Physician Assistant Clinical Preceptors and Mentors

All second-year PA students are required to participate in a series of primary care and critical care medicine rotations. The primary care experience consists of four services: (1) family medicine, (2) women’s health, (3) pediatrics, and (4) behavioral health. The critical care experience consists of three services: (5) internal medicine, (6) emergency medicine, and (7) general surgery.  The eighth opportunity in primary care or a specialty service is offered to students as an elective rotation. At some time during the clinical year, students must also have exposure to patients in long-term care. Students will be assigned to clinical rotations at program-approved training sites, many of which are based in medically underserved areas throughout Michigan. Occasionally, out-of-state placement opportunities approved by the program may present and be offered to students of interest.  

What can I expect a second-year PA student to know and do?

Our PA students will have completed 15 months of didactic education before beginning their pursuit of the formal clinical clerkship year. Our PA students are well-rounded, mature individuals, and many have sought this course of study as a second career. Second-year PA students should be able to perform comprehensive and focused histories and physical examinations. Their clinical reasoning skills should be refined to the point of developing a list of differential diagnoses and next steps in the diagnosis and treatment of common medical conditions.  They have had some practice with patient counseling and education through clinical case simulations, volunteer work, and their 9-month once weekly clinical mentorship experience in patient-centered medical homes and primary care sites. They also have been exposed to common medical procedures such as phlebotomy, splinting, casting, suturing, and simulated care involving catheterization, ultrasound, and thoracentesis to name a few. Experience and ability will vary from student to student, as they tend to come from varied backgrounds.

Have the PA students undergone pre-qualification reviews prior to the start of their clerkship year?

Yes, all of our PA students undergo prerequisite health screening and hospital training for addressing compliance issues with state and federal guidelines, and as specified in our affiliation agreements with each facility/health system organization. Health screenings include a physical evaluation (prior to the start of studies clearing the student physically and mentally to participate in the PA Program), as well as a 7-panel drug screen, immunization verification (including Hepatitis B), annual Influenza vaccination, and annual TB skin testing.  In addition, the students undergo recent criminal background checks and annual training to certify successful completion of HIPAA and FERPA reviews. Students have also successfully completed ACLS and PALS instruction, as well as OSHA with Blood Borne Pathogens (BBP) education. Once a student is confirmed to rotate with a preceptor site, proof of this information is provided from the program. All students are advised that supplemental training will likely be warranted at clinical sites in regards to HIPAA, BBP, and EMR use.

How much time is required?

Rotations vary from five to six weeks in length. Our PA students are expected to engage in hands-on patient care experiences at a minimum of 32 hours per week. Students should follow the schedule of the preceptor, including evening shifts, weekends, and holidays.

What are the required experiences for the student?

You will be provided the appropriate objectives for each clinical rotation in advance, and as part of the student orientation to the practice it is important to review them together. The current clinical rotation objectives are listed as follows:

• Family medicine
• Women’s health
• Pediatrics
• Behavioral health
• Internal medicine
• Emergency medicine
• General surgery

The intensity of the supervision will vary depending on the student’s experience and the preceptor’s comfort. It is typical for a preceptor to start by having the student observe patient encounters. After a day or two of orientation to the practice, it is reasonable to transition to observing the student performing history and physical examinations. Once you are comfortable with the student’s skills and knowledge, allowing them to perform histories and exams without direct observation is perfectly appropriate. The student would then present the patient to the preceptor, discuss possible next steps and complete the patient encounter with the preceptor reviewing and confirming the student’s findings with the patient. We also encourage you to quiz students and give them reading assignments as you teach. To reiterate, any patient the student sees also needs to be seen and evaluated by you. All chart notes need to be thoroughly reviewed and co-signed by you. Periodic direct observation throughout the rotation is recommended and a student should never discharge a patient without discussing the case with the preceptor first.

The practicing of clinical procedures is also important. Phlebotomy, starting an IV, wound care, splinting and Pap smears are some of the basic skills taught during the first year and should be reinforced through practice in clinical rotations. Students in a surgical setting need to be involved in pre-, intra-, and post-operative management of patients, and as appropriate, students should have the opportunity to assist in surgical procedures.

In addition to supervising the student as described above, we ask that you and your clinical partners provide the students with regular feedback regarding their clinical skills. This includes daily informal discussions and critical feedback to the student, as well as a mid-rotation meeting and review to assess progress and a written final evaluation using the PA student assessment form.