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21.1. Clerkship Descriptions

The second year of the PA Program will engage students in a variety of experiential learning that consists of nine five-week clerkships. There are seven required core disciplines: Family Medicine, Internal Medicine, Emergency Medicine, Surgery, Psychiatry, Pediatrics, and Women’s Health, and two elective clerkships where students have the opportunity to identify preferences. Clerkships will ensure students meet the standards outlined by ARC PA to prepare them for general practice.     

Most of the clinical year will be spent learning and refining patient care skills in clinical care settings with the supervision of a licensed preceptor. Each clerkship will be different, but the following guidelines are common to all experiences:

  1.        Students will be permitted to see patients with the supervision of their preceptors. The number of patients that the student will see is determined by each preceptor. The expectation is that by the end of the clinical year, students should be progressively seeing more complex patients.
  2.        Most patient interactions will consist of the students introducing themselves, receiving the consent of the patient to interact with them and their family, soliciting the medical history and conducting a physical examination as appropriate.
  3.        Students will present their patients’ history and physical assessment to the preceptor and together develop an assessment and plan.  Students must refrain from discussing any findings, suspected diagnoses, next steps, or recommended treatments with the patient until after discussing their findings and conclusions with their preceptor.
  4.        In some settings the student will be shadowing the preceptor or working with a multidisciplinary team for periods of time. In this case, patient interactions may be indirect, where students will learn from observation. This style of learning is a key component of the clinical education process and the student should not underestimate the importance of observation and team learning. If a student finds they are being restricted from direct patient contact on most days of any clinical experience, they should discuss this with their primary preceptor and contact the Director of Clinical Education.
  5.        Students should expect to work with other learners. Interprofessional education and practice are key to comprehensive and competent patient care. In consultation with their primary preceptor, it is strongly encouraged that each student when appropriate seek collaborative opportunities with students from other professions, such as medicine, nursing, dentistry, psychology, physical therapy, occupational therapy, pharmacy, and communication disorders.
  6.        Students are required to document each visit according to their site’s standards and follow the directions provided by each specific site.There may be paper charts, electronic medical records, or dictation systems. Sometimes special forms are used, such as for health maintenance exams or checklists for well-child and prenatal visits. Some sites may not allow students to document in the chart. In this instance, students should take the initiative to document the encounter in another format and obtain preceptor review. It is absolutely forbidden to dictate or document under the name or login of your preceptor
  7.        When signing any clinical document, students should always include the title: PA Student or PA-S and not include any other credentials.
  8.        In compliance with HIPPA, no document or medical record with patient identifiers may be taken from the medical facility. Students are forbidden from posting any clinical or patient information on social media sites. Students found to be discussing clinical experiences in any public forum (virtual and in–person) will be subject to disciplinary action, which may include dismissal from the Program.
  9.        Clinical schedules will be determined by the primary preceptor and may include evenings, nights, weekends, and holidays. Students are expected to be available to participate in learning opportunities during the times assigned by their preceptors. If the Institute is closed due to inclement weather and the clinical site is open, the student is expected to communicate with their primary preceptor and make every effort, within reason, to participate in clerkship that day.
  10.        CMS guidelines are used to teach physicians how to document for Medicare reimbursement. These guidelines have had a major impact upon medical education, with academic  medical centers receiving large fines for non-compliance. The MGH IHP PA Program has studied the guidelines and recommends that the guidelines be applied to all Medicare and Medicaid patient visits, to avoid creating different standards of care and documentation between patients. Guidelines Include: 
  •       PA student notes may not be used to support a billable service. 
  •       It is strongly recommended that the teaching preceptor refer to the PA student note only for past family history, social history and/or review of systems. 
  •       The preceptor responsible for the patient must document personal involvement in a personally dictated or written note that includes all of the relevant key information necessary for billing. 
  •       Most preceptors allow students to document the patient’s visit and then the preceptor will edit or write an addendum and co-sign. These rules do not mean the student cannot write/dictate a note. However, it does mean that the preceptor also needs to personally document the billable aspects of the history and physical.