Tuesday, December 23, 2014

Physician Assistant Clinical Rotations



After you have endured the didactic phase of your physician assistant
education, you’ll be on to bigger and better things, like your clinical
phase! Generally, students participate in a variety of rotations
including private, public, inpatient, and outpatient care. Rotations
will vary in duration and lodging accommodations vary from program to
program, although most programs allow 4-8 weeks for each rotation. Most
programs have 7-9 required rotations and 1 to 2 elective rotations with
one or more being in a rural or underserved area. Students in some
programs are required to log each patient care experience and to
complete evaluations at the end of each clinical rotation site. Below
are a few resources (online resources listed first, then texts for each)
for the most common rotations and ideas for common elective rotations.


Family Medicine Rotation
Primary
care, ambulatory medicine, general practice, community health, hospice,
palliative medicine, and rural medicine are all included under this
category

Primary Care Study Guide
ICD-9 Consult 2014 - Free download, $4.99 upgrade
  • Predicts long term safety and sustainability of chronic opioid prescription for a patient based on their history and situation
Family Medicine - What to Expect - includes some handouts


Primary Care Secrets, 3rd Edition by Mladenovic
Blueprints Family Medicine by Lipsky and King


Internal Medicine Rotation
This
includes allergy/immunology, ambulatory medicine, cardiology,
adolescent medicine, critical care medicine, endocrinology,
gastroenterology, geriatric medicine, hematology, infectious disease,
nephrology, oncology, pulmonology, and rheumatology as dictated by the
American College of Osteopathic Internists and the American Board of
Internal Medicine

Internal Medicine Study Guide
  • First sheet - use during your admission H&P
  • Subsequent sheets - for tracking daily progress, labs, changes, and plan
  • Complete with headings for reminders of what to ask during the interview
  • Geared for pediatric patients, but great explanations of mechanisms behind abnormalities
AGS Beers Criteria Pocket Card - inappropriate meds for geriatric patients


Blueprints Medicine by Young et al.
Medicine Recall by Bergin
First Aid for the Medicine Clerkship by Kaufman, Stead, and Rusovici


Pediatrics Rotation
Pediatric Study Guide
Well-Child Check Template (Infant, adolescent, and acute problem visits)
PedsCases.com - 100,000 podcasts on iTunes


First Aid for the Pediatrics Clerkship by Stead, Kaufman, and Waseem
Blueprints Pediatrics by Marino and Fine
The Harriet Lane Handbook by Johns Hopkins Hospital, Arcara, and Tschudy
Nelson Essentials of Pediatrics,6e by Marcdante et al.
Emergency Medicine Rotation
Emergency Medicine Study Guide
  • Includes FAST exam, pregnancy, gallbladder, DVT


Emergency Medicine Secrets by Markovchick et al


10 Second EM - less than $5
WikEM - free
EMRA (Emergency Medicine Residents’ Association) Antibiotic Guide 2013/2014 - $15.99
Tox Toolbox - Free toxicology reference; unavailable for iPhone
  • Top
    25 Toxins is a list of the most common toxins in America and provides
    drop-down information on symptoms, clinical pearls and treatment
    pitfalls
Epocrates - Free drug reference


Women’s Health Rotation
Occasionally referenced as women’s health or ob/gyn (obstetrics and gynecology) rotations.
  • Provided by the Association of Physician Assistants in Ob/Gyn


Basic Gynecology and Obstetrics by Gant and Cunningham
Ob/Gyn Recall by Bourgeois
Case Files Obstetrics and Gynecology, 4th Edition by Toy, Baker III, Ross, and Jennings
Blueprints Obstetrics and Gynecology by Callahan and Caughey
Essentials of Obstetrics and Gynecology, 5e by Hacker, Gambone, and Hobel
Pocket OB/GYN by Naylor


  • $99.99 in app-purchase


Psychiatry Rotation
Also known as “behavioral medicine,” mental health, or “psych” rotations.
Psychiatry Study Guide
Emily Cooper’s Psychiatry Clerkship Resources

First Aid for the Psychiatry Clerkship by Stead, Kaufman, and Yanofski
Blueprints Psychiatry by Murphy et al.
Clinical Psychiatry Essentials by Roberts, Hoop, and Heinrich
Surgery Rotation
Also
known as general surgery or plainly, “surgery” rotations. Subspecialty
elective surgery rotations including cardiothoracic and neurosurgery are
not included under this category, but these resources may be helpful
for such rotations.

