AI & PA Student Expectations
Med/Peds Hospitalist Elective Acting Internship:
Student expectations:
Provide excellent patient care. This is your primary goal on this rotation. Attend sign-out at 7AM to hear overnight events and new admissions. Pre-round on your patients electronically and in person and be ready to present your patients at 8:30. This may mean getting to the hospital before 7AM. Write notes on your patients daily. Discuss the best way to do this with your attending on day 1. Write all orders on your patients in CPOE (to be co-signed). Update your patient’s information in the rounds report daily before leaving. Attend all conferences. Carry 3-5 patients. If things are slow, contact 2nd shift attending to help with admissions from ED. Ask for and receive feedback.
Faculty expectations:
State your expectations of the student clearly on day 1 (notes, orders, rounds, etc). Treat student as an acting intern. Encourage and co-sign orders in CPOE (in the “unverified” tab in CPOE). Read (and use) daily progress notes from students. Notes should be attested using the .ATTESTATIONUNCHCS and selecting the MEDICAL STUDENT NOTE from the available list. Support conference attendance. Teach as much as possible. As work load allows, student may help with second shift admissions. Provide frequent feedback on notes, orders, professionalism, and patient care. At the end of your time with the student, write a brief email (3-4 sentences) to the course director with summary comments of the student’s performance.
Course Directors - Ashmita Chatterjee MD & Will Rearick MD¶
PA Student and Attending Expectations:
PA students spend a 6-week rotation in internal medicine at UNC Chapel Hill and Hillsborough Hospital. The PA student program has a two-year curriculum, with one year of pre-clinical studies and one year of clinical.
The students have a wide variety of backgrounds and experiences prior to starting PA school, ranging from more traditional applicants to those with extensive experience as medics, technicians, or other clinical duties. Early in the calendar year, these students will be coming to rotations and functioning much like a 3rd-year medical student, but we expect their skills to progress rapidly with a steep learning curve, such that toward the end of the year, they will be functioning nearly independently.
Please do your best to help them get the best educational experience possible! See Jon Heath’s document linked here for more details and specifics for each service (site blocked on hospital network): https://drive.google.com/open?id=19l9Ch9hUnGrQQ1uVguNrXADvjGeopQsi9LnuZMYeRo0
General Expectations of Students (any service)¶
Adhere to all regulations set forth by Physician Assistant Studies Program regarding professionalism, dress code, recording of patient encounters in Typhon, etc. These policies are set forth in the Clinical Year Manual (site blocked on hospital network). The PA program expects its students to follow the same schedules as their preceptors. It is appropriate for students to average ~1 day off per week. How this occurs is left to the discretion of the hospitalist and the student. Try to take advantage of additional learning opportunities (morning report, noon conferences, Grand Rounds, and didactic sessions). Complete an evaluation on each preceptor with whom you work.
General Expectations of Hospitalists (any service)¶
Hospitalists assigned a PA student should incorporate the student into the daily workflow of the team. Students are encouraged to learn as much as they can from EVERY patient on the service, so incorporate them into physical examination, decision making, and other aspects of care as much as possible. Student notes, while part of the medical record, cannot be used for billing at this time. You should give students feedback on their notes, but the hospitalist still needs to complete a standard note for billing purposes. For a review, see the bottom of page 9 of the Clinical Year Manual (Site blocked on hospital network). Allow the opportunity for students to attend morning report conferences, medicine Grand Rounds, medicine chief resident didactic sessions (usually Thursday afternoons), and hospitalist didactic sessions (often on Thursdays after chief sessions) when possible. For students rotating at Hillsborough, most of these conferences are broadcast remotely, but allowing the student to come to Chapel Hill for the afternoon on Thursdays will usually be high yield for the student. It is appropriate to allow some time for self-directed learning in the afternoon/evening if patient care learning opportunities are not prevalent. Feedback for the student is clearly important. Hospitalists should give regular formative feedback to the student throughout the week. Additionally, please fill out the evaluation form on the main links page (Site blocked on hospital network), which we will use to compile a composite evaluation of the student for submission to the program. Timely evaluation is imperative.
Specific expectations on rounding services - MDH, MDJ, MDL, HBA, HBB, HBC
In general, it is expected that the student will actively follow 2-3 patients on the service at any given time. The hospitalist should help the student identify patients that are appropriate to follow. “Actively following” those patients should include writing progress notes, writing orders (to be co-signed by the hospitalist), verbally presenting the patient to the hospitalist on rounds, taking an active role in the communications with the patient on rounds, calling consults, coordinating care, helping to prepare the hospital course for discharge summaries, etc. The hospitalist should set expectations early in the week for how rounds will go. The student should always do a chart “pre-round,” reviewing vitals, labs, notes, etc. It can be left to the discretion of the rounding hospitalist whether the student should also be expected to see and examine the patient before rounds, as practical considerations (like morning report conferences and hospitalist rounding style) may factor into that decision. You will also need to determine how you would like the student to “present” the patient (before walking into the room, at the bedside, degree of formality of presentations, etc.) to minimize ambiguity of expectations for the student. Students should make an effort to examine every patient on the service with the hospitalist on rounds, not just patients they are actively following. EVERY patient is a learning opportunity, and students are encouraged to know as much as possible about the medical problems and management for all the patients on the service. Students are encouraged to admit new patients when feasible. Students will intermittently be scheduled for dedicated admitting shifts, but they can admit new patients while on rounding services. Should occur after rounds. When the student needs to pick up a new patient, they should reach out to the 2nd shift admitting hospitalist to let them know they are available to admit a patient. Student should see patient first, participate in the admission orders and write an H&P. The student can then continue seeing that patient through their hospital stay. It is okay if the student drops a patient he/she has been previously “following” to allow more learning opportunities with newer patients.