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1 Master in Physician Assistant Studies Student Clinical Rotation Guide 2017
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Transcript of Master in Physician Assistant Studies Student Clinical ... · PDF fileAppendix C—Student...
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MasterinPhysicianAssistant
Studies
StudentClinicalRotationGuide
2017
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ContentsGeneralPoliciesandProcedures 3ClinicalRotationRequirements....................................................................................................................3
Immunizations..............................................................................................................................................4
MPASStudentExposuretoInfectiousandEnvironmentalHazards...........................................................5
LiabilityInsurance.........................................................................................................................................6
GeneralSafetyGuidelines............................................................................................................................6
AcademicPolicies.........................................................................................................................................8
GradingandEvaluation............................................................................................................................8
CanvasMed...............................................................................................................................................9
E*Value.......................................................................................................Error!Bookmarknotdefined.
ClinicalRotationAttendance........................................................................................................................9
StudentConductandProfessionalBehavior.............................................................................................10
NepotismandFraternization.....................................................................................................................10
StudentContactInformation.....................................................................................................................10
FamilyEducationalRightsandPrivacyAct.................................................................................................10
AppendixA—RequestforSiteAffiliationForm..............................................................................................12
AppendixB—AbsenceExcusalForm..............................................................................................................13
AppendixC—StudentAcknowledgementofReceiptofMPASStudentClinicalRotationGuideForm........14
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GeneralPoliciesandProceduresStudentsenteringclinicalrotationsareexpectedtothoroughlyreviewthisguide.Thismanualisinadditionto,andnotasubstitutionfor,theMasterinPhysicianAssistantStudies(MPAS)StudentHandbookthatstudentsreceiveduponbeginningtheprogram.MPASstudentsarerequiredtoabidebythestudenthandbook,andthepoliciesandprocedurescontainedinthisstudentclinicalrotationguide,atalltimesduringtheclinicalrotationphaseoftheprogram.Policiesaresubjecttochangeormodification.Changesand/ormodificationsoccurringduringthetermofthiseditionoftheguidewillbeaddressedbypolicymemos.QuestionsrelatedtothesepoliciesandproceduresshouldbeaddressedtotheMPASclinicalliaisonorclinicaldirector.
ClinicalRotationRequirements
TheclinicalphaseoftheMPASprogramisanintensetrainingperiodthattakesplaceinavarietyofclinicalsettingsincluding,butnotlimitedto,teachinghospitals;outpatientclinics;privatepracticeclinics;andcounty,state,andfederalgovernmentfacilities.PertheAccreditationReviewCommissiononEducationforthePhysicianAssistant(ARC-PA)standards,studentsmustbeexposedtopatients“acrossthespanoflifetoincludeinfants,children,adolescents,adults,andtheelderly”.Additionally,rotationsmustoccurinthefollowingsettings:outpatient,emergencydepartment,inpatientandoperatingroom.
Theclinicalyearhassevencorerotationsandtwoelectiverotationsasfollows:
• InternalMedicine 4-weekrotation
• EmergencyMedicine 4-weekrotation
• Surgery 4-weekrotation
• Pediatrics 4-weekrotation
• ObstetricsandGynecology 4-weekrotation
• Psychiatry 4-weekrotation
• FamilyMedicine 4-weekrotation
• Elective 4-weekrotation
Studentsmustsuccessfullycompleteallsevencorerotationsandtwoelectiverotations.Studentsmayelecttoperformelectiverotationsinotherspecialtyareassuchasorthopedicsurgery,cardiology,radiology,ortheycanelecttoperformelectiverotationsinacorespecialty.Ifastudentfailsacoreclinicalrotation,anelectiverotationwillbeutilizedtorepeatthefailedrotation.Astudentmayalsoberequiredtouseanelectiverotationtorepeatacorerotationifthefaculty,throughthereviewofpatientlogsandprocedurelogs,determinesthestudentexposuretothatcorespecialtywasinadequateordidnotmeetARC-PAstandards.
