Curriculum
The amount of medical knowledge that a PA student is expected to know continues to grow. It is therefore necessary that the delivery of this information be logical, sequential, and integrated. This curriculum allows students to start with a basic science understanding of a disease and build on that understanding a rationale for treatment. The curriculum is designed so that students not only recognize the pattern of a disease, but have an understanding of the process that causes the disease manifestations and the theory behind the therapeutics that manage that disease. It simultaneously integrates development of the appropriate clinical skills, biopsychosocial concepts, critical thinking skills, and lays a foundation in experiential learning so that the student enters the clinical year with a reality-based understanding of future patient interactions.
The 25-month, 146 credit PA Program curriculum is divided into a 12-month didactic year, a 12-month clinical year, and a one-month advanced didactic phase. Students are awarded the Masters of Medical Science in Physician Assistant Studies upon successful completion of the program.* In the three-term, 75 credit didactic year, the foundation biomedical and clinical sciences courses are Pathology and Pathophysiology I, II, and III, Clinical Medicine I, II, and III, and Pharmacology and Clinical Therapeutics I, II, and III. The didactic curriculum is progressive and integrated. In these foundation courses, basic science modules in cell biology, pathology, genetics, immunology, and pharmacokinetics are “front-loaded” in the first semester. Medical Microbiology similarly begins with an overview of infectious disease. During the three terms, these courses sequentially educate the student in general medicine topics in all body systems and special populations of patients (pediatric, geriatric, women’s medicine, etc.). The normal physiology and pathophysiology of diseases of a specific body system are first discussed in Physiology and Pathophysiology I, II, and III. The patient presentation, history and physical examination findings, diagnostic tests, differential diagnosis, and care plan for these diseases are developed in Clinical Medicine I, II, and III. Treatment modalities for these diseases are presented in Pharmacology and Clinical Therapeutics I, II, and III. All body systems, beginning with HEENT in the first term and ending with focused populations and focused courses (pediatrics, geriatrics, women’s medicine, emergency medicine, surgery) in the third term are presented.
The anatomy and history and physical examination courses in the first term (Anatomy, Clinical Assessment I) will be integrated. Didactic lectures and cadaver-based laboratories comprise the anatomy course in the first term. This course introduces students to the topographical and internal anatomic structures such that they will be familiar with the anatomy of a body system just prior to learning the history and physical examination skills specific to that body system in the Clinical Assessment I course. Students will be introduced to normal radiographic and imaged anatomy in the anatomy course.
In the Clinical Assessment I and II courses, students will first learn how to perform the complete adult history and physical examination. They will meet weekly and work in small groups with faculty instructors and visit long-term care facilities to work with residents to develop these skills. They will learn to write a complete “H and P” and “SOAP” note. The Clinical Assessment II course will develop skills in “focused” H and Ps and in specialty exams for men, women, pregnant women, pediatric, well-child, geriatric, and other patient populations.
As part of Advanced Clinical Skills I and II in the spring and summer terms, students will return to their cadavers in the anatomy lab. Just prior to studying a new body system in Clinical Medicine I, II, and III, students will discuss clinical anatomic correlates important in understanding the disease process and clinical procedures/skills pertinent to that body system (pelvic exam, prostate exam, placing central lines, etc.).
Behavioral Science I will introduce students to common primary care psychosocial and behavioral issues and the communication/counseling skills required to care for patients (with sensitivity to their gender, age, race, culture, disability, and socioeconomic status). Behavior Science II will present topics in psychiatry that are critical to the practice of medicine.
Health Care I and II will start with an overview of health care systems. Topics will include the historical underpinnings of today’s health care policy, managed care, the insurance and pharmaceutical industries, health care settings, quality assurance and risk management, medical education, and other contemporary health care issues and how providers and patients fit into this system. Health Care II will be specific to the PA profession. It will discuss PA history and the professional organizations, responsibilities, legalities, and issues important to a practicing PA.
Students apply skills gained during the Evidence Based Medicine (EBM) course in the first term to the Clinical Problem Solving (CPS) course sequence that extends throughout the first year. This three-course CPS sequence utilizes a problem-based methodology. In small groups with faculty facilitators, this course allows students to apply the clinical decision-making skills gained in the EBM course. It is the integrative course that applies the basic and biomedical science knowledge, clinical assessment skills, biopsychosocial understanding, communication techniques, and health care system knowledge developed in other parts of the curriculum to the diagnosis and management of patient cases. Again, case topics parallel the body system being taught in Clinical Medicine I, II, and III. Small-group instruction is used to develop critical-thinking, communication (oral and written), and other clinical assessment and diagnostic skills.
