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Sunday, April 13, 2014

Clinical Rotations & End of Rotation (EOR) Exams for Physician Assistant School


Physician Assistant Clinical Rotations
Updated: 08/18/2016
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.

Agency for Research and Healthy Quality (ARHQ ePSS) phone/tablet apps - identifies preventive services necessary for each individual patient based on age and gender, etc.
Prevention of Falls in Older Persons AGS/BGS Clinical Practice Guideline

Family Medicine Rotation
Primary care, ambulatory medicine, general practice, community health, hospice, palliative medicine, and rural medicine are all included under this category
American Academy of Family Physicians - Practice Question Bank
  • Click “Start Now” to create an account
  • Free for students, takes ~3 days to register/verify your account
  • Indicate you are a PA student
The Family Practice Notebook - great resource for any rotation, with phone app available
Family Medicine - What to Expect - includes some handouts

Diabetes, Asthma, Other Cheat Sheets

Medical Texts

Apps

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

History and Physical
  • 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

Strokes

Pneumonia - when to admit?

Acid-Base Resources

Electrolytes
  • Geared for pediatric patients, but great explanations of mechanisms behind abnormalities

Miscellaneous


Medical Texts

Pediatrics Rotation
Pediatric EOR Topic List (2016)

Study Guides

Supplemental Resources & Cases

Immunizations
Wellness Visit Information

Developmental Screening Tests

Medical Texts
Emergency Medicine Rotation
Emergency Medicine Study Guide
  • Includes FAST exam, pregnancy, gallbladder, DVT

Medical Texts

Medical Apps
  • 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.
APGO uWISE self-exam - free practice questions for the EOR exam

Obstetrics Resources

Study Guides

Supplemental Resources

Useful Resources for Patients

Medical Texts

Quick References

Medical Phone Apps

Psychiatry Rotation
Also known as “behavioral medicine,” mental health, or “psych” rotations.
Psychiatry EOR Topic List (2016)

Study Guides

SOAP Note Writing
Other

Psychiatric Assessments
Medical Texts
General 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.
Recommended Study Guides

Notes

Assessment and Evaluation Tools

Practice Questions

Skills
Medical Texts

Recommended Apps

Neurology Elective Rotation Resources
  • Stroke Trials App (iPhone) - great resource with articles on almost any topic related to strokes

Medical Texts

Infectious Disease Rotation Resources

Medical Texts

Pain Management Resources
Patient Reported Outcomes Surveys for Pain:
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 originally purchased them according to PAEA. Currently, PAEA states that over 90 PA 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 exam content, and they are somewhat expensive to incorporate, especially for smaller programs. 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. The exam is divided into 2 sections of 60 questions with 60 minutes allotted for each.

Programs are allowed to break up the exams with 5, 10, or 15-minute breaks. 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 version should be compared. The exam also includes 20 unscored questions, but which questions are not disclosed to the examinee.

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

A sample exam is posted on PAEAs website.

SELF STUDY RESOURCES:
Help Campus (same as Help Zebra and also known as Hancock)
  • 4,200+ questions
  • 3 Months of access - $324.95
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  • Davis PA Review included with every subscription
  • 1,200+ questions and explanations
  • One month subscription: $99
  • 12 month subscription: $199
  • $495
  • 12 months of access
  • 5% off promo code: AAPA2day
  • $75.99
  • 1,300+ questions
  • $55
  • Subscription lasts until your exam
  • $19.99 for 60 days
  • 300 questions and explanations
  • 1,200 Questions+
  • 1-Month Subscription: $79.00
  • 3-Month Subscription: $139.00
  • Free demo and savings coupon
  • PANCE or PANRE prep: $795
  • PANRE PLUS Lifetime Subscription: $1,900
  • 840 Questions
  • 13 Topic Areas
  • Individual License - $169
  • $19 for 1 month of access
  • $26 for 1 year of access
  • $23 for 3 months of access
  • 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:
CareZone - Free app that allows your patients to scan in their medications from their bottles at home. It documents all information from the label and will remind patients (via alerts) to take their medications to increase compliance. It also reminds them when their refills are expiring and provides them with the phone number of the prescribing provider so they can call to request a refill or an appointment. Patients can keep a journal with information and photos about their progress with new medications to show providers. Very useful app in my opinion!
Canopy Medical Translator - Very useful app for wards to communicate with patients in languages other than Spanish. It has pre-recorded phrases for each specialty (emergency medicine, pediatrics, dermatology, etc.) that are specific. It programs your school’s or work’s translator phone service into the app so you can easily press “call” and it dials the number for you if you can’t communicate what you need to.
ASCVD Risk Estimator - the American College of Cardiology and American Heart Association present this helpful app to determine your patient’s 10-year risk of atherosclerotic cardiovascular disease (ASCVD)
MELD Calculator - Used to determine a patient’s eligibility for liver transplant.
MyNetDiary - This app lets patients keep track of their daily calorie intake and also provides an area to track the amount of physical activity per day. It is pretty accurate and lets patients set their own goals (maintain, lose, or gain weight). The app lets you know how many calories you have left for the day, calculating in your exercise each day. It can calculate specifics about your fat, saturated fat, vitamins, minerals, etc. consumed each day.
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


Credits and References:
Huge credit goes out to The Running PA!
Emily Cooper - Med Source
Free Medical Texts for any rotation provided by our friendly medical residents
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