TheMPASprogramandARC-PAregulationsrequireformalaffiliationagreementsbetweenHerbertWertheimCollegeofMedicine(HWCOM)MPASandclinicalsites.ClinicalsiteselectionandapprovalrestswithHWCOMandtheMPASprogram.TheMPASprogramensuresthatclinicalsitesprovideclinicalinstruction,education,andexperiencesrequisitetophysicianassistanteducation.
Clinicalrotationsarescheduledaccordingtositeavailability,sitelocation,andstudentpreference.Reasonableeffortsaremadetoaccommodatestudentpreference,buttheMPASprogramcannotguaranteethatanyorallstudentpreferenceswillbehonored.
Circumstancesmayarisethatrequirechangestoastudent’sclinicalrotationschedule.Shouldchangesbenecessary,studentswillbeinformedofchangesassoonaspossible.Astudentrequestingachangein
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clinicalrotationschedulemustcompletetheMPASChangeofClinicalRotationRequestformandsubmitrequeststotheprogramclinicalliaisonorclinicaldirectornolaterthan90dayspriortotherotationstartdate.Studentrequestsforschedulechangeswillnotbeconsideredifmadewithin90daysofthestartoftherotation,exceptinexceptionalcircumstancesandatthediscretionoftheclinicaldirector.
MPASstudentsareresponsibleformakingtheirownarrangementsfortransportationtoandfromclinicalsites.Inabilitytoreachaparticularsiteisnotconsideredanacceptablereasonforarequesttochangeanyrotation.
Studentsarenotpermittedtoarrangetheirownclinicalexperiencesandarenotexpectedorrequiredtodoso.ArrangingclinicalsitesistheroleandresponsibilityoftheClinicalEducationteamandtheprogramtoassurequalityclinicalexperiences.Studentsarestrictlyprohibitedfromcontactinganyclinicalsitewithoutfirstobtainingwrittenpermissionfromtheclinicaldirectororprogramdirector.Thismayincludeemailcommunication/permission.
Designatedpreceptorsforstudentsuggestedsitesmustbeprofessionallyandeducationallycredentialed
(MD,DO,PA-C,orNP)aswellasfullylicensed(withoutrestrictions)intheStateofFlorida.PA-C
preceptorsmustbeNCCPAcertified.
StudentswishingtorotateatanonaffiliatedsitemustcompletetheRequestforSiteAffiliationform,foundinAppendixAherein,nolaterthan180dayspriortotherotationstartdateandmustsubmitittotheclinicalliaison.AffiliationdependsontheMPASprogram’sapprovalofthesitetobeaddedandabilitytosecureanaffiliationagreement.AllaffiliationagreementsaresubjecttorequirementssetforthbyARC-PAandHWCOM.Studentsuggestionsarenotguaranteed.Sitescanbe“rejected”formanyreasonsrelatedtothesiteand/orthepreceptor(s).
Studentsmaynotworkatanytimeduringtheclinicalexperiencewithpreceptorswhoarefamily
relatives.Studentsmaysuggesthealthcareproviderrelativesforotherstudentstoworkwith.
Immunizations
TheMPASprogramwillfollowCentersforDiseaseControlandPrevention(CDC)recommendationsfor
immunizations.AllMPASstudentswillberequiredtohavethefollowingimmunizations/titersuptodate
priortoenteringclinicalrotations:
a. Measles,Mumps,Rubella
b. Tetanus/Diphtheria/Pertussis
c. HepatitisB
d. Chickenpox(varicella)
e. Influenza
f. Purifiedproteinderivative(PPD)screeningforTuberculosis(TB)
ImmunizationsaretrackedintheAmericanDataBank.MPASstudentsarerequiredtoupdateimmunizations/titerspriortobeginningclinicalrotations.FIUStudentHealthServices(SHS)willworkinconjunctionwiththeMPASadmissionscoordinatortoscheduleimmunizationappointmentsforstudents.StudentswillreceiveinformationonservicesandpricingpriortotheirappointmentatSHS.Studentswillalsohavetorepeattheirphysicalexamandlevel-2backgroundcheckspriortobeginningclinicalrotations.Certainclinicalsitesmayrequirestudentstosubmittohigher-levelbackgroundchecks.
