP II, time during an elective course, over a school break, or may result in delayed program completion.

Violations of the Attendance Policy

A violation of the attendance policy is a violation of professionalism, academic policy, and the honor code. We expect each of you to adhere to these policies, as they will facilitate your success in the clinical year and help you establish “best practice” for professional conduct throughout your career. Time logs are reviewed by faculty at the conclusion of each rotation to ensure attendance and work hour requirements have been met. Failure to meet those requirements may result in make-up time during another rotation, weekend or break and/or delay of program completion.

II. Work Hours Policy

The Physician Assistant Program in the Duke University School of Medicine has adopted a work hours policy for students to provide guidance and protection for students in the clinical phase of the curriculum. It is recognized by faculty and students that the goals of educating students in this setting include the development of medical knowledge, clinical skills, and professional attributes through participation in in supervised clinical experiences. It is the intent of this policy to support achievement of these programmatic goals while allowing students sufficient time for self-care including physical rest, management of obligations outside of school, and recreation in order for them to be optimally effective as learners and healthy as people.

1. Students will be expected to be on-site on any clinical service no more than 80 hours per week, averaged over a rolling two-week period during the clinical rotations. This maximum should include actual time spent in the hospital or clinic on “on-call” nights, but need not include time a student may spend at home reading or studying.

2. Students will have one full day completely free of patient-care responsibilities in the hospital or clinic per 7-day week, averaged over any rolling two-week period for the clinical rotation.

3. Students will not be expected to be in the hospital or clinic setting for more than 30 consecutive hours, followed by a minimum of 8 hours off or away from clinical duties.

4. In conjunction with the restrictions on total time spent in the hospital or clinic, preceptors should design learning activities to make most efficient use of time from the standpoint of learning. Learning activities appropriately include:

a. The care of patients assigned to the student, the student’s team, or services being cross-covered, and other activities that are the work of the student’s team, and

b. Classes, conferences, rounds, projects and individual learning assignments that are part of a course.

5. Students should not be expected to use the hours allocated on tasks that are not directly related to learning activities (e.g. performing personal favors or services for other medical personnel), nor should they be expected to do work unrelated to their learning activities solely because residents must leave due to work hours restrictions.

Policies and Procedures

New Clinical-Year Evaluations

It’s the start of a new clinical year!  The Class of 2018 completed their program requirements and received their Certificates of Completion on Friday, August 3rd.  The Class of 2019 is officially out on clinical rotations, and enjoying reengaging with patients and learning the science and art of medicine from preceptors!

The Clinical Team wanted to remind all preceptors that in accordance with PA accreditation standards, the Duke PA Program is adapting student performance evaluations to better align with learning outcomes which will include verification of required competencies.  There are two major revisions for course courses, including Primary Care, Behavioral Medicine, Internal Medicine, General Surgery, Emergency Medicine, Pediatrics, and Women’s Health.  These changes include:

  • Course-specific learning objectives tied to each component of the student evaluation outlined in course syllabi. The student evaluation will still use descriptive behaviors to categorize the level of student performance.  Click here to see the list of student learning outcomes by course.  Course syllabi and evaluations of core course can be viewed in the Resources section on the right side of the screen.
  • Preceptors will now provide verification of competency specific to each clinical course that should be documented on the evaluation form and/or via a clinical passport maintained by the student. Preceptors for elective rotations will be given the option to acknowledge student competency for the acuity of the visit, the age of the patient, as well as to write in any specific skill or procedure the student may have demonstrated competency in during the course of the rotation.

When asked to verify competency, our program defines competency as the ability to perform the skill or task at the level required for entry into general clinical practice with supervision by a collaborative physician partner.   Once a student is verified as competent for a specific skill, the clinical preceptor must still provide appropriate supervision of that skill during supervised clinical experiences. Please note, the verification of competency is only one component of the many assessment measures to ensure comprehensive student performance evaluation.

We request that if you oversee a rotation that includes multiple preceptors, or persons who participated in student evaluation, that you provide them with this updated information.  We are here to partner with you, as we enter into this new era of evaluations.  Should you have any questions about this, please contact a member of the clinical year team.

The Duke PA Clinical Year Team

Policies and Procedures

Professional Conduct and Treatment of Learners

  • The Duke University School of Medicine (SOM) is committed to creating and maintaining a positive learning environment for learners that is respectful and appropriately attentive to their learning needs and free from conduct by teachers that could be interpreted by learners as mistreatment. Behavior that violates this stated expectation will be investigated, and if found to represent mistreatment, may become the subject of disciplinary action by the SOM. Clinical preceptors serve in teacher roles and are subject to this policy. We encourage you to read about this policy so you can understand the standards of conduct, definitions of mistreatment, and the mechanisms by which learners can report treatment and how the institution investigates them. We hope this information helps us all create and maintain the positive learning environments that our learners require and deserve.