Part of CPS is a required weekly clinical “shadowing” experience. Students are placed in a primary care outpatient setting for a minimum of four hours per week to initially observe and slowly, according to their skills and with preceptor supervision, sequentially apply the knowledge, skills, and professional attributes they are learning in the classroom. This will be their introduction to practice-based medicine. At the start of this course, students will be introduced to HIPPA regulations and safety policies. This experiential learning will be discussed in the weekly CPS meetings. It will serve as a way to introduce students to the health care system and discuss the application of didactic material to the “real world” care of patients. CPS will be a structure in which faculty can evaluate and reinforce evidence-based and health promotion concepts, counseling skills, cross-cultural sensitivities, and professional behavior. It will allow faculty to evaluate strengths and weaknesses on an individual student basis.
In the first CPS course to prepare them for their “shadowing” experience, students will be given an overview of billing, coding, reimbursement, and other practice- based essentials. As part of a weeklong PCO orientation process prior to the start of classes, students will have received information in areas of professional behavior and cross-cultural competency. They will be introduced to PAST™ - Physician Assistant Student Tracking System, patient-encounter tracking software that is loaded onto their palm pilots so that they can begin to collect patient information (gender, age, ICD-9 and CPT codes, etc.). The use of required laptop computers during the didactic year for dissemination of course materials and evaluations via Blackboard and access to evidence-based and other databases will ensure that students enter the clinical year and clinical practice with the required technology skills.
The clinical year consists of three terms (fall, spring and summer) over a twelve-month period. During this time, students complete nine required clinical rotations. These include eight, four-week rotations in the required/core primary care areas and one “Floating Block” to be selected by the student from the core areas as a repeat of one of the required core rotations. Required rotations are in Emergency Medicine, Family Medicine/Primary Care, Internal Medicine, General Surgery, Geriatric Medicine, Pediatric Medicine, Women’s Medicine, and Psychiatry/ Behavioral Medicine. The remaining twelve-week period is comprised of three, four-week electives in areas of the student’s choosing (primary care, hospitalist medicine, nephrology, interventional radiology, etc.) During this phase of the program, all students participate in supervised clinical practice in a variety of outpatient, emergency, inpatient, and long-term care settings. In these rotations, physicians, physician assistants, and other members of the health care team provide the clinical education. Students are not required to supply their own clinical sites or preceptors for programs required clinical rotations.
The clinical year will be followed by a one-month, 7-credit, “Advanced Didactic Phase” emphasizing the transition into the health care system as a practitioner. “Transition to Practice” will discuss matters specific to the PA as he/ she graduates and enters practice. The Physician assistant National Certifiction Exam (PANCE), the Physician Assistant National Recertification Exam (PANRE), Continuing Medical Education (CME), credentialing, licensure, and liability insurance will be addressed.
During the student’s last clinical rotation, the PACKRAT will be given. Results will determine class strengths and weaknesses in certain areas. Faculty will develop a list of topics in which the class, as a whole, did not perform well. Senior Seminar will consist of student presentations in these areas in preparation for PANCE. Students will bring their clinical year and other experiences to Legal and Ethical Aspects of Medicine. These experiences will allow for reality-based discussions of ethical dilemmas encountered in primary care in such areas as genetic testing and counseling, end-of-life issues, and the patient-provider relationship.
Serving as an independent study project linked to Clinical Problem Solving IV, the “Capstone Project” for the PCO Physician Assistant Program is a formal Grand Rounds presentation to the PCO Community along with the submission of a referenced review article and a written case summary. The Grand Rounds Presentation is an in-depth presentation of a medical patient case that the student encountered during his/her clinical rotations. It will demonstrate the evidence-based process that led to the final diagnosis, treatment plan, prognosis and patient counseling. The preventive medicine aspects of the disease will also be addressed. The referenced review article and case summary will be submitted prior to the formal presentation and will allow the faculty to generate questions regarding the case. This is a summative evaluation tool that will be used to measure cognitive, motor, and effective domains at a point near the completion of the program.
* Our Physician Assistant Program was granted accreditation status in March, 2007 by ARC-PA. Our graduates are eligible to sit for the National Certification Examination for Physician Assistants, a credential required for state licensure. For more accreditation information.