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MPASStudentExposuretoInfectiousandEnvironmentalHazards
TheMPASprogramfollowstheinstitutionalpoliciesofFIUregardingexposuretoinfectiousand
environmentalhazardswhileoncampusandtheinstitutionalpoliciesofitsclinicalaffiliatesregarding
exposuretoinfectiousandenvironmentalhazardswhileatclinicalsites.TheFIUBloodbornePathogens
ExposurePolicy(availableonlineintheFloridaInternationalUniversitySafetyComplianceGuide
[http://ehs.fiu.edu/SiteCollectionDocuments/USCG2005-100.pdf])offersguidelinestoprotectstudents
fromtheriskofoccupationalinfectionwithHIV,hepatitisB,orotherbloodbornepathogens,andto
implementtheUnitedStatesDepartmentofLaborOccupationalSafetyandHealthAdministration(OSHA)
Standard29CFRSection1910.1030BloodbornePathogens.
TheHWCOMBloodbornePathogenExposurepolicy,whichisincludedintheMPASStudentHandbook,
addressesmethodsofprevention,proceduresforcareandtreatmentafterexposure(includingdefinition
offinancialresponsibility),andeffectonstudentlearningactivitiesasfollows:
1. Allexposureincidentsareregardedasseriousandmustbereportedanddocumentedimmediatelyto
thephysicianfacultymemberoncall.
2. Firstaidshallbeimmediatelyadministeredforalltypesofinjuries,includingcutsandburns;exposed
areasmustbethoroughlywashedwithsoapandwater.
3. Thephysicianfacultysupervisingthestudentshallbeinformedimmediately.Ifnofacultymemberis
immediatelypresent,thestudentwillcontactthefacultymemberoncall.
4. Thesupervisormustattempttoobtainwitnessreportsoftheincident.
5. Thesupervisorshallattempttodeterminethenatureoftheexposure(s)andanyassociated
biohazardousrisks,includingdocumentationofroutesofexposure(s).
6. Ifpossible,sourcematerialoftheexposureshouldberetainedandsecuredinasafemanner.
7. Ifthesupervisordeterminesthattheincidentconstitutesanoccupationalexposuretobiohazardous
materials,thenhe/sheimmediatelywillbegindocumentationoftheincidentusingtheStudent
ExposureReportformfoundinAppendixBherein.
8. Allinformationrelatedtostudentexposureshallberegardedasconfidential.
9. Documentationoftheincidentshallincludetheactivityinwhichthestudentwasengagedatthetime
ofexposure,theextenttowhichappropriateworkpracticesandprotectiveequipmentwereused,
andadescriptionofthesourceofexposure.
10.On-campusinjuries:ThestudentisdirectedtoFIUStudentHealthServices(SHS)duringnormal
businesshoursforappropriatefollowup.Iftheincidentoccursafterworkinghours,orrequires
emergencycare,thenthestudentwillbedirectedtothenearestemergencydepartmentforproper
evaluation.
11.Off-campusinjuries:Thestudentisdirectedtoseekcareatthehospital’semergencydepartment
(accordingtotheclinicalaffiliationagreement),orreferredtotheclosestoutpatientclinic.
12.Thestudentassumesresponsibilityforallchargesassociatedwithdiagnosisandtreatmentof
exposureinjuriesnotcoveredbyhis/herhealthinsuranceplan.Astudentmayrequestthecollege’s
assistancebydiscussingthesituationwitharepresentativefromthedirector’soffice.
13.StudentsshouldfollowupwithSHSorwiththeirprimarycarephysician.
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MPASstudentsareinformedofinstitutionalpoliciesintheMPASStudentHandbook,ontheprogram’s
website,andduringorientationtotheprogram.Orientationincludesinstructiononfittingofrespirator
masks.Policiesspecifictoclinicalsitesaredocumentedineachcoursesyllabusutilizingthesite;students
areapprisedofsite-specificpoliciesduringorientationtotherotationand/orsite.Continuedmonitoring
andenforcementoftheFIUBloodbornePathogenExposurepolicyiscriticalformaintainingthesafetyof
MPASstudents,faculty,staff,andpatientsinalllearningenvironments.
