Clinical Site Policies

***Of Note: While on clinical rotations, students are responsible for following all MSU PA Medicine Policies in the student handbook. However, we understand certain program policies on occasion will be superseded by those at the clinical site. All questions regarding this should be addressed with the PA Medicine Clinical Coordinator immediately.

MSU Department of PA Medicine utilizes a state-wide approach to clinical rotation placement and site development. Students will utilize sites that may not be close to current housing. The cost of housing and travel to and from clinical sites is the responsibility of the student.

Program Placement of Students

The PA program does not permit students to provide or solicit clinical sites or preceptors. Students are not permitted to coordinate clinical sites and/or preceptors for program-required rotations. All supervised clinical practice sites will be evaluated with the same clinical site and preceptor analysis prior to student placement.

Student Identification

Supervisors of the PA Medicine Students in the Clinical Setting

During a student’s time at the clinic or hospital, the preceptor must be available for supervision, consultation, and teaching or designate an alternate preceptor. Educational continuity should be maintained when using multiple preceptors. Although the supervising preceptor might not be with a student during every shift, it is essential to assign students to another MD, DO, PA, or other qualified healthcare providers who will serve as the student's preceptor for any given time interval. Sharing preceptorship duties exposes students to important variations in practice style and feedback, which can help learners develop the professional personality that best fits them. If supervision is not available, students may be given an assignment or spend time with ancillary staff (x-ray, lab, physical therapy, etc.), as these experiences can be valuable. The preceptor should be aware of the student's assigned activities at all times.

Students are not employees of the hospitals or clinics and, therefore, work entirely under the preceptor’s supervision. Students are not to substitute for paid clinicians, clerical staff, or other workers at the clinical sites (Std A3.05). Students must always be clearly designated as a “PA student” in the clinical setting, easily distinguished from other health profession students/providers. (Std A3.06)

On each rotation, it is the student’s responsibility to ensure that the supervising physician or preceptor sees all of the student’s patients. The preceptor can provide direct supervision of technical skills with gradually increased autonomy in accordance with the PA student’s demonstrated level of expertise. However, every patient must be seen, and every procedure evaluated before patient discharge.

The preceptor must document the involvement of the PA student in the care of the patient in all aspects of the visit. The preceptor must also specifically document that the student was supervised during the entirety of the patient visit. Laws for Medicare patients are slightly different in terms of what a student is able to document, and this is explained further in the following “Documentation” section. The PA student will not be allowed to see, treat, or discharge a patient without evaluation by the preceptor.

Level of Supervision/Responsiblities

Clinical supervision is designed to foster progressive responsibility as a student progress through the curriculum, with the supervising medical provider allowing the PA medicine student the opportunity to demonstrate progressive involvement in patient care when indicated. MSUCOM PA Medicine students will be expected to follow clinical policies of the facility regarding medical records and clinical care. PA Medicine student participation in patient history/physical exam, critical data analysis, management, and procedures will include factors, but not limited to:

The student’s demonstrated ability
The student’s level of education and experience
The learning objectives of the clinical experience

PA Medicine students will be directly supervised at all times (supervising provider or designee present or immediately available). For some tasks, indirect supervision may be appropriate for some students as allowed by hospital/clinic policy. Direct supervision would be appropriate for advanced procedures.

Supervising providers will provide students with timely and specific feedback on performance. Supervising providers will complete a summative evaluation and are encouraged to contact the Course Director with any gaps in student performance.

Students with any concern regarding clinical, administrative, educational, or safety issues during a rotation will be encouraged to contact the supervising provider or the PA Medicine Clinical Coordinator immediately.

Preceptor responsibilities include, but are not limited to, the following:

Orient and assess each student at the onset of the rotation with the practice/site policies and procedures, including safety and emergency policies and procedures.
Review the expectations and objectives for the rotation as detailed in each rotation-specific syllabus.
Provide ongoing and timely feedback to the student regarding clinical performance, clinical knowledge, skills, attitudes, behaviors, and critical thinking skills.
Supervise, demonstrate, teach, and observe clinical activities to aid in the development of clinical skills and professionalism and to ensure high-quality patient care.
Provide the student ample opportunity to be an active participant in history taking, physical assessment, clinical decision making, and treatment planning. Delegate increasing levels of responsibility as appropriate. By the end of the first week students should actively participate in evaluating patients.
Delegate increasing levels of responsibility based on a student’s experience and expertise.
Participate in the evaluation of clinical skills and medical knowledge base through the following mechanisms:
- Direct supervision, observation, and teaching in the clinical setting
- Immediate evaluation of presentations (including both oral and written)
- Assignment of outside readings and research to promote further learning
Demonstrate cultural humility in all interactions with patients, families, health care teams, and systems.
Dialogue with faculty during site visits to evaluate student progress and assist the learning process.
Review and add supplementary documentation to student notes to evaluate the student’s clinical reasoning and documentation skills.
Demonstrate an ethical approach to the care of patients by serving as a role model for the student.
Complete and return the student evaluation forms to assess performance and improvement throughout the supervised clinical experience.
Promptly notify the PA program of any circumstances that might interfere with student safety or wellness or accomplishing the above goals or diminish the overall experience.
Communicate any student problems, issues, or deficiencies with the Clinical Coordinator.

