Course Goals: the Educational Goals of the Clinical: Adult Medicine Outpatient Rotation Include

/ Department of Physician Assistant Studies
Learning. Caring. Serving. Leading.
PAS 630: Primary Care
3 Semester Hours
Course Director: / Office / Phone / E-mail
Diane Duffy, MD / FC 205 / 336-278-6848 /
Tracey Tonsor, PA-C / FC 207 / 336-278-6852 /

Course Description: The Primary Care rotation is designed to give students exposure to the spectrum of adult outpatient medical practice. Students will learn the principles of routine (well) care, management of acute illnesses, and management of chronic/multiple diagnoses.

Course Goals: The educational goals of the Clinical: Adult Medicine Outpatient rotation include:

1. To apply the medical content and principles that define the care of primary care patients.

2. To provide opportunities for each student to develop the core PA competencies in a supervised primary care setting

3. To expose each student to an experienced and competent medical provider role model for the primary care of patients.

Learning Outcomes:

Upon completion of this clinical rotation clinical phase PA students will:

1. Demonstrate the ability to obtain accurate and complete information via the patient interview and conduct an appropriate physical examination for the various types of visits seen in adult outpatient medicine.

2. Demonstrate the ability to apply principles of clinical epidemiology and probabilistic reasoning to develop preliminary assessments/diagnoses and treatment plans.

3. Demonstrate familiarity with the common clinical presentations, physical exam findings, appropriate diagnostic tools and evidence-based treatments for common adult medicine patient problems including acute and chronic medical problems, common mental health problems and emotional illnesses.

4. Demonstrate familiarity with preventive care recommendations for promotion of health in the adult patient, identifying risks for specific illnesses that affect screening and treatment strategies.

5. Demonstrate the ability to effectively communicate with patients and other medical providers.

6. Demonstrate awareness of the impact of culture, ethnicity, socioeconomic status, advancing age and gender on the patient’s expression of illness and response to treatment, and demonstrate ability to incorporate that awareness into patient interactions.

7. Demonstrate proficiency in documenting medical care

8. Participate in and analyze the process of referral/consultation of a patient.

9. Recognize clinical processes established to improve performance of a clinical site.

Teaching Methodologies: The content of this module will be presented through a variety of methods that include observation and participation at the clinical site, independent reading and participation in online activities developed to guide experiential learning.

Accommodations: Students requiring academic accommodations must follow the “Academic Support” policy in the Elon University DPAS Student Handbook.

Academic Honesty: All Elon PA students acknowledged their commitment to abide by the Elon Honor Code by signing the Honor Pledge during orientation.

Required Textbooks:

All required first year text books
CURRENT Diagnosis & Treatment in Family Medicine, 3e

Other Resources:

1. *Moodle: Please check the course site frequently for new announcements, updated schedules, assignments and other course communication.