LiabilityInsurance
EachMPASstudentiscoveredforprofessionalliabilityundertheFIUself-insuranceprogram.Students
canlearnmoreaboutthisprogramat:http://www.flbog.sip.ufl.edu/index.php.MPASstudentsrotatingat
aclinicalsitemustmaintaintheroleofastudent;theyareprohibitedfromassuminganyresponsibilities
outsidethoseclearlydefinedandagreeduponforastudent.Studentsarenotallowedtosubstituteforor
functionasclinicaloradministrativestaff.Studentsshouldbeappropriatelyandroutinelysupervisedby
thepreceptorofrecordandmustperformdutieswithinthescopeoftheagreed-uponclinicalexperience.
Remainingwithinthescopeofagreed-uponstudentdutiesandresponsibilitiesisvitaltopreservingthe
professionalliabilitycoverageprovidedbytheuniversityandisimportantinprotectingthestudent,FIU
andtheclinicalsiteinthecaseoflegalactionsoughtbyapatient.
Studentsareprohibitedfromparticipationinanypatientcareactivityoutsidetheformalrotation
assignment,eveninthecasethatanoccasionforparticipationispresentedbytheclinicalsiteaspotential
employer.Thoughtheseopportunitiesmaybeattractiveandareseeminglybenign,theymustbe
avoided,asFIU’sliabilitycoveragedoesnotcoverthestudentinthesecircumstances.
MPASstudentsworkinginpaidpositionsinadifferenthealth-care–relatedcapacityatanytimeduring
theirphysicianassistanteducationarenotpermittedtoassumetheroleofMPASstudentwhileonduty
asapaidemployee.LiabilityinsurancewillnotcoveranystudentassumingtheroleofanMPASstudent
outsideanassignedclinicalrotation.
GeneralSafetyGuidelines
Studentsandfacultymustbeawareoftheneedforpersonalsafetyandactaccordinglytominimizerisks.
ThesafetyandsecurityofstudentsandfacultyarethefirstpriorityoftheMPASprogram.Safetyand
securitypracticesarereviewedpriortocommunityandclinicalexperiences.Examplesofsuch
educationaltrainingprogramsinclude:
• Universalprecautions
• Needlestickprevention
• Responsetoneedlestickorbodilyfluidexposure
• De-escalationtechniqueswhendealingwithanangrypatient,studentorco-worker
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• Emergencyproceduresinvolvingmedicalcare(e.g.,CPR),naturaldisasters,terrorism,assault,
illegalactivities,andothers.
Whileworkingincommunitysettings,includinghospitals,clinics,homevisits,andotheroff-campus
venues,MPASstudentsandfacultyshouldusecommonsenseandtakeprecautions,includingbutnot
limitedto,thefollowing:
• Beawareofyoursurroundings
• Don’tstandout(e.g.,wearingflashyorexpensivejewelry)
• Don’tcarryexcessiveamountsofmoney
• Don’tleavevaluablesinplainsight
• Travelinpairswheneverpossible
• Keepcardoorslockedandwindowsclosed
Whileworkingorstudyingoncampus,itisimportanttokeepinmindthattheUniversityPolice
Departmenthasjurisdictionovertheentireuniversity,includingHWCOM.Emergencyphoneshavebeen
installedatstrategiclocationsaroundFIU,whichconnectdirectlytotheUniversityPoliceDepartment.
Studentsandfacultyareurgedtotakenoticeofandbecomefamiliarwiththeirlocations.Asmembersof
theFIUcommunity,studentsandfacultycanenhancetheirpersonalsafetyandhelpkeepthecampus
safebytakingprecautions,includingbutnotlimitedto,thefollowing:
• Walkinpairsinisolatedplacesorduringtheevening.Studentsandfacultyshouldnothesitateto
calltheUniversityPoliceDepartmenttorequestastudentescortorothersecurityserviceat
night.
• Keepclosewatchonyourpersonalproperty.Donotleavepersonalpropertysuchasbooks,audio
orvideoplayers,cellphones,PDAs,laptops,purses,wallets,jewelry,cameras,orothervaluable
objectsunattendedoroutofyoursightorinclassrooms,thelibrary,restrooms,clinic,campus
diningareas,thebookstore,yourvehicle,orinanypublicplace.