Policies and Procedures

Routine Site Visits

  • The Duke PA Program has established processes for the initial and ongoing evaluation of all sites and preceptors used for supervised clinical practice experiences to ensure that sites and preceptors meet program expectations for student learning outcomes and performance evaluation measures.
  • Routine site visits are an important time for the preceptor to share about her/his experience with Duke PA students, describe the typical learning activities students participate in, and receive feedback about student experiences. The site visit is also a time where the program faculty can provide updates about the Duke PA program and share strategies for teaching in clinical settings.
  • In addition to routine site visits, program faculty may request to meet with preceptors on an as-needed basis. Also, preceptors are welcome to request a meeting with program faculty at any time. During the site visit, the faculty member may meet with the Duke PA student to learn more about her/his experience as well.
  • We appreciate your participation in site visits and invite your feedback about this important process!

Policies and Procedures

Clinical Phase Attendance Policy

PA education is known for being intensive and accelerated. For that reason, it is imperative for PA students to maximize every learning opportunity during the clinical phase of education with emphasis on direct patient interactions under appropriate supervision of licensed providers. While students do need to spend a significant amount of formal study/reading time in preparation for their days in clinic and required examinations, students should be taking every opportunity to participate in patient assessment, clinical reasoning, management, patient education, and procedures.

Preceptors have a critical role in connecting students with learning opportunities, so please review the program’s attendance policy with understanding that it is designed ensure students optimal participation in clinical learning under careful oversight of preceptors and program faculty.

Please note that that both the preceptor and the Duke PA Program faculty clinical coordinator have to approve time away from rotations.

Attendance Policy

1)  Attendance is mandatory for dates students are assigned to a clinical rotation site, with the exception of the one day off per week specified by the Work Hours Policy.  In general, if the clinic is open and the preceptor/and or team is working, the student should be working as well.  If the preceptor is on vacation, sick or away from the clinical site, every effort should be made to have the student work with another provider in order to meet required work hours.  If this is not possible, the student or preceptor should notify the assigned clinical coordinator at the PA Program.

2) Students must notify the preceptor and the assigned clinical coordinator at the PA Program regarding time missed for any reason.  Absences of greater than a half day or half shift require completion of the Student Time Away Form, which will be signed by the preceptor and the student’s assigned clinical coordinator.  Clinical preceptors cannot approve time away without the permission of the PA Program.

3) Student Time Away Forms may be faxed, scanned/emailed or presented in person to the assigned clinical coordinator for approval.

4) Students are allowed to miss up to one day/shift from a rotation for an excused absence (illness or family emergency, including funerals) without the need to make up the clinical hours.  Any absence(s) greater than one day/shift due to these circumstances will require arrangements to make up the clinical hours, which will be coordinated with the preceptor and assigned clinical coordinator.

5) Any absences for reasons other than illness, family emergency, or a PA Program approved holiday require prior approval by the PA Program.  Students requesting time away from clinical responsibilities should be directed to contact their assigned clinical coordinator for approval.  This includes Discretionary days.

6) Official approved PA Program holidays are noted in the Clinical Year Manual. On some services, students may be asked to work on the specified holiday.  If this is the case, the student should be given a day off during the week of the holiday to compensate for time worked on that day.

7) Students are expected to be on time for clinic, conferences, rounds and other learning events throughout the course of the rotation.  Preceptors are asked to notify the PA Program with concerns regarding tardiness or absences and document attendance issues on the student evaluation form under professionalism.

8) All time away from rotations (illness, d-day, holiday, inclement weather, clinic closure) should be accurately reflected in the E*Value Time Log completed by students for faculty review. Any questions about adequacy of logged time should be directed to the clinical coordinator during the rotation, particularly if related to unexpected clinic closure or preceptor absence. Inadequate time logs may result in remediation of clinical hours during a weekend, during EBP-II or over a school break.

Policies and Procedures

Student evaluation procedures and deadlines

Ideally, evaluations of students should be completed and discussed with students prior to their leaving your clinical site.  This discussion provides an opportunity for you and the student to provide both positive and constructive feedback to each other, and for the student to leave the learning experience with a clear understanding of their performance and how they can improve their knowledge and skills throughout their clinical education.

Student evaluations must be completed and submitted via E-Value within one week of rotation completion.  Evaluations are done electronically and require the preceptor have a valid email address and access to the internet.  No username or password is required to complete electronic evaluations. If you have any questions about the student evaluation process, please contact Kate Holeman at kate.holeman@duke.edu.