General Surgery Study Guide
Blueprints Surgery by Karp and Morris


  • $24.99 with various in-app animation pack purchases


Clinical Elective Rotations
There
are so many choices for elective rotations, although your program may
only offer a handful of these listed below. In addition, I’ve listed a
few international and domestic rotations you might not have heard about.
Some of these I’ve found links for online, but others are just listed
from PAEA’s survey of students who have done
international rotations.
Some of these sites may now be inactive. If you have any to add to the
list, please leave them in the comments below! Additionally, as a
resource, you may check out the
International Federation of Medical Students’ Associations. You can also join PAs for Global Health for $15.


Physician Assistant End of Rotation (EOR) Exams
During each of your rotations, you’ll need to study for the PANCE in addition to your End of Rotation
(EOR) Exam. The EOR, developed by the Physician Assistant Education
Association, is used to assess student progress and facilitate program
evaluation in the clinical phase. End of Rotation examinations were
first released in January 2013 and only 25% of PA programs purchased
them according to
PAEA. Currently, PAEA states that 60 programs nationwide are utilizing the exams.


While
programs are not currently required to purchase these exams and use
them for evaluation, they can provide less workload for faculty, provide
increased test security, allow for student performance comparison
across programs’ clinical phases, and can familiarize the student with
the test taking environment of the PANCE. Pitfalls of the EOR are that
they are new, scores might be lower than “in-house” produced exams,
faculty cannot view the exams, and they are somewhat expensive to
incorporate. Programs may still opt to use their own “in-house” exams
for rotation evaluation. For
example,
some programs utilize ExamMaster for evaluation in addition to writing
assignments and preceptor evaluations. You can read about other program
evaluations
here.
Generally, it seems that schools are giving you two chances to pass the
EOR. If you fail the second time, you must repeat the entire rotation
or undergo some remediation process. You can view a preview of the
policy at East Carolina University,
here.


These
120 multiple-choice question, peer-reviewed exams utilize relevant
up-to-date information following content blueprints and topic lists for
each of the specific rotations mentioned above. In addition to the topic
and blueprints above, a
Core Tasks and Objectives Learning Supplement
is also included in the requirements for each rotation. Further, PAEA
goes on to say that “comparative data is reported on specific test forms
and not across test forms, and the exam forms may not necessarily have
the same difficulty level.” Thus, each rotation’s exam may vary in
difficulty and passing or average scores will vary. Only the performance
of students who have taken the same exam should be compared. The exam
also includes 20 unscored questions.


The cost of each EOR exam currently $30 per exam, per student for all 7 of the exams.


A sample exam is posted on PAEAs website.


SELF STUDY RESOURCES:
Help Campus (same as Help Zebra and also known as Hancock)
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  • 840 Questions
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  • 1,125 PACKRAT board review questions (5 225-question exams)
  • 5 Quizlet Flashcard sets (each with 225 questions)


INTERNET SOURCES:
AAPA’s Rotation Do’s and Do Not’s - page 8 and 9
PAST for Physician Assistant Programs - by TyphonGroup Healthcare Solutions
  • Electronic
    student tracking system, including patient encounter logs and reports,
    an evaluation component for assessments, management of student rotation
    scheduling, student electronic portfolios, preceptor biographic
    databases, clinical site databases, curriculum mapping, and more.
Surviving Clinical Rotations by Cynthia Booth Lord, MHS, PA-C
  • Includes what to bring on your first day
  • Questions you may be asked by preceptors
  • How to present to a patient
  • Tips
The Turkey Book - pocket guide to medical clerkship
Wal-Mart $4 Prescription List - helpful for patients of low-income or without insurance
P450 Drug Interaction Table - very helpful if you are ever considering a drug-drug interaction
Emily Cooper’s Med-Source
Physical Exam Skills - Dartmouth
  • H&P Cards and Forms
  • Daily Rounding Logs
  • Specific Sheets/Forms for each rotation
  • Includes resources for every rotation
Pre-Physician Assistants - How to Succeed in PA School
UpToDate.com - clinical decision support resource
MedZoom - Links to medical websites
  • Details the evaluation your preceptors will likely use to judge your clinical knowledge
PA School Clinical Year YouTube Video

General Books for Any Rotation:
Sanford Guide to Antimicrobial Therapy by Gilbert, Moellering, and Eliopoulos
Current Medical Diagnosis and Treatment 2014 by Papadakis, McPhee, and Rabow
Physician Assistant: a Guide to Clinical Practice by Sullivan, Brown, and Vetrosky