• Reportallon-campustheftsorsuspiciouspersonsoractivitiestotheUniversityPolice
Department.Contactinformationislistedbelow.
WhilefulfillingMPASeducationalobjectives,studentsandfacultyalsomustbeawareoftheneedfor
personalsafetyandactaccordinglytominimizerisks.Thekeymessageforstudentsandfacultyistobe
cautiousandusecommonsense.Alwayslistentoyour“gut”andfollowyourinstincts.Ifanenvironment
orsituationfeelsunsafe,staycalmandleaveimmediately.Discusstheincidentwithafacultysupervisor
and/orcalllawenforcement.
Emergencycontactinformation:
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• Foralloff-campusemergencies,call911
• Forallon-campusemergenciesandurgentscenariosinvolvingsafety,calltheUniversityPolice
Departmentat305.348.5911(fortheModestoA.MaidiqueCampus)or305.919.5911(forthe
BiscayneBayCampus)
• Fornon-urgentsafetyconcernsorquestions,contact:
o 305.348.2626fortheModestoA.Maidiquecampus
o 305.919.5559fortheBiscayneBaycampus
AcademicPolicies
StudentsintheMPASprogrammustearnagradeof77%(C)orbetterinallMPAScoursesandcourse
enhancementsandmustmaintainanoverallGPAof3.0.Formoredetails,seetheMPASStudent
Handbook.Gradingsystemsincludeassessmentofparticipationinprogramcoursesandactivitiesand
assessmentofprofessionalism.
GradingandEvaluation
Aminimumfinalgradeof77%(C)isrequiredtopasseachrotation.
Thegradingscaleusedinclinicalrotationsisasfollows:
A 93-100%A- 91-92%B+ 89-90%B 85-88%B- 83-84%C+ 81-82%CF
77-80%<77%
Finalgradeswillbebasedoncalculationsaccordingtothefollowing:
End-of-rotationExamination 40%offinalgrade
FinalPreceptor’sEvaluation 40%offinalgrade
Comprehensivewrittennote/Casepresentation10%offinalgrade
PatientLogs 10%offinalgrade
Attheendofeachcorerotation,MPASstudentscompleteanend-of-rotationexaminationandreceiveanevaluationfromthepreceptor.Studentsmustalsocompleteapracticeexampriortothecompletionofeachclinicalrotation.Studentsalsoarerequiredtocompleteeitherawrittenclinicalnoteoranoralpresentationonapatientencounteredduringtheirrotation.Thewrittennoteiscompletedusinganelectronicmedicalrecord(EMR)designatedbytheMPASprogram.Studentsalsoarerequiredtomaintain
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apatientlogforeachrotation.ThepatientlogismaintainedinE*Valueandmustbeupdateddaily.Loggingshouldbecompletedonlyforpatientswithwhomthestudentinteractsinanactivecare/managementrole.NoidentifiablepatientinformationwillbeenteredinthelogornotetoensureHIPPAcompliance;thenoteisnotpartoftheofficialpatientrecord.Ifastudentfailsarotation,theremaybemandatoryremediationinaccordancewiththeproceduresdescribedinthestudenthandbook.
StudentsmayreceiveagradeofIncomplete(I)inaclinicalrotation,whichmayresultinreferraltoSEPC.
CanvasMed
AllrotationsyllabiarehousedinCanvasMed.Anyadditionalannouncements,lectures,assignments,and
otherdocumentsrelatedtorotationswillbepostedonCanvasMed.Studentsareresponsibleforchecking
CanvasMedatleastweeklyandforremainingup-to-dateoncurrentrequirements,assignments,
communications,andanyotherinformation.
eMedley
AllpatientencountersmustbeloggedineMedleyonadailybasis.Thepreceptorevaluationandstudent
evaluationalsoarerecordedusingthistool.
