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.

Teaching Tips

Video Resource: Providing Feedback to Learners

The Duke PA program is excited to share the second in a series of preceptor development videos.  The purpose of these videos is to provide useful information and best practice guidelines you can readily implement as an educator of PA students in your unique clinical setting.  Because you are busy we have aimed to keep these videos short and to the point.

The second video in the series reviews strategies for providing feedback in clinical settings with reference to principles of assessment and evaluation.

Please let us know if you have ideas for video topics and what you think of this resource: https://duke.qualtrics.com/jfe/form/SV_ebrlUPqyBlNNbX7

Announcements

Video Resource: Duke PA Program Curriculum

The Duke PA program is excited to announce the first in a series of preceptor development videos.  The purpose of these videos is to provide useful information and best practice guidelines you can readily implement as educator of PA students in your unique clinical setting.  Plus, because you are busy we have aimed to keep these videos short and to the point.

The first video in the series provides an overview of the PA profession and the Duke PA program curriculum so the you have a greater understanding of the preclinical and clinical phases of the program as well as recognize the knowledge and skills PA students need to be practice ready upon completion of the program.

Please let us know if you have ideas for video topics and what you think of this resource: https://duke.qualtrics.com/jfe/form/SV_ebrlUPqyBlNNbX7

Teaching Tips

Student Documentation in the Electronic Health Record

Guidelines for Student Documentation in the EPIC Electronic Health Record

As the Electronic Health Record (EHR) becomes established in the U.S. healthcare system, it is crucial that PA students practice documentation skills on these platforms during their clinical training under preceptor supervision.  Preceptors must strike a balance between satisfying Centers for Medicare & Medicaid Services rules and institutional guidelines for student documentation, while ensuring that students learn the critical navigational skills required for successful practice in today’s healthcare system.  Here are some helpful tips for you to achieve that balance. Note that some tips are specific to the EPIC platform used by Duke Health and several clinical sites, while others may apply to any EHR platform.

  • Have the student log in to the computer with his/her own login and password.
    • Do not Share your user ID and password with student to allow them to login as you.
    • You may contact your EHR administrator to query if a student account can be created; it is best to initiate this process in advance of the student rotation start date.
  • Allow the students to write learning notes in the NP/PA/physician Student tab in the Note section of EPIC.
    • The student note is for educational purposes ONLY. This is not part of the legal medical record even if a resident or attending adds their documentation and signs it.
    • Within the Duke Health EPIC EHR, student notes can be seen by patients in My Chart unless a specific dot phrase is included within the note. PA students have been instructed to include the ‘.DONOTSHARE’ dot phrase in all of their documentation so their notes are not shared. As part of your supervision and review of student notes, please make sure this dot phrase is included.  Preceptors who do not work for Duke Health should check with their individual EHR administrator for their policies.
    • Do not use copy and forward function to incorporate within your note.
    • Do offer verbal and/or written feedback on the student’s learning note.
  • Students may review and add information to the medication and allergy lists, but should not delete information.
  • Preceptors should create their own separate note and should not cut and paste from the student note.
  • Per CMS Guidelines, Preceptors may, in their note, refer to information obtained by students in the following sections: Review of Systems, Past Medical History, Family History, Social History, and Allergies.  The preceptor should review this information with the patient to verify accuracy.
  • Per CMS Guidelines, Preceptors must verify and document history of present illness, physical exam, and medical decision making.
  • Preceptors may allow students to write and pend orders for provider’s signature. The order is not active until the provider signs the order.  Students must not sign orders.
  • Most importantly, remember that students may NOT draft the provider’s note to enable the preceptor to edit, sign or use the student’s note to support billing the service.

Creative Tips from your colleagues for incorporating the student into the EHR experience and getting your office notes done on time:

  • Have the student assist you with tracking and reviewing information that may have occurred since the last visit, e.g. consult notes, lab results, and health maintenance exams.
  • Have the student write/print the after visit summary.
  • Try having the student present the patient encounter in the exam room with the patient present while YOU act as the scribe. Inform the patient before beginning that the student is now going to tell you both what he/she gathered.  After the student has finished orally stating the HPI, stop them, and ask the patient to verify the information.  Ask your own additional questions as needed. Go on in this manner to the physical exam, assessment, and so on.
  • Have the student practice writing notes by hand or in a word document that you can review with the student and provide feedback. These can also serve as a good memory jogger for you later when you compose your provider note.
    • Remember to discard paper documents in a confidential shred bin even if it does not contain patient identifiers.
    • Remember to delete word documents
    • Student notes in EPIC can be seen by patients in My Chart.
      • Duke PA Students have been instructed to include the following dot-phrase anywhere in their notes to prevent student notes from being visible: ‘.DONOTSHARE’
      • Please remind students to utilize this dot-phrase and check to ensure it is included in any student notes you review.

Teaching Tips

Incorporating Students into Patient Care/Workflow

Many clinicians want to “give back” to the profession and serve as a role model for future clinicians, but they are concerned about challenges with time management and maintaining efficiency with their patient load.  Check out this one-page resource to learn how to incorporate students into your busy clinic setting.  http://paeaonline.org/wp-content/uploads/2017/02/Incorporating-Students-into-Patient-CareWorkflow.pdf