PHONE APPS:
Best Review of Medical Apps by Houston Neal
PA Toolbox by Medical Wizards - $28.99
Physician Assistant Exam Review McGraw-Hill - $49.99
PEPID - Free
Epocrates - Free drug content, $159.99 disease content
Skyscape - Free; In app purchases up to $129.99
  • In app purchases up to $19.99
  • In app purchase up to $29.99
Medscape by WebMD - Free
UpToDate - Free
AgileMD - Free
Micromedex - $2.99 annual subscription
Diagnosaurus (McGraw-Hill) -$1.99
PANCE Flashcards - Lange - Free, Expansion Pack - $34.99
Physician Assistant LANGE Q&A - Free download, $49.99 for access
  • Contains 1,211 questions from PAEasy.com
Physical Exam Essentials (HippoSoft) - $2.99
iTriage - Free
ErRes - $4.99


Physician Assistant Rotation Blogs:
Below
is a list of student blogs from various physician assistant programs
across the nation (and international) that have written about their
experiences in the clinical phase. I’ve done my best to go through each
one and highlight what rotations they talk about so you can hand pick
which blogs to read.
Pre-Physician Assistant Blog - Various schools represented
  • Various rotations referenced
Life of a PA - South University PA Program
  • Orthopaedics
  • Psychiatry
  • Pediatrics
  • Ob/gyn
Timothy Loerke - The University of North Texas Health Science Center Fort Worth
  • Emergency Medicine
  • Family Medicine
  • Ob/gyn
  • Pediatrics
  • Psychiatry
  • Surgery
  • Underserved Medicine
  • Orthopedic Surgery
  • Pediatric Cardiothoracic Surgery
  • Inpatient Medicine
Jenna Lombardi - Philadelphia College of Osteopathic Medicine
  • Emergency Medicine
  • Psychiatry
  • Family Medicine
  • Internal Medicine
  • Primary Care
  • Surgery
  • Ob/gyn
  • Pediatrics
Bianca Belcher - Northeastern PA Program
  • Emergency Medicine
  • Ob/gyn
  • Critical Care
  • Surgery
  • Orthopaedics
  • Psychiatry
Snow Feng - Philadelphia College of Osteopathic Medicine
  • Surgery
Jen Pilchman - Philadelphia College of Osteopathic Medicine
  • Emergency Medicine
  • Surgery
  • Dermatology
  • Behavioral Medicine
  • Family Medicine
  • Pediatrics
  • Internal Medicine
  • Infectious Disease
  • Primary Care
  • Pediatrics
  • Surgery
  • Emergency Medicine
  • Internal Medicine
Harrison Reed - Yale University PA Program
  • Ob/gyn
  • Surgery
  • Pediatrics
  • Emergency Medicine
  • Psychiatry
  • Internal Medicine
  • Surgery
  • Surgical ICU
  • Orthopedic Trauma Surgery
  • Pediatrics
  • Psychiatry
  • Emergency Medicine
  • Ob/gyn
DJ and the PA Journey - Pacific University Oregon
  • Emergency Medicine
  • Family Medicine
  • Surgery
  • Primary Care
  • Women’s Health
Irene Gung Ho - Barry University
  • Psychiatry
  • Internal Medicine
  • Family Medicine
  • Emergency Medicine
  • Ob/gyn
  • Surgery
  • Pediatrics
Ashleigh - The Life of a Physician Assistant
  • Psychiatry
  • Emergency Medicine
  • Surgery
  • Pediatrics
Memo Sanchez - George Washington University
  • Pediatrics
  • Surgery
Katie Swan - University of Colorado PA Program
  • Ob/gyn
  • Surgery
  • Pediatrics
  • Orthopedics
  • Endocrinology
Chase Hungerford - University of Southern California Primary Care PA Program
  • Emergency Medicine
Paul Kubin - University of California Davis
  • Cardiothoracic Surgery
  • Inpatient Hospital
  • Outpatient Primary Care
Physician Assistant Ed - Various schools represented
Anne Dang - McMaster University PA School
  • Orthopaedics
  • Internal Medicine
  • Surgery
Eden Jerao-Shedden - University of Manitoba PA School
  • Ob/gyn
  • Family Medicine/Primary Care
  • Pediatrics
  • Orthopedics
  • Emergency Medicine
  • Internal Medicine
  • Ob/gyn
  • Family Medicine
  • Primary Care
  • Psychiatry
  • Emergency Medicine
  • Surgery
  • Emergency Medicine
  • Psychiatry
  • Geriatrics
  • Pediatrics
  • Ob/gyn
  • Inpatient Medicine
  • Orthopedics
  • Surgery
  • Internal Medicine
  • Pediatrics
  • Hospitalist
  • Emergency Medicine
  • Ob/gyn
  • Psychiatry
  • Family Practice


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