ClinicalRotationAttendance
Duringclinicalrotations,100%attendanceisrequiredofthestudent.Studentsshouldstarttheirclinicalrotationsatthetimedeterminedbytheirpreceptors.Unreliableorundependablebehaviorisconsideredunprofessionalbehavior.Scheduledactivitiesand/orclinicalrotationsmaytakeplaceonanydayoftheweek(includingweekends),andmaytakeplaceduringdayornighthours.Studentsshouldfollowtheinstructionsfromclinicalsitepreceptor(s)regardingthescheduleforaparticularclinicalrotation.MPASstudentsmustmaintainsufficientflexibilitytorespondtoschedulechangesandunexpectedpatientcaredemands.
ItisrecommendedthatallabsencesbeapprovedPRIORtotheiroccurrence.StudentsexpectingtobeabsentmustcompletetheAbsenceExcusalformandsubmitittotheclinicaldirector.Studentscannotmissmorethan10%ofaclinicalrotation,andallmissedtimemustbeapprovedbytheclinicaldirector.StudentsexpectingtobeabsentmustcompletetheAbsenceExcusalform.
Intheeventofanemergency,whenitisnotpossibletoobtainpermissionpriortotheabsence,studentsmustnotifythefollowingbyphoneandaconfirmatorye-mailwithin3hoursofthetimetheywere
expectedonsite:
• MPASclinicalliaisonandMPASclinicaldirector
• On-sitepreceptor
• MPASprogramoffice
StudentsmustalsocompletetheAbsenceExcusalformfoundinAppendixBhereinwithin24hoursoftheirabsence.FailuretonotifyandtoobtainapprovalfromboththeMPASprogramclinicaldirectorandtheclinicalsitepreceptormayresultinreferraltoSEPC.Studentswhoareabsentfromarotationsitefor2dayswithoutauthorizationandapprovalbyclinicaldirectorwillbereferredtoSEPCforfurtherevaluation.
Tardinessandearlydeparturesfromclinicalrotationsarenotpermitted.Astudentissubjecttoreceivingunsatisfactoryscoresonhis/herclinicalperformanceevaluationfortardinessandearlydepartures,which
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mayresultinthestudenthavingtorepeatpartoralloftherotation.Attendanceisacriticalelementinthestudent’sclinicalperformanceevaluation.
StudentConductandProfessionalBehavior
Studentsarerequiredtofollowtherulesofconduct,policies,andproceduresoutlinedintheFIUStudent
HandbookandtheMPASStudentHandbookandestablishedataffiliatedfacilities.Theresponsibilityof
assumingtheroleofaphysicianassistantdemandsthehighestmoralandethicalstandards.Developing
thesestandardsisalifelongprocesswhichcontinuesasanintegratedcomponentoftheMPASstudent’s
educationintheMPASprogram.Withthisasafundamentalprinciple,theMPASprogramdoesnot
tolerateviolationsofethicalandmoralvalues.Therefore,violationssuchascheating,plagiarism,and
unprofessionalconductarenottolerated.
NepotismandFraternization
Occasionallystudentsrequesttoservearotationwithafriendorrelative(whoisalsoahealthcare
provider)thatwillserveasthepreceptor.Duetothepotentialthatpersonalrelationshipscaninterfere
withtheclinicalevaluationprocess,whichisbothobjectiveandsubjectiveinnature,suchrotation
arrangementsareprohibited.
Studentsmayfindthemselvesattractedtoapreceptor(orviceversa)orotherpersonnelatthesite(s)at
whichtheyarerotating.Pursuitofamorousorsexualrelationshipsbetweenstudentsandclinicalrotation
personnelduringtherotationperiodcompromisestheintegrityoftheeducationandevaluation
processesandshouldbeavoidedbystudents.StudentsalsoshouldbeawareofFIU-104Sexual
Harassmentpolicyfoundathttp://hr.fiu.edu/uploads/file/EOP/Sexual_Harassment_Policy_as_of_02-
10.pdfandincludedintheMPASStudentHandbook.
Studentswithquestionsorconcernsabouttheaboveissuesshouldimmediatelyconsulttheclinical
liaison,clinicaldirector,academicdirector,orprogramdirector.