2. Practicing physician assistants, physicians, allied health care providers and laboratory teaching aids.

TOPICS LIST
Urgent Care / Dermatology / Dermatology (cont’d)
Respiratory failure/arrest / Dermatitis (eczema/ / Urticaria
Deteriorating mental status/ / seborrhea) / Vitiligo
unconscious patient / Nummular eczema / Folliculitis
Allergic reaction/anaphylaxis / Dyshidrosis / Tinea infections
Acute abdomen / Lichen simplex chronicus / Tinea versicolor
Burns / Drug eruptions / ENT/Ophthalmology
Third trimester bleeding / Lichen planus / Pharyngitis/tonsillitis
Bites/stings / Pityriasis rosea / Acute/chronic sinusitis
Foreign body aspiration / Psoriasis / Aphthous ulcers
Cardiac failure/arrest / Erythema multiforme / Blepharitis
Fractures/dislocations / Stevens-Johnson syndrome / Conjunctivitis
Sprains/strains / Toxic epidermal necrolysis / Dacryocystitis
Myocardial infarction / Bullous pemphigoid / Hordeolum
Hypertensive crisis / Acne vulgaris / Labyrinthitis
Pulmonary embolus / Rosacea / Tinnitus
Pneumothorax / Actinic keratosis / Laryngitis
Ingesting harmful substances / Seborrheic keratosis / Otitis externa
(poisoning) / Lice / Otitis media
Orbital cellulitis / Scabies / Tympanic membrane
Pulmonary / Spider bites / perforation
Asthma / Basal cell carcinoma / Ectropion
Bronchitis / Kaposi sarcoma / Entropion
COPD / Melanoma / Corneal abrasion
Pneumonia / Alopecia / Corneal ulcer
Tuberculosis / Onychomycosis / Glaucoma
Lung cancer / Paronychia / Hyphema
Sleep disorders / Condyloma acuminatum / Macular degeneration
Tobacco use/dependence / Exanthems / Papilledema
Cardiovascular / Molluscum contagiosum / Pterygium
Hypertension / Verrucae / Retinal detachment
Coronary artery disease / Cellulitis / Retinal vascular occlusion
Peripheral vascular disease / Erysipelas / Retinopathy
Arrhythmias / Impetigo / Cholesteatoma
Endocarditis / Acanthosis nigricans / Ménière disease
Hyperlipidemia / Hidradenitis suppurativa / Allergic rhinitis
Hypertriglyceridemia / Lipomas/epithelial inclusion / Epistaxis
Angina / cysts / Nasal polyps
Congestive heart failure / Melasma / Peritonsillar abscess
Chest pain / Pilonidal disease / Parotitis
Valvular disease / Pressure ulcers / Sialadenitis
TOPICS LIST (cont’d)
Infectious diseases / Genitourinary / Orthopedics/Rheum (cont’d)
Mononucleosis / Hernias / Rheumatoid Arthritis
Lyme disease / Cystitis / Reactive arthritis
HIV / Pyelonephritis / Osteoarthritis
Influenza / Glomerulonephritis / Gout
Meningitis / Nephrolithiasis / Sprains/strains
Salmonellosis / Benign prostatic / Ganglion cysts
Shigellosis / hypertrophy / Systemic lupus erythematosus
Gastrointestinal / Prostatitis / Osteoporosis
Colorectal cancer/ / Epididymitis / Fibromyalgia
colonic polyps / Gonorrhea / Plantar fasciitis
Anal fissure / Chlamydia / Overuse syndrome
Peptic ulcer disease / Urethritis / Bursitis/tendonitis
Gastritis / Orchitis / Neurology
Gastroenteritis / Balanitis / Dizziness
Diarrhea/constipation / Testicular cancer / Vertigo
Pancreatitis / Obstetrics/Gynecology / Syncope
Inflammatory bowel disease / Dysmenorrhea / Seizure disorders
Appendicitis / Dysfunctional uterine / Transient ischemic attack
Gastrointestinal bleeding / bleeding / Cerebral vascular accident
Hemorrhoids / Vaginitis / Alzheimer’s disease
Bowel obstruction / Pelvic inflammatory disease / Parkinson’s disease
Viral hepatitis / Breast mass / Essential tremor
Jaundice / Breast cancer / Bell’s Palsy
Cholecystitis/cholelithiasis / Cystocele / Dementia
Cirrhosis / Rectocele / Delirium
Giardiasis and other parasitic / Menopause / Headaches (cluster, migraine
Infections / Intrauterine pregnancy / tension)
Hiatal hernia / Contraception / Psychiatry/Behavioral Science
Gastroesophageal reflux / Cervical cancer / Depression
disease / Spontaneous abortions / Generalized anxiety disorder
Irritable bowel syndrome / Endocrinology / Panic disorder
Esophagitis / Diabetes mellitus / Phobias
Hematology / Adrenal insufficiency / Post traumatic stress
Anemia / Cushing disease / disorder
Leukemia / Hyperthyroidism / Insomnia
Thrombocytopenia / Hypothyroidism / Anorexia
Clotting disorders / Orthopedics/ / Bulimia
Lymphomas / Rheumatology / Mood disorders
Polycythemia / Acute and chronic lower / Substance abuse disorders
back pain / Domestic violence
Costochondritis / Suicide

Assessment Activities:

Exams/quizzes (30%), Preceptor Evaluation (60%), Professionalism (10%).

Grade Scale and Grade Points

Percentage / Letter Grade / Grade points
89.50-100
85.50-89.49
79.50-85.49
75.50-79.49
69.50-75.49
Below 69.50 / A
B+
B
C+
C
U / 4.0
3.3
3.0
2.3
2.0
0

There is no rounding of grades.

Note: For further information regarding academic standing in the Department of Physician Assistant Studies, please see the Student Handbook.

Grading Criteria:

Demonstrate acquisition of a strong basic science and medical science knowledge base as demonstrated on the written examination/quizzes.
Demonstrate satisfactory self-directed learning skills, clinical reasoning skills, commitment to patient-centered care and professionalism as evidenced by satisfactory performance on the preceptor evaluation.
Demonstrate a commitment to learning and professionalism by actively participating in all clinical activities and exceeding the professional behavior standards and minimum requirements for clinical rotations available in the Elon PA Student Handbook.

Instructional Objectives:

Upon completion of the clinical rotation clinical phase physician assistant students will be able to:

1. Clinical Skills

a. Demonstrate the ability to obtain accurate and complete information via the patient interview in the following clinical situations:

1. An acute medical problem

2. A chronic medical problem.

3. A patient presenting with multiple problems.

4. Routine health care

b. Demonstrate the ability to conduct a complete physical exam and a problem focused physical exam based on the stated reason for the visit.

c. Recognize and interpret pertinent physical examination findings when presented in written or illustrated form.