Student Responsiblities and Expectations

Student Attire and Etiquette

PA Medicine students are to wear clean, white, short lab coats during the clinical practicum unless otherwise instructed. An identification tag (Spartan Card) must also be worn at all times. As a student, you will come in close contact with patients, physicians, peers, and other health care professionals each day; good personal hygiene must be practiced. It should also be noted, that although the college does not have a “dress code,” tennis shoes, open-toed shoes, low-cut or midriff blouses, miniskirts and jeans are not considered appropriate attire for hospital/office/clinic settings including lectures. PA Medicine students should introduce themselves to patients and other health care professionals as a PA Medicine student, not as a medical student or physician. This is important so that individuals do not assume that students have more responsibility or authority concerning patient care than that of a PA Medicine student. Patients should be addressed using their last names. Students should remember that, in the clinical setting, they are a reflection of Michigan State University and the College.

Professional attire and demeanor are always expected on clinical rotations. Students are expected to be present and onsite at the time of the clinical rotation start daily. For example, if your clinical rotation starts at 8 am, you are expected to be ready to see the first patient at 8 am.

Students are not allowed to alter their clinical rotation schedule without first contacting the Clinical Coordinator to discuss. If an alternative schedule is approved, then the Clinical Coordinator will communicate with the preceptor and site. Students found to have altered their schedule without notification to the Clinical Coordinator can be referred to the Promotion Committee for further actions.

Students are expected to be respectful, polite, present, and engaged in clinical rotations. Students found to be argumentative, difficult to engage, resistant to instruction, disrespectful, tardy, and/or absent will be contacted by the Clinical Coordinator for remediation intervention on the first occurrence, the Program Director on the second occurrence, and referred to the Progressions committee on the third occurrence.

Professional attire includes, but is not limited to, the following:

1. No athletic clothing such as gym shorts, spandex, or athletic leggings are to be worn on clinical rotations.

2. Visible facial and body piercings are not allowed to be in place while on clinical rotations and shall be removed.

3 All visible tattoos will be covered while on clinical rotation.

4. Hair color will be of a natural shade.

5. Nails are to be kept trimmed in length not to exceed the fingertips. No acrylic nails are allowed.

6. All undergarments shall not be visible to preceptors or patients at all times on clinical rotations.

7. No open toes shoes are allowed on clinical rotations.

8. All loose-fitting clothing, hair, jewelry, or any personal item that could fall onto a patient during examination shall be secured and out of the treatment field.

*Professional attire policy reflects requirements for students to be in compliance with Clinical Site Institutional Policy.

MSU PA Medicine Clincial Year Policy Regarding Rotations with Family Members

Purpose

The goal of this policy is to provide PA students with a fair, well-rounded clinical education while upholding the highest standards of integrity and objectivity. We understand that students may wish to complete rotations with family members due to convenience or familiarity; however, to ensure an unbiased and comprehensive learning experience, certain restrictions are necessary.

Policy Statement

While we recognize the desire some students may have to complete rotations with family members, PA students are not permitted to do so for core clinical rotations, including under the direct or indirect supervision of parents, siblings, spouses, in-laws, or other relatives. This applies to all core rotation sites, regardless of the family member’s role or position within the healthcare team.

Additionally, students may not complete elective rotations assigned due to identified deficiencies or remediation under the supervision of family members as defined above. The Department of PA Medicine reserves the right to assign students to specific rotations and preceptors as necessary to support their education.

However, the program will consider allowing students to complete elective rotations with family members in the following areas: ambulatory health elective, internal medicine elective, open elective, and surgical elective. These exceptions will be evaluated on a case-by-case basis by the clinical year team and/or Promotion Committee.

It is the responsibility of the student to disclose any conflict of interest immediately to the program once identified.

Rationale

1. Conflict of Interest:
Family relationships may unintentionally lead to biased evaluations, or the appearance of bias, which could impact both the student’s performance review and the integrity of the program.

2. Professional Boundaries:
Maintaining clear professional boundaries is essential to ensure students are prepared for real-world healthcare environments. Rotating with family members can blur these lines and impede the development of key professional skills.

3. Objective Evaluation:
Fair, objective feedback is crucial for the student’s growth. Family members, despite best intentions, may find it difficult to evaluate students impartially, which could affect the accuracy of their assessments.

4. Learning Environment:
Clinical rotations are designed to expose students to diverse perspectives and teaching methods. Completing a rotation with a family member may limit exposure to these varied learning opportunities.