StudentContactInformation
EachstudenthasbeenprovidedwithaFIUe-mailaddress.Thisistheonlye-mailaddressusedforMPAS
programcommunication.Studentsareresponsibleforreadinge-mailcorrespondenceonadailybasis.
MPASstudentsmustfurnishcontactinformation,includingmobilephonenumberandinformationforan
emergencycontact,totheclinicaldirector.ItistheMPASstudent’sresponsibilitytokeepcontact
informationcurrentwiththeclinicaldirector.
FamilyEducationalRightsandPrivacyAct
IncompliancewiththeFamilyEducationalRightsandPrivacyAct(U.S.PublicLaw93-579;FERPA),the
MPASprogramrequiresitsstudents’writtenconsenttothesharingofpersonalinformationwithits
educationalpartners(clinicalaffiliatesandpracticesites)strictlyonaneed-to-knowbasis.Thissharingof
personalinformationmayincludesocialsecuritynumber,emailaddress,telephonenumber,resultsof
drugscreeningtests,orresultsofbackgroundchecks.Noticeisherebygiventhatinitialdrugscreening
andbackgroundchecks(beforetheclinicalrotationphase)andrandomdrugscreeningoradditional
backgroundchecksmayberequestedofthestudentatanytimewhilethestudentisenrolledinthe
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MPASprogram,aswellasforplacementincertainclinicalsitesasamatterofstandardoperating
proceduresforthosesites.TheMPASstudentwillberesponsibleforthecostofallabovedrugscreening
andbackgroundtests.
Astudent’ssignatureontheformfoundinAppendixChereinstatingreceiptofthisstudentclinical
rotationguideandacceptanceofthetermsandconditionscontainedwithinthisguideisconsidered
acceptanceofaboveinformedconsent.
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AppendixA—RequestforSiteAffiliationForm
MasterinPhysicianAssistantStudies
StudentName:__________________________________________(Print)
PracticeName:____________________________ContactName:_____________________________
PracticeAddress(es):___________________________________________________________________StreetCityStateZip
_____________________________________________________________________________________
_____________________________________________________________________________________
BoardCertification:oYesoNo
Specialty:_____________________________________________________________________________
Numberofyearsinpractice:____________ Averagenumberofpatients(perday):______________
NumberofMedicalDoctors:____________ NumberofPhysicianAssistants:___________________
Signature:___________________________________Date:____________________________
ForOfficeUseOnly:
oYesoNooPending
Recommendations:_____________________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature:___________________________________Date:____________________________
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AppendixB—AbsenceExcusalForm
MasterinPhysicianAssistantStudies
AnystudentanticipatingtimeawayforanexceptionaleventduringtheclinicalportionoftheMPAS
programshouldcompleteandsubmitthisformtotheclinicaldirectoratleast1monthinadvanceofthe
anticipatedabsence.
Studentsabsentfromaclinicalrotationasaresultofanemergencymustfilloutandsubmitthisformto
theclinicaldirectorwithin24oftheirabsence.FailuretodosomayresultinreferraltoSEPC.
StudentName(PRINT):______________________________________
Class:______
Anticipateddate(s)off:_______________________________________
ReasonforAbsence(s):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
StudentSignature:___________________________________________
DateSubmitted:________________
ProgramUseOnly
RequestApproved:_______NotApproved:_______Date:______________
ClinicalDirectorSignature:____________________________
ProgramDirectorSignature:___________________________
Comments:
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AppendixC—StudentAcknowledgementofReceiptofMPASStudent
ClinicalRotationGuideForm
MasterinPhysicianAssistantStudies
I,_________________________________________________(printname),havereadand
understandthepoliciesandproceduresfoundinthisMPASStudentClinicalRotationGuide.I
havealsoreviewedtheFIUStudentHandbookandtheMPASStudentHandbook.Iamfamiliar
withthecontentsofthesedocumentsandthepoliciesandproceduresherein.Iagreetoabide
bytheseregulations.
Thisformmustbesignedandreturnedtoclinicaldirectorpriortostartingclinicalrotations.
____________________________________________________
StudentSignature
____________________________________________________
ClinicalDirectorSignature
______________________
Date