2. Core Presentations

a. Acute Care: Differentiate among common etiologies based on the presenting symptom. Recognize “don’t miss” conditions that may present with a particular symptom. Elicit a focused history and perform a focused physical examination. Discuss the importance of a cost-effective approach to the diagnostic work-up. Describe the initial management of common and dangerous diagnoses that present with a particular symptom.

b. Chronic disease management: Apply diagnostic criteria. Elicit a focused history that includes information about adherence, self-management, and barriers to care. Perform a focused physical examination that includes identification of complications. Assess improvement or progression of the chronic disease. Describe major treatment modalities. Propose an evidence based management plan that includes pharmacologic and non-pharmacologic treatments and appropriate surveillance and tertiary prevention. Communicate appropriately with other health professionals. Document a chronic care visit. Communicate respectfully with patients who do not fully adhere to their treatment plan

3. Understand the basis of health promotion and be able to apply the principles of primary, secondary and tertiary prevention.

a. For women: elicit a full menstrual, gynecological and obstetric history

b. For men: Identify issues and risks related to sexual function and prostate health

c. Accurately identify clinical situations where life expectancy, functional status, patient preference or goals of care should override standard recommendations for screening tests and/or treatment in older adults.

d. Assess and describe baseline and current functional abilities in an older patient by collecting historical data from multiple sources and performing a confirmatory physical examination.

e. Develop a preliminary management plan for patients presenting with functional deficits, including adaptive interventions and involvement of interprofessional team members from appropriate disciplines, such as social work, nursing, rehabilitation, nutrition, and pharmacy.

f. Identify and assess safety risks in the home environment, and make recommendations to mitigate these.

g. Apply the stages of change model and use motivational interviewing to encourage lifestyle changes to support wellness (weight loss, smoking cessation, safe sexual practices, exercise, activity, nutrition, diet)

h. Provide counseling related to health promotion and disease prevention recognizing the risk factors for conditions amenable to prevention or detection in an asymptomatic individual.

i. Recognize the impact of stress on health and the psychological manifestations of illness and injury.

j. Recognize the effects of aging and family roles on health.

k. Define and differentiate among types of code status, health care proxies, and advanced directives in the state where one is training.

l. Discuss who should be screened and methods of screening for each of the following health conditions:

Breast cancer
Cervical cancer
Colon cancer
Coronary artery disease
Depression
Fall risk in elderly patients
Intimate partner and family violence
Obesity
Osteoporosis
Prostate cancer
Sexually transmitted infection
Substance use/abuse
Type 2 diabetes mellitus

4. Cognitive and Behavioral

a. Define and distinguish among the clinical presentations of delirium, dementia, and depression.

b. Formulate a differential diagnosis and implement initial evaluation in a patient who exhibits dementia, delirium or depression.

c. In an older patient with delirium, urgently initiate a diagnostic work-up to determine the root cause (etiology).

d. Perform and interpret a cognitive assessment in older patients for whom there are concerns regarding memory or function.

e. Develop an evaluation and non-pharmacologic management plan for agitated demented or delirious patients.

5. Integrate the process of therapeutic review (review of current therapies and medications the patient is using) into each patient encounter regardless of the reason for the visit.

a. Explain the impact of age-related changes on drug selection and dose based on knowledge of age-related changes in renal and hepatic function, body composition, and Central Nervous System sensitivity.

b. Identify medication, including anticholinergic, psychoactive, anticoagulant, analgesic, hypoglycemic, and cardiovascular drugs that should be avoided or used with caution in older adults and explain the potential problems associated with each. Document a patient’s complete medication list, including prescribed, herbal and over-the –counter medications, and for each medication provide the dose, frequency, indication, benefit, side effects, and an assessment of adherence.

c. Develop appropriate plans to monitor pharmacotherapy, checking for compliance, side effects, adverse reactions, and effectiveness.

d. Select a clinical therapeutic plan that considers the cost, efficacy, possible adverse reactions, contraindications, and drug interactions for the drugs selected.

e. Identify the risks for, and signs and symptoms of, drug interactions resulting from poly-pharmacy in the therapeutic regimen.

f. Modify the therapeutic regimen within the context of continuing care.

6. Demonstrate patient-centered communication skills:

a. Setting a collaborative agenda with the patient for an office visit.

b. Being able to elicit and attend to patients’ specific concerns

c. Explain history, physical examination, and test results in a manner that the patient can understand.

d. Clarify information obtained by the patient from such sources as popular media, friends and family, or the internet.

e. Effectively incorporate psychological issues into patient discussions and care planning.

f. Use effective listening skills and empathy to improve patient adherence to medications and lifestyle changes.

g. Effectively describe the treatment plans for prevention and management of acute and chronic conditions to the patient and work to formulate plan with patient.

h. Utilize motivational interviewing techniques with a patient to encourage behavior change

i. Identify the psychological, social, and spiritual needs of patients with advanced illness and their family members, and link these identified needs with the appropriate interprofessional team members.

7. Demonstrate proficiency in creating the medical record. Create progress notes for each of the following types of visits:

a. Acute medical problem visit

b. Chronic medical problem visit

c. Visit for patient with multiple medical problems