5. Accreditation and Compliance:
To maintain compliance with accrediting bodies and uphold program integrity, we must ensure that students are placed in learning environments that are free from conflicts of interest, preserving objectivity in student assessments.

Consequences of Policy Violation

Violations of this policy may result in disciplinary actions, including reassignment of clinical rotations, academic probation, and/or other appropriate measures as determined by the program’s Promotion Committee.

By following this policy, we aim to provide each student with equal opportunities to succeed based on their individual skills and knowledge, ensuring a valuable and equitable clinical training experience.

Student Responsibilities Regarding Patient

Supervision All medical procedures performed by PA Medicine students must be supervised by a licensed provider responsible for the care of the patient. Before starting any procedure, the student must be told to do the procedure on the patient by a provider responsible for the care of this patient. The supervising preceptor and the student share the responsibility for determining the level of supervision needed: either direct supervision (i.e., an appropriate supervisor is present while the procedure is being performed) or indirect supervision (i.e., an appropriate supervisor can be called into the room within a time span appropriate for that procedure). It is understood that a complete list of procedures that a student may perform is neither possible nor desirable to establish, but these general guidelines should be followed:

Appropriate informed consent must be obtained and documented. No procedure should be attempted by the PA Medicine student unless she/he is given permission to do so by a provider responsible for the patient.
If a student does not feel capable, then she/he must not undertake performance of the procedure without further instruction and direct supervision.
If the student is not known by the patient, the student should properly identify her/himself to the patient.
If the PA Medicine student is not successful in the performance of a procedure within the reasonable amount of time or without undue discomfort to the patient, the PA Medicine student must withdraw and notify the supervising provider.
It is the responsibility of the PA Medicine student to cease and desist from the performance of any procedure at the direction of any nurse responsible for that patient, if that nurse has reasonable cause to ask the student to cease and desist. The supervising preceptor should be notified promptly of any such action.

PA Medicine Student Responsiblities

Adhere to standards of professional conduct as outlined in the Student Clinical Year Handbook and at all times address the preceptor, clinical staff and patients with professionalism.
Always identify themselves as “physician assistant students” to faculty, patients, and staff.
All documentation and charting must be signed and include the initials “PA-S.” Students who possess other titles (e.g., RN, RT, etc.) will at no time be allowed to use these designations.
All documentation, charting, and orders must be co-signed by the preceptor immediately.
Arrive on time to the clinical site or to rounds, fully prepared and ready to fully participate.
Obtain detailed histories, conduct physical exams, develop a differential diagnosis, formulate an assessment and plan through discussion with the preceptor, and give oral presentations.
Develop an appropriate evidence-based treatment plan based on the clinical findings utilizing the medical decision-making process.
Perform and/or interpret common lab results and diagnostics.
Educate and counsel patients across the lifespan regarding health promotion and disease prevention.
When possible, take call, attend grand rounds, participate in hospital-based care as well as outpatient clinic.
Demonstrate emotional resilience and stability, adaptability, and flexibility during the clinical year.
Augment learning experiences to accomplish rotation learning outcomes and instructional objectives by review of medical textbooks and online evidence-based resources.
Abide by HIPPA standards and OSHA guidelines in honoring confidentiality and universal precautions at all times.
Work the pre-determined schedule weekly and report any absences to both the preceptor and Clinical Coordinator by 8am that day. Students must make up time missed on the rotation; if unable, contact the Clinical Coordinator.
Keep an accurate log of each patient encounter and input all pertinent data in Exxat.
Keep an accurate Procedural Skills Log in Exxat.
Always work under the direct supervision of the preceptor. Students are never in charge of a patient’s care, nor are they allowed to provide any services without consultation and supervision of the preceptor.
Meet with the Clinical Coordinator or the designee during a site visit.
Attend the End of Rotation assessment day on campus the third Monday of the rotation.

PA students are expected to adhere to the same high ethical and professional standards required of certified PAs. The professional conduct of our PA students is evaluated on an ongoing basis throughout the program. Violations of standards of conduct are subject to disciplinary actions administered by the PA program as specified in the student handbook. If preceptors observe/are concerned about a student’s professionalism, please contact the Clinical Coordinator immediately.

Policy for PA Medicine Student Supervision

Students Rights and Responsibilities

Each individual student is responsible for their behavior and is expected to maintain standards of academic honesty. Students share the responsibility with faculty for creating an environment that supports academic honesty and principles of professionalism. Proper relationship between faculty and student are fundamental to the college’s function and this should be built on mutual respect and understanding together with shared dedication to the academic honesty. It is a fundamental belief that each student is worth of trust and that each student has the right to live in an academic environment that is free of injustice caused by dishonesty. While students have an obligation to assist their fellow students in meeting the common goals of their education, students have equal obligation to maintain the highest standards of personal integrity.

The Preceptor−Student Professional Relationship

The preceptor and student should maintain a professional relationship in the clinical setting at all times and adhere to appropriate professional boundaries. Social activities and personal relationships outside the professional learning environment should be appropriate and carefully selected to avoid putting the student or preceptor in a compromising situation. Contact through web-based social networking platforms (e.g., Facebook, Instagram) should be avoided until the student fully matriculates through the educational program or completes the rotation where the supervision is occurring.

Problems on rotations can occur, be they academic, professional, or personal in nature. Students and preceptor should use the following guidelines in dealing with any problems:

Attempt to resolve problems with the individual directly.
If this is not possible, discuss it with the preceptor or contact person.
If unable to resolve a problem for any reason, contact the Clinical Coordinator ASAP. If the Clinical Coordinator is unavailable, please contact the Program Director.

Faculty Responsiblities

It is the responsibility of the college faculty to specify the limits of authorized aid (including but not limited to exams, study aids, internet resources and materials from senior students) in their syllabi, and it is the responsibility of students to honor and adhere to those limits. Course instructors shall inform students at the beginning of the semester of any special criteria of academic honesty pertinent to the class or course. It is the responsibility of the clinical faculty to provide students with ongoing feedback during rotation upon request. Clinical faculty are generally recommended (though not required) to limit student assigned duty hours from 40 to 60 hours weekly (and not exceeding 60 hours). Both faculty and students are to be treated fairly and professionally in order to maintain a proper working relationship between trainer and trainee.

Use of Electronic Devices During Clinical Practicum

Students are expected to be fully engaged in the clinical education experience. Using electronic devices while on clinical practicums or during other required activities can be distracting and disrespectful to patients, preceptors, lecturers, and your fellow students. Electronic devices are not to be used during rounds, meetings, small groups, or lectures, or when in the room with patients: the only exception would be if instructed to do so by a preceptor. Students wishing to retrieve information that may be relevant to the patient or small group discussion should get permission to do so from the preceptor. It is never appropriate for students to use electronic devices for reading e-mail, texting, surfing the web or other personal activities while on any clinical practicum required activity. Students may receive unprofessional behavior notation(s) for failure to use electronic devices appropriately. All unprofessional behavior notations are forwarded to Promotion Committee for review.

MSU COM PA Medicine Clinical Phase Absence Policies

Absence due to Interviews

For the purpose of interviewing only, a student may be absent 1 day on a 4-week non-core rotation during the months of June to August. Interview invitations must accompany the Clinical Practicum Excused Absence Request Form.

Illness/Personal Day Absences

Attendance is mandatory at all clinical sites and EOR days. Students will not be allowed to miss clinical rotations and/or EOR days for person travel, personal vacations, or personal life events. Unexpected life events (illness, death,) should be discussed with the Clinical Coordinator immediately as they occur, and accommodations can be considered on a case-by-case basis.

In the event and absence does occur a student will be required to fill out an excused absence form within 24 hours of absence and submit to the Clinical Coordinator.

The work schedule will be determined by your preceptor. Students may be required to participate in call, night shifts, and weekend shifts as designated by the preceptor. Holidays do not apply to the clinical year, and you will be expected to work a holiday if your preceptor is scheduled. The program will honor the religious observance policy with notice as required in said policy.

You must provide the Clinical Coordinator and the PA Program with your contact information while on clinical rotations. This required information should include an emergency contact number and cell phone number. Any changes in address or phone number must also be given to the program and this information needs to be maintained accurately in your student profile in Exxat.

Hospital organized events that might lead to periodic absence from rotations – student participation is encouraged and if preceptor approved, would be considered part of the rotation and not a personal day absence.

In cases of extended absence, students will be required to make up curricular content pertinent to the rotation as assigned by the Clinical Coordinator. If the time exceeds 25% of the scheduled rotation shifts, the student will have to repeat the rotation. Repeating the rotation may require that the student will have to forfeit an elective rotation. This will be decided by the Promotion Committee upon review of the student's case.

Conference Absence

While on required/core rotations, no excused absences for any professional meeting will be allowed unless the student is presenting research in which they have participated. Further students must be in good academic standing at the time of the conference in order to attend. Students on academic warning or academic probation may not be excused.

Appropriate paperwork with proof of presentation and copy of conference agenda must accompany the excused absence form.

Time off in this situation will be for travel and presentation only. While on selective/elective rotations: A student may submit a request for an excused absence to attend one (1) professional meeting, time not to exceed 3 days off rotation. The meeting agenda must accompany the Clinical Practicum Excused Absence Request Form.

The Department PA Medicine faculty approved this student handbook and policies on March 16, 2020.
Revised and approved by the Faculty of the Department of PA Medicine on 3/19/2021, 3/15/2022, 4/18/2023, 12/17/24.